Christiaan Barnard

South African surgeon

• Born: November 8, 1922
• Birthplace: Beaufort West, South Africa
• Died: September 2, 2001
• Place of death: Paphos, Cyprus

Barnard performed the first successful human heart transplantation on December 3, 1967, followed by his second successful heart transplantation on January 2, 1968. His success offered renewed and prolonged lives for many with heart disease.

Early Life

Christiaan Barnard (BAHR-nahrd) was born in Beaufort West, South Africa. His family was of Afrikaner descent. Christiaan’s father, a minister, earned little money, and the family lived on the edge of poverty. Christiaan, however, enjoyed a carefree childhood and a happy family life. He often went on nature hikes with his father, who taught him the names of the trees, the wildflowers, and the plants. His mother was a very determined woman, who insisted that her sons be first in school and never admit defeat. During his high school years, Barnard was usually first in his class. By the end of his senior year in high school, still first in his studies, he was chosen by his class to give the farewell address and, as a cadet, held the highest student rank of sergeant-major. Outside school, he formed a popular musical trio. Upon graduation Barnard left for Cape Town to study at the university there, hoping to enter the field of medicine. In Cape Town, he stayed with his brother and his wife.

Life’s Work

Barnard was graduated with honors from the university and then earned two higher degrees at the University of Minnesota. Between 1953 and 1955, he studied under Owen H. Wangensteen, who described Barnard as a man with a singleness of purpose. Barnard demonstrated this when he operated on forty-nine dogs before he achieved success in an attempt to learn about an intestinal abnormality in the newborn. In three years, he completed the master of science and Ph.D. degrees in surgery.

Upon returning to Cape Town, Barnard continued his transplantation research while he practiced heart surgery and supported a family. Having read about the Soviet experimentation with transplantation of a dog’s head, he performed two such operations himself. He filmed the operations and took the films to Moscow, where he hoped to learn more about transplantation. He later spent time at the Medical College of Virginia. Afterward he lectured at the University of Cape Town, where he was named head of cardiothoracic surgery in 1962 and was promoted to associate professor a year later.

Before his first successful orthotopic human-heart transplant, in which a recipient’s heart is replaced by a donor’s heart, Barnard and another brother, Marius, had performed some fifty unsuccessful experimental heart transplantations in dogs in their attempt to develop a successful technique. This search for a successful heart-transplantation technique was part of a worldwide ten-year study of heart transplantations. The groundbreaking experimentation that led to Barnard’s successful operation was performed in 1960 by Norman E. Shumway of Stanford Medical Center in Palo Alto, California. James D. Hardy of the University of Mississippi Medical Center attempted a heart transplantation from a chimpanzee to a man dying of heart failure in 1964. After these early efforts, several researchers, including Richard Laver of the Medical College of Virginia, David Blumanstock of the Mary Imogene Bassett Hospital in Cooperstown, New York, and William Likoff of Philadelphia’s Hahnemann Medical College and Hospital, were ready to perform human-heart transplantations at the first opportunity. Louis Washkansky was a fifty-five-year-old wholesale grocer who had suffered two heart attacks in a seven-year period. His diseased heart was twice the normal size and was not getting enough blood through clogged and closed coronary arteries. He also had diabetes, for which he had been taking insulin. His liver was enlarged, and increasingly his body was becoming edematous. Washkansky’s doctor believed that his patient had only weeks to live.

On November 10, 1967, Barnard consulted with Washkansky and told him about the heart-transplantation technique. Washkansky agreed to the operation and signed the consent form. Barnard called in his team of thirty women and men, and they remained on a twenty-four-hour alert until a suitable donor was found.

In December, Barnard received notification of a donor, Denise Darvall, a woman who was mortally injured when she was hit by a speeding car. The donor’s father gave his consent, and Barnard’s team went to work. A team of doctors matched the blood types of Washkansky and Darvall and found them to be compatible. The transplantation proceeded before the pathologist could match the white cells of the two patients to estimate how strong a rejection reaction Washkansky’s system would mount against the foreign protein of the transplanted heart. Barnard cut eight blood vessels and several ligaments to free the donor heart. He then moved to an adjacent operating room to continue with the surgery. The procedure took five hours. An hour later, Washkansky regained consciousness and attempted to speak. Thirty-six hours after he awakened, he ate a typical hospital meal and soon showed improvement. He was given antibiotics to guard against infection. His heart rate soon slowed to one hundred beats per minute and his liver shrank to near-normal size. His kidneys worked so well that he lost twenty pounds of edema fluid. Washkansky died eighteen days later as a result of double pneumonia, contracted because his immune system was weakened by drugs administered to suppress rejection of his heart. By this time, Barnard had already chosen Philip Blaiberg to receive the second transplanted heart. This transplantation took place on January 2, 1968, on the fifty-eight-year-old dentist. Blaiberg survived for nineteen and one-half months.

While Barnard was on a triumphal tour of the United States between the two operations, ethical questions were raised. How can one be certain that doctors will do everything to save a person’s life after an accident or disease if they are considering the possible donation of organs? Marius Barnard noted that his brother had insisted that they wait to see if Darvall would survive; in fact they waited until the local medical examiner had declared her dead. On his second tour of the United States, Christiaan Barnard said that he followed the Hippocratic oath “that the physician must do everything in his power to save life, to restore health, and at the very least to alleviate suffering.” In the case of Washkansky, he said, life was not saved; in the case of Blaiberg, however, suffering was alleviated. Marius Barnard claimed that three criteria were used to determine death. A patient is considered dead, he said, “when the heart is no longer working, the lungs are no longer working and there are no longer any complexes” on the EEG (electroencephalogram). Another ethical question raised regarding heart transplantations was who should decide which person was to receive the donor heart if there was more than one candidate. Christiaan Barnard saw no problem with this issue: The person with the most urgent need for the heart should receive it.

Barnard led his team in performing ten more orthotopic transplantations. Six of the patients survived for about a year or longer, a remarkable achievement considering that methods to prevent the body from rejecting the transplanted heart were inchoate. His program in Cape Town emerged as one of the four centers worldwide for transplantation. The University of Cape Town promoted him to professor of surgical science in 1972, yet he was unhappy that he never received the title that he wanted: professor of cardiac surgery. His team pioneered the “heterotopic” heart transplantation, performing forty-nine of them between 1974 and 1983. In this procedure, also known as a “piggyback” transplantation, the donor’s heart is placed alongside the patient’s heart so that the original heart can act as a standby in case the donor’s heart should undergo severe tissue rejection. The advent of advanced immunosuppressant drugs in the 1980’s largely ended the need for this procedure. Barnard also led research that extended the time that donor hearts can be stored outside the body before surgery.

Barnard retired in 1983 at the age of sixty-one, primarily because rheumatoid arthritis made surgery painful and difficult. He diverted his interest to business, including a controversial connection with the rejuvenation therapy offered at the Clinique La Prairie in Switzerland. He acted as an adviser as the Oklahoma Transplantation Institute in Oklahoma City was established, and he wrote nine books on health and medicine in addition to a sequel, The Second Life: Memoirs (1993), to his autobiography, Christiaan Barnard: One Life (1969). Additionally, he traveled extensively, lecturing to both medical professionals and to the public. He launched the Christiaan Barnard Foundation to further his interest in charity to the poor and other humanitarian efforts, such as helping the victims of the 1986 Chernobyl nuclear disaster in the Soviet Union. Barnard died of complications from an acute asthma attack on September 2, 2001, while on vacation in Paphos, Cyprus. He left behind five children from three marriages.

Significance

Barnard’s accomplishments marked a milestone in medical science and in the organ-transplantation field. His success was part of the ongoing process in renewing and prolonging life. The first successful organ transplantation, involving the cornea, took place in 1905. By the 1950’s, doctors at Boston’s Peter Bent Brigham Hospital were successfully transplanting kidneys between identical twins. By the middle of the 1960’s, doctors in Colorado and Minnesota were transplanting, with success, human livers and the pancreas with duodenum attached.

In the 1960’s, at least 500,000 Americans needed heart transplantations, but there were not 500,000 heart donors. Michael E. DeBakey insisted that the ultimate solution was a completely artificial heart. Indeed, he and C. Walton Lillehei were already experimenting with artificial hearts. The National Institute of Health decided in 1963 that the eventual remedy for incurable heart disease would be a complete artificial heart. Since that achievement was years away, however, human-heart transplantations would be a valuable intermediate stage. Barnard predicted that the supply of heart donors would increase once the public was sufficiently educated on the subject. He was soon proven correct.

While world famous and friends with many political leaders of his times, such as French president Jacque Chirac and former Soviet general-secretary Mikhail Gorbachev, Barnard was a controversial figure within his profession. His mercurial temperament and outspokenness sometimes disaffected other physicians and medical personnel. As the American Heart Association concluded in its memorial to him, “Chris Barnard exhibited an unforgettable blend of vision, intelligence, action, kindness, charm, warmth, and humor, tempered by human frailties. Despite these frailties, he made the world a better place for his many patients, colleagues, and friends.”

Bibliography

Barnard, Christiaan. “A Human Cardiac Transplant: An Interim Report of a Successful Operation Performed at Groote Shuur Hospital.” South African Medical Journal 41 (1967): 1271. Gives a description of the heart-transplantation procedure. Discusses the circumstances of the donor and recipient of the first successful heart transplantation. Lessons learned from the transplantation on Washkansky are discussed.

Barnard, Christiaan, and Curtis Bill Pepper. Christiaan Barnard: One Life. Toronto, Ont.: Collier-Macmillan Canada, 1969. Contains early accounts of Barnard’s childhood years through his university studies. Conveys the drama of his first heart transplantation and ends with Washkansky’s death.

Beck, W., Christiaan Barnard, and V. Schrvie. “Hemodynamic Studies in Two Long-term Survivors of Heart Transplants.” Journal of Thoracic and Cardiovascular Surgery 62 (1971): 315-320. Provides a detailed comparative study of survivors of the procedure. Cardiovascular measurements are reported to demonstrate that the transplanted heart can function at a level necessary to sustain life and can withstand various stresses.

McRae, Donald. Every Second Counts: The Race to Transplant the First Human Heart. New York: G. P. Putnam’s Sons, 2006. Recounts how Barnard and three American surgeons perfected techniques for human heart transplantation, each hoping to receive credit for performing the first operation. McRae presents a negative portrayal of Barnard, depicting him as a man with an inferiority complex, a troubled personal life, and an intense desire for publicity.

Miller, G. Wayne. King of Hearts: The True Story of the Maverick Who Pioneered Open Heart Surgery. New York: Times Books, 2000. Miller explains the cardiac surgery advances of C. Walton Lillehei, Barnard’s mentor. The book supplies the context for Barnard’s own advances, which are discussed.