IN TAIPEI - A TAIWANESE man lived without a heart for 16 days, kept alive by two artificial heart-lung machines as he waited for a transplant.
Mr Chen Chi-chung, 60, thus became the world's first 'heartless' survivor, according to the National Taiwan University Hospital (NTUH) where his heart transplant was done.
It all began in January when the retired electrician, who had no record of major illnesses, suffered from severe coughing and displayed flu-like symptoms.
He was hospitalised on Feb 12 at Chi Mei Medical Centre in southern Tainan city.
There he was diagnosed with infective endocarditis - a bacterial infection that can seriously damage the lining of the heart's chambers and valves.
A day later, his heart failed and doctors performed emergency surgery. They found the damage so extensive that they had no choice but to remove his entire heart.
'It was a very difficult decision to make. Such a move could have legal implications. And we were concerned about setting a bad precedent,' said Chi Mei's Dr Cheng Bor-chih, who operated on Mr Chen.
The surgeon of 23 years told The Straits Times that it would have been difficult to reconstruct the man's heart.
'Even if we had done so, from my experience, it would have been unlikely that the patient would have lived more than a year. He likely would have suffered from repeated congestive heart failures and intra-cardiac infection.'
The fact that the patient's son Chen Shih-chung is a doctor who understood the risks also played a part in the decision.
'His condition was more severe than thought,' said Dr Chen, 32, who also works at Chi Mei. 'I trusted my colleagues' judgment.'
After 20 minutes of discussion among the patient's family, they agreed to proceed with the heart removal. It took nine hours.
The patient was then connected to an ECMO or 'extra-corporeal membrane oxygenation' machine.
The artificial heart-lung machine is usually used to temporarily support - not replace - a patient's damaged or infected heart or lungs until a donor is found.
A day after the operation, Mr Chen was transferred by an ambulance to NTUH, the top hospital in Taiwan, while still hooked to the machine
The journey - from one end of the island to the other - took five hours.
'The chance of getting a transplant is higher in Taipei because the more conservative residents in Tainan are less receptive to the idea of organ donation,' said the patient's son.
At NTUH, doctors connected a second ECMO machine to Mr Chen.
Artificial arteries transferred blood from the gaping hole in his chest to an external blood pump and artificial lung. The blood was warmed and filtered before being returned to his body.
'We believe it is the first case in the world that a patient has survived without a heart, relying only on artificial machines,' said NTUH's Professor Wang Shoei-shen, who performed the heart transplant.
'We have checked with some foreign medical experts and looked up medical records. We have not found any other such cases,' he said. 'We had a patient who was connected to the ECMO for a month. But his heart was intact.'
A doctor from Harvard Medical School, who declined to be named, also said that he had not heard of similar cases.
Doctors had considered the option of an artificial heart transplant but were concerned about the risk of infection given his condition.
Relying on the artificial heart-lung machines to sustain the patient's life is also not without risk. Mr Chen suffered blood infections twice while waiting for a donor replacement.
The long and agonising wait for a donor ended on Feb 29.
On Tuesday, Mr Chen was discharged and is now recovering at home.
A major portion of his hospitalisation bill was taken care of by the government-run health insurance programme. The family shelled out about NT$500,000 (S$22,000).
But some doctors expressed reservations about the implications of removing the entire heart.
'If the patient died before the transplant, how do we decide on the time of death?' said Dr Ke Wen-che of NTUH's intensive care unit. 'When we remove his heart, where do we draw the line between life and death?'
Others were concerned that the case could give the families of heart patients unrealistic expectations.
Some surgeons that The Straits Times spoke to said that they would not attempt such a procedure because it is very risky.
A spokesman for Singapore's National Heart Centre also said: 'We have not done such a case here and would definitely not remove a patient's heart while waiting for a donor.'
