14 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION JANUARY, 1970

The Ethics of Heart Transplantation*

REV. CHARLES CARROLL, A.B.
Protestant Chaplain to Faculty and Students,
University of California San Francisco Medical Center
and
Executive Director, the Center for^ Human Values
in the Health Sciences
San Francisco, California

SCIENTIFIC experimentation upon human sub-
jects seldom became an object of universal
concern until the trial of the Nazi doctors at
Nuremberg in 1947-48. Since then public interest
in the United States at least has diminished. There
have, of course, been some notable exceptions:
1) the debates on the relative merits of the Salk
and Sabin vaccines; 2) the discussions surrounding
cardiac catheterization and angiography; 3) the
dismaying results of the research conducted into
the actual practices of clinical researchers by Dr.
Lewis C. Welt of the University of North Caro-
lina;' 4) the Willowbrook Studies on infectious
hepatitis in retarded children;2 5) the cancer cell
implant cases at the Jewish Chronic Disease
Hospital in Brooklyn;2 and 6) the thalidomide
tragedy.
More recently, however, public interest has in-
creased and concomitantly public concern has
grown. Charges of price fixing and restraint of
trade in the sale of quinine and quinidine by the
Federal government against 15 United States and
foreign drug companies on October 25, 19683 and
recent revelation of the testing of potentially fatal
new compounds on prisoners in Oklahoma, Arkan-
sas and Alabama "with little or no direct medical
observation of the results"4 have sparked renewed
public interest.
Still, nothing has excited public concern more
than heart transplanation. Here, as Francis D.
Moore, Moseley professor of surgery at Harvard,
has commented, "Surgery has invaded an entirely
different area of fundamental biology-one in
which it must rely for success not on an evolu-
tionary response or a physiologic adjustment, but
on the outright abolition of a normal response
Read in part at the 74th Annual Convention of the Na-
tional Medical Association, San Francisco, Calif., August
10-14, 1969.
established in the species during epochs of evolu-
tion. . . The transplant procedure involves the
simultaneous application of dangerous drugs and
a new operation; the success of both depends upon
the interaction of each. . Further, there is always
another individual involved. As the constella-
tion of biological variables around new surgical
operations becomes more complicated, as in trans-
plantation, so also does the ethical problem be-
come more pressing."9
Confirmation of this insight has come with in-
creasing frequency in every news report. Some
stories with the date of their appearances follow:
On February 3, 1969 the family of Israel's first
heart donor charged that the doctors killed him
to use his heart. The Tel Aviv Hospital admitted
his heart was used without permission.5 On Feb-
ruary 9 the widow of a Mexican-American heart
donor who alleged her husband died of "careless
and negligent acts" instituted a $1,000,000 suit
against Cook County Hospital in Chicago.5 On
February 14 insurance carriers cancelled the liabil-
ity insurance of three transplant surgeons in
Dallas.6 On Febraury 28, Dr. Denton Cooley
blamed the lack of heart donors upon criticism
by laymen and the "faint-hearted;" his colleague,
Dr. Michael E. DeBakey, upon the high mortality
rate of recipients. On April 5 the first implant
of an artificial heart (this, the invention of the
Argentinian Dr. Domingo Liotta) took place in
Houston; on April 8 Dr. Cooley replaced the
artificial heart with a human heart; on April 9
Haskell Karp, 47, died. In subsequent weeks Dr.
Cooley resigned and Dr. Liotta was suspended
from the program financed by the National Heart
Institute at the Baylor College of Medicine, the
DeBakey-Cooley controversy had become public
knowledge. On May 25, Dr. Theodore Cooper,
director of the National Heart Institute, expressed
VOL. 62, No. I Ethics of Heart Transplantation
concern about a possible "black market" in organs
and alleged use of the poor.7 This danger had
already been cited in an editorial in the Journal
of the National Medical Association.8
The July 11, 1969 Medical World News com-
mented upon a report of the American Civil Liber-
ties Union that is expected to show that in the
United States 64 of the first 100 heart donors
were black while there was only one black re-
cipient. (See appended Registry report.)
Thus it would appear safe to say that these
issues, long debated within "the professional com-
plex," have forced themselves to public attention,
certainly here in the United States.
World renowned Dr. Adrian Kantrowitz, di-
rector of surgery at Maimonides Medical Center
in Brooklyn, insists that human organs should be
considered part of the nation's natural resources.9
Likewise Dr. Henry K. Beecher, Dorr professor of
research in anesthesia at the Harvard Medical
School, writes that "those who were once a grave
and growing burden, the hopeless comatose, can
now be means of extending life for desperately
ill, but still salvageable individuals."2 This implies
a "Social Contract" theory of society that is not
as yet fully explored and a "Social Darwinism"
that may be un-Darwinian and actually anti-social.
Such distinguished scientists as Sir Peter Meda-
war may deride the "stream of advice and com-
ment and warning and exhortation," from the
press and from the pulpit and the judges' bench;"
and indeed they may insist as he that "there is no
need to be deeply philosophical about" heart trans-
plantation (and by implication, a new definition
of death) for he predicts that "it will come about
for the simple and sufficient reason that people
are so constituted that they would rather be alive
than dead." But he fails to admit, perhaps to see,
that the donor may have no less an interest than
the recipient in living!
The scientific community is itself divided. On
January 11, 1968, Boris Petrovsky, Soviet Minister
of Health, banned heart transplants pending more
research on rejection; he urged his colleagues to
continue work on an artificial heart. In early
November, however, Alexander Vishnevsky per-
formed a heart transplant at the Kirov Military
Medical Academy in Leningrad supported by a
group of military surgeons. The patient died
one day later. Still, Vladimir V. Kovanov, vice
president of the Soviet Academy of Medical
15
Science and head of the Transplantation Labora-
tory in Moscow, urged acceptance of heart trans-
plant techniques on March 15, 1969 this, in di-
rect opposition to the more cautious and earlier
statements of his superior. Note, too, the refusal
of Dr. Michael DeBakey of Houston to term any
heart transplants successful in January 1968 and
Dr. Christiaan Barnard's statement in Berlin in
June 1969 that one year of life after transplanta-
tion is perhaps the most that can be expected by
the heart recipient at the present time.
The religious community is no less divided.
Ralph Potter, Th.D., Associate Professor Social
Ethics at the Harvard Divinity School was a mem-
ber of the Ad Hoc Committee of the Harvard
Medical School to Examine the Definition of Brain
Death, which approved "The Definition of Ir-
reversible Coma," which appeared in the Journal
of the American Medical Association of August
5, 1968.
Eugene Tesson, the French Jesuit writing in
Etudes in March of the same year, was more cau-
tious. He concerned himself not alone with the
problem of the physician's inerrancy in pro-
nouncing the patient dead; he posed this problem
for both surgeon and recipient: Do transplants
merely prolong the recipient's sufferings (spe-
cifically, Mike Kasperak) ?
Monsignor Ferdinando Lambruschini, in the
Osservatore Romano, first in April 1968 in gen-
eral terms and later in May of the same year in
more specific terms, supported Tesson. In almost
a direct reference to the doctrine of informed
conscience he spoke of the substantive difference,
as he sees it, between "simple" and "certain"
conscience. Insistent that a group of doctors un-
related to the transplant service pronounce the
patient (about to become potential donor) dead,
he clearly supported the proposal of the National
Academy of Sciences of February 28, 1968.
In December 1968, when the first heart trans-
plant was performed in Israel, the chief rabbi of
Israel applauded this signal advance in Israeli
medicine while the rabbinate claimed postmortem
operations are prohibited by the Torah.
The legal community is equally divided. As
early as 1953 the Israelis passed a law allowing
organ donation without consent of next of kin.
In Mexico, a transplant was halted in March 1968
because the penal code made no provision for
surgery of this nature. In the following month
16 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
heart transplants were legalized in France by gov-
ernment definition of death as cessation of brain
activity. On the other hand, in the Netherlands
one of the most complete ethical codes in the
world published in 1955 "flatly disapproves of
experiments on dying patients under any circum-
stances."
The debate is growing. It is worldwide. No
attempt such as that of the British Medical As-
sociation of April 25, 1969 can still the voices
of concern. In a statement of policy the association
barred: 1) removal of the desperately ill pros-
pective donor to another hospital simply to be near
the recipient as "ethically unacceptable;" but also
banned 2) "excessive publicity" (without defining
'excessive'); and 3) identification of donor and
recipient. And this, in the very month that de-
velopments elsewhere and controversies within the
medical profession throughout the world indicated
the need for more information if people's fears
were to be allayed and suspicions overcome.
The issue is no longer "When does individual
life begin?" or "When does individual life end?";
it is, rather, "Who is man ?" -the question so
brilliantly and prophetically raised by Jean Bruller,
literary backbone of the French Resistance, in his
novel, "You Shall Know Them" (1953).
The power to answer that question must be
answered by all or that power will be used and
abused by a few. As Bruller perceived, D.M.
Templemore had made a point in Plus ou moins
bete, "All man's troubles arise from the fact that
we do not know what we are and do not agree
on what we want to be."
Margaret Mead, curator of ethnology at the
American Museum of Natural History and adjunct
professor of anthropology at Columbia University,
has observed, "The more powerless the subject is
per se, the more the question of ethics-and
power-is raised."
Hans Jonas, Alvin Johnson professor of philos-
ophy at the New School for Social Research, has
insisted "on the inflexible principle that utter help-
lessness demands utter protection."
The implication of these statements is stagger-
ing. The power to define life and death-and not
to define is to define-is the power of life and
death over others!
Who, for example, is more powerless than the
fetus? Recent legislation, however, without de-
fining individual human life, allows the fetus to
JANUARY, 1970
be taken in one month and makes it a crime if
taken the next month.
If, as Justice Oliver Wendell Holmes said, "To
live is to function; that is all there is to living,"
and as Tolstoi claimed Napoleon believed, "The
body is a machine for living, that is all;" and
again, if as Ashley Montague wrote, "Humanity
is an achievement, not an endowment," the man
must have the power to function if he is to en-
force his claim to be alive. What this implies for
the retarded, the mentally ill, the senile and the
aged to say nothing of the "irreversibly uncon-
scious" -is all too obvious.
David W. Rutstein, Ridley Watts professor of
preventive medicine at Harvard, sees the problem
clearly. "In accepting the new definition of 'ir-
reversible brain damage' as equivalent to death in
man," he declares "we are really concerned only
with irreversible damage of higher cortical centers.
We are saying that in man, "life" exists only
when he is aware of and can respond to his en-
vironment," and he claims that this "raises more
questions than it answers." He raises a few: "Does
acceptance of this concept mean that it is no longer
necessary to treat . . . the senile?" "How do
eligible donors differ in principle from totally
feeble-minded individuals?" "What are the im-
plications for the inheritance of property?" "Does
this new definition . . . open up new channels
of criminal activity that will lead to the burking of
patients to increase the supply of eligible donors ?"
With the reserve of a man acquainted with the
ambiguities of the human situation and the ironies
of history, with the love for his profession of the
sensitive and dedicated physician, he avers that "it
would have been better if some of these questions
had been explored before the first heart transplan-
tation," and claims further that "the ethical prob-
lem of donor eligibility might best be avoided by
the development of a suitable mechanical heart."
Dr. Dwight E. Harken, a Harvard colleague and
pioneer in cardiac surgery, writes with no less
candor:
Heart transplantation in an early experimental proto-
type form is here. Each man who contemplates entry into
the field of cardiac transplants must arrive at his own
decision by balancing the use of the considerable resources
for a few transplants, against his obligation to treat ailing
people and extend heart surgery in other ways. So far, I
have elected rehabilitation. . I reserve the right to
change tomorrow but today I am proud of our restraint
in not performing heart transplantations yesterday.
VOL. 62, No. 1 Ethics of Heart Transplantation
Louis Jaffe, Byrne professor of administrative
law at Harvard, claims that "those who aspire to
moral leadership should temper popular excess."
Hans Jonas,2 mentioned earlier, enjoys such lead-
ership. Emphatic in his condemnation of the view
that irreversible coma represents a new, i.e. accept-
able, definition of death, he has written:
I do not wish to be misunderstood. As long as it is
merely a question of when it is permitted to cease the
artificial prolongation of certain functions (like heart-
beat) traditionally regarded as signs of human life, I do
not see anything ominous in the notion of "brain death."
Indeed a new definition of death is not even necessary to
legitimize the same result if one adopts the position of
the Roman Catholic Church . . . that when deep un-
consciousness is judged to be permanent, extraordinary
means to maintain life are not obligatory." (g. Pius XII,
1958). Given a clearly defined negative condition of
the brain, the physician is allowed to allow the patient
to die by his own death by any [sic] definition, which of
itself will lead through the gamut of all definitions. But
a disquietingly contradictory purpose is combined with
this purpose in the quest for a new definition of death,
in the will to advance [sic] the moment of declaring him
dead: Permission not to turn off the respirator, but, on
the contrary, to keep it on and thereby maintain the
body in a state of what would have been "life" by the
older definition (but is only a "simulacrum" of life by
the new)-so as to get at his organs and tissues under
the ideal conditions of what would previously have been
vivisection."
Jonas goes on to say:
Surely it is one thing when to cease delaying death,
but another when to start doing violence to the body
[it is] one thing . . from protracting the sense of
dying, but another to regard that process as com-
plete and thereby the body as a cadaver free for inflict-
ing on it what would be torture and death to any living
body. For the first purpose, we need not know the exact
borderline between life and death-we leave it to nature
to cross it. . All we need to know is that coma is
irreversible. For the second purpose, we must know the
borderline; and to use any definition short of the max-
imal for penetrating on a possibly [sic) penultimate state
what only the ultimate state can permit is to arrogate a
knowledge which, I think, we cannot possibly have.
One paragraph later Jonas continues:
The patient must be absolutely sure that his doctor
does not become his executioner, and that no definition
authorizes him to become one. His right to this certainty
is absolute, and so is his right to his own body with all
its organs. Absolute respect for these rights violates no
one else's rights, for no one has a right to another's
body.
If it can be argued that informed consent is im-
possible to the patient who is conscious, it certain-
ly cannot be argued that informed consent is im-
17
possible for the patient who is unconscious. If it
can be argued that the informed conscience of the
experimenter is the most crucial guarantee of the
interest of the patient, it certainly cannot be denied
that "we have to live with the ambiguity, the treach-
erous impurity of everything human," as Jonas
perceives.
The Director General of the World Health Or-
ganization, Marcolino Candau of Brazil, in March
1968, called upon the medical profession to de-
velop a code of ethics for transplantation that
would include a definition of death. The World
Medical Association in August and the American
Medical Association in December took their first
steps in that direction. These moves were largely
in answer to his appeal that this be done by pri-
vate organizations, to his implicit warning that
failure in self-regulation could lead to state-regula-
tion and to his inherent acceptance of Jonas' thesis.
At stake is something more than the QOis custo-
diet ipsos custodes? of the law. (Who shall guard
those who guard? Who shall watch those who
watch?) At stake is a new definition of man.
Jay Katz, adjunct professor of law and psychiatry
at Yale, in the company of his students, seeks an-
swers to such questions as "Who should decide,
how and under what circumstances to resolve con-
flicts between science and the individual in favor
of either goal? What assumptions about man and
society underlie a decision to require or not require
his agreement to any intervention by others?" But
he seeks these in commentaries from a variety of
disciplines: medicine, law, sociology, theology and
philosophy.
The late, famed Dr. Homer W. Smith could
write, "Abandon Cartesian mechanism and you
will close up every scientific laboratory in the world
at once. You will turn back the clock by three full
centuries."
But Dr. Edmund D. Pellegrino, Director of the
Medical Center and Professor and Chairman, De-
partment of Medicine, State University of New
York at Stony Brook, replies, "Since Descartes
shattered the unity of man by his radical dualism,
medicine has increasingly taken a non-humanist
and even an anti-humanist view."
Dr. Otto E. Guttentag, Samuel Hahnemann pro-
fessor of medical philosophy, emeritus, University
of California San Francisco Medical Center, put it
succinctly, "It took the construction of the atom
bomb to make the physicist recognize sin (to use
18 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
the physicist Oppenheimer's words). . .. Let us
not forget the physicians' inalienable freedom
to explore all paths toward the benefit of his pa-
tients; but let us also not forget every human
being's inalienable freedom to resist manipulation."
The need of multi-disciplinary studies cannot be
too strongly emphasized.
Let us face it. We are seeking a new definition
of death because we need viable organs for heart
transplantations. The quest is for the most part
confined to the professional community. Indeed,
men such as Beecher are calling for "gr-onlp [sic]
agreement. . by thoughtful and distinguished
individuals" and forthright assertion of a policy
to cover the many decisions in the field of experi-
mentation now made by default. This, he hopes,
"would influence judicial decision and lead to the
establishment of a valuable legal precedent."
William J. Curran, Frances Glessner Lee profes-
sor of legal medicine at Harvard calling for broader
initer-disciplinary groups, claims the "institutional
review committee system allows for the build-
ing of a body of general principles... These
committees will be building the law as they go
along."
Guido Calabresi, professor of law at Yale, calls
for "publication of cases decided by committees."
These committees composed of professionals and
laymen "could well be anonymous (at least at
first) ." Such cases, he hopes, would become the
subject of intense study; "analyses in learned jour-
nals by lawyers, doctors, and historians of science
would inevitably follow. . From all this a sense
of what society at large deems proper in medical
experiments might well arise."
Whichever of these courses is now taken, this
must be said. Any new definition of death that is
achieved without inquiry into the views of the
total community and is implemented without its
approval is bound to have the most disastrous con-
sequences for the life sciences.
To insist, as does the editor of the New England
Journal of Medicine, in commenting upon the total
thymectomy experiments of 1964, that the Nurem-
berg Code has the disadvantage of having been
established as a result of "ghastly mass extermina-
tion" and "consequently tends to distinguish right
more easily than can be done with the nuances of
modern research" is to disregard the lessons of his-
tory, to assume that one nation's physicians had a
monopoly on evil, and to believe that those of all
JANUARY, 1970
other nations are immune as a consequence of that
experience.
Surely, it would be difficult to disagree with
Beecher, as Katz has already pointed out, that
while "it is absolutely essential to strive" for in-
formed consent, "a more reliable safeguard {in ex-
perimentation is] {sic] provided by the presence
of an intelligent, informed, conscientious, compas-
sionate, responsible investigator." Still, it would
be naive to assume that his words would be inter-
preted by all in the same way. "Intelligent," in
what fields? "Informed," by whom? "Conscien-
tious," according to what value system? "Compas-
sionate," toward the donor, recipient, science, or
future generations of mankind? "Responsible," to
whom? With what concerns? With what motives?
Furthermore, let us examine the "Definition of
Irreversible Coma" proposed by the Ad Hoc Com-
mittee of the Harvard Medical School of which
Beecher was chairman. There is much here that
gives rise to concern. There is mention of moral,
ethical, religious, and legal issues. Nonetheless,
only one theologian, one historian of science, onie
lawyer, and ten physicians formed this committee.
Of these ten physicians not one other than
Beecher had served on the working party or ad-
visory committee of the American Academy of
Arts and Sciences to prepare "Ethical Aspects of
Experimentation with Human Subjects," although
four of the advisory committee contributed to the
Spring 1969 issue of Daedalus and were from the
Harvard medical faculty. Of these four only Beecher
served the Ad Hoc Committee to Examine the
Definition of Brain Death. The question naturally
arises, how large is support for this definition
among the faculty members of the Harvard School
of Medicine? Indeed, how much support is there
from the Harvard Law School when only William
J. Curran served on the Ad Hoc Committee, al-
though he, David Cavers, and Paul Freund con-
tributed to the Daedalus Spring issue?
Within the first paragraph there is mention of
two reasons for a new definition of death. The
first reason concludes with reference to the "need
of hospital beds already occupied by comatose pa.
tients." Had Beecher in an earlier article not
written, "Money is [sic] human life; so are hos-
pital beds" ?10 While with Jonas, I would agree
that "There can be nothing but admiration for Dr.
Beecher's humanity," in all candor the questions
must be asked: Are our ethics to be fashioned by
VOL. 62, No. 1 Ethics of Hear^t Transplantation
our budgetary concerns? What are our priorities?
What is this majesty, this grandeur of governmcnt
that denies rich and poor alike the right to sleep
in our public parks and the alleys of our ghettos?
Within the first page the new criteria are spelled
out: first, "Unreceptivity and Unresponsitivity";
second, "No Movements or Breathing"; third, "No
Reflexes"; and fourth, "Flat Electroencephalo-
gram.
Now let us take a good look at the words that
follow brief mention of the fourth criterion estab-
lished by the Ad Hoc Committee, "Of great con-
firmatory value is the flat or isoelectric EEG. We
must assume that the electrodes have been prop-
erly applied, that the apparatus is functioning nor-
mally, and that the personnel in charge is compe-
tent."
In all fairness, who would want his life or,
more important, the life of one of his loved ones
to be dependent on any one of these three assump-
tions ?
I am not one who believes in the infallibility of
Pope or priest or physician. If Professor Valdoni,
personal physician to Pope John XXIII, could say
on June 3, 1964, that the Pope was "clinically
dead" 45 minutes before he breathed his last and
in that 45 minutes, the Pope gestured to one of
his brothers, asked for his crucifix and smiled,
I trust my views of human error do not appear too
exaggerated.
Beecher recently asked "What protection from
[N.B.] society do medical men need in the devel-
opment of new life-saving techniques?"'2The lay-
man could ask in turn, what protection from medi-
cal men does society need in the development of
life-preserving techniques? The physician, like the
clergyman and the lawyer, is a citizen. All are
members of society. To see the present discussion
in terms of "them" is to miss the "us," "all of us."
He has said, "To do nothing in this area is far
more radical than to act as proposed [sic]." I dis-
sent. Haste is a poor counselor. Moreover, I insist
that we ask:
1. What are our priorities? Space? The National
Defense? The Domestic Tranquility? or The Gen-
eral Welfare?
2. What are our values ?
3. Why insistence upon a declaration of death
before the 'patient' is taken off the respirator? Why
the rush to definition? particularly when Beecher's
own colleague, Dr. Herrman L. Blumgart, profes-
19
sor of medicine, emeritus, at Harvard) has written
as late as this year that "there is diversity among
medical and lay judgments as to what constitutes
death."
With the problem of rejection not yet resolved,
or, if you will, tolerance not yet achieved, with the
preservation of cadaveric organs in a viable state
not yet perfected, and in face of the high mor-
tality rate of heart transplant recipients to date.
I would in all humility suggest that the right to
adopt new criteria for defining death is not the ex-
clusive right of the medical community.
To insist that it is, is to invite stifling constraints.
To admit that it is not and to invite multi-disci-
plinary conversations is the course of wisdom.
Chief Justice Warren E. Burger said it well:
Science resembles an absolute monarch: It is a great
servant, but it would be a terrible master. The law, on
the other hand, is inherently a restraint; it is a restraint
on science as it is a restraint on kings, congresses, and
president, and none of them like it very much. If you
are impatient with the slow pace of the law's response
to the needs of science, let me remind you that all of
the history of Western philosophy shows that we cherish
many values above scientific advances; and science must
functien within this framework.2
Sir Theodore Fox put it in one way, "We shall
have to learn to refrain from doing things merely
because we know how to do them." Pius XII put it
in another, "In his personal being, man is not
finally ordered to usefulness to society."
If the richest nation in world history in her most
affluent period and in the midst of the greatest
scientific advances known to man can place two
of her own men on the moon, I suggest that we
may be able to achieve a solution to the problems.
of rejection and organ preservation without sac-
rificing those human values already threatened by
our failure to find 1) a viable alternative to war
as an instrument for the settlement of international
disputes, and 2) a viable alternative to armed force
as an instrument for the maintenance of the do-
mestic tranquility.
I suggest that quality medical care is a right in
any truly free, truly human society, that equality in
treatment is an indispensable element in that care,
and that the spiritual formation of men to an
appreciation of the inherent dignity of their fel-
lows is no less the responsibility of the school,
university and medical center than it is of the
church and synagogue.
If some say that Christianity has failed, I must
20 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION JANUARY, 1970

answer with G. K. Chesterton that "it has not tine reports.13

been tried." Moreover, I am heartened that one of
the most sensitive spirits in the community of sci-
ence could say, "I believe the strength and sound-
ness of Christian sensibility, the meaning of love
and charity have changed the world at least as
much as technological developments."'1 His name
-J. Robert Oppenheimer!
Professor Theodosius Dobzhansky quotes with
sympathy the words of Teilhard de Chardin, "The
consummation of the World, the gates of the Fu-
ture, the entrance into the Superhuman, they do
not open either to a few privileged or to one
chosen people among all peoples! They will ad-
mit only an advance of all together [sic] in a
direction in which all together could join and
achieve fulfillment in a spiritual renovation of the
Earth."
In conclusion the Earth is our home; our self-
centeredness, the mold to break away from, the
crust to break through; and our humanity, the
atom to be split and the coal to break into fire.
This is our primary task.
Life has become increasingly cheap in our time.
Today, Auschwitz and Dachau are museums; Cov-
entry, Dresden, and Hiroshima, vague memories;
the deaths several years ago of hundreds of thou-
sands of Indonesians, a footnote to history; race
riots in American cities, a subject of study; and
.the war casualties in Viet Nam, an object of rou-
The issue is nothing less than the future of man;
man was not made for science, but science for
man. Let us then in this present time, marked as
it is by so much knowledge and so little love, ad-
dress ourselves to that task, for if we are faithful
in that, we shall prove faithful in all others-and
to all men!
LITERATURE CITED
1. WALT, L. C. Reflections on the Problems of Human
Experimentation. Conn. Med., 25:75-79, 1961.
2. Symposium. Ethical Aspects of Experimentation with
Human Subjects. Daedalus, J. of Am. Acad. of Arts
and Sciences, v. 98, no. 2, Spring, 1969. (See also,
Colloquium. The Changing Mores of Biomedical
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CARDIAC DONOR RECIPIENTS ACCORDING TO RACE

The ORGAN TRANSPLANT REGISTRY of the American College of Surgeons-National Institutes of Health reports
the summarized data below. They included all U.S. cases known to involve blacks.

CARDIAC DONOR-RECIPIENT PAIRS*

DONORS RECIPIENTS
Black lWhite Other
Black ...2 5 0
White ......................0

Other ...0 3 1

One additional donor-recipient pair was oriental

* In the 114 transplant cases reported to the registry, the race
of the donor was listed 112 times. The donor was white in
100; black in 7; oriental in 1; Cape coloured in 3; and
Bantu in 1.