How to save a dying heart

BY Dr. Howard Markel  December 3, 2013 at 11:50 AM EST


In a monthly column for PBS NewsHour, Dr. Howard Markel revisits moments that changed the course of modern health and medicine on their anniversaries, like the world’s first human heart transplant on Dec. 3, 1967. In the photo above, Amy DeStefano of Portsmouth, N.H., recovers after a transplant in 2012. Photo by Wendy Maeda/The Boston Globe


Dec. 3, 1967 is a red-letter day in the history of medicine. It was also an important date in the personal history of Dr. Christiaan Barnard.

The South African surgeon made international headlines by successfully removing the dying heart of a 54-year-old grocer named Louis Washkansky and replacing it with a healthy heart.

Dr. Christiaan Barnard in 1969. Photo by YOU magazine/Gallo Images

The donor, a 25-year-old woman named Denise Darvall, was in a car accident the day before. While still technically alive, Darvall was diagnosed by her physicians as “brain-dead.” The operation, at Cape Town’s Groote Schuur Hospital, lasted nine hours and required a team of 30 people, including Dr. Barnard’s brother Marius, who was also a surgeon.

Louis Washkansky emigrated from Lithuania to South Africa in 1922 and built a thriving grocery business in Cape Town. A decorated World War II veteran who saw action in Africa and Italy, Louis was once an avid athlete who excelled in swimming, football and weightlifting.

Unfortunately, Washkansky was also a diabetic who developed a progressive and incurable form of congestive heart failure. Unresponsive to medications and rest, Washkansky’s cardiologist referred him to Dr. Barnard, who had been hard at work experimenting with heart transplants in animals.

Although the kidney transplant was still a relatively new but successful procedure, having been developed in the early 1950s, heart transplantation was a far more difficult problem both in terms of surgical procedure and in effectively turning off a patient’s immune system to prevent the rejection of another person’s heart. There was also the issue of finding suitable organ donors — a concept now well-known and acceptable to most people, was once a disturbing, ethical dilemma.

Dr. Barnard was hardly the only surgeon interested in heart transplantation during this period. He had active competition from Dr. Adrian Kantrowitz and his surgical team at Brooklyn’s Maimonides Medical Center, where the world’s second (and the United States’ first) heart transplant was performed on Dec. 6, 1967. Two other surgeons who performed the controversial procedure soon after Barnard were Drs. Norman Shumway of Stanford University, on Jan. 6, 1968, and Richard Lower of the Medical College of Virginia in May of 1968.

As Dr. Barnard later wrote in his memoir, “One Life,” it was relatively easy to convince Louis Washkansky to undergo the novel operation: “For a dying man, it is not a difficult decision because he knows he is at the end. If a lion chases you to the bank of a river filled with crocodiles, you will leap into the water, convinced you have a chance to swim to the other side.”



Dr. Barnard in the operating room. Photo by Popperfoto/Getty Images.


Getting a suitable heart to replace Washkansky’s damaged one was a bit more difficult. Brain death was a controversial diagnosis back in 1967 and several judges around the globe threatened to arrest and jail surgeons who took organs from such afflicted individuals. Nevertheless, Dr. Barnard secured permission from Denise Darvall’s father and commenced with the operation.

Recalling these historic moments years later, Dr. Barnard explained, “as soon as the donor died, we opened her chest and connected her to a heart-lung machine, suffusing her body so that we could keep the heart alive. I cut out the heart. We examined it, and as soon as we found it was normal, we put it in a dish containing solution at 10 degrees Centigrade to cool it down further. We then transferred this heart to the operating room, where we had the patient and we connected it to the heart-lung machine. From the time we cut out the heart, it was four minutes until we had oxygenated blood going back to the heart muscle from the donor’s heart lung machine. We then excised the patient’s heart.”

Louis Washkansky, the world’s first heart transplant patient, recovering in the Groote Schuur Hospital. Photo by Popperfoto/Getty Images

After suturing the donor heart into Washkansky’s chest cavity, it was gently warmed up to body temperature and began to beat with a lively vigor. The procedure worked!

Sadly, Washkansky lived only 18 more days. The massive doses of immunosuppressive drugs (azathioprine and hydrocortisone), along with the radiation treatments he received in order to prevent a rejection response, left the grocer wide open to contracting life-threatening infections. The all-but-forgotten medical hero died of pneumonia on Dec. 21, 1967.

A few weeks later, on Jan. 2, 1968, Christiaan Barnard again made global headlines by transplanting the heart of a bi-racial young man into the body of a retired, white dentist named Philip Blaiberg. This was especially controversial not only because of that era’s vastly different views on race and integration, but also because of South Africa’s racist apartheid policies. Blaiberg survived 19 months and 15 days, probably due to a marked reduction of immunosuppressive drugs.

Today, nearly half a century after the first heart transplant, organ transplantation medicine has advanced by leaps and bounds and has prolonged and improved the lives of countless people with failing kidneys, hearts, livers, lungs and other organs. Better drugs, better procedures, more advanced technologies, and modern systems of organ donation have all made this once-shocking surgical approach a common means of saving lives in the 21st century.

What a remarkable legacy for a pioneering surgeon and a brave grocer from Cape Town, South Africa.

 


Dr. Howard Markel writes a monthly column for the PBS NewsHour website, highlighting the anniversary of a momentous event that continues to shape modern medicine. He is the director of the Center for the History of Medicine and the George E. Wantz Distinguished Professor of the History of Medicine at the University of Michigan.

He is the author or editor of 10 books, including “Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892,” “When Germs Travel: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed” and “An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine.”


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