Women Leaders in Cardiac Transplantation
Authors: Sharon A. Hunt
Journal: Circulation (2019)

t must always be daunting to be asked to do something that other people haven't done (or needed to do) before.That was how I felt when our chief heart transplant surgeon started encouraging 4 of us, who were last year cardiology fellows, to provide more clinical care for heart transplant patients.There had not been a formal cardiology transplant service before.For the first years of the program after our initial transplant in 1968, the survival rates for patients were so poor that the need for long-term medical care for the patients was not deemed essential.We were part of an evolving team that worked to overcome some of the major issues limiting long-term survival against the tide of a generally-accepted international moratorium on clinical heart transplantation at that time.Demonstrating the safety of distant heart procurement and introducing the use of the endomyocardial biopsy to objectively diagnose allograft rejection and document its resolution after therapy were among some of the transformative changes that significantly improved survival.Gradually, as patients started living longer and developing medical problems that were challenging to manage-problems such as diabetes, hypertension, and coronary vasculopathy-it became clear that cardiologists were needed for management.These issues became even more apparent after introducing the then-new immunosuppressive agent cyclosporine in 1980, and observing even better 1-year survival rates and, thus, bigger patient cohorts which needed care.Four of the cardiology trainees, who seemed undifferentiated around that time, were asked to start being involved in transplant patient care.The 4 trainees included myself, Michael Bristow, Jay Mason, and Donald Ricci.All of us have stayed involved over the years in the field that evolved after this initial work.In a sense, our team was privileged to have a whole decade to work out many of the bugs limiting the volume of transplants and the long-term survival of patients.Most of us were not really aware of how seemingly daring this was.I was certainly not aware until 1 stunning moment in 1975.I was the first author on an abstract that was submitted to the annual American Heart Association meeting, which reported our 1-year post transplant survival rates, and I was invited to present the abstract at an oral session.This was my first presentation of any type at a large medical meeting.I was shocked to find my session packed with standing room only in the audience, press photographers all around, and even several celebrities in the audience (which, of course, would not be allowed today).The critical component to future leadership was being part of the innovative and transformative team from the beginning.I was only the second woman trainee in the history of our cardiology training program, and my selection or involvement, I believe, was truly fortuitous, but welcomed, and it turned into a career that has been most gratifying and one that I've enjoyed greatly.I was the medical director of our post-transplant program until just over a year ago, was president of the International Society for Heart and Lung Transplantation in 1996,