When University of Alberta pediatric cardiologist Lori West was put in charge of the transplant program at Toronto’s Hospital for Sick Children in 1994, the situation was dire for newborns with bad hearts.

Up until the first infant heart transplant in 1986, children born with certain kinds of heart malformations had a 100 per cent mortality rate.

Even after that, the rarity of matching hearts with blood-type and size ensured that half the babies in need would die on the waiting list. 

Increasing the donor pool was the solution, however getting around the blood-match compatibility issue was as big an impediment in organ transplantation in the early 1990s as it is today.

In thinking about options for increasing the donor pool, West says she kept coming back to the beauty of the infant immune system—its malleability. 

“It’s not all set in stone like adults,” she said. “It is well known that babies don’t have antibodies and that has been known for decades.” 

In animal models, researchers have shown that if an organ, like a heart, is introduced early enough, the still-developing immune system could be tricked into recognizing what is foreign as self, and not reject it.

If that’s the case, then it made sense—at least to West—that a mismatched donor heart, regardless of blood type, could be transplanted into a newborn with a bad one.

“Once you think it through, why wouldn’t that work?” she said.

Although this concept could never be tested in humans, West said the science was on her side, as was the fact that there was nothing left to lose.

“When you have a child who has a 100 per cent risk of dying, what is cautious about not trying a new way forward?”

The breaking point came when West watched a baby die on the waiting list as a perfectly good donor heart was turned down because it was the wrong blood type.

“It was a double tragedy,” said West. “I thought, ‘We could do this better.’”

On Valentine’s Day in 1996, Caleb Schoeder became the first baby to receive a donor heart of a different blood type.

And it took: Caleb is a healthy and happy adult turning 25 years old this month.

“The first big eureka moment was this is not only possible but it is actually really easy. And that’s why centres around the world are doing it.”

Today, many more babies born with a heart condition that requires a transplant get the heart they need.

“Organ and cell transplantation is a remarkable endeavour of human medicine, one that involves the very edges of life and death for both transplant recipients and donors,” she said. “The very fundamental nature of the altruism that gives life between donors and patients is unique in medicine.”

In 2005, West and her family moved to Edmonton at the behest of the surgeon who did the first ABO incompatible heart transplant, Ivan Rebeyka, who had come to the U of A some years earlier.

West is now director of the Alberta Transplant Institute and the Canadian Donation and Transplantation Research Program, while continuing her research tackling transplant rejection, the negative side-effects of immunosuppressive drugs and, more recently, the role blood type might play in the severity of COVID-19 cases.

She has also been appointed as an officer of the Order of Canada, announced just before the new year.

“It is my belief that success in complex endeavours such as science and medicine depends on the efforts of teams,” said West, who is also a member of the Women and Children’s Health Research Institute. “I have been fortunate to work with talented and dedicated people over the years who have made important contributions to moving our field forward, and I am grateful for those efforts.”

The article is an excerpt from University of Alberta’s Folio.

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