50th Anniversary: First Heart Transplant

Upon celebrating 50 years since the first heart transplant one has to wonder at the bravery and daring of Dr. Christiaan Neethling Barnard and his team that performed this operation on 3 December 1967.

Doctors and veterinary surgeons had been experimenting on transplanting different organs in animals for many years. Body parts such as kidneys had been successfully transplanted into humans but many surgeons were afraid to take the risky step of transplanting a heart until there was a guarantee of absolute success.

It has to be conceded that the road to the transplant was paved by the work of medical pioneers whose discoveries in medicine made the transplant possible. Anaesthetics, X Rays, antiseptics, immunosuppression, analgesics, antibiotics, and advanced technology were some of the innumerable non-human factors that made the operation possible. But the final one step required for the first transplant required immense courage, vision and pragmatism. The quote attributed to Dr. Chris Barnard attests to the above: ‘It is infinitely better to transplant a heart than to bury it to be devoured by worms.’

Nowadays when transplants and double organ transplants are commonplace and the functioning of the heart in the body is better understood, it becomes difficult to grasp the tremendous significance of the transplant. The heart was to many a sacrosanct organ that was the basis of life and could therefore not be disturbed. One can therefore wonder at the origins of Dr. Barnard and at what shaped him.

Christiaan Neethling Barnard was born in the Karroo in the Cape Province on 08 November 1922. His father was a minister of the Dutch Reformed Church. Although many say, the young Chris did not particularly display much intellect he was highly disciplined, focused and curious; qualities that enabled him to qualify as a medical doctor and to become a specialist at a young age. Incidentally, Dr. Barnard was not the only medical doctor in the family, his younger brother Marius was part of his original transplant team!

Dr. Barnard studied for his junior degree at the University of Cape Town. He completed both his Masters and Doctorate of Medicine at the same institution in 1953. Although his dissertation was titled, ‘The treatment of tuberculous meningitis’, he concurrently undertook research work on Intestinal atresia (bowel obstruction) in infants. The technique he developed; was adopted in the UK and the USA helping to save many babies.

In 1956 he started postgraduate training on surgery of the intestines under Dr Owen H. Wangensteen at the University of Minnesota, USA after receiving a scholarship. He later joined Walt Lillehei’s, the pioneer in open heart surgery.

In 1958, Dr. Barnard was awarded his degree in Master of Science in Surgery for his thesis ‘The aortic valve – problems in the fabrication and testing of a prosthetic valve’. Also in the same year, he defended his doctoral thesis, titled ‘The aetiology of congenital intestinal atresia’ and received his second PhD.

Dr. Barnard returned to South Africa and joined Groote Schuur Hospital in Cape Town as cardiothoracic surgeon in 1958. Subsequently, he established the hospital’s first heart unit. He shortly became full-time lecturer and Director of Surgical Research at the University of Cape Town and then the Head of the Division of Cardiothoracic Surgery. By 1961 he was Associate Professor in the Department of Surgery at the University of Cape Town.

Dr. Barnard was an inexhaustible hard worker; he lectured, experimented prolifically, carried out operations and still had time for research. He designed artificial valves for the human heart with Carl Goosen and also performed transplantation of the hearts in dogs. All this work stood him in good stead when the opportunity for the first human to human transplant presented itself.

The opportunity for Dr. Barnard and his team of thirty personnel came when he met 54-year-old Louis Washkansky, who was suffering from extensive coronary artery disease. He agreed to take a chance with an experimental procedure. On 3 December 1967, Washkansky received the heart of Denise Darvall a young lady who had become brain dead as a result of an accident on 2 December 1967.

The transplant was successful, Washkansky was able to talk and breathe independently after the operation. The operation was not widely publicised beforehand but before long thereafter it had become an international story of a medical miracle. A wonder operation had been performed, frontiers of surgery moved and medical boundaries shifted. Washkansky unfortunately died from double pneumonia after eighteen days.

Although Dr. Barnard received a lot of attention and adulation and even became an international celebrity after the transplant, he never stopped work on refining techniques and on experimenting with new ones. Notwithstanding a high failure rate after the initial transplant leading to much disappointment, Dr. Barnard was not discouraged instead he worked on improving the post-transplant prognosis. He improved the postoperative regimen and devised a new technique in 1974. In this heterotopic technique, or piggyback technique, the donor heart is added to the patient’s diseased heart. It proved to be more viable with his longest surviving patient living for 23 years thereafter.

The heart transplant was just the beginning and it is heartening to know that lifesaving work on treating heart patients continues and the legacy of the original team continues.