Dr. James D. Hardy

Headlines around the world told the astounding news of a surgical team in Mississippi which had transplanted a human lung into another human being.

The year was 1963, and the team was led by Dr. James D. Hardy, professor of surgery and chairman of the department at the University of Mississippi Medical Center.

But it was the following year when an event at the young Medical Center really had the world's press in a frenzy. Dr. Hardy and his team transplanted the heart of a chimpanzee - man's closest genetic relation - into the chest of a dying man. The world's first heart transplanted into man beat 90 minutes before it stopped.

The operation "precipitated intense ethical, moral, social, religious, financial, governmental and even legal concerns," Dr. Hardy has written. "We had not transplanted merely a human heart, we had transplanted a subhuman heart."

Even some of his medical colleagues were critical. They said his nine years of work in the laboratory with animals weren't adequate preparation for his bold move in the operating suite and that not enough was known about xenografts to warrant their use.

The noted transplant surgeon Dr. Thomas Starzl, who had transplanted a human liver about the same time, once told Dr. Hardy, as the latter related in his memoirs, "You know, you and I are absolute pariahs in American surgery."

In the ensuing months, some of the criticism waned - particularly among medical colleagues, because Dr. Hardy's paper on the subject appeared in the Journal of the American Medical Association which described the strict ethical guidelines his team had followed in evaluating both donor and recipient.

By 1966, Dr. Hardy says, the American public showed a major shift in perception, and the notion of the heart as a pump began to hold sway over the idea of the heart as the seat of the soul.

After Dr. Christian Barnard performed his heart transplant in 1967, the barriers to human transplantation in the United States were swiftly swept aside, and human-to-human heart transplants followed quickly at Maimonides Hospital in Brooklyn, NY, by Dr. Adrian Kantrowitz and at Stanford by Dr. Norman Shumway.

Paving the way to all transplantation

Dr. Mario S. Barnard, brother of Christian, and author of the paper in the South African Medical Journal describing the first human-to-human heart transplant, gave credit to the Mississippi team for the 1964 operation, saying it proved that "the feasibility of cardiac transplantation was now irrefutable."

A transplant team led by Dr. Hardy performed the world's first heart transplant in man Jan. 23, 1964, at the University of Mississippi Medical Center.

Those first two operations in Mississippi - met with such dubious acceptance in the beginning - set the stage for all future heart and lung transplantation. They demonstrated that surgical techniques perfected in nine years of work on animals would work in humans. They proved that a transplanted lung would breathe and transplanted heart would beat and support a blood pressure in a human host.

Dr. Hardy said the operations "set in motion the inexorable process of human imagination and gradual acceptance which has evolved into our current almost casual attitude toward transplantation."

Accumulating a record of accomplishment

But whether the object of reproach or acclaim, Dr. Hardy continued a steady pace of scholarly contributions and professional leadership. He edited and wrote 23 books throughout his career, including two which became standard surgery texts in American medical schools. He published more than 500 articles in medical journals, and served as editor-in-chief of the World Journal of Surgery, Surgical Capsule and Comment, and Advances in Surgery. The proceedings of the 1983 Surgical Forum of the American College of Surgeons was dedicated to Dr. Hardy, "... an outstanding surgical educator, investigator, clinical surgeon and international leader."

In 1971, the Vishnevsky Institute in Moscow, Russia, honored Dr. Hardy for his pioneering role in transplantation, and presented him with two medals - one for the lung transplant and the other for the heart.

He served as president of the Society of University Surgeons, the Society of Surgical Chairmen, the Southern Surgical Association, the American College of Surgeons, the American Surgical Association and the International Society of Surgery. He is an honorary member of the French Academy of Medicine, the French Association of Surgery and the Royal College of Surgeons, London.

He was a member of the American Board of Surgery and the American Board of Thoracic Surgery.

Dr. Hardy has been a visiting professor in 36 medical schools in the United States and abroad and has presented as many named lectures throughout his career. Dr. Hardy also served on the National Institutes of Health Surgery Study Section and on the NIH Anesthesiology Training Grant Committee among others.

He was also busy directing the department. "When I came to Mississippi, I decided that our department should start out on an even footing with other institutions in at least one field," Dr. Hardy recalled. "That's why we began transplantation research. I knew it would be difficult to compete with other centers which already had long established programs in older fields."

In addition to the first lung and heart transplantations, Dr. Hardy's team also performed the first successful human kidney autotransplant and the first human adrenal autotransplant in the United States.

He has continued to receive honors in the years since his retirement from the Medical Center.

• He was selected Distinguished VA Physician in 1987, a post he occupied until 1990.
• His very popular autobiography, The World of Surgery 1945-1985: Memoirs of One Participant, was published by the University of Pennsylvania Press in 1986.
• In 1991, he was the 12th recipient since 1934 of the Rudolph Matas Award in Cardiovascular Surgery - an honor he shared with such surgery notables as Alfred Blalock, Michael DeBakey and Norman Shumway.
• In 1992, the University of Pennsylvania initiated an annual award to honor outstanding resident alumni, and Dr. Hardy was chosen the inaugural honoree.

Shaping the practice of surgery

But as startling as his surgical achievements in the world arena, generations of Mississippians owe a large debt to him for his work at home. More than any other single individual, Dr. Hardy has influenced the way surgery is practiced in Mississippi.

He was the first chairman of the Department of Surgery from 1955 when the Medical Center opened until his retirement in 1987.

As one of the first clinical chairs appointed for the new medical school, he worked closely with the first dean, Dr. David Pankratz, in the selection of other clinical chiefs. As the first chairman of surgery, he was the one who set standards for the surgeons who had operating privileges in the new University Hospital.

Dr. Johnnie W. Williamson of Tupelo is a UMC alum who benefitted from Dr. Hardy's rigorous but humane teaching. He spent a decade at the Medical Center - as a medical student, then as intern and surgery resident and finally as a fellow in peripheral vascular surgery.

From Dr. Williamson's perspective, one of Dr. Hardy's notable achievements was that "he afforded good old country boys from Mississippi the opportunity to become well-educated, well-trained professionals who could stand on our own wherever we wanted to go."

Despite his towering presence in the world of surgery, his residents didn't perceive that his attentions were elsewhere. "All of us knew that he was a world class surgeon, but not from anything he told us about himself. With us, he was always present. Even when he had to be away, he'd call at the drop of a hat. And he spent much of his time here operating. We knew he was highly respected in international circles, but we knew him also as a man and as a surgeon."

Dr. Hardy has said, "Our students and residents are here to learn to operate, and I couldn't help them very much if they never saw me in the OR. The final act of surgery, after all, is operating."

In the operating room and on patient rounds, Dr. Hardy had a unique teaching style that left a lasting mark on students.

"On a surgical case," Dr. Williamson said, "it was always intense, always all business. He kept everybody at the table participating. He wanted everyone participating in some form or fashion from the chief resident to the third-year student.

"On rounds, we went at breakneck speed, from the first floor to the top always using the stairs. And we learned from his rapid fire questioning how to think and talk on our feet. I learned later that ability was the mark of a Hardy-trained resident."

Dr. Williamson learned something else about the mark of a great teacher. "When I left the Medical Center in 1980, I felt I meant more to Dr. Hardy than a resident who had filled a slot. He wanted me to be a good father, a good husband and a good citizen as much as he wanted me to be a good surgeon. I think he cared deeply about his students."