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A legend in the evolution of heart surgery in Ireland

It was a momentous day for the man dubbed ‘the superstar of Irish medicine’.

It was September 10, 1985, and Mr Maurice Neligan had arrived in the Mater Misericordiae University Hospital in Dublin to prepare for an operation that would propel him into medical history.

For two other men, it was a day that would bring tragedy to one and hope to the other. One of them, a 35-year-old Wexford man, had been killed in an accident, and the other, a 35-year-old Louth man, had been told by doctors that the dead man’s heart might offer him a lease of life.

But that September morning in the Mater, it was all down to Mr Neligan. He was preparing to carry out Ireland’s first heart transplant on Mr Eddie Kelly from the Louth townland of Ballagan.

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Mr Maurice Neligan

Mr Kelly, who worked in the local Greenore Plastics and had built a home in Carlingford in the Cooley peninsula, had everything to look forward to with his wife, Eileen, and their three children. Then, suddenly, tragedy struck. His health began to deteriorate and very quickly, he was forced to give up work.

“At first, doctors failed to diagnose the problem,” the local Argus newspaper reported. “But when they did, they broke the news to the family that the condition of Eddie’s heart was so poor that he had one-to-three years to live.”

His only hope was a heart transplant. While South African Dr Christiaan Barnard had performed the world’s first human-to-human heart transplant at Groote Schuur Hospital back in 1967, none had ever been performed in Ireland.

But Mr Kelly and his family did not give up hope during the nine weeks he spent waiting in the Mater Hospital. Neither did Mr Neligan, even after one false alarm when a donor heart was found but was not suitable for transplantation.

But, of course, Mr Neligan, then a 48-year-old Consultant Cardiac Surgeon at the Mater, wasn’t driven only by hope. He was one of the world’s leading cardiac surgeons, with the training, skills, determination and confidence for such a daunting challenge. He knew it was only a matter of time before Ireland, like South Africa, would make medical history.

After all, nine years earlier in 1974, Mr Neligan had performed Ireland’s first open-heart surgery for congenital heart defects. Then, in 1975, he went on to perform Ireland’s first coronary artery bypass graft.

Now, 10 years later, in 1985, the pioneering surgeon faced one of the biggest challenges of his life as Eddie Kelly was wheeled into his operating theatre.

“It was a risky procedure; you would expect one-in-five people to die from it. But the patients picked had terminal heart failure, so there was no other treatment for them,” recalled Prof Freddie Wood, a Consultant Heart Surgeon at the Mater, who had worked alongside Mr Neligan that morning and spoke about his experience at an RCSI ceremony in 2010 to mark the 25th anniversary of the operation.

Mr Kelly, too, was fully aware of the risks involved — he might die in the operation or it might be able to extend his life, if only for a short while. He chose to place his life in Mr Neligan’s hands.

In the event, it would become a day of joyful celebration for the Kelly family. In the days that followed, as news broke that Mr Neligan had successfully completed Ireland’s first heart transplant operation, some reporters dubbed the young surgeon ‘Ireland’s answer to Dr Christiaan Barnard’.

But Mr Neligan played-down his pioneering role. “I’m not exceptional,” he said later. “I consider myself extraordinarily fortunate to have been where I was at the right time.”

Transplant statistics

Mr Neligan performed about 15,000 heart operations during his career, many of them on children, and his historical legacy endures. The Organ Donation and Transplant Ireland (ODTI) 2017 annual report shows a record-breaking 311 organ transplants were carried out in Ireland in 2016, including 16 heart transplants at the Mater.

A total of 296 heart transplants have been carried out since Mr Neligan’s breakthrough in 1985 and the average life expectancy of a heart transplant recipient is 14 years.

Worldwide, about 3,500 heart transplants are performed annually, the majority of them — over 2,000 — in US. Cedars-Sinai Medical Centre in Los Angeles is the largest heart transplant centre in the world, having performed 132 adult transplants in 2015.

Heart transplantation has now entered an era of “tremendous growth and innovation,” according to Doctors Kevin Koomalsingh and Jon Kobashigawa, writing earlier this year in the Annals of Cardiothoracic Surgery.

“The future of heart transplantation is bright with the advent of newer immunosuppressive medications and strategies that may even result in tolerance. Much of this progress in heart transplant medicine is predicated on a better understanding of acute and chronic rejection pathways through basic science studies,” they wrote.

“The future will also include personalised medicine, where genomics and molecular science will dictate customised treatment for optimal outcomes. The introduction of mechanical circulatory support (MCS) devices has changed the landscape for patients with severe heart failure to stabilise the most ill patient and make them better candidates for heart transplant.”

Family background

Maurice Neligan, who paved the way for such progress and in the process saw his name etched into medical history, was born in Dublin in 1937 into a family that was itself steeped in Irish history.

His father, John Neligan, was an Army officer from Templeglantine in Co Limerick, who fought in the Civil War, while his uncle, Colonel David Neligan, was Michael Collins’s spy in Dublin Castle during the War of Independence and wrote a book about his life, titled The Spy in the Castle.

Maurice Neligan grew up in Booterstown, Co Dublin, with two older sisters in a family he once described as “not well-to-do and not poor”. He loved literature and read widely and at the age of 15 he came upon a book that would inspire his choice of career.

The book was The Story Of St Michele, a collection of memoirs by a Swedish physician named Axel Munthe, and it led the young Neligan to become a doctor, he recalled in ‘King of Hearts’, an Irish Times profile, in 1997.

He attended Blackrock College and went to medical school at University College Dublin, from which he graduated in 1962. He did his residency in the Mater.

In 1966, he married Pat, an anaesthetist, and together they had seven children, one of whom, a daughter, Sara, died in 2007. Their eldest son Maurice followed in his father’s footsteps and today he is Chief of Orthopaedic Surgery and Director of the Division of Sports Surgery at the Beacon Hospital in Dublin.

Media advocacy

After Mr Neligan retired in 1997, he spent much of his time in his beloved Kerry. He continued to advocate for patients and frequently used his newspaper columns and other media to campaign for the improvement of patient services.

“In conscience, one can’t shut up,” he said. “You can’t be afraid and you mustn’t be silent about things that have a moral imperative. The medical profession must point to the deficiencies in the health service, because who else is going to do it? Who else will be the patient’s advocate?

“We have to say [it] where there are people waiting for all kinds of treatment, and where there is the inhumanity of people lying on trolleys for 48 hours, where there are huge and glaring inequalities. You do no favour to anybody by remaining silent and if this offends people, so be it. What is happening is far more offensive.”

In early 2010, recalling his 1985 heart transplant, he said this about the Department of Health: “We did the first transplant off our own bat. We did not get any help from the Department of Health or anything like it. In fact, not long after we did the first transplant, the Mater stopped the programme during the cutbacks of the late 1980s. We got around that by doing transplants in the recently-opened Blackrock Clinic. Then we sent the message that the only way you could have heart transplant is Ireland is if you were a private patient.”

Later in 2010, Mr Neligan was interviewed for a book, Insights into Leadership in Ireland: Insights from Contemporary Leaders in the Public, Private and Voluntary Sectors, launched by Dr Martin McAleese in September, just a month before Mr Neligan died. “I find that the best leaders and the best teachers are always the most understanding and the kindest,” he said. “You don’t really get very far by upsetting people and humiliating people. You’ve got to bring out the best they have and use it.”

His sense of humour was also evident in his writing. Recalling his days at UCD, he wrote in 2007: “Early on, I noticed that there were two basic groups of students — the airy ones and the earthy ones. The latter group tended towards the sciences; medicine, dentistry, engineering and veterinary and, I suppose, the ‘ags’ (agricultural students). Nobody was quite clear as to whether the agricultural sorts really counted, as they spent much time away from the centre doing unspeakable things to cows.”

Mr Neligan also co-founded the Blackrock Clinic. From 1971 until 2002, he was Consultant Cardiac Surgeon at the Mater Hospital and, from 1974 until 2002, he served at Our Lady’s Hospital for Sick Children in Crumlin, Dublin.

Tributes

When he died suddenly at his home at the age of 73 on the morning of October 8 2010 tributes quickly began pouring in to his family.

Prof Wood described his former colleague as “the outstanding surgeon of his generation”. The board of Our Lady’s Hospital for Sick Children said he was a pioneer of children’s cardiothoracic surgery and was instrumental in the establishment of cardiopulmonary bypass and intensive care facilities.

Taoiseach Brian Cowen called him “a distinguished practitioner of medicine, a distinguished surgeon, and there are many families in Ireland who are grateful for the lifetime’s work he undertook.” Then Fine Gael leader Enda Kenny called him “the first superstar of Irish medicine”.

The Mater Foundation, together with the Neligan family, established the Maurice Neligan Tribute Fund in recognition of his ground-breaking achievements, and named a new operating theatre after him.

“Many hearts are beating today thanks to his skills,” said Monsignor Seamus Conway at Mr Neligan’s funeral on October 12, 2010, giving thanks for “the lives saved, the lives prolonged and the lives enhanced” by this visionary and pioneering surgeon.

SOURCES: RCSI, Mater Hospital, Argus newspaper, Irish Independent, Irish Times ‘King of Hearts’, RTÉ documentary ‘The heart of the Mater’; American Heart Association; Annals of Cardiothoracic Surgery.

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