Cooley, Denton Arthur
COOLEY, Denton Arthur
(b. 22 August 1920 in Houston, Texas), cardiac surgeon, medical educator, and surgeon who performed one of the first American heart transplants and the first artificial heart implant.
Cooley, one of two sons of Ralph C. Cooley, a dentist, and Mary Augusta Fraley Cooley, graduated from San Jacinto High School in Houston and earned a B.A. from the University of Texas at Austin (UT) in 1941. He enrolled in UT's medical school but transferred to Johns Hopkins Hospital, earning an M.D. in 1944.
While at Johns Hopkins, Cooley became associated with Alfred Blalock, who had been experimenting with anastamosis, the tying of blood vessels, in dogs. At the suggestion of the cardiologist Helen B. Taussig, Blalock tried the procedure to repair a congenital heart condition known as tetralogy of Fallot; Cooley assisted on the very first one. Cooley left for brief stints in the army and with Lord Russell Brock, another noted surgeon in the rapidly growing field of pediatric heart surgery. In January of 1949 Cooley married Louise Goldsborough Thomas, the daughter of a surgeon and a nurse at Johns Hopkins; they had five daughters. In 1951 he returned to Houston.
At Houston he teamed with the Baylor Medical School professor Michael DeBakey and in 1955 helped DeBakey design the heart-lung machine used at Houston's Methodist Hospital. In the early 1960s Cooley began to work with transplanting artificial valves in diseased hearts. By the start of 1967 he had become so skilled that he received the Rene Leriche Prize as "the most valuable surgeon of the heart and blood vessels anywhere in the world."
In December of that year, Dr. Christiaan Barnard of Cape Town, South Africa, transplanted the first human heart. Cooley watched this technique closely and performed transplant surgery himself in May 1968. Cooley implanted the heart from a fifteen-year-old female suicide victim into Everett Thomas, a forty-seven-year-old man. Previously, American surgeons had cooled the heart before implantation, but Cooley believed that he could suture a donated heart into place before damage to the heart could occur. Thomas lived 204 days. Cooley went on to transplant twenty-one human hearts and one ram's heart in the space of a year.
Controversy followed these operations, however. Shortly after the first transplant, Cooley had two patients in need of hearts and only one donor. Cooley installed the heart in the younger person; the older person was given a heart forty-eight hours later. The latter patient received the still beating heart of a brain-dead man. A grand jury indicted two hospital workers for the murder of the heart donor, but the charges later were dropped. Nevertheless, Cooley's transplants were raising questions that plagued medicine at this period: Who shall live, and what is the legal definition of death? Up to this point medical examiners always had been able to define death as cessation of a pulse. After the transplants brain death became the accepted criterion. As Cooley said in a Life magazine article, "the heart … is the servant of the brain."
On 4 April 1969 Cooley performed surgery on a patient named Haskell Karp, an Illinois printing estimator. Karp's heart muscle was so severely damaged by coronary artery disease that it could barely function, but a suitable heart for transplant could not be found. In what Cooley himself termed "an act of desperation," he inserted an artificial heart made of a type of silicon plastic in the patient at Saint Luke's Episcopal Hospital in Houston. A short-term measure, the pump was the same size as a natural heart. A large bedside pump sent out pulses of carbon dioxide into sacs on the artificial heart, which then forced Karp's own heart to expand and contract sufficiently to enable blood to oxygenate through Karp's own lungs. While he was on the artificial heart, Karp said a few words and survived long enough to receive Cooley's nineteenth heart transplant a few days later. DeBakey was furious. He charged that his former colleague had stolen the concept for the heart from him and had violated federal guidelines on the use of experimental devices. A Baylor committee recommended censuring Cooley. As a result of the controversy, Cooley terminated his eighteen-year relationship with Baylor and established the Texas Heart Institute. He also responded to DeBakey by insisting that he was obliged only to receive his patient's permission to perform the operation. A federal district court dismissed a suit by Karp's widow, and the United States Supreme Court denied review of the dismissal.
For his part Cooley argued that "we have demonstrated that a mechanical device will support the body. But we've got to get more experience." None of the transplant recipients, in Houston or elsewhere, survived long in that era of medicine. As a result Cooley turned his attention to perfecting the heart-bypass operation. By the end of the twentieth century he had performed 20,000 bypasses. All of these operations relied on perfecting the techniques of attaching and reattaching blood vessels that Cooley had learned in his initial contact with Blalock. Barnard observed Cooley at work and proclaimed, "Every movement had a purpose and achieved its aim. Where most surgeons would take three hours, he could do the same operation in one hour."
Cooley has been described as a man who speaks calmly. His secretary told Cooley's biographer that over the course of his career Cooley had dealt with "suicidal maniacs, religious fanatics, gypsies, cranks, reporters, politicians, cracked inventors, and exhibitionists" in his practice. In 1972 he received an award for having performed the most bypass operations of any living surgeon. In 1984 he received the Presidential Medal of Freedom, the highest United States civilian honor.
Cooley and his associates have performed more than 100,000 open-heart operations. His patients have included the Hall of Fame baseball pitcher Whitey Ford. Cooley has published many technical works, including Surgical Treatment of Congenital Heart Disease (1966), written with Grady I. Hallman, a close associate at the Texas Heart Institute.
The most detailed biography of Cooley is Harry Minetree, Cooley: The Career of a Great Heart Surgeon (1973), written by a former patient who had access to Cooley and his staff. Other treatments are Thomas Thompson, Hearts: Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac Frontier (1971), and Roger Rapoport, The Super-Doctors (1975), which view Cooley in the larger context of heart surgery of the time.
John David Healy