Alan Gilston

BMJ 2005; 331 doi: (Published 01 September 2005) Cite this as: BMJ 2005;331:518

Founder of the Intensive Care Society and anaesthetist for the first UK heart transplant

When the first UK heart transplant was performed, by Donald Ross, Keith Ross, and Donald Longmore at the National Heart Hospital (now part of the Brompton Hospital) on 3 May 1968, the anaesthetist was Alan Gilston, a recently appointed consultant with a particular interest in intensive care. Such was Gilston's dedication, he spent the night sleeping alongside the patient in the operating theatre. This proved a sensible precaution as the patient's central venous line came out and had to be replaced.

In the event, the transplant—on 45 year old Fred West, who received the heart of 26 year old Patrick Ryan, who had sustained head injuries at work from which he could never recover—was successful, but the patient died 45 days postoperatively.

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Two years later, in 1970, Gilston founded the Intensive Care Society, and was its honorary secretary for five years. It now has 2000 members, mainly, but not exclusively, anaesthetists. The society has an Alan Gilston medal in his honour and he was its first recipient. He was also secretary-general and initiator of the first world congress on intensive care, and founder and former president and secretary-general of the World Federation of Societies of Intensive and Critical Care.

His achievements received international recognition, and he was invited to speak in 23 countries, including Iran and Japan. He also worked as visiting anaesthetist in Israel, and as visiting professor in Toronto.

Gilston was the principal author of Cardio-Pulmonary Resuscitation (1971), with Leon Resnikov. This was later translated into Spanish, Italian, and Chinese. He published editorials and papers on cardiac anaesthesia, resuscitation, intensive care, and technology. Gilston was on the editorial board of Intensive Care Medicine, Heart and Lung Resuscitation, and Intensive Care Monitor. He was elected to life membership of intensive care societies in the United Kingdom, Spain, Venezuela, and Ecuador.

Alan Gilston was born in Leeds, the son of an electrical retailer and antique dealer. He was a frail child with severe asthma, and was sent to boarding school in Bournemouth, where, as the only Jewish pupil, he was isolated and lonely. This, his family think, gave him a passion for reading and learning.

He qualified at Leeds medical school in 1953. From 1956 to 1959 he was senior house officer in anaesthetics at Darlington Memorial Hospital and the Royal Victoria Hospital, Newcastle upon Tyne. In 1959 he was appointed registrar to the Brompton Hospital, where open heart surgery had recently commenced, and where he spent three years. In 1962 he went to the National Heart Hospital as senior registrar, again in anaesthetics.

He was appointed consultant there five years later and spent the rest of his career at the “Heart,” working extensively with Donald Ross and Magdi Yacoub. He was involved in research and development of anaesthesia and intensive care. Gilston also initiated mechanical ventilation for acute postoperative respiratory distress syndrome after heart and lung surgery.

The heart transplant surgery was rehearsed on a pig, which famously escaped, and Gilston recalled chasing it around the hospital corridors.

Like many anaesthetists he was a great inventor, developing the tracheotomy T-piece that bears his name and the sleeve on the Wallace cannula. Domestically he made many household devices, such as a gadget for opening large windows, and elaborate hinges, unhindered by aesthetic considerations. His family took this on the chin.

Gilston was a short man with an amazing amount of energy—despite the asthma—which he harnessed but never tamed. His interests and hobbies included Judaica, archaeology, ancient technology, and DIY. He collected aphorisms and quotations.

Colleagues found him both abrupt and bolshie, and inspiring and modest. He had an incisive mind, saw the world for what it was, loved asking difficult questions, and had an innate aversion to authority, even refusing to wear uniform when called up for his national service. He was proud to be a Jew and a Yorkshireman.

Gilston retired from the NHS in 1990 and in 1997 founded and was the first chairman of the Royal Society of Medicine's Retired Fellows Society. He went to the RSM frequently; his last visit, in 2001, was on the day before he went into a care home, suffering from Alzheimer's. He died from pneumonia.

He leaves a wife, Avelina, and two sons.

Alan Gilston, consultant anaesthetist National Heart Hospital 1967-90 (b 1928; q Leeds 1953; FRCA), d 18 June 2005.

[Caroline Richmond]


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