Salem Press

Science and Scientists
Heart Transplantation

The Science
Christiaan Barnard transplanted the first human heart, opening a new era in medicine.

The Scientists
Christiaan Barnard (1922-2001), a South African heart surgeon
Louis Washkansky (1914-1968), the recipient of the first transplanted
human heart

A Heart for Louis
In 1967, many surgeons in medical centers throughout the world were on the verge of performing the first human heart transplant. Since 1954, when the first successful kidney transplant had been achieved, surgeons had performed innumerable heart transplants on dogs, calves, and monkeys in preparation for the first attempt on humans. Major obstacles had to be overcome. For example, the immune systems of heart recipients tended to reject the new hearts. This problem had not yet been solved. There were also moral, legal, and emotional problems with transplanting a heart into a human.

Nevertheless, on December 2, 1967, Christiaan Barnard and the thirty members of his team transplanted the heart of Denise Darvall into the body of Louis Washkansky at the Groote Schuur Hospital in Cape Town, South Africa. Even though Washkansky lived for only eighteen days after the operation, a whole new medical frontier had been entered.

Washkansky had suffered several major heart attacks since 1960. His coronary vessel, which sends blood to the heart muscle, was almost completely destroyed, and both ventricles (the lower chambers of the heart) were also failing.

Beginning in November, 1967, Barnard's team got themselves and Washkansky ready for the transplant. Marthinus Botha, the immunologist, would have to make sure that the new heart matched Washkansky's body. Arderne Forder, a bacteriologist, looked for any dangerous bacteria, not only in Washkansky but in all the team members as well. Washkansky was washed many times to remove any germs, and a germ-free recovery room was prepared. The biggest risk was that the doctors might not be able to tell the difference between rejection of the new heart and an infection.

Washkansky's health was getting worse every day. On November 23, a possible heart was found, but it failed before the parents of the donor could be reached for permission. On the afternoon of December 2, twenty-five-year-old Denise Darvall and her mother, Myrtle, were hit by a car as they were crossing a street. Myrtle Darvall was killed instantly. Denise Darvall was taken to Groote Schuur Hospital, but her skull was fractured in many places, and the doctors knew there was no hope. By 5:30 P.M., her brain was dead. A machine was used to keep her heart beating, and after a few hours Botha found that her heart would match with Washkansky's. Edward Darvall, Denise's father, gave permission for her heart to be given to Washkansky.

Eighteen Days of Success
By 1:30 A.M., on December 3, the team was ready. Washkansky was anesthetized in one room, while in another room Darvall's heart was taken off the machine. Fifteen minutes later, her heart stopped beating. It was then chilled to keep it from decaying, and a drug was used to prevent the blood from clotting. Darvall's heart was then removed from her body by Barnard and his surgical team.

Barnard then prepared to remove Washkansky's diseased heart. There was a moment of crisis when he found that one of the arteries was hardened, making it difficult to attach the heart-lung machine that would keep the patient alive while his heart was taken out. While the team hurried to try to connect the machine, Washkansky's blood spilled out on the floor.

When everything was ready, Washkansky's heart was removed by Barnard. Meanwhile, Darvall's heart was bathed in Washkansky's blood. Two hours later, the heart was fully connected. The next major problem came in trying to get the heart to beat. Almost an hour later, at 6:24 A.M., the first human heart ever transplanted began to beat strongly in Washkansky. The patient was rushed to the germ-free recovery room and given drugs to stop his body from rejecting his new heart.

Once the press was told of the operation's success, reporters began climbing trees to peek inside Washkansky's window. Some tried to go into the sterile room, and others demanded press conferences with Barnard and his team.

Washkansky was known as a brave, feisty, uncomplaining person, but for the next eighteen days, his health went up and down. The doctors had weakened his immune system so that, even though it tried, it could not reject the new heart. Unfortunately, it was also too weak to fight germs. He was exhausted by the drug and radiation treatments, and his heart raced.

By December 9, though, he felt better. His oxygen tent was removed, and he was given sterilized newspapers and a radio. His heart was working normally, and he was allowed visits from adult family members. He was even allowed to sun himself on the balcony.

The struggle began again on December 15, with weakness, a rising fever, and chest pains. The thirty-member team met for long hours every day, trying to figure out whether his body was fighting an infection or his new heart. Finally, on December 21, Washkansky died of bacterial pneumonia in both lungs. After his death, there was no sign that his body had rejected Denise Darvall's heart. The doctors had mistakenly fought too hard against rejection and not hard enough against infection.

Washkansky's death was a crushing blow to Barnard. Yet he and his team had learned that heart transplants were possible and quickly began planning ways to use this hard-won knowledge to save others.

Impact
It had been expected that the first heart transplant would take place in the United States, where doctors had been preparing for it for decades. Barnard took the knowledge he had learned from the Americans and with courage--some say arrogance--went ahead and did a transplant. As soon as he did, other doctors, who had been waiting cautiously, followed his lead. Five heart transplants took place in the next two months, and 170 in the next three years.

However, of the first 170 transplant operations, 50 recipients died from rejection of the heart, 30 died from infections, and others died for other reasons. After four tries, Barnard gave up. Almost no transplants were done during the 1970's; the rejection problem needed to be taken care of first.

In 1969, Jean-François Borel discovered cyclosporine, which not only killed any immune cell but also killed the T lymphocytes that spread to fight any foreign tissue, such as a transplanted heart. Cyclosporine became widely used after 1983, when it was finally approved by the U.S. Food and Drug Administration, and doctors once again began transplanting hearts.

Although many legal, moral, and emotional questions surrounding heart transplants remained, and although the numbers of people waiting for hearts outnumber the numbers of available hearts that are usable, heart transplantation was established by the end of the twentieth century as a medical procedure, in large part thanks to the actions of Barnard and his team. By the 2003, more than two thousand transplant operations were being undertaken annually in the United States alone.

See Also
Blood Groups; Blue Baby Operation; Hand Transplantation.

Further Reading
Barnard, Christiaan, and Curtis Bill Pepper. Christiaan Barnard: One Life. New York: Macmillan, 1969. Blaiberg, Philip. Looking at My Heart. New York: Stein & Day, 1968. Frist, William. Transplant. New York: Atlantic Monthly Press, 1989. Gohlke, Mary, with Max Jennings. I'll Take Tomorrow. New York: M. Evans, 1985. Gutkind, Lee. Many Sleepless Nights: The World of Organ Transplantation. New York: W. W. Norton, 1988. Hawthorne, Peter. The Transplanted Heart. Skokie, Illinois: Rand McNally, 1968. Thompson, Thomas. Hearts: Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac Frontier. New York: McCall, 1971.

Grace Dominic Matzen