Man Alexandre, a Belgian transplant surgeon who within the Nineteen Sixties risked skilled censure by eradicating kidneys from brain-dead sufferers whose hearts have been nonetheless beating — a process that tremendously improved organ viability whereas difficult the medical definition of dying itself — died on Feb. 14 at his house in Brussels. He was 89.
His son, Xavier, confirmed the dying.
Dr. Alexandre was simply 29 and contemporary off a yearlong fellowship at Harvard Medical Faculty 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 visitors accident, and regardless of in depth neurosurgery, medical doctors 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 dying, he mentioned, is dying. Machines can preserve a coronary heart beating for a very long time with no hope of reviving a affected person.
His argument went in opposition to centuries of assumptions in regards to the line between life and dying, 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 big 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 can be any query of taking organs from a dying one that has a ‘nonreasonable likelihood of getting higher or resuming consciousness,’” he informed the gathering. “The query is of taking organs from a useless particular person. The purpose is that I don’t settle for the cessation of heartbeat because the indication of dying.”
Others within the room, together with a few of the best names within the organ transplant subject, have been much less certain, and mentioned so.
“Any modification of the technique of diagnosing dying to facilitate transplantation will trigger the entire process to fall into disrepute,” Roy Calne, a pioneering British transplant surgeon, mentioned in the course of the convention. (Dr. Calne died in January.)
Dr. Alexandre remained steadfast, and he provided 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, don’t have any capability to breathe with no machine, and present no indicators of mind exercise.
Inside a number of years, Dr. Calne and others started to come back 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 needs to be understood because the equal of dying, whether or not the center continues to beat or not.
Right now, Dr. Alexandre’s perspective is broadly shared within the medical neighborhood, and eradicating organs from brain-dead sufferers has grow to be 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 review drugs. 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 embody their daughters, Anne, Chantal, Brigitte and Pascale; 17 grandchildren; and 13 great-grandchildren.
By the late Nineteen Fifties the sphere of transplant surgical procedure was evolving shortly. Among the many main analysis facilities was Peter Bent Brigham Hospital (now a part of Brigham and Girls’s Hospital) in Boston, one in all Harvard’s educating services, the place the primary kidney transplant was carried out in 1954.
Dr. Alexandre arrived at Brigham in 1962, overlapping by a number of weeks with Dr. Calne, who was wrapping up his personal fellowship time period. Each of them labored underneath Joseph E. Murray, who in 1990 shared the Nobel Prize in Physiology or Drugs for his work in transplant surgical procedure.
Dr. Alexandre observed 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 dying, however at a big value to the organ.
“They seen 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 informed Mr. Berman for his Pill article. “Along with ‘killing’ the affected person, they have been giving the recipients broken kidneys.”
Dr. Alexandre returned to the College of Louvain after a yr, intent on placing his convictions into observe.
He made a number of additional contributions to the sphere of transplant surgical procedure. Within the early Nineteen Eighties, he developed a technique to take away sure antibodies from a kidney in order that it may very well be positioned inside a affected person with an in any other case incompatible blood kind.
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.
