Our Ace of Hearts - Prof Peter Macdonald

A stamina for long distances - in walks, life and medical discoveries

23 May 2019

He walks long distances for fun – 500 kilometres of hiking trails whilst on holidays – and doesn’t mind travelling 450 kilometres just to go to work some days (more on that later).

But it’s Professor Peter Macdonald's stamina and extraordinary discoveries in the voyage of cardiovascular research for which he is most revered in medical circles around the globe.

The heart in a box transplant

Professor Macdonald and his team of heart transplant researchers at the Victor Chang Cardiac Institute developed a unique preservation solution that, combined with a portable “heart in a box” machine, extends the amount of time a donor transplant heart can spend in transit from four to 14 hours. This means donor hearts can be transported further and so be better matched with a recipient, improving the outcomes for patients.

The revolutionary technique also allows donor hearts that have stopped beating to be reactivated, so that at least 20% more transplants can be performed each year in Australia, and around the world.

It is described as the most important global advance in heart transplantation since organ transplants began in the early 1980s, but you wouldn’t know it, talking to the humble man with a dry sense of humour, whose “other job” is as a highly respected cardiothoracic specialist at St Vincent’s Hospital, where the Cardiopulmonary Transplant Program is regarded as one of the most successful in the world.

“In all of our years, our biggest hindrance has been the limited availability of organ donors. In many respects this breakthrough represents a major inroad to reducing the shortage of donor organs,” Professor Macdonald said, understatedly. A similar character trait, according to those who knew him, to that of Dr Victor Chang, who was one of Professor Macdonald’s early mentors.

It was 30 years ago when Professor Macdonald was in his first year as a Cardiology Fellow at St Vincent’s Hospital Sydney that Dr Chang asked him to stay. He packed up his wife and small children from Melbourne and moved to Sydney’s southern beaches, having decided to devote his career to heart failure and transplantation.

“Beta blockers were just starting to be investigated … there were surgical solutions. It seemed to me there was more you could do for the heart than any other organ or system in the body.”

Race against the clock

The first time he was sent to retrieve a heart for transplantation was “exhilarating and confronting at the same time,” he recalled. “I flew there and back with the heart and watched it all being sewn in – there’s nothing that prepares you for that experience.”

“There were green lights all along South Dowling Street for the police escort from St Vincent’s Hospital to the airport, which we did in just seven minutes. Later I remember Victor casually telling me their record was four minutes … he was witty and funny, and he had charisma.”

Professor Macdonald remembers once assisting Dr Chang in the early days of lung transplantation. The two lungs from one donor were being transplanted into different recipients, so two operating theatres ran simultaneously.

“There weren’t as many surgical assistants in those days, so they roped me in to helping – mainly holding a retractor – but I remember that the atmosphere in the theatre was very relaxed, with Victor making it all look very straight forward, although it was only his first or second lung transplantation.”

He said being a cardiothoracic specialist, and a scientific researcher, was the perfect partnership of jobs.

“You see challenges in the hospital, and you come in here to the Institute to try to find solutions to those problems.”

Professor Macdonald said his team in the Cardiac Transplantation Laboratory want to improve donor heart preservation techniques even further, and develop better methods to manage organ donations

Healthy hearts for more Australians

For patients with heart failure who are not eligible for transplantation, Professor Macdonald and his colleague, Professor Chris Hayward, have played a critical role in the team that has developed a highly successful program implanting mechanical devices, such as defibrillators and pacemakers.

Professor Macdonald’s expertise managing critically ill patients helps to translate laboratory findings into clinical practice, driven purely by wanting to extend life‑ saving treatments to more Australians.

To all Australians, that is, including our indigenous community.

Which is why Professor Macdonald travels 450 kilometres each way, one day every six weeks or so, in a 1960s Chifton 8‑seater propeller plane to work at the Condobolin Aboriginal Medical Centre in outback New South Wales.

He cites the gap in life expectancy between Aborigines and non‑indigenous Australians, plus the imbalance of cardiovascular disease among the indigenous population, as reasons for wanting to “give something back”. So he’s been going back to Condobolin for 12 years.

Professor Macdonald has been heard before to say: “I won’t solve the problem, but at least it’s something,”which would be why he is described by his peers as “very much a noble, humble guy”.

“There are not too many people who can say their research has had such as major impact on the world,” said Professor Bob Graham, Executive Director of the Victor Chang Cardiac Research Institute.

Professor Macdonald, who has been awarded a Queen’s Birthday Honour for services to cardiovascular research and heart transplantation, has published more than 300 research papers.

His three adult sons have left home, but he gets to see them once or twice a week; he body surfs at Maroubra Beach, and he really enjoys hiking with his wife. The best training for that, he said, is playing golf once a week.

The hardest part of any of his jobs, Professor Macdonald said, “is referring a patient for a transplant and finding out they are not suitable, then having to say ‘sorry, we can’t help you’. They place a lot of trust in you,” he said, solemn for just a moment. “And so have very high expectations.” A fairly well‑placed presumption, wouldn’t you agree?