Christiaan Barnard, in a highly controversial surgery, successfully transplanted a human heart from a donor to a recipient. Although his patient, Louis Washkansky, lived only eighteen days after the operation, Barnard’s procedure would be refined to become more effective at increasing patients’ lifetimes and improving their quality of life.

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 was achieved, surgeons had performed innumerable heart transplants on dogs, calves, and lower primates in preparation for the first human attempt. Yet, the unsolved problems of rejection by the immune system of the recipient and the emotional, moral, and legal aspects of removing a yet-living heart from a brain-dead donor were major obstacles. On December 2, 1967, Christiaan Barnard of Groote Schuur Hospital, Cape Town, South Africa, and his thirty-member team overcame those barriers to perform the first human heart transplant. Even though the transplant was considered only partially successful because the patient, Louis Washkansky, lived only eighteen days, it was eminently successful in opening a new frontier in modern medicine. Surgical procedures;heart transplant
Heart transplants
Organ transplants
[kw]Barnard Performs the First Human Heart Transplant (Dec. 2, 1967)
[kw]Heart Transplant, Barnard Performs the First Human (Dec. 2, 1967)
[kw]Transplant, Barnard Performs the First Human Heart (Dec. 2, 1967)
Surgical procedures;heart transplant
Heart transplants
Organ transplants
[g]Africa;Dec. 2, 1967: Barnard Performs the First Human Heart Transplant[09510]
[g]South Africa;Dec. 2, 1967: Barnard Performs the First Human Heart Transplant[09510]
[c]Health and medicine;Dec. 2, 1967: Barnard Performs the First Human Heart Transplant[09510]
Barnard, Christiaan
Washkansky, Louis
Darvall, Denise

Louis Washkansky had suffered several major heart attacks since his first bout with angina in 1960. In addition to the irreparable destruction of the coronary vessels, which deliver blood to the heart muscle itself, and of both ventricles, which are the lower chambers of the heart, he suffered from diabetes.

In November, 1967, the team worked steadily to prepare for this landmark surgery. Marthinus Botha Botha, Marthinus , the immunologist, was ready to do the tissue matching of a donor heart when it became available, according to the methods developed by Jan van Rood Van Rood, Jan and Paul Terasaki Terasaki, Paul . Arderne Forder Forder, Arderne , a bacteriologist, studied innumerable swabs from Washkansky’s body to determine the presence of potentially dangerous bacteria. Forder was also studying similar swabs from the entire care-giving team. Many antiseptic washings of the patient’s entire body were carried out in addition to the preparation of a germ-free room for his recovery. The hospital staff built a temporary mobile cobalt radiation apparatus to use to prevent the heart’s rejection by Washkansky’s white blood cells; thus, the machine could be brought to the patient.

A review of reports from the United States and Europe on the signs of incipient rejection proved to be more confusing than informative. Therefore, continuous studies were done of Washkansky’s blood chemistry, liver, kidneys, and lungs to establish a standard by which to judge between rejection and infection. Peter Rose-Innis Rose-Innis, Peter , the neurosurgeon, and the emergency room personnel were requested to report a possible donor. This led to a false alarm on November 23 because of the deterioration of a donor heart in the hours before the donor’s parents could be reached to obtain consent.

Washkansky’s condition continued to worsen daily. On the afternoon of Saturday, December 2, twenty-five-year-old Denise Darvall and her mother, Myrtle, were struck by an automobile while crossing the street. Myrtle Darvall Darvall, Myrtle was killed instantly, and the staff at Groote Schuur Hospital knew that Denise’s severely fractured skull was beyond repair. By 5:30 p.m., Dr. Rose-Innis had ascertained the cessation of all reflexes, and a flat EEG confirmed her brain’s death. Artificial respiration was applied to keep her heart beating. Within the next few hours, Dr. Botha was able to establish her tissues’ relative compatibility with Washkansky. Her father, Edward Darvall, gave permission for the donation of her heart.

By 1:30 a.m. of December 3, both operating rooms were in readiness, and Washkansky was anesthetized. In a most critical and difficult step for Barnard and his pioneering team, the respirator was withdrawn from Darvall at 2:10 a.m. Fifteen minutes later, her heart ceased to beat. It was then chilled to prevent deterioration, and heparin was given to prevent blood clotting. The heart was removed by Christiaan Barnard; his brother Marius Barnard; Terry O’Donovan; Coert Venter; and Cecil Moss, the anesthesiologist.

In the other operating room, when Christiaan Barnard prepared to remove Washkansky’s diseased heart, a moment of crisis arose. Hardening of the femoral artery caused difficulty in attaching the heart-lung machine needed to give the patient’s organs oxygen while his body would be temporarily without a heart. While the team attempted to remedy this problem, his blood spilled out on the floor. Soon thereafter, the recipient team of Christiaan Barnard; Rodney Hewitson; François Hitchcock; Siebert Bosman; and Joseph Ozinsky, the anesthesiologist, removed Washkansky’s heart while bathing Darvall’s heart in his blood. Two hours later, the suturing of the last of the new heart’s major blood vessels was complete. The next major difficulty now occurred: It took almost an hour and three attempts to get the donor heart to beat in the recipient’s chest cavity. Each time, Washkansky had to be attached temporarily to the heart-lung machine. Finally, at 6:24 a.m., the team rejoiced when they saw the first human heart ever transplanted beat strongly in Louis Washkansky.

While antirejection therapy was begun by the injection of massive doses of hydrocortisone, prednisone, and Imuran, the patient was rapidly transported to a sterile room. The hospital superintendent was informed that the first heart transplant had been accomplished. His first announcement to the press on December 3 was followed in the next few days by a deluge of press representatives who constantly tried to enter the sterile areas, climbed trees outside the patient’s room, and demanded endless press conferences with the team.

Washkansky, known as a brave, feisty, uncomplaining person, now began a seesaw existence as his new heart fought for his life. His deliberately weakened immune system failed to fight effectively against infection, and it fought to reject the new foreign heart. The long cobalt treatment wore him out, his pulse raced, and his enzyme levels rose. Higher doses of both antirejection drugs and antibiotics were given. He felt much better from December 9 to 14; his oxygen tent was removed, and he was given sterilized newspapers and a radio. His heart and kidney functions normalized, he was allowed visits from adult family members, and he was even allowed to sun himself on the balcony.

The struggle began on December 15. Daily, endless conferences of the thirty-member team could not solve the problem: to determine whether the infection or rejection was the cause of his increasing fever, chest pains, and weakness. Ultimately, it was a massive bacterial pneumonia of both lungs that caused Washkansky’s death on December 21. Since the postmortem showed no rejection of the new heart, it seemed that the team had been more vigorous than necessary in their use of antirejection methods. Yet, they were not vigorous enough in their use of therapy against infection, which they were unable to diagnose in time.

Washkansky’s death was a crushing blow to Barnard, but he and his team learned that heart transplantation was possible and promptly planned to apply their hard-won knowledge to saving others for whom a new heart was their only hope for continued life.

It was expected for some time that the first heart transplant would be performed in a major American cardiac center where decades of research and preparation had already occurred. Yet, while these gifted, talented surgeons stood ready, Christiaan Barnard used the knowledge and skill he had acquired from them and, with courage—some say audacity—performed this unique operation. His action had an immediate impact on the medical community. Others, once free of their hesitancy and scruples, performed five transplantations in the next two months, and 170 transplantations were done worldwide in the next three years.

Between 1946 and 1958, Soviet Vladimir Demikhov Demikhov, Vladimir performed heart transplants on 250 dogs, attaching a second heart within each, thereby proving it was possible to restart a heartbeat by electric shock. During the 1960’s, Norman E. Shumway Shumway, Norman E. of Stanford, believing human transplants would soon be possible, performed endless experiments to develop the technique. Working apace with Shumway were Richard Lower Lower, Richard , Adrian Kantrowitz Kantrowitz, Adrian , and James Hardy Hardy, James . They perfected the use of hypothermia to keep the donor heart from deteriorating. They learned how to attach the atria, or two top chambers, without destroying the nerve centers.

Barnard, during a fellowship at Minneapolis in 1955, learned open-heart surgery from Owen Wangensteen along with C. Walton Lillehei and returned to South Africa with the first heart-lung machine. In 1966, Barnard returned to the United States to study kidney transplantation. Instead, he learned from Lower what he had experienced already while working for ten years with Shumway at Stanford. Barnard then performed his own canine experiments in South Africa.

Undeterred by the failure of Hardy in 1964 when his patient, Boyd Rush, died two hours after a chimpanzee heart was transplanted, Barnard took his giant step on December 2, 1967. Immediately thereafter, on December 6, Kantrowitz performed the first heart transplant on an infant, who survived only two hours. Although Washkansky had died after eighteen days, on January 2, 1968, Barnard proceeded with a transplant of Philip Blaiberg Blaiberg, Philip , who lived 593 days before the heart was rejected by his immune system. A veritable flood of transplants followed: January 6 by Shumway, January 10 by Kantrowitz, and February 16 by P. K. Sen in Bombay. By 1971, Denton A. Cooley Cooley, Denton A. and Michael Ellis De Bakey De Bakey, Michael Ellis of Texas had performed more than thirty transplantations, while Shumway had performed twenty.

Among the first 170 transplantations performed worldwide, fifty patients died from rejection of the heart, thirty died of infections, and others died from various other causes. After four attempts, Barnard gave up. Heart transplants all but ceased in the 1970’s; the rejection problem needed to be solved by biochemists and immunologists. In 1969, the answer was found by Jean-François Borel Borel, Jean-François with the discovery of cyclosporine, which not only killed any immune cell but also killed the T lymphocytes that multiply in response to foreign tissue.

Christiaan Barnard’s dream today is a daily occurrence throughout the world, because he dared to do something and make it a reality. In the United States alone, about two thousand heart transplants were being performed annually in the early twenty-first century, and the one-year survival rate had increased to more than 86 percent for males and 84 percent for females, while the three-year survival rate had reached about 79 percent for males and 76 percent for females, indicating that the procedure was no longer merely experimental and afforded the vast majority of its recipients with additional prospects of longer quality of life. Surgical procedures;heart transplant
Heart transplants
Organ transplants

• Barnard, Christiaan, and Curtis Bill Pepper. Christiaan Barnard: One Life. New York: Macmillan, 1969. Biography of Christiaan Barnard. Part 7, “The Transplant,” contains detailed information in a highly readable style on the actual operation and postoperative care of Washkansky. Parts 4-6 shed light on the years of study and preparation for this epic surgery. Parts 1-3 chronicle Barnard’s early years. Contains index.
• Blaiberg, Philip. Looking at My Heart. New York: Stein & Day, 1968. Written four months after Blaiberg became Barnard’s second transplant patient. Since Washkansky died after eighteen days, little is known about Washkansky’s reactions to this experience. Blaiberg’s book is a straightforward report on what it is like to live with another person’s heart.
• Frist, William. Transplant. New York: Atlantic Monthly Press, 1989. As director of the Heart Transplant Program at Vanderbilt University Medical Center, Dr. Frist has performed more than one hundred transplants. Especially good explanation of how cyclosporine has helped solve the problem of heart rejection. Excellent review of federal legislation regarding transplants.
• Gohlke, Mary, with Max Jennings. I’ll Take Tomorrow. New York: M. Evans, 1985. On March 9, 1981, Mary Gohlke survived the first transplant of heart and both lungs. Interesting narrative of her experience. Shows great advances in transplantation two decades after Barnard’s pioneering work.
• Gutkind, Lee. Many Sleepless Nights: The World of Organ Transplantation. New York: W. W. Norton, 1988. Documents the evolution of transplantation, especially in the United States. Very thorough summary of the state of the art of transplantation. Especially interesting account of the work of Pittsburgh’s Presbyterian University Hospital, the world’s largest transplant center. Includes index.
• Hawthorne, Peter. The Transplanted Heart. Skokie, Ill.: Rand McNally, 1968. Fast-paced, interesting account of the first heart transplant written within two months of the event by a South African journalist. Written largely from interviews with the transplant team and other Groote Schuur personnel. Best source of information in conjunction with the Barnard/Pepper book (cited above). Illustrated.
• Leinwand, Gerald. Transplants: Today’s Medical Miracles. New York: Franklin Watts, 1985. Brief overview of transplantation: techniques, difficulties, moral and legal questions. Written for adolescents. Includes bibliography and index.
• McRae, Donald. Every Second Counts: The Race to Transplant the First Human Heart. New York: G. P. Putnam’s Sons, 2006. Tells the story of the four surgeons racing in 1967 to become the first transplanter of a human heart and how Barnard won the race. Bibliographic references and index.
• Thompson, Thomas. Hearts: Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac Frontier. New York: McCall, 1971. Describes the heart transplants performed three years after Barnard’s. Focuses especially on the work of Cooley and De Bakey in Texas. Most important feature of the book is a complete chronological list of the 170 heart transplants attempted from Hardy’s surgery in 1964 until March 1, 1971. The list includes place, survival time, and eventual cause of death for nonsurvivors.
• Thorwald, Jürgen. The Patients. Translated by Richard Winston and Clara Winston. New York: Harcourt Brace Jovanovich, 1972. An excellent and surprisingly complete account of the first heart transplant. Particularly interesting when contrasted with his account of Hardy’s 1964 attempt on Boyd Rush and Cooley’s transplantation on Everett Thomas in May, 1968. Index.

Blalock and Taussig Perform the First “Blue Baby” Surgery

Bevis Describes Amniocentesis as a Method to Check Fetal Genetic Traits

Donald Uses Ultrasound to Examine Human Fetuses

Lasers Are First Used in Eye Surgery

Favaloro Develops the Artery Bypass Surgery