“Modify, simplify, apply” is Dr. Denton Cooley’s motto, which is displayed on the Web site of the society that bears his name. With 100,000 heart surgeries for him and his teams, Dr. Denton Cooley has pioneered heart surgery, refining the procedures and improving the quality of life for his many patients. From his first heart surgery to correct an infant’s congenital problem, Dr. Cooley was intrigued by the human heart. The heart is “really a fascinating organ. It’s about the only organ in the body that you can witness its function. Doing things. And so on. Some of the other organs you can witness, like the intestines, will have this sort of peristaltic motion. But nothing that can compare with the activity of the human heart.”
Dr. Cooley did not shrink from controversy. Removing the beating heart from a donor and transplanting it into the chest of a recipient raised the ethical question—when is a person dead? In an interview for Life magazine, Dr. Cooley spelled out his view on the issue. “The heart has always been a special organ. It has been considered the seat of the soul, the source of courage. But I look on the heart only as a pump, a servant of the brain. Once the brain is gone, the heart becomes unemployed. Then we must find it other employment.” But the issue was not settled easily, and it ultimately led him to an audience with Pope Paul VI in 1969 to discuss the morality of heart transplants. Since then, legislation has been adopted to define death as the irreversible end of brain activity.
Dr. Cooley was embroiled in one of the nation’s longest and most famous medical feuds. When he made the decision to implant an artificial heart in a patient awaiting a heart donor, he used a device developed at the Baylor College of Medicine by Dr. Michael DeBakey and Dr. Domingo Liotta. While his decision was praised by Dr. Christiaan Barnard, Dr. DeBakey accused him of stealing the heart and not having consent to do the operation. Dr. Cooley responded that it was a life-or-death matter, and he did what had to be done to save the life of his patient. Determining that Dr. Cooley had broken University and National Heart Institute rules, the American College of Surgeons censured him.
The feud between the two doctors lasted for 40 years. The doctors avoided each other if possible and did not acknowledge the other if in a meeting. Whether the icy relations stimulated each to greater achievement or the lack of collaboration delayed medical advancement is a matter of conjecture. Each doctor thought the other should have taken the first step toward reconciliation and the standoff continued for decades.
On October 27, 2007, the ice broke. Dr. DeBakey had just received a Congressional Gold Medal for his achievements when he accepted a lifetime achievement award from the Denton A. Cooley Cardiovascular Surgical Society. The event had not been publicized because it was not certain whether Dr. DeBakey would accept the invitation. Dr. Cooley personally presented the award to Dr. DeBakey, who at the age of 99 was restricted to a motorized scooter. Six months later, the honor was reciprocated when Dr. Cooley accepted a lifetime achievement award from the Michael E. DeBakey International Surgical Society. Reflecting on their rivalry, Dr. Cooley observed, “I’m relieved we are again together and can be colleagues and friends again.” Dr. Cooley had one more honor to give to his colleague—the Texas Heart Institute Denton A. Cooley Leadership Award. Dr. DeBakey accepted the award but passed away before it could be presented. The rapprochement was hailed by doctors around the world who felt uncomfortable taking sides because of a dispute that was not theirs.
As medical care has evolved, insurance companies have taken a broader role in determining treatments and their costs. Some, including Dr. DeBakey, maintained that only physicians should dictate treatment. Dr. Cooley, recognizing the inevitability of the change, signed on with dozens of insurance plans, earning him the nickname “the Sam Walton of heart surgery.”
With a work pace that sometimes meant performing as many as 25 heart operations a day, Dr. Cooley still had time for family (he and his wife raised five daughters) and playing the upright bass in his band, The Heartbeats (all physicians).
Denton Cooley was born and raised in Houston, Texas. His father was a successful dentist and role model for his son. Young Denton Cooley had the skill to fashion an inlay for his own cavity. As a youth he was shy and turned to sports and his studies for outlets. He entered the University of Texas at 16, where he pursued a degree in zoology, intending to become a dentist and take over his father’s practice. While at UT, he played varsity basketball, lettering for three years and playing on the team that won the Southwest Conference championship in 1939. Dr. Cooley credits sports with contributing to his success as a surgeon. “I’ve always thought that my exposure to competitive sports helped me a great deal in the operating room. It teaches you endurance, and it teaches you how to deal with defeat, and with complications of all sorts. I think I’m a well-coordinated person, more than average, and I think that came through my interest in sports and athletics.” Cooley was not just a great athlete; he was also a gifted student, graduating Phi Beta Kappa in 1941.
Originally planning a career in dentistry, he changed his mind and entered University of Texas Medical Branch. After two years, he transferred to Johns Hopkins University where he graduated in 1944. Pursuing his residency there, he assisted his mentor, Dr. Alfred Blalock, in a “blue baby” operation, correcting a congenital defect in an infant’s heart that prevented an adequate flow of blood. Interrupted by two years of active duty with the Army Medical Corps where he served as chief of surgical services at a hospital in Linz, Austria, he completed his residency and taught briefly at Johns Hopkins on his return to Baltimore. As an intern, Dr. Cooley honed his surgical skills. He practiced tying surgical knots with each hand. He perfected his technique with a scalpel. How does one gain the skills to be a surgeon? “Get a scalpel and practice just, say, cutting a piece of meat or something like that. You sort of learn how you want to hold your fingers, and that sort of thing, and try to become graceful when you operate.”
In 1950, Dr. Cooley spent a year at the Brompton Hospital for Chest Diseases in London. Working with Lord Russell Brock, one of England’s most prominent surgeons, he assisted in the first intracardiac operation in England.
In 1951, Dr. Cooley joined the faculty of Baylor College of Medicine and the affiliated Methodist Hospital. While at the college he collaborated with Dr Michael DeBakey, becoming proficient at a range of procedures—heart valve replacement, removing aortic aneurysms, and correcting congenital heart defects. Working together they developed a heart ălung bypass machine, which allowed a patient’s heart to be immobile during surgery by circulating and replenishing the blood with oxygen.
Strong personalities can create friction, so in 1960 Dr. Cooley moved his practice 300 feet away to St. Luke’s Episcopal Hospital while continuing his affiliation with Baylor. Two years later, Dr. Cooley founded the Texas Heart Institute “to reduce the devastating toll of cardiovascular disease through innovative programs in research, education, and improved patient care.”
In 1961, Dr. Cooley became the first doctor to remove a pulmonary embolism. A 37-year-old woman experienced a massive blood clot in her lung. Using the newly developed heartălung bypass machine to provide 15 minutes of life support, Dr. Cooley was able to remove the clot and discharge the patient in 14 days.
During the 1960s, Dr. Cooley developed and improved artificial heart valves, which reduced the mortality rate for heart valve transplants from 70 percent to 8 percent.
When the world’s first heart transplant was accomplished by Dr. Christiaan Barnard of South Africa in December 1967, Dr. Cooley studied the techniques, perfecting them while waiting for an opportunity to perform a similar procedure. On May 3, 1968, Dr. Cooley performed his first heart transplant on Everett Thomas, a 47-year-old accountant from Phoenix. The donor was a 15-year-old girl who had attempted suicide. While her brain showed no activity, her heart was still beating. The patient survived 204 days. While controversy swirled about the procedure, Dr. Cooley performed 22 more heart transplants over the next year.
On April 4, 1969, Dr. Cooley passed a major medical milestone by implanting the first artificial heart. Haskell Karp, 47, from Skokie, Illinois, was awaiting a heart donor and lived with the artificial heart for 56 hours, responsive at times, until a donor heart became available. While the implant was a surgical success, the patient survived only a day and a half after receiving a donor’s heart. But Dr. Cooley was censured by the medical association for his unauthorized use of an artificial heart, and in the events that followed, Dr. Cooley resigned from Baylor. The patient’s widow filed suit for $4.5 million. The case was dismissed in 1972 by federal court and the decision was upheld by Supreme Court.
With advances in treatments and technology, Dr. Cooley switched the focus of his work to coronary bypass surgery using patients’ veins to bypass blocked arteries. By September 1972, Dr. Cooley had performed 10,000 open heart surgeries and 1,200 coronary bypasses. Over his career, Dr. Cooley has streamlined operative procedures, invented various surgical tools, and invented a fabric heart graft, which has been used by millions. Dr. Cooley is naturally an advocate for healthy living. Weighing in at 178 pounds, he was the same weight at 90 as he was in college.
Dr. Cooley has been recognized around the world for his accomplishments. Cardiovascular surgeons and fellows of the Texas Heart Institute honored Dr. Cooley in 1972 by forming the Denton A. Cooley Cardiovascular Surgical Society. The society currently has more than 800 members from 44 states and 49 countries.
In 1967, the International Surgical Society honored him with the Rene Leriche Award, its highest recognition, calling him “the most valuable surgeon of the heart and blood vessel anywhere in the world.”
In 1980, he received the Theodore Roosevelt Award (“The Teddy”) from the NCAA, the organization’s highest recognition for a former varsity athlete who achieves outstanding life accomplishments.
On March 26, 1984, President Reagan presented the Presidential Medal of Freedom, the nation’s highest award for a civilian. The president noted, “As one of this country’s leading heart surgeons, he has charted new territory in his search for ways to prolong and enrich human life.”
Dr. Cooley was also the recipient of the 1998 Medal of Technology and Innovation, awarded by President Clinton on April 27, 1999, “for his inspirational skill, leadership, and technical accomplishments during six decades practicing cardiovascular surgery, including performing the first successful human heart transplant in the United States and the world’s first implantation of an artificial heart in man as a bridge to heart transplantation; and for founding the Texas Heart Institute, which has served more heart patients than any other institution in the world.”
Once a trial lawyer asked him whether he considered himself to be the best heart surgeon in the world. “Yes,” answered Dr. Cooley. “Don’t you think that’s being rather immodest?” inquired the lawyer. “Perhaps, but remember I’m under oath,” Dr. Cooley replied.
While he has received some of the nation’s most prestigious awards, Dr. Cooley has kept his role in perspective. “So much goes into doing a transplant operation. All the way from preparing the patient to procuring the donor. It’s like being an astronaut. The astronaut gets all the credit, he gets the trip to the moon, but he has nothing to do with the creation of the rocket or navigating the ship. He’s the privileged one who gets to drive to the moon. I feel that way in some of these difficult operations, like the heart transplant.”
Dr. Cooley has been exceedingly generous. Through the foundation he established in 1958, he has supported endowed chairs at William and Mary College, the University of Texas at Austin, the University of Texas Medical Branch, and the University of Texas Medical School at Houston. His gift to the University of Texas School of Dentistry honoring his father was to endow a chair and build a new facility. “I think the role of philanthropist is one of the real satisfactions in life.” Dr. Cooley has shared his insights freely; he has authored more than 1,300 scientific articles and 12 books.
When Dr. Cooley retired from the presidency of the Texas Heart Institute after 46 years, he was replaced by Dr. James Willerson who had been the president of the University of Texas Health Science Center at Houston. Dr. Willerson was no stranger to Dr. Cooley. When he was a 15-year-old high school sophomore, his parents made arrangements for him to go with several doctors who were on their way to meet Dr. Cooley at the airport. Dr. Cooley was impressed by young Willerson and began what became a lifelong friendship. Dr. Willerson is a cardiologist, while Dr. Cooley was a surgeon. The transition reflects a change in cardiac treatments to less invasive procedures. Nevertheless, Dr. Cooley can be assured that his legacy is in good hands.
—Tom and Gena Metcalf
Cooley, Denton A. “100,000 Hearts: A Surgeon’s Memoir.” Briscoe Center for American History, University of Texas at Austin, 2012.
Cooper, David. Open Heart: The Radical Surgeons Who Revolutionized Medicine. New York: Kaplan Publishing, 2010.
Knapp, Marianne, ed. Reflections and Observations: Essays of Denton A. Cooley. Waco, TX: Eakin Press, 1984.