James Hardy (surgeon)

James D. Hardy (May 14, 1918 – February 19, 2003) is a United States surgeon who performed the world's first lung transplant with patient John Russell living for 18 days. The transplant was performed at the University of Mississippi Medical Center on June 11, 1963.

Hardy also performed the world's first heart transplant and first heart xenotransplant when he transplanted the heart of a chimpanzee into comatose and dying Boyd Rush's chest during the early morning of January 24, 1964. This heart beat for approximately one hour, and then Rush died without regaining consciousness. The consent form did not include the possibility that a chimpanzee heart may be used, although Hardy stated that he included this in discussions with Rush's step sister.

Early life
Hardy grew up in Newala, Alabama, a small community in Shelby County. His father owned a lime plant in Newala. He studied at a high school in Montevallo before entering the University of Alabama for pre-medical curriculum. He received his MD in 1942 from University of Pennsylvania School of Medicine in Philadelphia. He held the office of the president of Alpha Omega Alpha during his senior year and his first scientific publication was on wound healings.

Career
Hardy served in the U.S. Army Medical Corps in early 1944 during the Second World War. He first worked at Stark General Hospital, Charleston in South Carolina. Hardy began writing his first book, Surgery and the Endocrine System, in 1950 which was published two years later. He was awarded the Master of Medical Science in physiological chemistry by the University of Pennsylvania in 1951 for his research on using heavy water for measuring body fluids. He became the chair of surgery at the University of Mississippi School of Medicine, Jackson in 1955. He was also the first Professor of Surgery at the University of Mississippi School of Medicine.

Hardy wrote 24 books, 139 book chapters, 466 papers, and produced over 200 films. Vishnevsky Institute, Moscow honored him in 1971 for his pioneering work in organ transplantation and awarded him two medals for lung transplant and heart, respectively. He has served as President of the Society of University Surgeons, the Society of Surgical Chairmen, the Southern Surgical Association, the American College of Surgeons, the American Surgical Association and the International Society of Surgery.

Hardy also led the team responsible for performing a double-lung transplant that left the heart in place, in 1987.

First lung transplant (1963)
Approximately two months before transplant surgery, 58-year-old John Russell was admitted to the University of Mississippi Medical Center in Jackson, Mississippi, with recurrent pneumonia unresponsive to antibiotics. He also had emphysema of both lungs, squamous cell carcinoma of his left lung, and kidney disease. To complicate matters, Russell was a prisoner at the Mississippi State Penitentiary serving a life sentence for murder. One source states Russell was in prison for accidentally shooting and killing a 14-year-old boy. James Hardy wrote in the article regarding this case, "Although the patient was serving a life sentence for a capital offense, there was no discussion with him regarding the possibility of a change in his prison sentence. However, authorities of the state government were contacted privately, and they indicated that a very favorable attitude might be adopted if the patient were to contribute to human progress in this way."

Prior to the surgery, Russell would awake at night coughing up bloody sputum until he was blue in the face. Every movement left him extremely short of breath, and he was scared of suffocating. Tests showed he only had one-third of normal lung capacity. When Hardy approached him about the potential transplant, Russell talked with his wife and three children. His main concern was whether the transplant would help improve his shortness of breath. Hardy told him that he thought it would.

Thoracic resident Martin Dalton sought and received permission from the family to use the left lung of a recently deceased heart attack patient. He used an endotracheal tube to keep the lungs ventilated and injected heparin into the heart to prevent clotting. When the time came, he removed the left lung and carried it to the adjourning operating room.

On June 11, 1963, when Hardy and his team first opened up Russell's chest to begin the transplant, they saw that his cancer had spread beyond the left lung. The transplant would not save his life from the cancer. However, it might give him better breathing. The team continued with the planned transplant of the left lung. The cancerous left lung had shrunk, and so had the space around it. The team made space for the new lung and changed a few of the planned vascular connections. Watts Webb assisted Hardy with the transplant.

Initially, the transplanted lung did provide Russell with better breathing, and then kidney disease started to get the best of him. Hardy used azathioprine, prednisone, as well as radiation to suppress his immune system. John Russell lived for another 18 days and then died of kidney failure. One source states that Russell died from a combination of cancer, infection, and kidney disease.

The book Second Wind: Oral Histories of Lung Transplant Survivors (2012) states that University of Mississippi Medical Center had unreliable blood banking, no intensive care unit, only limited 24-hour lab support, a weak anesthesia program, and most critically for Russell, no artificial kidney machine.

There is brief surviving film footage of the lung transplant. Martin McMullan participated in the operation as a surgical technician, and later became a doctor and a professor of surgery.

First heart transplant (1964)
At the University of Mississippi Medical Center in Jackson, Mississippi, Hardy transplanted the heart a chimpanzee into the chest of a dying Boyd Rush and shocked it with a defibrillator to cause it to re-start beating at approximately 2:00 a.m. on Friday, Jan. 24, 1964. This heart beat between 60 and 90 minutes (sources vary) and then Rush died without regaining consciousness. Since the operation begun at approximately 11:00 p.m. on January 23, 1964, the transplant is sometimes given this date.

Hardy had been inspired by the limited success of Keith Reemtsma at Tulane University in Louisiana who had transplanted chimpanzee kidneys into thirteen human patients. Most of these transplants failed within four to eight weeks, although one patient lived for nine months.

Boyd Rush was a 68-year-old retired upholsterer described as a "deaf mute" who was referred to Hardy by a community hospital on Jan. 21, 1964. He had been found by neighbors in a comatose state with only a faint pulse. Rush's step sister Mrs. J.H. Thompson signed a consent form which stated, "I agree to the insertion of a suitable heart transplant if such should be available at the time. I further understand that hundreds of heart transplants have been performed in laboratories throughout the world but that any heart transplant would represent the initial transplant in man." The consent form did not include the possibility that a chimpanzee heart may be used. Hardy later stated that he had verbally discussed the procedure in detail with relatives, although there was only the one relative.

Hardy had previously purchased four chimpanzees. There was also a trauma victim in the hospital's ICU who was brain-dead and whose family had given permission for him to be a heart donor. However, the legal definition of death at the time required that the heartbeat stop, and this trauma victim's heart still beat. Around 11:00 pm on Thursday, Jan. 23, Rush went into shock with low blood pressure, and Hardy took him into the operating room. Rush's heart stopped just before they attached him to the heart-lung machine. Hardy polled the other four doctors regarding whether should continue with the transplant knowing that they would now use a chimpanzee heart and would likely receive substantial public criticism. The first doctor said yes, the next abstained, and the last two also said yes. Just after 2:00 am in the early morning hours of Friday, Jan. 24, 1964, Hardy completed the stitching to connect the chimpanzee heart into Rush's chest. He used a defibrillator to start the donor heart beating. It did beat for 60 minutes (some sources say 90 minutes) and then could not be restarted.

The hospital's director of public information put out a very guarded statement which included the vague statement "the dimensions of the only available donor heart" and did not disclose that the donor heart was that of a chimpanzee. The Associated Press widely distributed a story which began with, "Surgeons took the heart from a dead man, revived it and transplanted it into the chest of a man dying of heart failure today." At that point, the Mississippi Medical Center revealed previously withheld details. On Jan. 25, the New York Times printed a more accurate headline: "Chimpanzee Heart Used in Transplant to Human." Years later, Hardy stated, "The publicity, the outcry and the criticism were enormous. Public media reporters seemed to come out of the woodwork.  We hunkered down and waited it out."

Several weeks later Hardy attended the Sixth International Transplantation Conference in New York City. Author Donald McRae of Every Second Counts (2006) wrote that the publicity surrounding the transplant had made Hardy's work "seem chaotic and even duplicitous" and that Hardy could feel the "icy disdain" from his fellow physicians. Hardy was introduced by Willem Kolff, the creator of the kidney machine, and toward the end of introduction Kolff turned to Hardy and quipped, "In Mississippi they keep the chimpanzees in one cage and the Negroes in another cage, don't they, Dr. Hardy." Donald McRae wrote that the impact of this offhand remark on an already unsympathetic audience was profound, especially since the audience knew that Kolff had lived through the Nazi occupation of Holland. Kolff said later that he had merely been joking in an effort to lighten the mood. Hardy wrote, "For one of the few times in my professional career, I was taken aback and did poorly. The audience was palpably hostile.  .  .  .  .  there was not a single hand of applause thereafter."

Hardy later wrote, "I had noted that when one loses his academic post, for whatever reason, he is not likely to get another one of comparable significance. I decided to wait until [Norm] Shumway and his group transplanted a heart in man." James Hardy thereby withdrew from the race to perform the first successful heart transplant.

More than three and a half years later, the first heart transplantation with a human heart was performed by Christiaan Barnard of South Africa on Dec. 3, 1967, with patient Louis Washkansky who survived for eighteen days.

Personal life
Hardy married Louise Scott Sams of Decatur, Georgia in 1949; they met when he was working in Stark General Hospital in Charleston. She died from Alzheimer's disease in 2000. They had four daughters – Dr. Louise Roeska-Hardy, professor of philosophy in Heidelberg and Frankfurt, Germany, Dr. Julia Ann Hardy, psychiatrist in Michigan, Dr. Bettie Winn Hardy, clinical psychologist and director of the eating disorders program at the University of Texas Southwestern Medical School, Dallas and Dr. Katherine H. Little, medical director of the Diagnostic Center for Digestive Diseases at Baylor University Medical Center, Dallas.

Retirement
Hardy retired from the Department of Surgery, University of Mississippi School of Medicine, Jackson, in 1987. He died at the age of 84 on February 19, 2003.

Books
Hardy wrote an autobiography, The World of Surgery 1945–1985: Memoirs of One Participant, which was published in 1986. Apart from his autobiography, Hardy also wrote several other books including:
 * Hardy's Textbook of Surgery
 * Surgery and the Endocrine System
 * The Academic Surgeon