Valery Ivanovich ShumakovBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39521.777083.BE (Published 03 April 2008) Cite this as: BMJ 2008;336:778
- Boleslav Lichterman
Valery Ivanovich Shumakov was a leader in transplantation medicine in the former Soviet Union (USSR) and Russia. From 1974 until his death he directed the Research Institute for Organ and Tissue Transplantation (now the Research Institute of Transplantology and Artificial Organs). He was a pioneering cardiac surgeon who managed to overcome official bureaucratic barriers for recognition of brain death and performed the first successful heart transplantation in the USSR in 1987. For almost 20 years he was a coordinator of the Soviet-American collaboration on developing artificial hearts and mechanical circulation (Michael DeBakey was a coordinator from the American side). His numerous inventions include a mitral valve prosthesis and several types of artificial heart.
Born in Moscow, the son of a construction engineer, he was fascinated by the beauty of the human body and human anatomy at secondary school and decided to be a surgeon. In 1950 he became a student of the medical faculty of the First Moscow Medical Institute (now the Sechenov Moscow Medical Academy). There he met his first teacher of surgery, Gleb Solovyev (obituary, BMJ 2004;329:1187), who was an aspirant (a postgraduate student preparing his kandidatskaya dissertation) at the chair of topographical anatomy and operative surgery and was obliged to teach undergraduates. In his book Memoirs of a Cardiac Surgeon (2002), Solovyev recalls that Shumakov, then a student just three years younger than him, asked the most difficult questions.
Solovyev recommended Shumakov to the aspirantura (a three year postgraduate programme) at the chair of topographical anatomy and operative surgery and introduced him to Boris Petrovsky (obituary, BMJ 2004;328:1381), a pioneer of Soviet heart surgery. In his memoirs Solovyev wrote that his pupil was literally possessed by the work. He could come to his teacher’s house around midnight after experimenting on dogs to discuss the results. When Shumakov decided to marry he brought his bride to the Solovyevs to get their approval for marriage (before introducing her to his parents!). Petrovsky performed about two dozen operations on mitral valve prolapse in his clinic using Shumakov’s technique.
After aspirantura Shumakov started to work as a junior researcher in Pertovsky’s lab. In the early 1960s valve prostheses were not produced in the USSR. Petrovsky suggested that Shumakov develop a commercially available valve prosthesis. Together with military engineers, Shumakov created a ball prosthesis of the mitral valve—Starr’s ball valve prosthesis being the prototype—which was used in Soviet clinics for about two decades. His doctorskaya dissertation (similar to a habilitation thesis in Germany) on valve prostheses was supervised by Petrovsky and Solovyev and published as a book (with Petrovsky and Solovyev as coauthors) in 1966.
The same year Shumakov was appointed head of the laboratory for artificial hearts and assisted circulation at the All-Union Research Institute for Clinical and Experimental Surgery directed by Petrovsky (now the Petrovsky Russian Scientific Centre for Surgery). In 1969 Solovyev became director of a newly established the Research Institute for Organ and Tissue Transplantation. The idea for such an institution was Petrovsky’s; he performed the first successful kidney transplantation from a living related donor in the Soviet Union (in 1965). However, he did not let Shumakov join Solovyev, instead making him head of the department of transplantology and artificial organs at the All-Union Research Institute for Clinical and Experimental Surgery. Shumakov became the first in Europe to use intra-aortic balloon counterpulsation, in 1969.
Petrovsky did not accept the concept of brain death and fiercely opposed the idea of heart transplantation, calling it “a manifestation of fascism.” He wrote that “a physician should fight for a patient’s life using all facilities of modern intensive care up to its last minute, last breath, last beat of heart, and even after this, until biological death is declared.” There was also concern that the term “incompatibility with life” could be subject to an overly broad interpretation and therefore abuse.
The real reason behind this denial might be Petrovsky’s understanding that Soviet medicine in general and cardiac surgery in particular were not ready for such operations both mentally and technically. Also he always wanted to be the first and could not tolerate competitors. Solovyev’s days as a director of the Research Institute for Organ and Tissue Transplantation were numbered after his failed attempt at heart transplantation in 1971. He wrote in his memoirs: “After my rupture with Petrovsky, Shumakov’s positions became stronger. He supported the teacher [Petrovsky] in his denial of heart transplantation and started to develop an artificial heart as a counterbalance.”
Solovyev was replaced by Shumakov as the institute director in 1974 after an agreement of the Soviet-American collaboration on developing artificial hearts and mechanical circulation was signed. However, he stayed at the institute for few years as a deputy director. “At first he [Shumakov] needed me,” Solovyev wrote. “For almost nine years he did not work in the clinic and did not perform cardiac surgery. He forgot many things and lost many skills. Remembering our friendship, I sincerely helped him for about three years, assisted him during heart surgeries, corrected his mistakes, prompted him on what to do in difficult situations. He removed me from kidney transplantations.”
By the late 1970s Shumakov had transplanted about 350 kidneys and had the greatest experience in this field in the USSR and Europe. He developed techniques of arterial anastomosis for multiple renal arteries, repeat kidney transplantation, and modified vesicoureteral anastomosis. He also studied acute and chronic rejection of renal transplants, management of patients after transplantation, and problems of haemodialysis. To prolong the viability of isolated donor kidneys he developed a special solution which bears his name.
In the early 1980s Shumakov established a laboratory of biomaterials to study haemocompatible polymers used in artificial organs. Several models of artificial heart and artificial ventricle were designed and tested in calves. He viewed implantation of an artificial heart as a “bridge” to heart transplantation. He also initiated research for using transgenic animals and stem cells to overcome deficit of donor organs.
According to the decree of the ministry of health issued in 1977, organ procurement was allowed only after the biological death of a donor. It took 10 years for the ministry to issue a new decree on transplantation and to adopt the concept of death based on a diagnosis of brain death. By that time Petrovsky was no longer a minister of health, and Shumakov managed to convince the authorities to allow him to perform heart transplantations to make good the 20 year lag from the West. His first attempt in 1986 failed (the patient died from renal failure on the fifth day after surgery), but the second attempt, in April 1987, was a success. The patient lived for nine years after heart transplantation.
Federal law regulating human transplantation was adopted in 1992. It is based on so called presumed consent of brain-dead patients to become potential donors. Their relatives are not informed that organs and tissues will be taken for transplantation. There is no way to record disagreement during the lifetime of a potential donor. Moreover, according to a recent survey of the ministry of internal affairs, only 20% of respondents would agree to become organ donors in case of their brain death. Therefore the presumption of consent in most cases is false. The lack of transparency is a source of mistrust of the lay public, and even many physicians, to cadaver organ donation. This might explain a recent court case when several transplantologists were accused of illegal organ procurement from a living patient. Finally they were acquitted, but the number of transplantations has fallen markedly since.
Shumakov went public. In his numerous interviews he argued that the direct consent model would result in a severe deficit of donor organs. He also mentioned that he kept many hearts in his hands but could never find a soul in them.
He did about 120 heart transplantations during subsequent decades (1987-2007). In 1990 he made the first successful orthotopic liver transplantation. The annual number of kidney transplantations in Russia in the 1990s was about 600, one fifth of them having been performed by Shumakov himself at his institution.
He was awarded numerous decorations and became a member of the Russian Academy of Sciences and the Russian Academy of Medical Sciences; a hero of Socialist Labour; a member of many international societies (including the Transplantation Society, the Society of Thoracic Surgeons, the International Society for Heart and Lung Transplantation, the International Federation for Artificial Organs); an honorary member of the French Society of Transplantologists and Czechoslovak Society of Surgeons; coeditor of Artificial Organs; and a member of the editorial board of Dialysis. He became an honorary citizen of Moscow—the second surgeon to receive the title, the first being Nikolai Pirogov in 1881. A star was named after him in the constellation Scorpio.
Shumakov’s motto was “Not a day without an operation.” Apart from loving surgery, he was a gourmet. He was literally a surgical giant. His favourite pastime was reading detective stories. He usually spent his vacations at his dacha on the Volga river. In 1962 he joined the Communist party—an absolute condition for an administrative and academic career in the USSR—but by the end of his life he had turned to religion and opened an Orthodox church in his institute.
He suffered from neglected acquired heart disease and died after heart surgery. He is survived by his wife, Natalya Mikhailovna Shumakova (née Kalitievskaya), a retired anaesthesiologist; his daughter, Olga, an art critic at the Tretyakov gallery; and his son, Dmitry, a professor of cardiac surgery at his father’s institution; and four grandchildren.
Valery Ivanovich Shumakov, professor of surgery and director of the Research Institute of Transplantology and Artificial Organs, Moscow (b Moscow 1931; q Moscow 1956; MD), died from heart failure on 27 January 2008.