Washkansky received the heart of Denise Darvall, a young woman who was run over by a car on 2 December and had been declared brain dead after suffering serious brain damage. Her father, Edward Darvall agreed to the donation of his daughter's heart and kidneys. The operation started shortly after midnight on a Saturday night and was completed the next morning just before 6 a. After regaining consciousness he was able to talk and on occasion, to walk but his condition deteriorated and died of pneumonia eighteen days after the heart transplant.
On the first occasion, a baboon heart was transplanted, but this failed to support the circulation sufficiently, the patient dying some six hours after transplantation. Some baboons were followed for up to two years after these procedures and showed normal cardiac function and myocardial histology throughout this period.
With the success of this storage system in the laboratory, Barnard encouraged his team to use it in the clinical transplant programme. This would enable the transportation of hearts from distant centres in South Africa, which had hitherto been impossible, all donor hearts being procured locally in Cape Town.
The device was used successfully on several occasions. It was believed that this phenomenon of delayed function suggested temporary depletion of myocardial energy stores, related to the fact that, whereas in the baboon experiments the heart had been removed from a healthy anaesthetised animal, in the clinical situation the heart had been excised from a brain-dead subject.
This alerted the team to the fact that brain death must have a detrimental effect on myocardial function, and led to extensive investigations into the haemodynamic and metabolic changes during and after brain death, and the implications of these changes.
This work was the first comprehensive study investigating the effects of brain death. It was documented that these could have a detrimental effect on subsequent myocardial function and were sometimes associated with histopathological features of myocardial injury.
Previously unrecognised major endocrine changes that occur following brain death were documented. These include a massive catecholamine surge and a depletion of thyroid hormones and insulin, and other neuro-hormonal effects. These were associated with a loss of myocardial energy stores and other detrimental effects on cardiac function. Experimental studies in baboons indicated that aerobic metabolism soon ceases after brain death, and life is sustained by anaerobic metabolism.
The concept of hormone-replacement therapy was proposed, particularly with regard to thyroid hormone replacement, which experimentally was reported to be beneficial to the maintenance and improvement of myocardial function. Subsequently, this therapy was administered to a number of human heart donors, with documented improvement in haemodynamic function.
As previously mentioned, there were no laws relating to brain death at the time of the first transplant. This undoubtedly helped to accelerate the growth of bioethics and to wrestle from the medical profession the monopoly over medical ethics, which they previously held. It was evident that transplantation had raised serious ethical and legal questions for society. Doctors were still very much committed to the view that the profession should make the decisions about contentious issues such as the moment of death and when to stop certain treatment.
Most of the medical witnesses who appeared before the congressional hearings were opposed to the bill. Many did not resent input from philosophers or theologians but most felt that doctors ought to retain control and have the final say.
In the UK Conference of Royal Medical Colleges accepted the view that damage to the brainstem was the crucial factor causing profound irreversible coma, and this became the definition of brain death.
Barnard was also a champion of the disadvantaged and the poor, and an opponent of racism and apartheid, who welcomed its demise. He did his best to not allow racial segregation of patients within his department, in defiance of Government policy to segregate patients in hospitals according to race, as elsewhere in South Africa.
Nevertheless nationalist politicians undoubtedly exploited him in the years following the first transplant, in order to improve the image of South Africa around the world, a time when repression was at its fiercest within the country and the worldwide condemnation of the apartheid regime was on the increase.
He went on to be a leading physician in Britain, eventually becoming president of the Royal College of Physicians and being knighted by the Queen. By the early s, Barnard was tiring of the stresses and strains of clinical heart surgery and was losing interest in running a busy department. Furthermore, rheumatoid arthritis in several joints was causing him constant pain and making it increasingly difficult to operate to his satisfaction. Barnard took the opportunity to pen an autobiography, One Life , which sold widely throughout the world.
Soon after announcing his retirement, Barnard was invited to act as a consultant at Baptist Medical Center in Oklahoma City, where a new heart transplant programme was being planned. He spent six months a year for a number of years in Oklahoma, advising on the establishment of this programme, although not participating in the actual surgery. He finally retired from medicine in and settled back in Cape Town.
He remained active as an international speaker on medical matters of general interest and continued to travel widely. He died during one of his travels on the island of Cyprus on 2 September While no longer actively involved in basic laboratory transplant research, the Chris Barnard Division of Cardiothoracic Surgery at the University of Cape Town still has an internationally renowned cardiovascular research laboratory, directing its current research into methods of improving the surgical management of cardiac valvular and coronary diseases, which are more relevant to the cardiovascular diseases common in the African population.
The most recent advance from this research unit has been the development of an external support for venous conduits used for coronary artery bypass grafting, which promises to increase the long-term patency of these grafts, and an international clinical trial using this mesh is currently underway. National Center for Biotechnology Information , U. Journal List Cardiovasc J Afr v. Cardiovasc J Afr.
Author information Article notes Copyright and License information Disclaimer. Johan G Brink: az. Received Dec 7; Accepted Jan This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Open in a separate window. The second transplant Not daunted by this failure, Barnard immediately selected his second patient, a year-old local dental surgeon named Philip Blaiberg.
Orthotopic heart transplantation Between December and November , exclusively orthotopic heart transplantation was performed. The development of heterotopic heart transplantation In , Barnard performed a heart transplant and the donor heart failed to function satisfactorily, so the patient died in the operating theatre.
Heterotopic heart transplantation: the clinical programme Forty-nine consecutive heterotopic heart transplants were performed in Cape Town between and , with moderately good results for that era. Xenotransplantation The ability of the heterotopic heart to provide temporary circulatory support to a failing native heart, in the hope that the native heart would recover, was extended into the realm of xenotransplantation. Investigations into the haemodynamic and metabolic effects of brain death This alerted the team to the fact that brain death must have a detrimental effect on myocardial function, and led to extensive investigations into the haemodynamic and metabolic changes during and after brain death, and the implications of these changes.
Brain death and ethical issues As previously mentioned, there were no laws relating to brain death at the time of the first transplant. The idea of transplanting occurred to Chris. If it was possible with kidneys, why not the heart?
Groote Schuur Hospital was waiting his return in to start the first heart unit to perform a cardiac bypass operation. The core of the heart transplant team of the future was formed when the heart lung machine arrived.
Chris was again involved in much experimental work and research, and took courses in immunology in USA where immuno -suppressive agents had been developed. Back in SA he prepared for kidney transplants and built up surgical expertise. From the legal aspect there had to be clear rules to remove organs from the human body and criterion of death.
He performed the first kidney transplant at Groote Schuur on Mrs Edith Black and everything functioned perfectly.
It was hailed as a major surgical event in SA. Professor Val Schrire, who had built up the Cardiac Clinic, was informed by Chris in October "Everything is ready for a heart transplant. We have the team and we know how to do it. In November Prof Schrire called Chris and told him that there was a suitable patient for a heart transplant. Louis Washkansky was suffering from gross heart failure with a short time to live and was prepared to take the chance.
One can say the rest is history. A series of events were set in motion which led to the first human heart transplant, a remarkable feat.
A young woman, Denise Darvall, had been struck by a car and suffered severe brain damage.
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