December 3rd is a historic day in modern medical history – this year marked the 50th anniversary of the world’s first heart transplant. Once considered the stuff of science fiction, this miraculous procedure now saves thousands of lives each year, with 3,191heart transplants performed in the United States in 2016 alone.

The medical miracle of heart transplantation has affected the world for so much the better. More personally, it has dramatically influenced my own journey as a clinician, medical scientist, and U.S. Senator with life lessons, and helped shape current and future holistic models of the continuum of patient care delivery.

I vividly remember seeing, when I was 15 years old, the LIFE magazine cover featuring South African heart surgeon Christiaan Barnard and his patient Louis Washkansky, the very first recipient of another person’s donor heart. Barnard had leap-frogged several pioneering American surgeons, who had spent years painstakingly perfecting the procedure through systematic bench and animal research. Barnard borrowed their techniques and took advantage of South Africa’s more lenient medical ethics laws to find a donor. Washkansky went on to live 18 days before his body rejected the donor heart.

Dr. Barnard opportunistically won the race and got the glory, but the decades long, meticulous legwork necessary to accomplish this surgery was led by my friend and mentor Dr. Norman Shumway. As a young heart surgeon, I had the privilege of studying at Stanford under Dr. Shumway, who is widely considered the true father of heart transplantation and the surgeon almost all had expected to achieve the medical milestone of performing the first transplant.  A month after Barnard’s operation, Dr. Shumway completed the first heart transplant in the United States on January 6, 1968.

Dr. Barnard put heart transplantation on the map, but it was Dr. Shumway’s longstanding commitment to disciplined, principled research and perfectionism that ultimately established it as the standard of care for those with terminal heart disease. After that first transplant on December 3, 1967, a flurry of high-profile heart surgeons followed suit with their own attempts at the procedure – with dismal results. Approximately 85% of these patients died soon after transplantation, and most surgeons abandoned the field, concluding transplantation of the heart too challenging.

These surgeons painfully learned that the success of the surgical procedure itself was not sufficient for long-term patient survival. That would require more meticulous research into the biology and immunology associated with rejection of the transplanted organ. Again it was Dr. Shumway who systematically led the way in determining how to diagnose rejection and how to manage the delicate balance between rejection and infection. Where others had failed, he kept 40% of his patients alive and over time steadily improved those results.

Lesson 1.  Tenacious persistence and discipline trump opportunism every time.

Still, these early outcomes threatened heart transplantation as a viable medical treatment. When I was in my surgical training at Massachusetts General Hospital (MGH), the MGH board of trustees in 1980 mandated that the surgeons would not be allowed to do heart transplants. I was amazed and deeply disappointed in what I strongly felt to be a short-sighted and unwise policy decision, especially in light of the fact that much of basic transplant immunology had been defined at MGH and that the hospital had a world-class clinical research tradition.

MGH Director Dr. Charles A. Sanders said the crucial question considered was “what choice would reap the greatest good for the greatest number.” The board argued that the procedure was unproven and too costly. They said no to innovation. The chilling effect of this well intended but ill-considered policy meant New England would not see a heart transplant until four years later – when Brigham and Women’s Hospital decided to take the lead after MGH abdicated. Clinically, Boston fell far behind the rest of the world in the field.

Lesson 2. Well intended but bad public policy can destroy innovation.

The moratorium of heart transplants in Boston also meant that I had no choice but to leave Boston and MGH if I were to pursue the promising field of heart transplantation.  I moved west and joined the nation’s leading heart transplant clinical research center, Stanford University Medical Center, to study under Shumway. There, he and his team continued to make consistent, step-by-step progress to improve patient survival, first by creatively inventing instruments and a method for sampling heart tissue to diagnose early rejection, and then through investigational use of the drug cyclosporine, which suppressed the immune system of the transplant recipient sufficiently to prevent the body from rejecting the new heart. It was 1983, and I was thrilled to join the team dedicated to finding innovative solutions to seemingly insurmountable problems.

Lesson 3. Impactful innovation isn’t just the new invention, it’s successfully addressing all the new problems the invention introduces.

I remember like it was yesterday the first time I ever cut out a human heart and replaced it with the heart of another person. The patient was a young girl who would otherwise have died within six months, but with the transplant received a second chance at life. It was 3 a.m. when I stepped back from the operating table and watched under the bright spotlight the new heart slowly wake up, come to life, and then begin beating powerfully in her chest.

Lesson 4. Doctors are good facilitators, but the real miracle is the biology of the human body. Stay humble.

Fast-forward to 2017. This June, I joined physicians, nurses, patients, and families to celebrate the Vanderbilt Transplant Center’s 1000th heart transplant. After learning from the best in Boston and Stanford, I along with my colleague Dr. Walter Merrill created Vanderbilt’s heart transplant program in 1985 (closely following the Shumway method of disciplined scientific discovery and a team-based, nurse-centric approach). Today the Vanderbilt University Medical Center is neck-in-neck with Cedars Sinai for the busiest heart transplant program in the country, with approximately one hundred heart transplants performed this year.

One of our very first patients, Jimmy Moore, is alive today, nearly 32 years after receiving his new heart. The five infants less than a year old (some operated on as early as six days of age) we transplanted in the early 1990s are all with us today thanks to continued advances in transplantation medicine. We have come a long way and the science continues to progress.

Lesson 5. If you build a fundamentally strong foundation, the impact can grow exponentially over time.

Advances in heart transplantation over the last 50 years opened new doors, leading to lung transplantation which evolved a few years later and better care for patients with other conditions. For example, our experiences at Vanderbilt in the 1980s of managing hundreds of patients with advanced heart disease first planted the seeds that, 30 years later, grew into building what has become a nationwide palliative care organization for those with serious illness.

Without enough donor hearts to transplant all these referrals, we set up the first-of-their-kind, multidisciplinary care teams that managed each of these severely ill heart patients (Referrals for transplantation at that time were made only if the patient was judged to have less than six months to live.). The tightly knit teams were comprised of nurses, social workers, physical therapists, nutritionists, chaplains, ethicists  — and, yes, doctors — who treated the patient’s mental, spiritual, emotional and physical health. This heretofore had not been done at scale because no single center had such high a concentration of patients dying from such advanced disease.   To our amazement, this team-based, holistic approach focusing on the patient and the family led to a much longer than expected life, and a life of much higher quality. A remarkably successful new care model had emerged.

Recollections of this novel approach in the sickest of all patients in the 1980s led me in 2013 to create, with co-founder Brad Smith, Aspire Health. Aspire Health has grown to become the largest, non-hospice, community-based palliative care organization in the country, treating over 20,000 patients a day.

Lesson 6. Developing a solution to a bad problem today just might lead to game-changing solutions for other challenges tomorrow.

Yes, transplantation has taught us to innovate and believe the impossible can be possible. Whenever we faced a setback, Dr. Shumway had us return to the laboratory to design experiments to solve it. Diligent, consistent scientific research holds the key to future medical milestones (and it’s one of the reasons we must continue robust federal funding for scientific research – but that’s another story!).

And so, as we address how to strengthen care delivery today, we have learned from the transplant care model that the type of care that is truly transformative and saves lives requires a team. The surgeon may be the one making the cut and replacing the heart, but a successful transplant is a massive feat of coordination, with nurses, anesthesiologists, social workers, psychiatrists and the family all playing a role. The holistic, team-based approach that Dr. Shumway touted, and that we stood up at Vanderbilt’s Transplant Center 30 years ago, is today fundamental to treating the increasing number of patients with advanced serious illness.

As we embark on this new era of more value-based healthcare, and promotion of health and well-being of the individual, the lessons we have learned from the past 50 years of heart transplantation will serve as useful guidelines for the future.