A harvester of skills

Renowned heart surgeon for over 25 years, Prof Freddie Wood has transformed both cardiac and heart and lung transplant surgery, writes JUNE SHANNON

AS A young medical student in Dublin Freddie Wood sat transfixed listening to a lecture by Dr Christiaan Barnard, the South African heart surgeon who, in 1967, carried out the world’s first heart transplant.

Little did he know then that 18 years after Barnard, together with the late Mr Maurice Neligan, Wood was to perform Ireland’s first heart transplant. Two decades later he would carry out Ireland’s first lung transplant.

“It was just the fascination that you could take a human heart, stop it, take it from one individual who was dead, and put it into someone who was dying and restart it . . . the whole process from a science point of view just fascinated me,” Wood says.

A renowned heart surgeon, Wood worked as consultant cardiothoracic surgeon in the Mater hospital and Crumlin children’s hospital in Dublin for more than 25 years. During that time he has transformed both cardiac and heart and lung transplant surgery in Ireland.

He also developed the State’s first artificial heart programme and the first heart valve tissue bank.

Wood has carried out more than 14,000 heart and lung operations throughout his career including approximately 120 heart transplants and 36 lung transplantations.

Although he retired from clinical practice in the Republic in 2010, Wood currently works as consultant cardiac surgeon in paediatric congenital heart disease in the Royal Victoria Hospital in Belfast.

As one of the State’s leading experts in congenital heart disease, Wood was also instrumental in progressing the development of open-heart surgery in infants and newborns in Ireland.

Congenital heart disease is the most common physical birth defect and in Ireland it occurs in 8.4-10 per 1,000 live births. Not all babies born with congenital heart defects will require surgery but of those who do, 60-70 per cent will require it in the first year of life.

Wood explains that an adult heart is similar in size to an adult’s clenched fist and a newborn baby’s heart therefore is about the same size as a strawberry or a small plum.

It is on these tiny hearts that Wood carries out some of the most complex surgical procedures.

On September 12th, 1985 Wood and Neligan made history when Dublin’s Mater hospital became the 35th unit in the world to do heart transplantation.

The first patient to receive a donor heart in Ireland died at day 75 post transplant, the second survived for 13 years and the sixth patient who was transplanted in 1986 is still alive today.

Wood explains that he would travel to the donor hospital to harvest the heart while Maurice Neligan prepared the recipient to receive the new organ.

Wood continued to harvest the hearts and he and Neligan “scrubbed in in every transplant” until 1992 when there were enough appropriately skilled surgical trainees to take over the harvesting. This meant that he and Neligan could transplant individually.

“We would leave the hospital most nights about midnight and be in again at 6.30am and we would expect to get called every hour, every hour and a half after you left the hospital,” Wood says.

Wood says both surgeons were “excited” and “focused” at the prospect of carrying out the first heart transplant in Ireland.

“The surgical stitching that was required for a transplant was indeed simpler than for a lot of the congenital heart disease that we had to deal with. So what we were doing in our daily surgical work left us particularly skilled to connect all the connections in a transplant,” he explains.

According to Wood, the two main advances in cardiac surgery have been the standardisation of education and the development of new solutions, which allow the heart to be stopped safely for longer periods of time.

“Cardiac surgery isn’t just dependent on the surgeon. It is equally dependent on the anaesthetist, the theatre staff, in particular the perfusion staff, and intensive care.

“When Maurice and I were doing things in the 80s, other than the anesthesia we did all of the intensive care . . . and then you also had to do the post-operative care. What has happened since is . . specialists have developed in all of those so you can have a consistency in the delivery of care in the first 48/72 hours which is absolutely critical.

“We were often up 35/40 hours on the trot operating, never going to bed and doing care as well. That is unsustainable in this current era but that was what was needed to move things on.”

The development of a technique called cardioplegia, which allows the heart to be stopped safely for up to two hours using a special solution, has allowed surgeons to “be slower and take time in correcting defects”, Wood adds.

“When we started, everything was under time constraints. You would have maybe 45 minutes to get absolutely everything spot on and correct. In the 80s and early 90s for instance . . . we used to cool children down regularly to 18 degrees centigrade and then you could stop everything, suspend life. But you had only between 40 and 45 minutes to put everything together and restart the heart before you started getting brain damage or heart death. So it was all much more pressurised than now.”

This extra time also allowed surgeons to teach skills and pass them on.

In May 2005, together with Prof Jim Egan and Mr Jim McCarthy, Wood performed Ireland’s first single lung transplant and a year later they performed the first double lung transplant.

Wood says that the best part of his job was “the excitement of introducing something new and getting it to work”.

He also describes getting “a real kick” out of meeting his once tiny patients years later as healthy adults.

“You are operating on a one-day old baby or a five-day old baby and then you meet them when they are 25 or 26 and . . . they don’t know anything about it . . . they don’t know you which is wonderful, they might have heard about you, but they are just normal human beings. They just have a scar and it is great. That is the ultimate kick,” he smiles.

With genuine emotion in his voice, Wood says the worst part of his job was “going out to talk to parents or family that their father or mother but in particular baby or son or daughter is dying or dead . . . from a retirement point of view I am glad I don’t have to do that any more. It is really hard . . . whatever they say you remember the majority of cases that you lost. You always think you could have done something else.”

Due to the nature of transplant work, surgeons like Wood invest a great deal of time and care in their patients, which leads to a unique doctor patient relationship.

“You become a key part of their lives, [there is] respect on both sides . . . you never forget them.”

Wood explains that his transplant patients were either unable to work or got so ill waiting on a new organ that they had to stop working. “But,” he says, “every single transplant got back to work. They really thought life was very valuable and they didn’t sit around. They made the most of it.”

“It was just the fascination that you could take a human heart, stop it, take it from one individual who was dead, and put it into someone who was dying and restart it . . . the whole process from a science point of view just fascinated me