Prof. A. Bochenek: the first successful heart transplant in Poland lasted over two hours

The first successful heart transplant in Poland was performed by Prof. Zbigniew Religa's team in Zabrze on November 5, 1985. Prof. Andrzej Bochenek was a member of that team and co-inventor of that groundbreaking procedure. Today, he serves as a consultant for cardiac surgery at the American Heart of Poland Group.

PAP: Professor, today we say that the heart is simply a pump. Why was a heart transplant a major event 40 years ago?

Prof. Andrzej Bochenek: The heart has always been a symbol of emotion and life. Just a hundred years ago, surgeons believed that anyone who touched a heart would be expelled from the guild. And suddenly, it turns out it can be transplanted. Technically, it's a simple procedure; livers and pancreases are more difficult. But it's the heart that evokes the most emotion.

PAP: From the immunological point of view, the heart is apparently easier to transplant than other organs.

Prof. AB: Yes, the kidneys are the worst. Prof. Franciszek Kokot, the famous nephrologist and endocrinologist, used to say that the kidney is the most important because it regulates hormones and many metabolic processes. But that's precisely why much research is being conducted on heart transplants, including xenotransplantation—attempts to harvest a heart, for example, from a pig, while inhibiting the rejection process.

PAP: Have you taken part in such experiments?

Prof. AB: Yes, in Zabrze and Katowice. Professor Zbigniew Religa and I conducted research on animals—pigs and calves. That's when the idea of ​​heart support began. Religa suffered greatly when he had to forgo transplants due to a lack of donors. That's why he wanted to create devices that would allow patients to receive a donor heart.

PAP: It was a great thing when work on artificial heart support began in Zabrze.

Prof. AB: Exactly. They were huge devices, the patient was bedridden. I joked that these machines weren't even suitable for watering a garden. Religa was furious! But today we have portable pumps that save lives.

PAP: Prof. Religa had a vision, but also character.

Prof. AB: Yes. He was a true battering ram. When patients were dying and donors were scarce, he wouldn't give up. He said: we can't lose. If it weren't for his persistence, we might never have performed another transplant after that first one, which was de facto unsuccessful, as the patient only survived eight days. But he kept going, unafraid of failure.

PAP: Apparently Religa had an American sense of the press.

Prof. AB: Oh yes. He knew he needed public opinion on his side. He called the radio and asked for journalists. I protested because the patient was still fighting for his life, and he replied, "When a hen lays an egg, it clucks." He knew that success had to be demonstrated to gain the favor of the people and the authorities. I remember one day he was stuck in his office. We had some important matters to discuss, but it turned out that Prof. Religa was giving an interview to "Przegląd Akwarystyczny." He had a knack for it, because anglers are a huge group.

PAP: However, the first heart transplant in Poland was performed by someone else, many years earlier.

Prof. AB: Yes, Professors Jan Moll and Jan Dziatkowiak in 1969, shortly after the first transplant of this organ performed by Dr. Christiaan Barnard on December 3, 1967, in Cape Town. Their patient died immediately after the operation, and Barnard's patient died 18 days later from sepsis.

But they were met with hate, and a prosecutor's investigation was launched. The communist authorities banned such "dangerous experiments," which could have sparked social discontent. Another matter was that the legislation at the time didn't help. For example, there was no definition of brain death. Religa had an advantage over his brilliant predecessors – the press was on his side. And that saved his mission.

PAP: Please tell us about November 5, 1985, point by point.

Prof. AB: I walk into work, it's a normal day, terrible weather, clouds, drizzling rain. Religa says: there will be a transplant. I already knew I wouldn't be returning home for at least two days. The patient was in critical condition. The donor was brought from Warsaw. Religa traveled personally to transport him to Zabrze in perfect condition.

The transplant began in the afternoon, probably late. In the next room, Religa and Marian Zembala were harvesting the heart. My team and I were preparing the recipient. At one point, Religa entered carrying the heart in a metal bowl filled with ice. He was wearing clogs with thick, smooth soles. I looked at him and the thought flashed through my mind: I hope he doesn't slip, but thankfully he doesn't.

The surgery went quickly, two hours and a half. Religa was lightning fast, connecting the blood vessels as if he were a regular at it, as if this wasn't our first time. Another thing is that he had been preparing for this, practicing heart transplants on cadavers. He was assisted in this first transplant by Marian Zembala, Bogusław Ryfiński, and Jerzy Wołczyk.

I'll admit, when we removed the heart from the recipient's chest and I looked into the empty space between the ribs, I felt a twinge of fear. But it didn't last long; the new heart was "sewn in," we removed the clamps, and the new heart began to beat. It was a moment I'll never forget.

PAP: And euphoria?

Prof. AB: Everyone was moved. But the patient was very devastated, he had a bleeding disorder. He started bleeding, and there was a shortage of blood. Religa told people to call the radio to organize donors. Then the army from Gliwice arrived, and 20 soldiers donated blood directly for transfusion. Today, that wouldn't happen. But we saved lives.

PAP: Today such a procedure is a procedure, back then – improvisation.

Prof. AB: Yes, we had no medicines, no equipment, not even access to medical journals. Every trip abroad was a miracle. Religa traveled to the US, raising money through the Polish diaspora. Thanks to this, we had the first tool kits, supplies, and sutures. He said: I'm doing this for the people, not for politics.

What's more, the professor bent over backwards to send us youngsters beyond the borders of the Polish People's Republic, to countries where miracles were happening in medicine that we could only read about in scientific journals, and that was only on the condition that the university medical library sent us scans of articles we had ordered, which didn't happen often.

But that's not all: Professor Zbigniew Religa had the gift of being able to encourage his students, including me, to return from those "better countries" to Poland. I was in the UK, settling in quite well, but when I heard from Professor Religa that we could do great things in Zabrze, I didn't hesitate.

PAP: What was the cooperation between you and Zbigniew Religa like?

Prof. AB: It was like a creative tension. I was a skeptic, he was a visionary. We sometimes argued, but we respected each other. When he sent me to Ochojec, to be the head of cardiac surgery, he said: "You have to go out on your own." That was his wisdom – he knew how to give young people space to grow. Thanks to this, new centers were established: Wrocław, Lublin, Zamość, Bielsko, Opole, Białystok, Rzeszów, and Wrocław.

PAP: Back then, not only was cardiac surgery different, but also the entire system.

Prof. AB: Of course. It was the Polish People's Republic, no gas, no ration cards. Religa would go to the First Secretary, arrange for fuel, stitches, salami for the holidays, and protection from politics. He'd say: I'll take care of the politics, you do the work. And indeed, no one ever dragged us to committees.

I remember a story: the two of us once went to see the First Secretary of the Provincial Committee of the Polish United Workers' Party. It was, as always, about money for the Zabrze clinic. I didn't participate in the conversation; I sat in the hallway, waiting for what seemed like four hours. Finally, Religa emerged, ecstatic, having arranged everything. And he gave me a car voucher. Do you know what a car voucher was back then? You could have a lot of money, but without a voucher, you couldn't buy a car.

I explained: "The professor doesn't want to buy his own car?" And Religa said no, he has his old one, he's attached to it, he doesn't need any new ones. Incidentally, the inside of his favorite car was, how should I put it, not entirely clean. Cigarette butts were strewn everywhere.

PAP: You were 35 years old when you performed this transplant. What did you feel?

Prof. AB: A mixture of pride, fear, and disbelief. You knew you were part of something great. But at the time, I wasn't thinking about history, only about the patient surviving.

PAP: Was there a party after the surgery?

Prof. AB: Let's just say it was a relief. Someone brought bread with lard, someone a glass. I didn't drink, so I observed it sober. But Religa, although he liked a drink, never operated under the influence. He was responsible to the extreme.

PAP: From the perspective of four decades, what moves you most about modern transplantology?

Prof. AB: The idea that a system was born from the dream of a few people. Back then, we had one center; today, heart transplants are performed in many cities. This is a continuation of Religa's idea: to share knowledge, not keep it to yourself.

PAP: What if Professor Religa entered the operating room today?

Prof. AB: I think he'd smile. He'd say, "Andrzej, it's finally all working as it should." And then he'd probably argue with someone, because he couldn't do it any other way. But it's thanks to him that we have world-class transplantology in Poland.

Interviewed by: Mira Suchodolska (PAP)

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