Brian Keeley explores the discrepancies between the realities of heart transplantation and its representation in popular culture, calling for a more realistic and sensitive approach based on lived experience. The article was presented at the Medical Humanities and the Fantastic: Neurodiversity and Disability Online Symposium.
Heart transplantation has been a medical reality since Dr Christiaan Barnard conducted the first procedure in 1967, yet the ways in which it is portrayed in fiction film continue to perpetuate outdated superstitions and myths. These deny reality in favour of the fantastical or supernatural. I argue that heart transplant recipients’ lived experiences have become fair game for fictional exploitation in ways that would not be acceptable if applied to people with other corporeal differences or medical conditions.
There were over 8,000 heart transplants across the world in 2020.[i] A transplant is the only viable treatment for end-stage heart failure, and this was made possible with the introduction of immuno-suppressant drugs in the early 1980s. These drugs prevent organ rejection, but also increase the risks from infections and cancer.[ii] A transplant brings with it a shortened life expectancy, lifelong clinical monitoring, and constant medication. Recipients may also live with physical impairments and the psychological impact of surviving critical illness. Many also face practical life challenges post-transplant, including unemployment, loss of income, and reliance on health benefits or pensions.[iii]
The heart continues to hold a powerful symbolic status, and many of its historical associations have become attached to representations of heart transplantation in film and other media. There is a disconnection between such outdated symbolic ideas about heart transplantation and reality. It is, therefore, important to have some basic understanding of how the heart works – particularly when it is transplanted. The traditional understanding of a beating heart as determining life or death has been superseded by advances in medical science and knowledge. It is routine for the heart to be stopped during surgical procedures, and during transplantation the donor heart survives outside the body until it is successfully grafted into the recipient. People can survive for six months or more with a total artificial heart (TAH) as a bridge to transplantation.[iv] A heart can also continue beating in a brain-dead patient, with the aid of mechanical ventilation. A patient in this state is considered to be dead, and this is a typical precondition for procurement of hearts for donation.
Popular notions of the heart as the centre of emotion and personality still persist, although these are demonstrably fantastical when we consider that a transplanted heart has had its nerve connections severed. It receives no parasympathetic control to regulate the resting heart rate, so it functions independently of the brain.[v] The connection between the heart and the brain is physiological, and the absence of nerve connections in transplant recipients does not affect personality or the ability to feel emotions. Nevertheless, theories about personality change in heart transplant recipients still surface in academic research and popular culture.
Other popular myths in fictional portrayals of heart transplantation involve ‘bodily integrity’ and emotional attachment to one’s heart. During a heart transplant, the old heart is simply removed and discarded. We see an example of this in the 2018 BBC documentary ‘Heart Transplant: A Chance to Live’. When the surgeon Asif Hasan, removes the diseased heart of 9-year-old Max Johnson, he instructs an assistant to “throw it in the bin.” [vi] After his successful transplant, Max helped change English law on organ donation to presumed consent. This became known as ‘Max and Keira’s Law’ after Max and his donor, a child who had died in a car crash.[vii]
Any effect on the ‘embodied self’ or sense of identity following transplant is more likely a psychological effect of the trauma of surviving long critical illness. A psychological study of heart transplant recipients as early as 1992 found that 79% of respondents reported no personality change, and many ridiculed the very suggestion. 15% reported changes as a legacy of the trauma rather than the transplant itself. Only three individuals reported ‘fantasising’ that they had undergone personality changes associated with incorporating the donor’s personality traits.[viii]
Heart transplantation has provided a rich source of inspiration for creators of mainstream fiction films. These are overwhelmingly imagined interpretations, rather than those which reflect reality, and there is a distinction between plausible fiction and fantastic narratives. A search for the keywords ‘heart transplant’ in the Internet Movie Database (IMDB), reveals 208 titles[ix]. Excluding short films, documentaries, TV episodes, a sample of sixty films show a clear plot reference to ‘heart transplant.’ Of these, horror and science-fiction genres account for thirty (50%), and these typically associate heart transplantation with criminality including murder and organ trafficking. There are twenty-three films (c. 40%) which focus on supernatural phenomena or relationships involving a heart transplant recipient, a deceased donor, and a donor’s loved one. Such relationships can be referred to as ‘biosentimentality’ – a term coined by Lesley Sharp, in her 2006 book Strange Harvest.[x] Only six films (10%) deal with realistic portrayals, and these are mostly biopics and others based on true stories. So, around 90% of fictional films which portray heart transplantation, do so in ways that are not only fictionalised, but fantasised.
Heart transplantation has not been in the realm of fantasy for more than half a century, but the popularity of fantastical stories created by filmmakers shows no signs of waning. An increasing awareness of the psychological impact of heart transplantation also coincides with films since the 1990s where psychological themes and family relationship dynamics have become more common.[xi] Even recent films such as Last Christmas (2019), and the Nexflix productions The Marked Heart (2022) and Chambers (2019), variously link heart transplantation with violence, fear, and supernatural relationships.
An analysis of how the media influences public perceptions of organ donation in 2005 found that the most influential source of information came from fictionalised portrayals of heart transplantation, with films having a significant negative influence on people’s willingness to become organ donors.[xii] Interviewees in the study often referred to movies they had seen on television where “something dreadful happened involving organ donation” including “premature declaration of death, the transference of personality traits from donor to recipient, and a black market for organs.” [xiii] The study concluded that a more responsible approach to the subject may foster more positive attitudes to the important issue of organ donation.[xiv]
Portrayals of heart transplantation may inform – or misinform – public attitudes, but there also ought to be a more consideration on the part of filmmakers and financers for those who are directly impacted by transplantation. For bereaved loved-ones of organ donors, terminally ill people waiting desperately for a transplant, and those trying to rebuild their lives post-transplant, the reality is very different from those narratives which are presented from non-experiential perspectives.
Heart transplantation is a serious health condition which has been the lived experience for many people for more than half a century, yet potentially damaging and offensive misrepresentations in film culture are still tolerated. This is despite societal attitudes having rightly changed in many areas relating to depictions of marginalised people, including those with other medical conditions, disabilities, or corporeal difference. Therefore, more critical discourse around the ethics of exploiting heart transplantation for entertainment would be a step forward.
About the Author
Brian Keeley is a visual artist, filmmaker, and heart transplant recipient. He is currently undertaking a PhD in Film & Visual Culture at the University of Aberdeen which examines contemporary art and cultural representations of heart transplantation.
Renaissance – by Brian Keeley
This artwork is a life-sized self-portrait using magnetic resonance imaging (MRI) scans, created in collaboration with the University of Aberdeen’s Biomedical Imaging Centre. This image shows the interior of my body, including the transplanted heart which has been beating within me since 2013. Surrounding the figure is a collage of the 7,600 packages from the medications which I need to stay alive for one year. RENAISSANCE deals with the fragility and preciousness of life, at the intersection of art and medical science. It refers to the sense of rebirth following heart transplant. It also symbolises humankind’s relationship with medical science in the form of the iconic Vitruvian Man. (See more on Brian Keeley’s website)
Aware – by Brian & Bibo Keeley (still from short film, 2022)
The short film Aware was commissioned by the Scottish Mental Health Arts Festival 2022, and screened at the CCA in Glasgow during the 2022 SMHAF festival. (Watch the short film on the festival’s website)
[i] Global Observatory on Donation and Transplantation, International Activities report, (2020), http://www.transplant-observatory.org/2020-international-activities-report/ accessed 05 June 2022
[ii] Tönshoff, Burkhard, Immunosuppressants in Organ Transplantation, (Handb Exp Pharmacol. 2020), 261:441-469:1
[iii] Marcinkowska, Urszula et al. Professional and social activity of patients after heart transplant, International journal of occupational medicine and environmental health vol. 28,4 (2015): 741-9:747
[iv] Achilles V. Aiken, Tahli Singer-Englar et al. Outcomes Of Total Artificial Heart Placement – The Learning Curve From A Single-Center Experience, Journal of Cardiac Failure, Volume 28, Issue 5, Supplement, (2022) Page S61, https://www.sciencedirect.com/science/article/pii/S1071916422002597 accessed 08 June 2022
[v] James A. Arrowood et al. Absence of Parasympathetic Control of Heart Rate After Human Orthotopic Cardiac Transplantation, Circulation Journal Circulation. 1997; 96:3492–3498
[vi] Heart Transplant: A Chance to Live, (2018), producer – James L Newton, 7 Wonder Productions, for BBC TWO, UK
[vii] NHS Blood and Transplant Services, organ donation website, Max, heart transplant recipient and campaigner, (2020), https://www.organdonation.nhs.uk/helping-you-to-decide/real-life-stories/people-who-have-benefitted-from-receiving-a-transplant/max-heart-transplant-recipient-and-campaigner/ accessed 02 June 2022,
[viii] Bunzel, B., Schmidl-Mohl, B., Grundböck, A. et al. 1992, Does changing the heart mean changing personality? A retrospective inquiry on 47 heart transplant patients. Qual Life Res 1, 251–256
ix] Internet Movie Database (IMDB) keyword search – ‘heart transplant’, accessed 02 June 2022, https://www.imdb.com/search/keyword/?keywords=heart-transplant&ref_=kw_ref_key&sort=alpha,asc&mode=advanced&page=1
[x] Sharpe, Lesley, Strange Harvest: Organ Transplants, Denatured Bodies, and the Transformed Self, (Berkeley: University of California Press, 2006)
[xi] Kalra, Gurvinder and Bhugra, D, Representation of Organ Transplantation in Cinema and Television, International Journal of Organ Transplantation, Med 2011; Vol. 2 (2011), page 96
[xii] Morgan, Susan E, Tyler R. Harrison, Shawn D. Long, Walid A. Afifi, Michael S. Stephenson, and Tom Reichert. Family discussions about organ donation: how the media influences opinions about donation decisions. Clinical transplantation 19, no. 5 (2005): 674-682, page 681
[xiii] Morgan, Susan E, Tyler R. Harrison, Shawn D. Long, Walid A. Afifi, Michael S. Stephenson, and Tom Reichert, Family discussions about organ donation: how the media influences opinions about donation decisions, Clinical transplantation 19, no. 5 (2005): 674-682, page 676
[xiv] Kalra, Gurvinder and Bhugra, D, Representation of Organ Transplantation in Cinema and Television, International Journal of Organ Transplantation, Med 2011; Vol. 2 (2011), page 98