Leonard Bailey MD, the thoracic surgeon whose daring innovations at the cutting edge of aciurgy and transplantation gained international attention for himself and Loma Linda University Medical Center for more than three decades, died on Sunday May 12.
Bailey succumbed to cancer just a little more than a month after his wife, surgical nurse Nancy Schroeder Bailey who had been with him an intrinsic part of the Loma Linda Heart Team that traveled the globe in dispensing care for hundreds of patients, passed away April 7 following an extended illness.
Leonard Bailey rocketed to international fame on October 26, 1984 when he transplanted a baboon’s heart into 12-day-day-old Stephanie Fae Beauclair, who had been born three weeks prematurely and with hypoplastic left heart syndrome, a condition in which the left ventricle of the heart is severely underdeveloped.
Bailey’s performance of the procedure on the child was the first xenotransplant involving an infant and the first successful infant heart transplant. Young Beauclair, who became popularized as Baby Fae, lived three weeks after the transplant, but died of heart failure due to organ rejection brought on by humoral response against the graft, an outcome due to Fae’s type O blood creating antibodies against the type AB xenograft. In the immediacy of the emergency given young Beauclair’s condition, with only seven young female baboons available to Loma Linda University all of which had type AB, there was not time to locate within the baboon population, in which less than one percent have type O blood, a compatible donor. The intention was that the transplant could be replaced by a human heart that might conceivably become available at a later date, prior to the onset of intensified antigen-antibody reaction. When no such donor could be found, Stephanie Fae Beauclair died.
As a pioneer in the research on and the application of cross-species heart transplants, which had involved more than 150 transplants in sheep, goats, and baboons, Bailey had entered into an arena about which ensued substantial ethical and legal debate and controversy. Bailey was subjected to criticism from within some quarters in the medical community. Hate mail streamed into the mailbox at the Redlands home he shared with Nancy. Animal rights activists charged him with “ghoulish tinkering” that was ethically unsound and cruel to animals.
A year later, Bailey performed the first infant allograft heart transplant on Eddie Anguiano, who was born on November 16, 1985  like Beauclair with hypoplastic left heart syndrome. His death was imminent when Bailey successfully performed the procedure, using the heart of a newborn from the San Francisco Bay area with birth asphyxia, whose parents consented to the donation. Originally known as Baby Moses, Anguiano still lives with the heart that was implanted by Dr. Bailey yet beating within his 33-year-old chest.
A significant contribution that accompanied Dr. Bailey’s surgical successes was the creation of a donor base for infants. Based upon what Bailey had accomplished, organ procurement agencies around the country began encouraging institutions and heartbroken parents who had experience the wrenching loss of a child from birth trauma or brain death to consider organ donation.
Throughout his career, Bailey transplanted hearts into 376 infants. One of those infants has now matriculated into medical school and is on a trajectory to become a surgeon. Bailey was considered the world’s leading authority on congenital heart surgery, and was a consultant to or otherwise called upon to assist over 500 surgeons worldwide. Though the sheer number of heart transplants Bailey performed is impressive, the lion’s share of his surgical work fell in other areas, including open heart surgeries and all order of pediatric surgical procedures.
Bailey’s work put Loma Linda University Health at the forefront of pediatric heart transplantation worldwide. Singularly or in the context of working with others he devised techniques, approaches, strategies and innovations that in a select set of cases avoided the need for patients undergoing a transplant in favor of repairing some congenital heart defects.
During his 42 years with the Loma Linda University Health Institution, Bailey distinguished himself as a professor of cardiovascular and thoracic surgery and of pediatrics at Loma Linda University School of Medicine and surgeon-in-chief at Loma Linda University Children’s Hospital.
Bailey downplayed the suggestion that he was the pioneer the rest of the world was crediting him with being, pointing out that others broke the ground he later cultivated so successfully. “I’d had a fascination with transplantation since visiting a laboratory at Stanford while I was in medical school,” Bailey said in an interview with Larry Kidder done for Scope, a publication of the Loma Linda University Adventist Health Sciences Center done in 2007. “I thought the natural thing would be to put the two together – babies born with incurable heart disease who are dying, and this transplantation technology that hadn’t found life yet in this age group. Oddly enough, one of the very first transplants – and probably the first transplant done in this country human to human – was on a newborn baby. Dr. Adrian Kantrowitz in New York had done a few infant animal tranplantations in his laboratory, and had this same notion that transplantation ought to be good for babies with broken hearts too. So he made that attempt in 1967. The baby actually didn’t survive. I believe they were able to get the baby out of the operating room and into the intensive care unit for about five or six hours, and that was as far as it got.”
Bailey told Kidder that “Dr. Jim Hardy had put a chimpanzee heart in a human down at the University of Mississippi, in Jackson, in the mid-1960s. He had a patient with terrible heart disease whom he couldn’t wean off the heart/lung machine. He’d always had an interest in the idea of transplantation but hadn’t worked it out fully. Nevertheless, he went down to the lab and found an aging chimpanzee, harvested the heart, and put it in this fellow. It worked for awhile, but it wouldn’t sustain his circulation beyond the operating room. When they performed an autopsy on the chimpanzee’s heart, lo and behold, the old chimp was suffering from severe coronary artery disease. It probably wasn’t really a fair situation.”
Bailey pointed out that, “Dr. Keith Reemtsma had transplanted chimpanzee kidneys into human beings at Tulane in those early days, and actually had done reasonably well with that group of patients.”
Bailey insisted he had been able to succeed because Loma Linda University had supported his research. “When I returned to Loma Linda from training, the surgery department was very generous with me. They budgeted some money for a laboratory. We got the laboratory going again – it  had kind of fallen idle for a while. Dr. Lou Smith, who did the first organ transplant at Loma Linda University, had an active laboratory program going for a number of years. So we found some funding, put the lab back together, and hired some technical people to help with transplanting and looking after some little newborn goats.”
Bailey explained to Kidder he was interested in working with newborn goats for multiple reasons, which included that they were “easy to test… and very hardy, as opposed to lambs, which aren’t nearly as tough. So lambs, at some level, became donors, and goats were always the recipients.”
He learned much from his experimentation on goats, Bailey said in the Scope interview. “One of the greatest stimuli I had when I was studying pediatric heart surgery up in Canada was the awareness that the newborn immune system is indeed fairly special—it has very little of the aggressiveness of the older child or an adult. It has no experience, which helps. And much of the suppressor type behavior is still intact in the newborn. So the possibility that a newborn could receive a graft and actually grow up without any immune suppression was curious enough. We were able to demonstrate close to that. We had a baby goat named Livingston who was transplanted as a newborn and grew to 6 months of age with no immunosuppression at all. On average however, the transplanted goats without immunosuppression survived about two and a half months. Then they began a slow rejection process. So their immune systems, we knew from that experience, were intact—they were just much more accommodating as newborns.”
Bailey said his progress was boosted by the advances others were making at the time.
“A fellow by the name of John Borel, in Basil, Switzerland, was working for a pharmaceutical house,” Bailey recounted to Kidder. “He had found a fungus-like substance out in the hills. His job was to study it and see if there was anything there that he could make a medicine out of. I think he was originally looking to see if he could find something that would be effective with allergies. He began to study the immune properties of this substance and how it might alter the immune response in a host. It was pretty promising—something called cyclosporine. I contacted John Borel—I’d met him earlier at a presentation I was making one time down in Texas. He began to send this material to me in brown jars. It was a powder. You had to mix it with some oily substance in order to get it suspended. And then you could begin to quantitate how much you were giving an animal. We prepared a group of little goats for allograft transplants—goat to goat. We performed the transplants and treated them with cyclosporin all along. With that, they lived indefinitely. That was all it took. Cyclosporin-A became the mainstay of our immunosuppression. That took our breath away—the fact that we could transplant a baby at birth and have that baby grow up with nothing more than receiving injections of this oily substance.”
Even as he was functioning at the extreme end of the adult world, Bailey never lost sight of the fact that his patients were children, and he routinely wore neckties that featured cartoon characters. Likewise, his standing as a point man in the scientific world was leavened by his religious faith. In the aftermath of the operation on Baby Fae, when he was asked why he had used the heart from a baboon as opposed to a primate higher up the evolutionary chain and closer to humans, Bailey stated he did not believe in evolution. In 2017, he remarked, “When we operate on these babies, the hope is that they will live longer than us. It’s nice to know that’s playing out. Often when we start a case we thank the Almighty that He has put us in this position to help and that the outcomes will be according to His will.”
Born Leonard Lee Bailey on August 28, 1942 in Takoma Park, Maryland, his father was a professional chef. He credited his parents with inspiring him to “dream big.” He graduated from Columbia Union College – now Washington Adventist University – in 1964. He subsequently obtained his MD from the Loma Linda University School of Medicine in 1969.
It was during a thoracic and cardiovascular surgery residency at Toronto’s Hospital for Sick Children in the 1970s that he witnessed recurrences of babies dying from hypoplastic left heart syndrome, and was profoundly disturbed that the condition was not correctable through reconstructive heart surgery.
He returned to Loma Linda University in 1976 to join the faculty as an assistant professor at the School of Medicine. It was at that point that he embarked on the more than 200 experimental transplantations in infant research animals to prepare himself to bound toward transplantation in young humans.
“In those days, the advice to parents was to leave the baby here to die or take it home to die,” Bailey said in a 2009 interview.
Bailey was diagnosed with cancer of the tongue in 2001. Therapy he underwent slowed the progression of the disease, but over the course of 18 years it spread throughout his body. He made no secret of the fact that he was fighting the disease, which ultimately claimed him.
“Our colleague and friend, Len Bailey, served this institution and the world beyond with dignity and courage,” said Richard Hart, MD, PhD, president of Loma Linda University Health. “Despite his fame, he was always part of our own faculty family and stood tall in later years as one of our senior statesmen. His humble demeanor and quest for quality exemplified the best of our core values.”
Bailey is survived by his two sons, Brooks and Connor.
-Mark Gutglueck