Faculty Bibliography

Before the doctors discovered the source of that dangerous complication at surgery about six hours after the implant, they had said Mr. Schroeder's operation went ''perfectly.'' Today, the only blood loss was ''oozing,'' not of major importance, Dr. [Allan M. Lansing] said. He also said, ''There appear to be no major complications in any of the organ systems.'' Mrs. Schroeder said: ''We sat down and said, 'Dad, do what you want to do.' He said, 'I have no thoughts but to go all the way.' We said, 'We are behind you.' ''

''They were very relieved, very thankful,'' Dr. [Allan M. Lansing] said, ''to the medical and surgical teams and to the Lord, for the benefits of this day.'' Today, Dr. Lansing said, he could not recall any ''moments of high excitement.'' The strain on the heart team came more from trying to cut through the scars left from a cardiac bypass operation that Mr. [William J. Schroeder] underwent in March 1983. As Dr. Lansing held Mr. Schroeder's natural heart in his hands, he saw evidence of ''multiple previous heart attacks,'' he said. ''I know you will,'' Mr. Schroeder replied. ''I trust you.''

As for his own view of Mr. [William J. Schroeder]'s prospects, Dr. [Allan M. Lansing] said: ''He's just right. He can't live much longer without it, yet I think he is strong enough to survive it.'' Dr. DeVries's team revised the informed consent form before Mr. Schroeder signed it to include specific details about the complications that Dr. [Barney B. Clark] experienced. The form also allowed Mr. Schroeder to designate an advocate with the power to make decisions on his behalf if he became physically or mentally disabled. Further, it gives Dr. DeVries the authority to release to the public any information about the procedure ''within generally accepted bounds of good taste.'' His doctors said Mr. Schroeder faced just as stormy and complicated a period following the implant as Dr. Clark did. Dr. [Robert K. Jarvik] said his team could offer ''no promises'' but that it hoped ''the individual feels his life is enhanced'' by the experiment

Generally, by the time symptoms develop, such as the heart and kidney failure Baby Fae experienced, the rejection reaction is irreversible. For that reason some doctors knowledgeable about transplant reactions were less optimistic about the chances for Baby Fae's recovery than were the reports coming from Loma Linda. It was such caution - perhaps excessive - on the part of Dr. Bailey's team that led Loma Linda doctors to say that they may have brought on Baby Fae's rejection reaction inadvertently by prescribing too small amounts of cyclosporin-A for her. One is the amount of swelling, called edema, that appears in the heart, presumably from damage to its blood vessels. Normal heart cells are tightly bound, but when severe edema is present in a rejection reaction, the muscle cells may be separated. The abnormality helps explain why the rejection reaction can disrupt normal heart function

Each time a new test is developed, scientists have to determine how accurately it detects what it is supposed to detect. In the case of what scientists call a ''false positive,'' test results indicate evidence of infection when, in fact, the specimen is from someone who is infection-free or who has been infected with an agent biologically similar to the one being studied. Conversely, a ''false negative'' occurs when a test fails to detect the presence of an agent. Obviously, each type of error can be extremely harmful, both for the person falsely labeled as having a disease such as AIDS and for the person who receives infected blood. Why so few of the estimated 20,000 hemophiliacs in the United States using Factor VIII therapy have developed the syndrome is not known. Some epidemiologists suspect that hemophiliacs contract AIDS because of contamination of an entire lot of Factor VIII that may have been used by more than 100 individuals, but no lot of Factor VIII has yet been proved to have infected more than one victim. Another possibility is that some hemophiliacs have developed asymptomatic AIDS infections, or an early, unmanifested form of the disease. AIDS is not like measles, in which virtually every susceptible person who comes in contact with the measles virus gets the disease. In fact, as with polio, only a tiny percentage of those who get infected with AIDS go on to develop the severe form of the disease. The situation breeds confusion. For example, some patients living in large cities have gone elsewhere for transfusions in the mistaken belief that blood received there would be safer than blood donated near home. But much of the blood collected in one area of the United States is transfused elsewhere. In several transfusion-associated AIDS cases, the donated blood came from more than one city. In one case in the Middle West, for example, the 22 units of blood a patient received came from 6 states. THE NEWS OF A LINK between Factor VIII and AIDS led some hemophiliacs to stop taking the component, despite the urging of National Hemophilia Foundation officials that the risk of not taking the therapy outweighed the risk of getting AIDS. Avoiding Factor VIII injections could lead to uncontrolled bleeding as well as pain and swelling of the joints

Baby Fae's doctors were encouraged that she survived as long as she did. But success with such highly experimental procedures as baboon heart transplants cannot be measured only in terms of survival times. Survival times with transplanted animal organs must be compared with the times that babies with Baby Fae's condition would usually live with their birth defects. Quality of Life Loma Linda doctors have said the baby lived her best days with the animal heart. ''Baby Fae has now lived longer with her transplanted heart than with her own lethally malformed heart,'' they said in a statement Nov. 11. ''Sunday, Day 16, has probably been the best day of her life to date,'' they added, even though on that day her body was struggling to reject the heart in an episode that the hospital was then denying. Dr. [Leonard L. Bailey], the surgeon who performed the operation on Baby Fae, said her case was successful enough for him to plan another one ''by and by.'' It is anyone's guess when that will be, and the date almost certainly will be affected by the debates that physicians, ethicists and others will hold in the weeks to come at Loma Linda and elsewhere

Dr. [Leonard L. Bailey] thanked Baby Fae's parents for offering ''a ray of hope for the babies to come.'' He said her family felt ''the surgery was worth it'' and told him ''not to let this opportunity be wasted.'' ''It has shown us that it is definitely feasible,'' Dr. [Sandra L. Nehlsen-Cannarella]-Cannarella said. But, she added, ''we can define that it didn't work because we lost the patient.'' A memorial service for Baby Fae will be held at 4 P.M. Saturday on the Loma Linda University campus. Dr. Bailey said her parents would probably speak out about their experience in the near future. ''I think you'll find it very impressive,'' Dr. Bailey said

In an interview in The American Medical News, a newspaper published by the American Medical Association in Chicago, Dr. [Bailey] said that after the parents took the baby from the medical center, they ''were notified that one final possibility existed for their child: They were told to think it over and to readmit the child if they were interested.'' The Los Angeles Times, reporting interviews with friends of Baby Fae's mother, said today that after the diagnosis of the fatal heart birth defect was made, a physician told the mother she could take the baby home to die, leave her at Loma Linda to die or put her back in Barstow Community Hospital, where she was born. Mr. Weismeyer said Loma Linda had no comment on the newspaper's report. Dr. Bailey also told The American Medical News: ''In disorders like Baby Fae's, a baboon heart not only may be justifiable, it actually may be preferable to a human heart.'' He added, ''We're optimistic that within three months, she'll be able to go home.''