Episode 1: Professor Sir Magdi Yacoub

OLI LEWINGTON

To mark the first ever episode of this series, we wanted a guest that everyone would be familiar with. To most, a living legend, to some, a surgical maverick. To me, a lifesaver...

*JINGLE*

OLI LEWINGTON

As a transplant recipient at Harefield, I don't know if there's any better way to kick off our podcast series than our conversation today with Professor Sir Magdi Yacoub, marking the 40th anniversary of his completion of Europe's first combined heart and lung transplant. Sir Magdi is one of the most recognisable names in modern medicine.

Here at Harefield Hospital, he created the largest heart and lung transplantation programme in the world and his portrait still watches over patients in the transplant clinic. The statue erected to him in his native Egypt shows how far his influence has reached over a career that has transformed my own life among thousands of others. Beyond his countless professional achievements, he has also founded and led several research and charitable institutions, including the Harefield Heart Science Center, The Magdi Yacoub Global Heart Foundation and Chain of Hope, a charity dedicated to bringing life-saving treatments to children in developing and war-torn countries.

Sir Magdi, thank you so much for speaking to us today.

PROFESSOR SIR MAGDI YACOUB

Thank you for talking to me.

OLI LEWINGTON

So, take us back 40 years ago today... you’re preparing to go into theatre to perform the Europe's first combined heart lung transplant. How did it feel at the time? Did it feel like a really significant moment to you?

PROFESSOR SIR MAGDI YACOUB

No, not at all. Obviously, I knew that this was the first heart lung transplant in Europe. The operation was already performed at Stanford University, and I knew about that. However, we had a relationship with Sweden where we were transplanting hearts for all their patients because at that time, they did not recognise brain death criteria. I used to go there and help them to establish brain death criteria and start their own transplant, which we did.

But also, we had a programme of harvesting hearts from all over Europe, Germany, Sweden, uh, Greece. And so, they were very generous in generating organs for British people, and that was great. Now the first heart lung transplant went to Stanford first, and they said, you are not suitable for the operation, you're too far gone. And we knew that, if you leave patients to deteriorate too far, the multiple organs fail, even if the transplant succeeds. 

Now, this person was a very brave person, and I have empathy with my patients. I realise that how they feel, they are the end of the road. Nobody wants to help them, but they are brave to try and help themselves. So,I feel for them. Why not give this person a chance knowing that there is there are increased risks because this is his last chance and you know something? Chances are chances. You can suddenly win.

So, I felt that we should give him a chance. And he was just a wonderful person. Now, have I seen the operation before? I heard about it. In those days, I used to study everything so meticulously. I knew the example of ‘you don't have to do everything in animal models’, you can study the thing intensely and define all the steps of the operation, including the movement of the hand and the brain and everything else. 

And also, I used to read a lot about sleep, and what happens during sleep, and there was a whole issue of nature, which was entitled sleep researchers caught sleeping. And it was very, very intense because it showed, for example, one of the editorials or news and views in nature at that time said, if you are worried about something, sleep on it. What does that mean? It means that the brain, when you have an intense feeling to solve a problem, does not stop when you go to sleep. It actually goes on processing the problem and in the morning you get more answers.

So, I kept doing that until I knew absolutely every step of the operation, every movement of the hand, everything. So, I went in to perform this operation for this Swedish, lovely man. I just went through very quickly, seamlessly, as if I had done thousands of these operation and didn't even hesitate.

And some of my assistants later wrote of that saying they were amazed. Now, this kind of things might not be allowed today because they would say, how many animal model have you done? Or there, there, there... which is stifling progress. Anyway, the organs worked beautifully. But his other organs started to fail, and what Stanford predicted actually happened three or four weeks later.

Everybody was very saddened, of course, at Harefield. But you must try and know that there is something called teaching or initial experience, which will have a higher risk, but that will establish a whole lot of other things in the future. And that's precisely what happened at Harefield. Because Harefield became the centre which did 3500 transplants, of which like 2000 were heart lung, and introduced innovations in heart lung transplantation including revascularisation, the domino operation, so on...

So, trying in desperate situations, but for the sake of the patients. Because sometimes people say, oh, you were experimenting on the patient for your own glory, NEVER for my own glory, I never thought of myself. I knew that the most important thing when young people ask me that what is the secret of success, I want to do heart surgery or some other thing... that is really simple. 

There are three things you have to follow, letters... and they are PPH. What is PPH? I say to them the first is passion, that you want to be in love with your chosen specialty. And that's exactly what I had, that I wake up in the morning, I want to rush to the hospital because I have a passion to my vocation and what I want to do. The second is P is persistence. You don't have to be a genius. You just have to persist because geniuses go here, there and everything and never get anywhere. But persistence is very important. And the third, which is the most important one, is humility. Be humble, not full of yourself, and know that discovery is only a step in the line of other things. It opens up what you think is the top of the mountain is actually a small hill, and the mountain is sitting up there and you have to keep going after it. So that is, in short, what happened with the first heart lung transplant in Europe.

And this has opened up research to help many, many, many patients, forgive me, dear, you yourself, because we also at Harefield did a champion surgery for cystic fibrosis because everybody thought cystic fibrosis is just incurable because there is infection, persistent infection. And there was a dedicated physician by the name of Margaret Hodgson who really did a wonderful thing looking after because they died at a young age, and she made them survive to 20-30, when we could do something and we knew that you have to replace both lungs because if you leave one, then it’ll infect the other one, and we were finished. And taking the lung, which is so infected, the lung stuck full of pus... and people would say, you'll never get out of that, but we did. We took both lungs. And that was again part of the experience gained from the first heart lung transplantation, which was for pulmonary hypertension, raised blood pressure in the lungs and opened really many, many, many avenues around the world to benefit patients.

OLI LEWINGTON

I think one of the things that strikes me what that the things that you talk about in terms of not being limited by what other people think of patient's chances. And I think for people like me with cystic fibrosis, that's obviously made a huge difference. But I think the other thing about transplant that people often miss is it's not just about saving someone's life, it completely transforms lives. I mean, my life for the for the two years I was on a waiting list before my transplant, my life was nothing, essentially. I mean to all intents and purposes, I was bound home to tied to an oxygen machine and couldn't really do anything. And now I mean, now I'm sitting in Harefield talking to you and being able to do things like this that frankly, I would never have been able to do. And I've done so much more. And I think that's an important part of transplant, isn't it, that it's not just about not dying, it's about being able to live again, right?

PROFESSOR SIR MAGDI YACOUB

Absolutely. I couldn't agree with you more. It is the quality of life which matters a lot. If you ask many patients, do you want to live longer or do you want to have a good quality of life? You can't have both. They will always go for the quality of life. As it happens, transplantation gives you both, gives you a longer life and a better quality of life.

And there was a very, very interesting thing in the history of this hospital, because initially Donald Longmore and others were and many of us, even before the first heart transplantation in South Africa, we knew that transplantation has reached a level that heart transplantation needs to be applied clinically. But what happened after that is that it took some time for it to be established.

And like I was just saying to you, particularly in terms of heart transplantation, it went from something which newspapers, forgive me, used to fight saying this dreadful unethical operation, which is experimental and the patients are not going to survive for more than a year or two just for experimentation and making people famous. Absolutely no. It completely turned around and became the success story of the 20th century. It's just completely the opposite. And the Ministry of Health at that time, when we established heart transplantation, initially with cyclosporine and good the immunosuppressant came, there was a moratorium. So, us and Papworth, started the heart transplantation. Then the ministry said two things. The first one was heart transplantation should not be done in a village hospital, and we said, are we a village hospital?

So, they said yes, it should be done in central London in a teaching hospital. So, they established a committee and that was called the Goodwin Committee. Goodwin was the most internationally known cardiologist in the world, and he assembled a whole lot of cardiologists, as well as immunologists from this country and from abroad. And they came and scrutinised the facilities at Harefield.

And the report was this is the one of the best international centres we have seen anywhere in the world. So, they couldn't get rid of that. The next thing is they said, oh, but is transplantation itself a viable thing? So again, the Department of Health said, we're not going to pay for it. You have to find the money yourself to pay for a transplant operation.

So, the people in the village and many other people were collecting money. And this unit where we are sitting in (the research centre) was established initially to collect money to pay the NHS for the operations. But then people said we were very upset at that time and they said okay. And that was quite nice that they said to scientifically prove that transplantation is a worthwhile operation or not, we will give money to an independent group, which happened to be the neighbouring university here, and they will look into the efficacy of the operation between Papworth and Harefield.

So, we were cross and said, why are you wasting this money? Actually, it was not money wasted, because we said, okay, we will cooperate so long as you let us know where are we wasting money? So, they reported back to the ministry, quantifying what they call QALY’s. QALY’s are quality adjusted life years. So how many much more quality and how longer are you living. And compared that to other operations performed for cancer or anything else, and transplantation was way superior, much better.

So that was the greatest thing which happened to transplantation that they said we have to prove in a scientific fashion how effective the procedure is. The following morning in Parliament, they gave several millions funding and we stopped collecting money in the church and everywhere to pay for the transplant operation.
So, all this is history. People don't know the greatest success, I'd say, of the success story of the 20th century. How did it come about? Not painlessly. There was a lot of pain.

OLI LEWINGTON

I think that political fight is, as you say, it's part of the history that people don't often know. They think that this progress of transplants that come through that, you know, there's a natural progress or progression through the different types of transplant that came in and, you know, by 1983, the skills and the science and the techniques were good enough to do a heart lung transplant.

But it's about the years and years that you went through trying to fight to make sure that you were allowed and you were funded to do these operations. Was there ever a point in there where you gave up hope or you thought, this is never going to happen?

PROFESSOR SIR MAGDI YACOUB

Absolutely. I think you put your finger on it that without the determination for saving humanity, because there is massive inequalities in health care delivery, and if you don't fight back and try and help humanity because humanity is in pain and it is in pain because a lot of it is due to cardiovascular disease, both heart, lung and vessels.
So, we really have to be determined to get rid of that pain. And it doesn't happen spontaneously. It has to be determined fight, if you like.

OLI LEWINGTON

And is that something, do you think the fight that you had to go through back then, do you think that informed the way that your life and career went from that point, I'm thinking particularly of the foundations and the charities that you've set up like Chain of Hope, which is very much focused on the inequalities of access to health care and things.
So, do you think that period of time helped shape what you went on to do?

PROFESSOR SIR MAGDI YACOUB

Absolutely. The progress in life, like the philosopher of science, Karl Popper, who is credited to being the person with greatest influence on our thinking. And he wrote a whole book entitled Conjectures and Refutation, and he said that science does not progress slowly and predictably in a straight line. Actually, it starts with an imaginative leap. But, following that imaginative leap, several years will elapse to try and either prove or refute to his way of thinking.

We, the scientist, or whoever came with the imaginative leap, should try and refute. Sometimes we fall into the trap of not trying to refute, but then our peers come with a refutation, and we should accept that because they are driving us towards the truth, because science is their search for the truth. So, the science is an integral part of human care or medicine.

And without science, without trying to criticise yourself, there will be no progress. And certainly, transplantation and what you have gone through, what we have gone through, is instrumental in moving towards our current thinking and shaped us as much as we shaped these specialties. But establishing a service is so good that even now, 50 years later, half a century, I'll be walking in the street and somebody says, thank you. What have I done to you? I've done nothing. And he said the unit of transplantation has saved my son only last week, and without this, it wouldn't have happened. So this is wonderful.

And, uh, that or the other thing, which is have affected us, or is it actually superseded our expectation because we were transplanting patients from New Zealand, Australia, and so on. And they were thinking they would survive 2 to 3 years. Some of them are alive 37 years later to see their grandchildren and all that. Wonderful! What a thing. So that is sometimes if you try, uh, the result actually shapes you more than you expected. Does that answer your question?

OLI LEWINGTON

It does. It's really interesting to hear you say that. It's not a common thing that you hear, I think. You imagine surgeons or doctors or whoever they are that they, I mean, it's always more than a job, right? That there are very few doctors or surgeons who have dedicated their careers to this sort of thing because it, it's a job.

Um, but I think it's, it's always interesting to know and to hear from people... mean, you can hear the passion in your voice. You can hear how much it means to you and the difference it has made to see some of your patients live as long as they have. One of the things that I'm trying to dig into as part of this podcast is to understand the community that exists in Harefield and the Brompton hospitals.

And I think I've had a particular personal experience of it. And I remember distinctly just after my transplant, the first time I was kind of mobilised and walked down the corridor, still with all of the various chest drains and wires and everything else off me, I remember really vividly that one of the cleaners stopped and cheered me on as I went past him.

And it's I mean, that sort of community doesn't exist in any other hospital and believe me, I've been to a lot of hospitals, but I feel like a lot of that started with you and the group that you brought together, to start way back at the beginning of building what you've built here at Harefield. And I'm interested in and why that was important to you? Why did you want to build a group that worked like that? And how is it how is it better who or how did it seem to be better for you?

PROFESSOR SIR MAGDI YACOUB

Absolutely. I think what you are describing is what I call the spirit of Harefield. And many people actually articulate it in different ways. And you did, the cleaner cheered you... the spirit of excellence is of it is patient centric and we've created that in our Aswan Heart Center where again they have the same spirit where we are patient centric.
We want to see the patient and whether it's the cleaner, it is anybody around, striving to achieve excellence or sometimes we talk about, I was talking about the mountain and the hills and so on and saying, we want to climb mount excellence. Can we? We are trying! Oh my God, we trying to get to do it!

And that is what Karl Popper mentioned in his book called Conjectures and Refutations, is what he called an imaginative leap. You jump, but where do you go from here? Arghhh, you hold on and see whether or not this jump is achieving what you wanted in the first place, but never let go.

OLI LEWINGTON

But creating. I mean, you could. You could describe your creation of that that culture of excellence that's in an imaginative leap of its own, right? That wasn't really a huge focus for hospitals and surgeons and things like that when you started Harefield. So, what was it that you saw the potential for?

PROFESSOR SIR MAGDI YACOUB

I think I'm proud to belong to this group because I think that they are self-driving now. They don't need me at all. And the same in Aswan Heart Center, they have this spirit. But how did they come about? I think they have it in them that they identify with excellence and as we were looking for them, but also they were looking for us, and they came.

So, I cannot claim credit for all these guys who came here and formed part of the Community of Excellence trying to climb mount excellence, had it in them. I didn't create it myself. It's just we found each other and there was like meeting of minds, if you like.

OLI LEWINGTON

I think we might have to, to agree to disagree on that one because I think, I think you did play quite a big part in that. I think it's impossible to see that that culture coming to pass without you at the centre of it. I think one of the things I'm interested in is from when you were first training, you sought out some of the best people in the world to train under.
And it's exactly what you're talking about now is people are seeking to come and be part of that that excellence. But also, people have spent years now coming to you specifically wanting to train under you. How does it feel to be on the flip side of that coin now that you've gone from seeking the best people to train under to being sought to train under?

PROFESSOR SIR MAGDI YACOUB

I think that's a very good description and generous on your part. And some of that [MAGDI HOLDS BOOK UP] is already published in this book by two reporters from the Sunday Times.

OLI LEWINGTON

So, you're talking there about a surgeon and a maverick.

PROFESSOR SIR MAGDI YACOUB

Yeah.

OLI LEWINGTON

The life and pioneering work of Magda Yacoub, which is the new biography, isn’t it?

PROFESSOR SIR MAGDI YACOUB

Yeah, it is a kind of biography, and they did a whole lot of research to find out who was living at the time, who did I target? So, like you were saying, I targeted people when I was a student, I knew of Lord Brock. He was Mr. Brock at the time. And I said I must go and work for this person, particularly because my dad was a doctor and he lost his younger sister because of rheumatic heart disease and Brock was already opening valves and they said, I really have to go and work for this guy. And I did. And he had a profound effect on my life. And now the cycle goes on.

OLI LEWINGTON

I suppose it is a cycle, isn't it, that there's always the people who train and then they start training other people... I think there are always people who are at the peak of whatever, whatever profession and whatever specialism it is, who people will want to train under. And I think it's clear that that you are one of those people, and you have been one of those people for a long time now. And you must get asked quite a lot that at what point do you start slowing down?

PROFESSOR SIR MAGDI YACOUB

Sometimes I feel I don't deserve all that credit, but I do feel proud when I get letters from Yemen saying I went into medicine because I heard about you. If you can do it, I can do it. That gives me a lot of thought because the specialty needs a lot of talent, young talent. And it is happening because of hearing about the story.

OLI LEWINGTON

It's really clear just from the conversation that we're having right now, you're an incredibly humble man. And you talked about the need for humility in the PPH. But you must recognise the significance of the achievements that you've made over the years of the things that you have pioneered, the research centres that you've built. You must recognise that’s a singular success that's come from the work that you have done?

PROFESSOR SIR MAGDI YACOUB

Partly. And I'm happy to have that, to witness that and may it continue because we have to pass on everything. I don't want to die until I pass on everything I've learned to the new generation, because I see, ook at what's happening now with the wars and this and this and that and the hatred and it's disaster.

But the younger generation have a lot more understanding of how they can mend our work if you like, have a world without war, for example, have a world without hatred. Are we going to achieve that? We’ve moved a bit forward in the days of Gorbachev, Mrs. Thatcher, taking the Berlin Wall down, but we went back badly.

So, we need to gain momentum again. And the young people and our role in passing on that to the young people is essential.

OLI LEWINGTON

And you're still passing on your knowledge and your skills to young people. And, you're making sure that people have the opportunities to... I mean, it's not just people having the opportunity to access cardiac treatment and cardiac care, but you're investing in training new doctors and surgeons around the world as well.

PROFESSOR SIR MAGDI YACOUB

Fundamental. I think it’s a real fundamental area which I continue, where I don't operate myself, but I scrub with trainees. They want me to scrub or stand at the end of the table, saying this, do this or do that... and innovate as well as saying let's have another operation which is more effective worldwide and more applicable, and as it happens. So that gives me a lot of pleasure.

OLI LEWINGTON

I know that over the years you must have met definitely hundreds, if not thousands of people who have said thank you for the work that you've done. And I think it's important to recognise that we're not just talking about patients here. It's not just my life that's been affected by my transplant, it's my family's lives. It's my friend's lives. And so, every single person who has a transplant that touches many more lives and I think it's really rare in life that you can ever say you speak for a group of people, but I think I speak for everybody that your legacy has touched, when I say thank you.

And I can't sit here, in your office, talking to you without saying thank you for the work that you've done and however much credit you want to take or refuse to take. It’s a really big deal. And I think just having the opportunity to be here is exceptional. And I genuinely can't think of a better way of starting off this podcast series that we're doing now.

So, Sir Magda Yacoub, thank you so much for talking to us today.

PROFESSOR SIR MAGDI YACOUB

Thank you for your kind words.

OLI LEWINGTON

That was Professor Magdi Yacoub talking to us in his office in the Harefield Heart Science Centre. And it was an amazing conversation. It was incredible to hear him talking so openly about the difficulties that he's faced, particularly in the early years of setting up such an incredible place, but also the pride that he clearly has not only in the work that he's done, but in the work that the people who have followed him, and who are learning under him, are doing.
I'm looking forward to having a lot more of those conversations in the New Year, so subscribe wherever you get your podcasts and thank you so much for listening.