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Donald Nixon Ross,
FRCS Fellowship of the Royal Colleges of Surgeons (FRCS) is a professional certification, professional qualification to practise as a senior surgeon in Republic of Ireland, Ireland or the United Kingdom. It is bestowed on an wikt:intercollegiate, ...
(4 October 1922 – 7 July 2014) was a South African-born British thoracic surgeon who was a pioneer of cardiac surgery and led the team that carried out the first heart transplantation in the
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Northwestern Europe, off the coast of European mainland, the continental mainland. It comprises England, Scotlan ...
in 1968. He developed the pulmonary autograft, known as the Ross procedure, for treatment of aortic valve disease.


Early life and education

Donald Ross was born in
Kimberley Kimberly or Kimberley may refer to: Places and historical events Australia Queensland * Kimberley, Queensland, a coastal locality in the Shire of Douglas South Australia * County of Kimberley, a cadastral unit in South Australia Ta ...
,
South Africa South Africa, officially the Republic of South Africa (RSA), is the Southern Africa, southernmost country in Africa. Its Provinces of South Africa, nine provinces are bounded to the south by of coastline that stretches along the Atlantic O ...
, on 4 October 1922.Pioneers of Cardiology: Donald Ross, DSc, FRCS
''Circulation'': European Perspectives, 6 March 2007, downloaded from http://circ.ahajournals.org/ by guest on 25 December 2012
His parents were Scottish. He matriculated from Kimberley Boys' High School in 1939.


Early career

He began his medical career enrolling as a student at the
University of Cape Town The University of Cape Town (UCT) (, ) is a public university, public research university in Cape Town, South Africa. Established in 1829 as the South African College, it was granted full university status in 1918, making it the oldest univer ...
, training first as a dedicated scientist and subsequently as a
doctor Doctor, Doctors, The Doctor or The Doctors may refer to: Titles and occupations * Physician, a medical practitioner * Doctor (title), an academic title for the holder of a doctoral-level degree ** Doctorate ** List of doctoral degrees awarded b ...
. He graduated (BSc, MB, ChB) in 1946 with first-class honours and the university gold medal. He had also received a two-year overseas scholarship which allowed him to further his studies in the
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Northwestern Europe, off the coast of European mainland, the continental mainland. It comprises England, Scotlan ...
.


Career in surgery in England

Ross has recalled eagerly accepting the scholarship: once in England he took up a career in surgery and became a Fellow of the Royal College of Surgeons (1949) within two years instead of the usual three. Working initially in
Bristol Bristol () is a City status in the United Kingdom, cathedral city, unitary authority area and ceremonial county in South West England, the most populous city in the region. Built around the River Avon, Bristol, River Avon, it is bordered by t ...
he focused on chest and oesophageal surgery, and then began to include early cardiac surgery, such as on the
ductus arteriosus The ductus arteriosus, also called the ductus Botalli, named after the Italian physiologist Leonardo Botallo, is a blood vessel in the developing fetus connecting the trunk of the pulmonary artery to the proximal descending aorta. It allows mos ...
. He was appointed Senior Registrar in Thoracic Surgery, Bristol, in 1952. Ross acknowledges the particular influence on his career of two key figures: Ronald Belsey, MD, and Russell Claude Brock, FRCS, FRCP (later Lord Brock). Ross has recorded how Belsey, the oesophageal surgeon in Bristol with whom he was working, took him to
Guy's Hospital Guy's Hospital is an NHS hospital founded by philanthropist Thomas Guy in 1721, located in the borough of Southwark in central London. It is part of Guy's and St Thomas' NHS Foundation Trust and one of the institutions that comprise the Kin ...
in
London London is the Capital city, capital and List of urban areas in the United Kingdom, largest city of both England and the United Kingdom, with a population of in . London metropolitan area, Its wider metropolitan area is the largest in Wester ...
to see Sir Russell Brock attempt to split open a calcified aortic valve. "There was no open-heart surgery in those days, and the operation was a dramatic failure. But the drama involved convinced me that I had to study new developments in cardiac surgery." Ross had been a fellow student of Christiaan Barnard at the
University of Cape Town The University of Cape Town (UCT) (, ) is a public university, public research university in Cape Town, South Africa. Established in 1829 as the South African College, it was granted full university status in 1918, making it the oldest univer ...
, the man who carried out the world's first heart transplantation at Cape Town's
Groote Schuur Hospital Groote Schuur Hospital is a large government-funded teaching hospital situated on the slopes of Devil's Peak (Cape Town), Devil's Peak in the city of Cape Town, South Africa. It was founded in 1938 and is famous for being the institution where ...
. Throughout his early training, moreover, he had felt a lure toward chest surgery and cardiology because they seemed to be the most active specialities in an era when very little could be done for a patient with heart disease of any type. Dr Brock, in charge of surgery at Guy's Hospital, took on Mr Ross as a cardiovascular Research Fellow (1953) and later as Senior Thoracic Registrar (1954). Four years later, in 1958, Ross was appointed Consultant Cardiothoracic Surgeon, and subsequently Consultant Surgeon, National Heart Hospital in London (1963), and Senior Surgeon there (1967). In 1970, he was made Director of the Department of Surgery at the Institute of Cardiology, London. Ross retired in 1997.


First heart transplantation in the United Kingdom

It was in 1968 that Donald Ross led the team of doctors (including Keith Ross (no relation) and Donald Longmore and the anaesthetist Alan Gilston.) and nurses at the National Heart Hospital in London in the United Kingdom's first heart transplantation. The operation, on a 45-year-old man, lasted 7 hours. The patient survived for another 46 days before dying from what was described at the time as an "overwhelming infection." Looking back, Ross observed that it was almost logical that he should lead the team for the United Kingdom's first transplantation. "Operations on the open heart introduced the need to be able to deal with a quiescent heart action, so like most cardiac surgeons, I was involved in operating on an arrested heart and, as an extension of that, a quiescent transplanted heart…We felt that transplantation was a natural evolution." There had been a surge of media attention around the heart transplantation, but the team had not considered the surgery itself particularly unique or challenging. The greatest issue faced was overcoming rejection of the newly transplanted heart. "We did not feel we had achieved any particular advances in transplantation at that time," Ross has said, "and we stopped after the third transplantation because the problem of rejection had not been overcome."


The Ross procedure

Ross's greater achievement was the development, in 1967, of what has been termed the Ross procedure, or pulmonary autograft for aortic valve disease. He has said that his interest had lain "particularly with the valves—especially the aortic valve—but, in general, anything that was related to the function of the heart." Initially he was involved in developing a bypass machine and the use of hypothermia to facilitate open heart surgery. In 1962 Ross introduced the use of homografts to replace diseased aortic valves. He used a technique of subcoronary implantation developed in the laboratory by Carlos Duran and Alfred Gunning in Oxford. Despite early promise, homografts had a limited life span of around 8 years. The pulmonary autograft, now widely known as the Ross procedure, first performed in 1967, was the logical development of the homograft: it involves replacing a patient's damaged aortic valve with his or her own pulmonary valve. Ross believed that, "with care, the patient's own living pulmonary valve could be transplanted to replace the diseased aortic valve in that critical and vulnerable position and that it could persist there permanently." The benefits of the procedure were that it did not require lifelong anticoagulation with its attendant risks, and it could grow proportionately with the patient, making it suitable for use in children.


Honours and awards

Ross is recipient of the following honours and awards: * Honorary FRCSI, 1984 * Honorary FRCS Thailand, 1987. * Honorary DSc CNAA, 1982. * Clement Price Thomas Award, Royal College of Surgeons, 1983. * Order of Cedar of Lebanon, 1975; * Order of Merit (1st class) (West Germany), 1981; * Royal Order (Thailand), 1994.


Publications

* ''A Surgeon's Guide to Cardiac Diagnosis'', 1962; * Co-authored ''Medical and Surgical Cardiology'', 1968; * Co-authored ''Biological Tissue in Heart Valve Replacement'', 1972; * He has also contributed to the ''
British Medical Journal ''The BMJ'' is a fortnightly peer-reviewed medical journal, published by BMJ Publishing Group Ltd, which in turn is wholly-owned by the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world ...
'', ''
The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal, founded in England in 1823. It is one of the world's highest-impact academic journals and also one of the oldest medical journals still in publication. The journal publishes ...
'' and other journals.


On future prospects in cardiac surgery

In retirement, Mr Ross anticipated much in the future of cardiac surgery, for example, with respect to the burgeoning role of
radiology Radiology ( ) is the medical specialty that uses medical imaging to diagnose diseases and guide treatment within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiation), but tod ...
in both the diagnosis and treatment of heart disease. He was an advocate for tissue engineering to address the worldwide shortage of human organs and tissues for transplantation procedures.


Extramural interests

Outside of his medical pursuits, Ross bred
Arabian horse The Arabian or Arab horse ( , DIN 31635, DMG ''al-ḥiṣān al-ʿarabī'') is a horse breed, breed of horse with historic roots on the Arabian Peninsula. With a distinctive head shape and high tail carriage, the Arabian is one of the most easi ...
s, and he had been a devotee of the
theatre Theatre or theater is a collaborative form of performing art that uses live performers, usually actors to present experiences of a real or imagined event before a live audience in a specific place, often a Stage (theatre), stage. The performe ...
,
opera Opera is a form of History of theatre#European theatre, Western theatre in which music is a fundamental component and dramatic roles are taken by Singing, singers. Such a "work" (the literal translation of the Italian word "opera") is typically ...
, and, particularly,
chamber music Chamber music is a form of classical music that is composed for a small group of Musical instrument, instruments—traditionally a group that could fit in a Great chamber, palace chamber or a large room. Most broadly, it includes any art music ...
at the
Wigmore Hall The Wigmore Hall is a concert hall at 36 Wigmore Street, in west London. It was designed by Thomas Edward Collcutt and opened in 1901 as the Bechstein Hall; it is considered to have particularly good building acoustics, acoustics. It specialis ...
.


Death

Ross died in London on 7 July 2014.


References


External links


1968: Surgeons conduct UK's first heart transplant
* {{DEFAULTSORT:Ross, Donald Nixon 1922 births 2014 deaths University of Cape Town alumni Fellows of the Royal College of Surgeons of England Scottish surgeons British cardiac surgeons 20th-century Scottish medical doctors South African people of Scottish descent Fellows of the Royal College of Surgeons in Ireland British transplant surgeons 20th-century British surgeons South African emigrants to the United Kingdom Alumni of Kimberley Boys' High School