Guy Alexandre, transplant surgeon who redefined death, dies at 89

Guy Alexandre, a Belgian transplant surgeon who risked professional censure in the 1960s by removing kidneys from brain-dead patients whose hearts were still beating — a procedure that significantly improved organ viability while challenging the medical definition of death itself — died on February 14 at 1 p.m. his house in Brussels. He was 89.

His son, Xavier, confirmed the death.

Dr. Alexandre was only 29 and had just graduated from Harvard Medical School when, in June 1963, a young patient was driven to the hospital where he worked in Leuven, Belgium. She had suffered a traumatic head injury in a traffic accident and despite extensive neurosurgery, doctors declared her brain dead, although her heart continued to beat.

He knew that in another part of the hospital a patient was suffering from kidney failure. He had assisted in kidney transplants at Harvard and understood that the organs began to lose viability shortly after the heart stopped beating.

Dr. Alexandre pulled aside the chief surgeon, Jean Morelle, and made his position clear. Brain death, he said, is death. Machines can keep a heart beating for long periods of time without the hope of reviving a patient.

His argument went against centuries of assumptions about the boundary between life and death, but Dr. Morelle was convinced.

They removed a kidney from the young patient, turned off her ventilator and completed the transplant in a few minutes. The recipient lived for another 87 days – a significant achievement in itself, considering that the science of organ transplants was still developing at the time.

Over the next two years, Dr. Alexandre and Dr. Morelle quietly performs several more kidney transplants using the same procedure. Finally, Dr. Alexandre confessed at a medical conference in London in 1965 what he had done.

“There has never been, and never will be, the practice of taking organs from a dying person who has an ‘unreasonable chance of recovery or regaining consciousness,’” he told the meeting. “It involves taking organs from a dead person. The point is that I do not accept the cessation of the heartbeat as an indication of death.”

Others in the room, including some of the biggest names in organ transplants, were less sure and said as much.

“Any change in the way of diagnosing death to facilitate transplantation will bring the whole procedure into disrepute,” Roy Calne, a pioneering British transplant surgeon, said at the conference. (Dr. Calne died in January.)

Dr. Alexandre remained firm and offered a set of criteria to determine whether a patient was brain dead. In addition to having suffered a traumatic brain injury, the patient must have dilated pupils and drops in blood pressure, no reflexes, no ability to breathe without a machine, and no signs of brain activity.

Within a few years, Dr. Calne and others the arguments of Dr. Alexandre to accept. In 1968, the Harvard Ad Hoc Committee, a group of medical experts, adopted Dr. Alexandre largely over when it stated that an irreversible coma should be understood as the equivalent of death, regardless of whether the heart continues to beat or not.

Today, Dr. Alexandre has been widely shared in the medical community, and organ removal from brain-dead patients has become an accepted practice.

“The greatness of Alexandre’s insight was that he could see the insignificance of the beating heart,” says Robert Berman, an organ donation activist and journalist. wrote in Tablet magazine in 2019.

Guy Pierre Jean Alexandre was born on July 4, 1934 in Uccle, Belgium, a suburb of Brussels. His father, Pierre, was a government administrator and his mother, Marthe (Mourin) Alexandre, was a personal assistant.

He went to the University of Leuven in 1952 to study medicine. After completing his studies in 1959, he remained at university to train as a transplant surgeon.

He married Eliane Moens in 1958. She died in October. Along with their son, Dr.’s survivors include Alexandre their daughters, Anne, Chantal, Brigitte and Pascale; 17 grandchildren; and 13 great-grandchildren.

By the late 1950s, the field of transplant surgery was developing rapidly. One of the leading research centers was the Peter Bent Brigham Hospital (now part of Brigham and Women’s Hospital) in Boston, one of Harvard’s teaching facilities, where the first kidney transplant was performed in 1954.

Dr. Alexandre arrived at Brigham in 1962, overlapping with Dr. Calne, who was completing his own fellowship term. Both worked under Joseph E. Murray, who served in 1990 Nobel Prize in Physiology or Medicine for his work in transplant surgery.

Dr. Alexandre noted that before Dr. Murray removed an organ from a brain-dead patient, he turned off the ventilator and waited for the heart to stop beating. This met a conventional definition of death, but at significant cost to the organ.

“They considered their brain-dead patients to be alive, but they had no problem turning off the ventilator to stop the heart from beating before removing the kidneys,” said Dr. Alexandre to Mr. Berman for his Tablet article. “In addition to ‘killing’ the patient, they also gave the recipients damaged kidneys.”

Dr. Alexandre returned to the University of Leuven after a year, with the intention of putting his beliefs into practice.

He made several other contributions to the field of transplant surgery. In the early 1980s, he developed a method to remove certain antibodies from a kidney so that it could be placed into a patient with an otherwise incompatible blood type.

And in 1984, he performed one of the world’s first successful xenotransplantations: the transfer of an organ from one species to another. In this case, he transferred a pig kidney to a baboon.