50 years ago —
The human heart transplant, led by Dr Christiaan Barnard, was made possible by an extraordinary interplay of scientific dedication, human courage and generosity and a timely chain of events
I was towards the end of my second year in medicine in then Calcutta when the news broke out on December 3, 1967: the first heart transplant in the world had been successfully carried out by Dr Christiaan Barnard and his team at the Groote Schuur Hospital in Cape Town, South Africa. Like my friends, and the medical fraternity all over the world, I too was quite excited about this fantastic exploit. But I was as yet too immature to understand much about it or about its repercussions and wider implications for the field of medicine and of surgery, particularly with regard to the treatment of heart disease, save to appreciate with the rest of my friends and our teachers that this was what we would call today a game-changing moment and event in the history of medicine.
After the news had calmed down, and then we heard about the second transplant carried out again by Dr Barnard, we got on with our own studies. But the topic of cardiac transplantation sort of hung about in the air, and I remember vaguely that in the ensuing year, a professor PK Sen from Bombay who had attempted the procedure came to deliver a lecture on the topic in my medical school. I had little notion then what surgery was all about, and less even any idea that someday I would fall in love with that discipline.
But a recent visit to the Heart of Cape Town Museum revived in me some memories of my early childhood and my first few years in Mauritius as a junior doctor which had to do with heart disease.
Beginnings of cardiac surgery in Mauritius
In fact it was only when I became a doctor that I came to realise that my mother had most probably suffered from, and died at an early age of rheumatic heart disease which affects the valves of the heart. The most frequently affected one is known as the mitral valve which, on the left side of the heart, allows blood to flow from the upper chamber (atrium) into the lower chamber (ventricle), from where it is then pumped out of the heart to be distributed around the body.
Rheumatic fever causes a narrowing of the valve, a condition known as mitral stenosis, and one of the earliest surgical treatments consisted in dilating the narrowed valve aperture with a special instrument – a procedure known as closed mitral valvotomy which nobody was performing in Mauritius at the time my mother was ill, the 1950s. In fact except for orthopaedics we hardly had any surgical specialists then, and definitely there was no question of cardiac surgery.
This was true of medical specialties too, but I do recall the name of a Dr Ah Hang, who lived in Quatre Bornes, and was said to be a cardiologist. I stand under correction by my older colleagues, but it was in the late 1960s that we began to have more and more specialists in different disciplines, and a few of the older generation of surgeons performed some operations across specialities. Thus, Dr Steven Keating, under whom I began my training in orthopaedic surgery in 1975 at the SSRN Hospital, used to perform mitral valvotomies as well as operation for a heart condition known as patent ductus arteriosus, at a time when we did not even have a proper ICU.
But it was either that, that is the surgeon taking the risk, or nothing, which would mean the sure death of the patient. Late Dr Ng Kee Kwong freshly returned from the UK also used to perform cardiac surgeries during that period, and these were indeed the true pioneers of cardiac and pulmonary surgery in Mauritius. Too often latter-day surgeons make as if nothing happened before them, in a bid to seek cheap fame. And this does not apply to cardiac surgery only! Such publicity mongers should learn from their older peers, and who better in cardiac surgery to inject into them a certain sense of humility than Dr Christiaan Barnard. This is what he had to say about the pioneering heart transplant that he carried out on that momentous day 50 years ago to make medical history: ‘It is the crowning effort of a team of men and women who bring at that moment, the training of a lifetime. Structured with the inherited technique and skill of a millennium – all are fused to one objective: to replace a dying heart with a new one, to save one life.”
Heart of Cape Town Museum
It is to acknowledge ‘One of the Greatest Moments in Medical History’ that the Heart of Cape Town Museum was set up 20 years ago, and the write-up on its website highlights the teamwork and the gratitude at the very beginning:
‘The drama of the world’s first human heart transplant, led by Professor Christiaan Neethling Barnard, played out within the walls of the Charles Saint Theatre, at Groote Schuur Hospital on the 3rd December 1967.
‘The human heart transplant, one of the greatest moments in medical history, was made possible by an extraordinary interplay of scientific dedication, human courage and generosity and a timely chain of events.
‘Today, the Heart of Cape Town Museum honours all those who played a major role in the surgical feat that pushed the boundaries of science, into the dawn of a new medical era, an era in which it became possible to transplant the symbol of the essence of life, our human heart.’
The elderly lady guide who took us through the museum on a two-hour tour which included a film of 25 minutes on the life of Christiaan Barnard had worked briefly at the Groote Schuur Hospital, and was thoroughly familiar with the events that unfolded and the immediate aftermath. Thus, despite the fact that she was soft-spoken, the emotions came through and resonated with the group of about 20 who were visiting that morning, mostly lay people but no one could be left untouched by what was on display, all of which can be viewed on the website, and by the tenor of the narrative.
World’s first heart transplant
For recall, the donor was 25-year Denise Darvall who was involved in a road accident not far from the hospital. Her mother died instantly, and when she reached the hospital she was diagnosed as brain dead by two independent neurosurgeons. Dr Christiaan Barnard with the team he had painstakingly assembled over the years after he returned from America and set up the department of cardiothoracic surgery in 1958, was waiting for the opportunity of a donor. With as yet no definitive legal framework or ethical guidelines, he could not miss this one that presented itself. It was not easy for him to approach a grieving father, and husband who had been traumatically widowed but a few minutes ago, announce to him the finality of the neurosurgeons’ diagnosis, and ask that he consent to donate his daughter’s beating heart.
Yet he did, when Dr Barnard took Mr Darvall to his room and had a face to face talk with him. Apparently Mr Darvall did not take long to agree, after reflecting that Denise had been a giver all her short life, and he was sure that had she been able to, she would have done the same. In fact, it was not only her heart but also her kidneys that were transplanted, the one in an 8-year old boy surviving, the other one was rejected.
Mr Louis Washkansky, the 59-year old in heart failure who was the recipient of Denise’s heart, was up and smiling the next day after operation, but unfortunately he died 18 days later of a chest infection. Denise’s heart was still beating, and as the record goes, her heart did not let him down.
Dr Christiaan Barnard was heartbroken on learning about Washkansky’s death. He went to his office, sat there alone, and shed tears. Mr Darvall too was in a similar state, and said that that day he realized that his daughter was now no more.
About a month later, though, Dr Barnard performed his second heart transplant, on Philip Blaiberg, who lived for nearly 18 months. In all, by the time he retired in 1983, he had performed 67 heart transplants, with one of his patients holding the world record to date for the longest heart transplant survivor: 23 years.
Dr Barnard had a tumultuous life after he performed the world’s first heart transplant. His surgical fame catapulted him into the public limelight, he became a star and an international socialite, and at the same time he had to carry out his academic and surgical activities. He passed away in 2001 in Cyprus, dying of a bronchial asthma attack after a swim.
I read his autobiography ‘One Life’ when I was training as a surgeon in the UK, and visiting the Heart of Cape Town Museum along with seeing the film about his life made me reminisce about the toughness of surgical training. But if I had to do it all over again, I would…
To anyone, whether health professional or not, on a trip to Cape Town, I highly recommend a visit to the Heart of Cape Town Museum. You will not come out unmoved.
* Published in print edition on 19 January 2018