Heart Failure Clin 3 (2007) 111–115

A Tribute to Norman E. Shumway, MD, PhD(1923–2006)

Sara J. Shumway, MDDepartment of Surgery, University of Minnesota, Minneapolis, MN, USA

My father was a raconteur who led a storiedlife. Norman Edward Shumway (Figs. 1 and 2),

Jr was born on February 9, 1923, to Norman Ed-ward Shumway and Laura Irene VanderVlietShumway. He was the only child of his generation

in both families. His parents ran the Home Dairyin his hometown of Jackson, Michigan. It wasa combination diner and creamery. Norman Ed-ward Shumway, Sr also worked occasionally as

an accountant. Bud, as he was known, was kickedout of a public pool at age 10 because he was notwearing a bathing suit that covered his chest. In

later life he was not accustomed to setting fashiontrends.

During high school, Norman did very well and

enjoyed participating in debates and was a keymember of the debate team. In fact, 1 year theywere able to win the state contest. He starred in

his Latin class and was class valedictorian whenhe graduated in January of 1941. He went to theUniversity of Michigan in September of 1941.Initially he thought he would pursue a prelaw

degree but also took several classes in engineering.He and a classmate enlisted when it was clear theywere going to be drafted. Once in the army he

took an aptitude test. A colonel gave him thechoice of the infantry, or medicine or dentistry asalternatives. He was quick to select a career as

a doctor.He was sent to Waco, Texas to complete an

accelerated premed course, and from there, hewent to Vanderbilt in 1945 where he graduated

with a medical degree in 1949. While at Vander-bilt, he spent a summer at the MassachusettsGeneral Hospital in 1948. There he was impressed

that several surgeons were reading about new

E-mail address: shumw001@umn.edu

1551-7136/07/$ - see front matter � 2007 Elsevier Inc. All ri

doi:10.1016/j.hfc.2007.03.001

operations being performed at the University ofMinnesota. The University of Minnesota became

a place that he was certain he would apply to fora surgical residency.

He arrived at the University of Minnesota in

the summer of 1949. His first 2 years were spentperforming general surgery. He was in the AirForce Reserve and was called up in 1951 andspent 2 years in Texas and Louisiana during the

Korean Conflict. He returned to the University ofMinnesota in 1953 and spent 2 years workingtoward a PhD. At that time F. John Lewis was his

mentor, and his PhD thesis was on hypothermia.His final 2 years at the University of Minnesotawere on the clinical wards in general surgery and

cardiac surgery. In those times, the surgicalresident was usually in the position of a secondassistant during a cardiac case. It was at that time

that he realized that one of the hardest thingsabout cardiac surgery was getting the opportunityto perform cardiac surgery.

While at the University of Minnesota, he had

married Mary Lou Stuurmans, and after receivinghis PhD in 1956, he was eager to complete hissurgical residency. He asked Dr. Wangensteen

when that might be possible. He was asked howmany publications he had to his name and repliedthat there were seven. Dr. Wangensteen thought

that he should have a few more before he finished;my father informed Dr. Wangensteen that per-haps reading the papers rather than countingthem was a more appropriate way of judging

academic performance.Another episode is well documented in G.

Wayne Miller’s book about C. Walton Lillehei

called, ‘‘The King of Hearts’’ [1]. It occurred onrounds when Dr. Wangensteen thought that a pa-tient was suitable for a second-look operation.

ghts reserved.

heartfailure.theclinics.com

112 SHUMWAY

Fig. 1. Norman Shumway scrubs in the dog lab, circa 1960. (Courtesy of Sara J. Shumway, MD, Minneapolis, MN.)

The patient herself thought that Dr. Lillehei wasDr. Wangensteen, and despite Dr. Wangensteen’sbest efforts, she would not believe that he was Dr.Wangensteen. On rounds with Dr. Wangensteen

at the time, when Dr. Wangensteen left herroom, Dr. Shumway put his arm around himand said, ‘‘You know you’ve got to stop this going

around the hospital telling everyone you are Dr.Wangensteen!’’

Upon completing the surgical residency in

1957, the Shumways traveled to Santa Barbara,California. There Dr. Shumway joined an olderpartner in private practice and performed one of

the first open-heart operations in California atCottage Hospital in Santa Barbara. It was suc-cessful; however, the combination of the olderconservative thoracic surgeon and the younger

cardiac surgeon was not a good match; after 6weeks, Dr. Shumway was fired for what was called‘‘gross insubordination.’’ He interviewed at the

University of California, but found a job atStanford doing primarily research activity aswell as performing hemodialysis.

By that time, the Shumway family had grownto include four children, and it was important tohave a paying job. While in the laboratory at

Stanford, in somewhat rustic conditions, the earlywork in topical cooling for myocardial preserva-tion as well as heart transplantation took place.Helping him in the laboratory was a young

resident surgeon named Richard Lower. Underconditions whereby the roof leaked, and wherebysome of the time they were forced to leave to

perform dialysis at various places around SanFrancisco, the situation was less than ideal. They

did have funding, however, and they did haveplenty of animals as well as plenty of time on theirhands. Perhaps this is the ideal setting for theyoung academic attending.

In 1958, the Stanford Medical School movedto Palo Alto and a large number of the big-cityphysicians did not accompany this move. There-

fore, by default, Norman Shumway became the

Fig. 2. Norman Shumway, circa 1987. (Courtesy of Sara

J. Shumway, MD, Minneapolis, MN.)

113A TRIBUTE TO NORMAN E. SHUMWAY

one and only cardiac surgeon at the Stanfordcampus. He was told repeatedly that he would bereplaced as soon as they could get a big name tocome to Stanford. During this period of little

clinical work and the slow process of buildinga clinical program, the laboratory thrived withactivities like heart transplants and studies on

myocardial protection. In 1960, at the SurgicalForum, Lower presented their work on hearttransplantation [2]. It was an early-morning

talk, and apparently only the projectionist, themoderator, and Dr. Shumway and Dr. Lowerwere present. They were hoping for a larger

draw. Work continued in the laboratory, and clin-ical work in congenital heart disease began to sur-face at the Palo Alto campus. One of the earliestseries was on patients who had tetralogy of Fal-

lot. It was found that these patients did betterwith topical cooling of the heart in the operatingroom. In fact, Lower, when he took his oral

boards in thoracic surgery, spoke of 100 patientsundergoing tetralogy of Fallot repairs withouta mortality. The examiner thought he was making

it up.It was not until 1967 in a Journal of American

Medical Association article that Dr. Shumway

said the way was paved to perform clinical hearttransplantation [3]. This was after a dog namedRalphy had been able to live for a year with an-other dog’s heart. On December 3, 1967, in

Groote Schuur Hospital in Cape Town, SouthAfrica, Christiaan Barnard performed the first hu-man heart transplant. The patient lived for 18

days. Barnard had had the opportunity to watchLower perform a heart transplant on an animalat the Medical College of Virginia, and was able

to make arrangements to do the procedure ona human in South Africa without some of thesteps felt necessary in the United States. On Janu-ary 2, 1968, Adrian Kantrowitz performed a heart

transplant on an infant who died on the table.That same week Barnard performed his secondheart transplant on a dentist named Philip

Blaiberg.It was not until January 6, 1968, that doctors

at Stanford University performed the first adult

heart transplant in the United States. The patient,Mike Kasperak, lived for 15 days before dying ofwhat Dr. Shumway called ‘‘a galaxy of complica-

tions.’’ At that time, Dr. Shumway felt that hearttransplants should be performed only on patientswho were desperately ill and had no otheralternative. Some of these patients were so ill

that there was already an element of multiorgan

system failure, and that made for a difficult post-operative course. Two years later, it was fairlyroutine for the patients to at least make it out ofthe hospital.

In 1970, Dr. Shumway appeared before a Sen-ate subcommittee because various surgeons hadcalled for a moratorium on heart transplantation.

This included Michael DeBakey. Frank Churchwho was a Democratic senator from Idaho wasinstrumental in allowing doctors at Stanford

University to continue to perform heart trans-plantation. The early 1970s saw a slow increase inthe number of heart transplants over a period of

time. Approximately a dozen were done on anannual basis until the advent of cyclosporinechanged things.

In 1973, the Santa Clara county coroner and

the Stanford hospital administrators agreed not touse donors that were the victims of homicide. InSeptember of that year, the Alameda county

district attorney called to offer a heart donor atthe request of the next of kin. The donor was inOakland, and the heart was removed at Highland

hospital and brought by helicopter to Stanford,and the transplant proceeded. Unfortunately thedefense at trial felt that the gunshot victim would

have recovered had the surgeons not removed theheart. Fortunately the Harvard panel had con-vened and the diagnosis of brain death was wellestablished [4]. The judge was able to instruct the

jury that the definition of brain death had been re-spected. The appropriate verdict was reached, andthe State of California had a precedent for the leg-

islature to redefine death in terms of brain func-tion. This legal precedent allowed for the use ofremote heart procurement.

In 1971, Philip Caves came to Stanford asa British American research fellow. Working inconjunction with Margaret Billingham, an estab-lished cardiac pathologist, they developed a tech-

nique for and were able to interpret the results ofpercutaneous transvenous endomyocardial biop-sies. His bioptome really revolutionized the way

rejection was diagnosed. During the 1970s, onlytwo institutions were doing much in the way ofheart transplantation in the United States. These

were Lower’s group at Medical College of Vir-ginia and Shumway’s group at StanfordUniversity.

There were several ongoing projects that con-tinued to improve survival. It was not, however,until the advent of cyclosporine in the late 1970sthat survival was good enough to interest other

groups in performing heart transplants. It was

114 SHUMWAY

also in 1978 that Dr. Bruce Reitz began workingon heart–lung transplants, which were broughtinto the clinical arena on March 9, 1981. The

patient who received a heart–lung transplant onthat day was operated on by Dr. Reitz with Dr.Shumway in his favorite role as first assistant. Thepatient was able to live 5 years before she died of

a problem completely unrelated to her heart–lungtransplant. Throughout the late 1960s and early1970s, Dr. Shumway traveled widely throughout

the United States and the world. He functioned asthe pied piper of heart transplantation. By the1980s, he had a well-rehearsed talk on the

evolution of heart transplantation.He took great pride in the progress of his

trainees and their contributions to the field. FromWangensteen, he seemed to have taken to heart

the idea that professional jealousy was not con-tributory and a lot more could be accomplishedwhen no one cared who received the credit. He

was a great facilitator of other people’s ideas atStanford. He enthusiastically encouraged his fel-lows to take leadership roles throughout the

United States and Europe.In 1986, he was surprised to learn that he had

been made a Vice President of the American

Association for Thoracic Society (AATS). Hedid not realize that this meant that he wouldthen become the President of the AATS. Dr. Sa-biston was able to cover for him by having a robot

accept the title of Vice President. A year later, hispresidential address was very well received. He re-viewed Stanford’s progress over the years and was

quick to give everyone appropriate credit. He wasalso humorous, and he was especially pleased withthe amount of laughter generated.

I believe he would consider his key accom-plishment to be:

� Topical cardiac hypothermia [5]� Auto transplantation of the pulmonic valveinto the aorta [6]

� Excision of the mitral valve and replacementwith the autologous pulmonic valve [7]� Congenital heart surgery with early successfulseries involving repair of tetralogy of Fallot

� Valve replacement with biologic valves� Orthotopic homotransplantation of thecanine heart [8]

� Long-term survival of cardiac homografts indogs [9]� Heart transplantation in human

� Diagnosis of cardiac allograft rejection bytransvenous endomycardial biopsy [10]

� Heart–lung transplantation [11]� Pediatric heart transplantation� Lobar lung transplantation [12]

� Management and treatment of aortic aneu-rysms and dissections� Training of numerous, dedicated cardiovascu-lar surgeons

Professionally I think his only regret was thathe did not have the opportunity to take on

leadership roles in other surgical societies besidesthe AATS. I think he felt it was important for himto stay at Stanford and direct the clinical and

research activity there. He did travel widely topromote heart transplantation, but did not par-ticipate actively in the usual surgical societies.

Dr. Shumway retired from his role as chief ofcardiovascular surgery at Stanford University onFebruary 9, 1993. There was an appropriate

university-sponsored event. Almost all of histrainees were able to return. During the ensuing13 years of semiretirement, he continued tooperate off and on for 3 more years and enjoyed

hearing about other people’s cases in a vicariousmanner. He enjoyed offering advice, which wasasked for frequently. He enjoyed golfing more and

continued to travel. His last year of life wascomplicated by many health issues. He gave itall he had, but the last 6 weeks proved that it was

time to move on. Those who know him well areleft with lasting memories of good times andmultiple quips.

In the operating room, he felt the best thing the

surgeon could do under any circumstance was tokeep his or her cool. This was a lasting lesson helearned from Walt Lillehei. He had several other

sayings that would come up at any appropriatetime. These include: ‘‘Time will tell. Air rises. Thepump is your friend. All bleeding stops. Never

quit in a fit of pique. There is plenty of time forsleep on the other side of the grave.’’ He wasa good father, friend, and mentor, and he lived

a life complete.

References

[1] Wayne Miller G. King of hearts. New York: Times

Books, Random House; 2000. p. 207.

[2] Lower RR, Shumway NE. Studies in orthotropic

homotransplantations of the canine heart. Surg

Forum 1960;11:18–9.

[3] Shumway NE. Way is clear for heart transplant.

JAMA 1967;202:31.

[4] Report of the Ad Hoc Committee of the Harvard

Medical School to Examine the Definition of Brain

115A TRIBUTE TO NORMAN E. SHUMWAY

Death. A definition of irreversible coma. JAMA

1968;205:85.

[5] Shumway NE, Lower RR. Topical cardiac hypo-

thermia for extended periods of aortic arrest. Surg

Forum 1959;10:563.

[6] Lower RR, Stofer RC, Shumway NE. Autotrans-

plantation of the pulmonic valve into the aorta.

J Thorac Cardiovasc Surg 1960;39:680.

[7] Lower RR, Stofer RC, ShumwayNE. Total excision

of the mitral valve and replacement with the autolo-

gous pulmonic valve. J Thorac Cardiovasc Surg

1961;42:696.

[8] DongE Jr, Hurley EJ, LowerRR, et al. Performance

of the heart two years after autotransplantation.

Surgery 1964;56:270.

[9] Lower RR, Dong E Jr, Shumway NE. Long-term

survival of cardiac homografts. Surgery 1965;58:

110.

[10] BillinghamME,Caves PK,DongE Jr, et al. Diagno-

sis of canine orthotropic cardiac allograft rejection

by transvenous endomyocardial biopsy. Transplant

Proc 1973;5:741.

[11] Reitz BA, Wallwork J, Hunt SA, et al. Heart-lung

transplantation: successful therapy for patients

with pulmonary vascular disease. N Engl J Med

1982;306:557.

[12] Starnes VA, Lewiston NJ, Luikart H, et al. Current

trends in lung transplantation. Lobar transplanta-

tion and expanded use of single lungs. J Thorac

Cardiovasc Surg 1992;104:1060.