Man Alexandre, a Belgian transplant surgeon who within the Nineteen Sixties risked skilled censure by eradicating kidneys from brain-dead sufferers whose hearts had been nonetheless beating — a process that tremendously improved organ viability whereas difficult the medical definition of loss of life itself — died on Feb. 14 at his house in Brussels. He was 89.
His son, Xavier, confirmed the loss of life.
Dr. Alexandre was simply 29 and recent off a yearlong fellowship at Harvard Medical College when, in June 1963, a younger affected person was wheeled into the hospital the place he labored in Louvain, Belgium. She had sustained a traumatic head damage in a site visitors accident, and regardless of intensive neurosurgery, docs pronounced her mind useless, although her coronary heart continued to beat.
He knew that in one other a part of the hospital, a affected person was affected by renal failure. He had assisted on kidney transplants at Harvard, and he understood that the organs started to lose viability quickly after the center stops beating.
Dr. Alexandre pulled the chief surgeon, Jean Morelle, apart and made his case. Mind loss of life, he stated, is loss of life. Machines can maintain a coronary heart beating for a very long time with no hope of reviving a affected person.
His argument went towards centuries of assumptions concerning the line between life and loss of life, however Dr. Morelle was persuaded.
They eliminated a kidney from the younger affected person, shut off her ventilator and accomplished the transplant inside a couple of minutes. The recipient lived one other 87 days — a major accomplishment in its personal proper, provided that the science of organ transplants was nonetheless evolving on the time.
Over the subsequent two years, Dr. Alexandre and Dr. Morelle quietly carried out a number of extra kidney transplants utilizing the identical process. Lastly, at a medical convention in London in 1965, Dr. Alexandre introduced what he had been doing.
“There has by no means been and there by no means might be any query of taking organs from a dying one that has a ‘nonreasonable likelihood of getting higher or resuming consciousness,’” he instructed the gathering. “The query is of taking organs from a useless individual. The purpose is that I don’t settle for the cessation of heartbeat because the indication of loss of life.”
Others within the room, together with a number of the biggest names within the organ transplant subject, had been much less positive, and stated so.
“Any modification of the technique of diagnosing loss of life to facilitate transplantation will trigger the entire process to fall into disrepute,” Roy Calne, a pioneering British transplant surgeon, stated throughout the convention. (Dr. Calne died in January.)
Dr. Alexandre remained steadfast, and he supplied a set of standards for figuring out if a affected person was mind useless. Along with struggling a traumatic mind damage, the affected person ought to have dilated pupils and dropping blood stress, exhibit no reflexes, haven’t any capability to breathe and not using a machine, and present no indicators of mind exercise.
Inside a couple of years, Dr. Calne and others started to return round to Dr. Alexandre’s argument. In 1968, the Harvard Advert Hoc Committee, a bunch of medical specialists, largely adopted Dr. Alexandre’s standards when it declared that an irreversible coma ought to be understood because the equal of loss of life, whether or not the center continues to beat or not.
Immediately, Dr. Alexandre’s perspective is extensively shared within the medical group, and eradicating organs from brain-dead sufferers has change into an accepted observe.
“The greatness of Alexandre’s perception was that he was capable of see the insignificance of the beating coronary heart,” Robert Berman, an organ-donation activist and journalist, wrote in Pill journal in 2019.
Man Pierre Jean Alexandre was born on July 4, 1934, in Uccle, Belgium, a suburb of Brussels. His father, Pierre, was a authorities administrator, and his mom, Marthe (Mourin) Alexandre, was a private assistant.
He entered the College of Louvain in 1952 to check medication. After finishing his research in 1959, he remained on the college to coach as a transplant surgeon.
He married Eliane Moens in 1958. She died in October. Together with their son, Dr. Alexandre’s survivors embrace their daughters, Anne, Chantal, Brigitte and Pascale; 17 grandchildren; and 13 great-grandchildren.
By the late Nineteen Fifties the sector of transplant surgical procedure was evolving rapidly. Among the many main analysis facilities was Peter Bent Brigham Hospital (now a part of Brigham and Ladies’s Hospital) in Boston, one in all Harvard’s instructing amenities, the place the primary kidney transplant was carried out in 1954.
Dr. Alexandre arrived at Brigham in 1962, overlapping by a couple of weeks with Dr. Calne, who was wrapping up his personal fellowship time period. Each of them labored beneath Joseph E. Murray, who in 1990 shared the Nobel Prize in Physiology or Drugs for his work in transplant surgical procedure.
Dr. Alexandre seen that earlier than Dr. Murray eliminated an organ from a brain-dead affected person, he would flip off the respirator and wait till the center stopped beating. This fulfilled a standard definition of loss of life, however at a major value to the organ.
“They considered their brain-dead sufferers as alive, but they’d no qualms about turning off the ventilator to get the center to cease beating earlier than they eliminated kidneys,” Dr. Alexandre instructed Mr. Berman for his Pill article. “Along with ‘killing’ the affected person, they had been giving the recipients broken kidneys.”
Dr. Alexandre returned to the College of Louvain after a 12 months, intent on placing his convictions into observe.
He made a number of additional contributions to the sector of transplant surgical procedure. Within the early Eighties, he developed a technique to take away sure antibodies from a kidney in order that it might be positioned inside a affected person with an in any other case incompatible blood sort.
And, in 1984, he carried out one of many world’s first profitable xenotransplants, the switch of an organ from one species to a different. On this case, he moved a pig kidney right into a baboon.
