World-renowned Professor Sir Magdi Yacoub, who established heart transplantation in Britain, visited St George’s this week for an unusual appointment. He came to see a heart that he had originally transplanted in 1995.

Magdi Yacoub

calendar-icon 5 July 2018

Following the eventual death of the patient, the specimen had been donated to medical research, and had arrived in the lab of St George’s, University of London’s Professor of Cardiac Pathology, Mary Sheppard, at her national referral centre for cardiac pathology for analysis. Professor Sheppard and her team receive around 10-12 hearts every week for close examination into the causes of death.

The transplant operation at the time had been particularly complex; known as a ‘piggyback heart’, Sir Magdi had transplanted a donor heart stitching it on top of the native heart of the patient. Both hearts then had pacemakers inserted to make them counterpulse each other.

Sir Magdi explained: “This operation can only be done for a very specific group of patients, around 10 percent of the total number of transplant recipients. It is done when the donor heart is too small to replace the failing heart in the recipient, but acts as a ‘helper’ to the failing heart.”

Examining the huge double heart together in Professor Sheppard’s lab, Professor Sheppard commented on the ‘Beautiful surgery and suturing – no thrombosis, no vein stenosis, no narrowing!’ Sir Magdi agreed: it’s still a good heart, 25 years later. ”

On the sidelines of the visit the pioneering Egyptian-born surgeon, 81, discussed his memories of setting up the famous heart and lung transplant programme at Harefield Hospital, which became the world’s biggest. “We were doing 120 operations a year, hearts and hearts-lungs, and there was a massive need for it. When we first started transplanting we had been hoping for one-five years more life expectancy for the recipients. But if there weren’t other complications they could be very successful – some patients survived over 30 years!”

Sir Magdi continued; “Almost all of the reasons transplant patients die are chronic rejection – which accounts for less than 20 percent - and the remainder are almost entirely complications of non-specific immune suppression. The immune suppression drugs also affect other patients. We need brilliant people in research to study why patients die and prevent this from happening. And to develop more specific types of immune suppression agents. We must keep working on it.”

Reflecting on the NHS’s 70th anniversary, Sir Magdi had several things to say. “I want the NHS to be as healthy as possible. I want people to stop criticising the NHS, but instead come up with positive ideas for improving it. I’ve worked in excess of 50 years, in developed countries and in developing countries, and don’t enjoy working outside the NHS. Ideologically, it’s the best way. In other countries a doctor’s time is seen as a commodity. No exaggeration! They say; I have paid to see you, you are wasting my time if you’re not on time for an appointment. It’s the wrong attitude, because the system is wrong. Healthcare between doctor and patient is a relationship, not a commodity. But the NHS - no other system on planet Earth is like it. I’m very proud of the NHS. We want it to get better and better!”

Sir Magdi retired from performing surgery in 2001, but continues to oversee research at the Harefield Heart Science Centre and at Imperial College where he is Professor of Cardiothoracic Surgery. Sir Magdi has an active interest in global healthcare delivery and is busy with his charity Chain of Hope, treating children with correctable cardiac conditions from developing countries. He has set up training and research programmes in Egypt, Mozambique, Ethiopia and Jamaica.

He explained: “Healthcare delivery at the highest level is a human right. We can’t ignore 80 percent of the world’s population because they are poor. Any units I set up have to be sustainable, done by people from that country, and research at the very highest level is a core part of any programme. Genomic, cellular and mechanisms.”

If he could wish for one birthday present for the NHS at 70? Sir Magdi would wish for an ‘opt out’ scheme for organ donation. This would involve patients’ consent to donation being assumed, with everyone given the right to ‘opt out’ of that by signing a form. “Stupidly, many years ago I thought that this might be taking liberties with the community. But I’ve changed my mind. We are not taking any liberties, just asking people to think about it. Make up your own mind if you want to be in or out. People always come to the right decision!”