When Dr Christiaan Barnard performed the world's first human heart transplant at the Groote Schuur Hospital in South Africa in 1967, he made headlines around the world. Even if his patient survived only 18 days after the operation, the event fired the human imagination and spurred on greatly what was already a rapidly developing medical technology. It may have been the organ that was the subject of the transplant which fired the imagination: the heart in popular myth was perceived as the seat of the emotions. But the technology has now made the procedure almost routine. Where this technology continues to be newsworthy is usually in the area of the allocation of resources in medical services. Heart transplantation itself is not generally at the core of the resource problems which confront these services. Because there is a natural limit on the number of hearts which can become available for transplantation, resource allocation for it must be finite; and limitations on the availability of hearts means that transplantation can never be a cure for the huge volume of coronary heart disease that afflicts today's society.
Yet many other techniques of cardiac surgery can indeed make significant contributions to the prolongation of life in those with severe coronary artery disease. Coronary by-pass surgery is now well established as one of the most cost-effective means of relief in such cases and there is, at least in theory, no measurable limit to the demand for this life-enhancing procedure. In addition, there are many heart anomalies, once fatal, which are now amenable to the improved and still developing techniques and technologies of cardiac surgery, while heart-and-lung transplants are literally vital for those with such conditions as cystic fibrosis.
While the resources required for cardiac surgery are large by any standards and the demand for such surgery is more likely to grow than to decline, these resources will have to be found. The Minister for Health's announcement this week that these resources are to be significantly increased must, therefore, be welcomed. The cardiac unit at the Mater Hospital in Dublin will continue to be the national centre of excellence in this field and will doubtless provide some of the training of staff at other centres. The establishment of a cardiac surgical centre in Galway is particularly to be welcomed, as is the development of increased facilities for children's surgery at Crumlin and adult surgery in St James's Hospital in Dublin and at Cork University Hospital.
The cost of these services will not come cheaply, but with a waiting list now in excess of 1,600 patients, this must be met in the short term. It may well increase in the medium term. But in the long term the proper answer to a growing demand for cardiac surgery is preventive. Some countries have shown that death rates from coronary artery disease can be reduced by 25 percent and more through effective preventive methods designed to stop smoking, change the daily diet, increase exercise and otherwise alter high-risk life-styles. The most effective of the Minister's proposals this week is likely to be the establishment of a working group to produce such a strategy.