James Daniel Hardy (1918–2003)

James Daniel Hardy was a surgeon and researcher practicing in the United States during the twentieth century who studied organ transplantation, or the transfer of an organ from a donor to another individual. In 1963, he performed one of the first recorded lung transplants from a human lung donor. The transplant was successful for three weeks before the patient died of kidney failure. In 1964, Hardy also performed one of the first human heart transplants with a chimpanzee donor, and the transplanted heart pulsed for ninety minutes in the patient’s chest prior to death. He also collaborated on one of the first successful uterus and ovary transplants in a dog, in 1966. Hardy’s research on organ transplantation helped paved the way for improved forms of the technique, which as of 2025 saves the lives of millions of people every year.

1. Early Life and Education
2. Army Years and Surgery
3. Returning to Residency
4. Open Heart Surgery and the Move to Transplantation
5. Human Heart Transplantation
6. Later Years

Early Life and Education

Hardy was born on 14 May 1918 in Birmingham, Alabama, to Julia Ann Poyner and Fred Henry Hardy. Hardy’s father was the owner of a lime manufacturing plant, which converted limestone to white calcium oxide, or quicklime. Prior to marriage, his mother was a schoolteacher who taught at both a high school and a university. He had a typical middle-class childhood alongside his twin brother, Julian Patterson Hardy, his younger brother Taylor, and four stepsiblings. Hardy received his early education from the local public school district along with his mother’s tutoring lessons. Later on, he completed his secondary education at Montevallo High School in Montevallo, Alabama, where he played football and the trombone. In 1935, he graduated second in his class. Then, from the fall of 1935 to 1938, Hardy completed his pre-medical studies at the University of Alabama in Tuscaloosa, Alabama, with a major in chemistry and minors in zoology and German.

After graduating from the University of Alabama with his bachelor’s degree, Hardy began his education in the fall of 1938 at the University of Pennsylvania’s medical school in Philadelphia, Pennsylvania. At medical school, Hardy was required to participate in the Reserve Officers Training Corps, or ROTC, a college program training students for future service in the Army, Navy, Marine Corps, Air Force, or Space Force. He was also a member of the Phi Chi medical fraternity and president of the honor medical society, Alpha Omega Alpha. As a medical student, Hardy began clinical research in wound healing. At the end of his senior year, Hardy and four of his peers, under the mentorship of Harold Zintel, a resident in surgery at the time, published his first research article in 1942. The article was initially published in the medical journal Surgery and was titled “The Effect of Therapeutic Blood Levels of Sulfonamides Upon Wound Healing.” The article summarized the results of sulfonamides, a group of drugs that primarily treat infections, on uninfected wounds. The study’s results did not provide significant evidence supporting the idea that sulfonamides would improve the healing of uninfected wounds. Hardy received his medical degree in 1942 from the University of Pennsylvania.

Following graduation, Hardy completed his internship year and nine months of an internal medicine residency at the University of Pennsylvania Hospital. During his residency, Hardy turned his research to physiology of the circulatory system, which is the body system that moves blood throughout the body using the heart and blood vessels, and bodily fluids. He worked with Isaac Starr, a physician and researcher who studied diseases of the heart and developed the ballistocardiograph, an instrument that measures the body’s movement as a result of the heart ejecting blood. Starr suggested that Hardy and his peer Lincoln Godfrey should research the heart’s blood output using the ballistocardiograph and determine whether intravenous fluid treatment would increase blood output, allowing for the replenishment of nutrients and a removal system for waste. Hardy demonstrated that intravenous fluids do increase the blood output for dehydrated patients, and the Journal of the American Medical Association published their article “Effect of Intravenous Fluids on Dehydrated Patients and on Normal Subjects” in 1944. Hardy also worked on a blood plasma substitute project, where they investigated plasma volume expanders to aid soldiers experiencing blood loss. Physicians use plasma volume expanders to retain volume in circulatory system, which ultimately helps with blood flow and pressure. Hardy and colleagues concluded that gelatin is an effective substitute to increasing the blood volume. They published their results in The Journal of Clinical Investigation in 1945. At the Starr lab, he also conducted a study investigating whether individuals with low protein blood levels will still absorb amino acids at a normal rate and published the results in 1952 in The Journal of Applied Physiology.

Army Years and Surgery

In 1944, Hardy left his internal medicine residency program to join the US Army and serve in World War II. His first permanent assignment was at the Stark General Hospital in Charleston, South Carolina, where he met his future wife, Louise Scott Sams. In October of that same year, the US Army reassigned Hardy to the 81^st Field Hospital, which was a unit that began in September of 1944. Then, in December of the same year, Hardy was sent to Europe, where he moved between camps in England, France, and Germany. In 1945, the war concluded, and Hardy returned to the US.

In 1946, Hardy became chief of the ear, nose, and throat, or ENT, department at the Pentagon, Washington, D.C., which is the headquarters for the US Department of Defense. Hardy writes in his autobiography that it was during his time at the Pentagon when he knew that he wanted to pursue surgery instead of internal medicine. In July of 1946, he was discharged in pursuit of a surgical career.

Returning to Residency

In 1946, Hardy returned to the University of Pennsylvania to complete his medical residency. After communicating with his previous mentors and the surgical department, he was able to switch from the internal medicine program to the surgical program. As a resident, Hardy received the title of chief resident and chose to specialize in thoracic surgery, which includes any operation in the organs of the chest. In the late 1940s, he applied for and received a Damon Runyon Clinical Research Fellowship, an award that provides funding to early career scientists. The fellowship award enabled Hardy to continue developing his research interests.

In 1949, Hardy married Louise Scott Sams in a Presbyterian church in Decatur, Georgia. In 1950, Hardy’s first daughter, Louise Röska-Hardy, was born, and his second daughter, Julia Ann Hardy, was born the following year in 1951. He also completed his residency at the University of Pennsylvania that same year. Along with completing his residency, the University of Pennsylvania awarded him a Master of Medical Science in physiological chemistry for his previous research in bodily fluids and circulatory physiology.

In 1951, Hardy moved his family to Memphis, Tennessee, and worked as the Director of Surgical Research, surgical staff member, and eventually associate professor of surgery, at the University of Tennessee College of Medicine in Memphis. In 1952, the Society of University Surgeons elected him as a member. Later that same year, he published his first book, Surgery and the Endocrine System, a comprehensive review on the relevant advancements and surgical concepts in endocrinology, or the study of hormones, and the endocrine system. During his time in Tennessee, the recently founded four-year medical school at the University of Mississippi in Jackson, Mississippi, offered Hardy a position as chairman of the surgery department. Hardy explains in his autobiography that he wanted the position of chairman of surgery before retirement, so he immediately accepted the position. In 1955, Hardy moved from Memphis to moving to Jackson. In 1953, Hardy’s third daughter Bettie Winn Hardy was born. In 1954, Hardy published his second book, Fluid Therapy, which summarized the importance of understanding body fluid physiology during surgery and the use of intravenous fluid treatment for ill patients. Then in 1955, his fourth daughter, Katherine H. Little, was born. In the same year, Hardy helped develop the surgical department, along with the curriculum for the medical student and residency training programs and moving his clinical lab from Memphis to Jackson.

Open Heart Surgery and the Move to Transplantation

Hardy’s research lab began experimenting with open heart surgery at the University of Mississippi’s medical school in 1956, shortly after technological advances had made that type of surgery safer. In 1953, John Heysham Gibbon, a surgeon, had invented the heart-lung machine, which enables surgeons to perform open-heart surgery without stopping a patient’s circulation. Hardy’s started performing heart surgery on animal subjects with Gibbon’s heart-lung machine. After years of animal experimentation, Hardy and Watts Webb, another physician specializing in thoracic surgery performed their first open-heart operation on a human patient with hypothermia in 1959. The successful operation launched the hospital’s open-heart patient program, which provided open-heart surgeries to patients in critical condition.

Around the same time when Hardy and his team were researching open-heart surgeries, they were also researching animal organ transplantation with a goal to one day attempt it in humans as well. Hardy’s work on organ transplantation built on prior attempts by others at transplanting several types of organs. Skin transplantation, or skin grafts, had become common by the early 1900s, while transplanting other organs came later. For example, in 1947, Vladimir Demikhov, a researcher working on organ transplantation in Moscow, Russia, performed the first recorded lung transplantation with dogs, which survived for ten days afterward. Then in 1954, Joseph Murray, a physician who practiced plastic surgery at Harvard Medical School in Boston, Massachusetts, performed the first successful human organ transplantation surgery with a kidney. His success led to rapid growth in experimental organ transplantation research, but as the research grew, so did its ethical and moral dilemmas. Scientists considered various ethical issues that come from organ donation including, where the organs should come from, who should be providing the organ for the surgery, and the lack of a specific criteria defining death for potential donors. In 1959, Richard Lower and Norman Shumway, physicians researching organ transplantation, were among the first to successfully transplant a heart from one dog to another. By the 1960s, scientists continued researching kidney and liver transplants, but there remained significant criticism and attacks on the experiment science.

After seven years of animal lung transplantation research, Hardy and Webb proposed conducting one of the first human lung transplantation. Due to ethical and clinical concerns about endangering a human patient, they outlined four specific transplant criteria regarding the recipient patient, including that the recipient must have a fatal disease and would have to benefit significantly from a successful lung transplant. In June 1963, a fifty-eight-year-old male candidate who came from the state penitentiary presented to the hospital with cancer in his left lung. He fit all four pillars of Hardy’s transplant criteria, and Hardy along with the surgical teams performed the first human lung transplantation on 11 June 1963 using a lung from a human cadaver. The lung transplant was successful, but three weeks later the patient died due to uncontrollable renal failure, which was unrelated to the transplant surgery. An autopsy demonstrated no evidence for lung rejection, which is when the immune system attacks the transplanted lung tissue, confirming the transplantation itself a success. The lung transplant received mixed responses, but many commenters accepted the surgery as Hardy had set a moral criterion and received informed patient consent. After Hardy’s lung transplant, for the next twenty years researchers and surgeons attempted lung transplantation, but there were not many successful cases.

Human Heart Transplantation

By 1964, Hardy had performed several hundred heart transplants in animals, and the success of his lung transplant encouraged him to attempt the first ever human heart transplantation. Hardy planned to transplant a chimpanzee heart into a human recipient. At that time, ethical committees had not yet established the concept of brain death, which is the irreversible loss of all functions of the brain. Brain death is the state at which organs are most commonly removed from deceased donors as of 2024. Hardy’s procedure required a heart from a human donor, but since it was difficult to find a donor that met the criteria at the time, he turned to chimpanzees. Chimpanzees are closely related, genetically, to humans, and Hardy had observed a chimpanzee that had the same cardiac output as a human. As a result, he decided to have the chimpanzee as an option for heart transplantation. On 22 January 1964, the university hospital at the University of Mississippi admitted a comatose sixty-four-year-old male with a history of high blood pressure and heart attacks. That night, the patient underwent terminal shock and then cardiac arrest. The patient’s family gave Hardy permission to perform a heart transplantation. On 23 January 1964, Hardy transplanted a chimpanzee heart into the patient with an accompanying pacemaker placement. The complete surgery was recorded on film and the patient was alive for ninety minutes with the chimpanzee heart before he died. Hardy explains that the patient had died due to his deteriorating metabolic state but also mentions that the heart was not able to maintain the blood flow back into the heart.

Because they transplanted a chimpanzee heart rather than a human heart into a human recipient, Hardy and his colleagues received significant criticism from the medical community and the general public. At the Sixth International Transplantation Conference, a panel was put together for heart transplantation. The panelists gave the operation both criticism and praise. Most of Hardy’s critics attacked him for placing a lower primate’s heart into a human body, saying that such a procedure was unethical because it was crossing species barriers. Despite the backlash, Hardy continued his research in organ transplantation.

Later Years

In 1966, Sadan Eraslan, a physician working at the University of Mississippi Medical Center, alongside physician Robert J. Hamernik and Hardy, performed the first successful uterus and ovary transplantation in a dog, resulting in a successful pregnancy. They had yet to transplant the organs into a different dog but he and Suinstead were able to remove the ovaries and uterus and transplant it back into the same dog. Hardy, Eraslan, and Hamernik replicated their own uterus transplantations in eighteen nonpregnant female dogs. The procedure allowed for successful transplantation in ten of the eighteen dog subjects and two pregnancies by the time of publication. The surgeons published their article “Replantation of Uterus and Ovaries in Dogs, With Successful Pregnancy” in the Archives of Surgery in 1966. Since Hardy, Eraslan, and Hamernik’s uterus transplantation, researchers continued to improve the transplantation making it possible to conduct in humans.

In 1967, criticism from scientists regarding organ transplantations shifted due to the first recorded successful human-to-human heart transplantation by surgeon Christiaan Barnard.

Barnard, who was working in Cape Town, South Africa, conducted the first human-to-human heart transplantation, where the patient survived for 18 days. As more attempts were made, the patients ended up surviving for a longer period of time. In his autobiography, Hardy writes that the criticism for organ transplantations as an experimental science appeared to dissipate overnight in the United States following Barnard’s successful operation. Barnard’s transplantation demonstrated that heart transplantations were no longer experimental, and thus, the attitude of scientists and research committees towards transplants shifted. Transplant teams in the United States quickly emerged, and the National Institutes of Health held a meeting at the O’Hare Airport in Chicago, Illinois, to discuss the future of transplants in 1967. From that point forward, global scientific communities viewed Hardy’s transplants and other scientists’ attempts at transplantations as innovative, rather than radical and immoral.

In the 1970s and 1980s, Hardy continued teaching, participating in surgery, researching and writing, while still working at the University of Mississippi. In 1971, he published his book Critical Surgical Illness, a comprehensive summary of issues and illnesses that occur during surgery and how to treat them. In 1979, Hardy was elected as president-elect of the American College of Surgeons, a professional medical association for surgeons and surgical staff dedicated to providing ethical care to the patient. His presidency began in 1980. In 1981, his team published new editions of various books including the Scientific Foundations of Surgery and Complications in Surgery and Their Management. Hardy also published a surgical textbook titled Hardy’s Textbook of Surgery in 1983. Hardy retired from the department of surgery at the University of Mississippi School of Medicine in 1987. In 2000, his wife died from Alzheimer’s disease.

Hardy has authored twenty-four books, including surgical textbooks, and published over 500 articles in medical publications. He has also written autobiographical memoirs, including The Academic Surgeon and The World of Surgery, 1945–1985: Memoirs of One Participant. Hardy influenced heart and lung transplantation technology in the US through his research and publications. Succeeding surgeons expanded and improved upon the techniques he created and used in his attempts at heart and lung transplants, which provide necessary live-saving therapy for patients with terminal illnesses. In 2023, surgeons in the US performed 4,540 heart transplantations and 3,025 lung transplantations. After Eraslan and Hardy’s work with uterus transplants, researchers continued researching using uterus transplants as treatment option for uterus disorders and transgender women. As of 2024, uterine transplantations are still in the process of being researched, but in 2022, forty successful births had occurred from uterus transplantations globally. Hardy’s attempts at the first heart and lung transplantation surgeries influenced other researchers to experiment with organ transplantation surgeries and deliver success.

Hardy died on 19 February 2003 at the age of eighty-four in Jackson, Mississippi.

Sources

1. Aru, Giorgio M., Kenneth D. Call, Lawrence L. Creswell, and William W. Turner Junior. “James D. Hardy: A Pioneer In Surgery (1918 to 2003).” The Journal of Heart and Lung Transplantation 23 (2004): 1307–10.
2. Cooper, David K.C. “Christiaan Barnard —The Surgeon Who Dared: The Story of The First Human-to-Human Heart Transplant.” Global Cardiology Science & Practice 2 (2018). https://pmc.ncbi.nlm.nih.gov/articles/PMC6062759/ (Accessed May 28, 2025).
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5. Dunn, Rob. The Man Who Touched His Own Heart: True Tales of Science, Surgery, and Mystery. New York: Little, Brown and Company, 2015.
6. Eraslan, Sadan, Robert J. Hamernik, and James Hardy. “Replantation of Uterus and Ovaries in Dogs, With Successful Pregnancy.” Archives of Surgery 92 (1966): 9–12.
7. Fleischmann, Walter. “Surgery and the Endocrine System Physiologic Response to Surgical Trauma-Operative Management of Endocrine Dysfunction. James Daniel Hardy.” The Quarterly Review of Biology 29 (1954): 83. https://www.journals.uchicago.edu/doi/10.1086/400023 (Accessed May 28, 2025).
8. Fletcher, A.G., James D. Hardy, C. Riegel, and C.E. Koop. “Gelatin as a Plasma Substitute: The Effects of Intravenous Infusion of Gelatin on Cardiac Output and Other Aspects of the Circulation of Normal Persons, of Chronically Ill Patients, and of Normal Volunteers Subjected to Large Hemorrhage.” The Journal of Clinical Investigation 24 (1945): 405–15.
9. Hardy, James, and Lincoln Godfrey Junior. “Effect of Intravenous Fluids on Dehydrated Patients and on Normal Subjects: Cardiac Output, Stroke Volume, Pulse Rate and Blood Pressure.” Journal of the American Medical Association 126 (1944): 23–5.
10. Hardy, James Daniel, and Julius Schultz. “Jejunal Absorption of an Amino Acid Mixture in Normal and in Hypoproteinemic Subjects.” Journal of Applied Physiology 4 (1952): 789–92.
11. Hardy, James Daniel. Fluid Therapy. Philadelphia: Lea & Febiger, 1954.
12. Hardy, James Daniel, Watts R. Webb, Martin Dalton Jr, and George R. Walker. “Lung Homotransplantation in Man: Report of the Initial Case.” Journal of the American Medical Association 186 (1963): 1065–74.
13. Hardy, James Daniel , Carlos M. Chavez, Fred D. Kurrus, William A. Neely, Sadan Eraslan, Don Turner, Leonard W. Fabian, and Thaddeus D. Labecki. “Heart Transplantation in Man: Developmental Studies and Report of a Case.” Journal of the American Medical Association 188 (1964): 1132–40.
14. Hardy, James Daniel, and Carlos Chavez. “The First Heart Transplant in Man: Developmental Animal Investigations with Analysis of the 1864 Case in the Light of Current Clinical Experiences. ” The American Journal of Cardiology 22 (1968): 772–81.
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27. Zintel, H.A., D.B. Freshwater, J.D. Hardy, W.M Harris, C.S. Neer, and S.W. Robinson. “The Effect of Therapeutic Blood Levels of Sulfonamides Upon Wound Healing.” The American Journal of Medical Sciences 204 (1942): 915.