As a resident surgeon at Groote Schuur Hospital, Cape Town —56 , Barnard was the first to show that intestinal atresia , a congenital gap in the small intestine , is caused by an insufficient blood supply to the fetus during pregnancy. This discovery led to the development of a surgical procedure to correct the formerly fatal defect. After completing doctoral studies at the University of Minnesota —58 , he returned to the hospital as senior cardiothoracic surgeon, introduced open-heart surgery to South Africa , developed a new design for artificial heart valves, and began extensive experimentation on heart transplantation in dogs. On December 3, , Barnard led a team of 20 surgeons in replacing the heart of Louis Washkansky, an incurably ill South African grocer, with a heart taken from a fatally injured accident victim.
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The daring operation and the charismatic surgeon received immense public attention around the world. Although the patient, Mr. Louis Washansky, died after only 18 days, Barnard soon carried out a second transplant, and this patient led an active life for almost 19 months.
Barnard subsequently introduced the operation of heterotopic heart transplantation in which the donor heart acted as an auxiliary pump, with some advantages in that early era. It took great courage to carry out the first heart transplant, and this is why Barnard is remembered as a pioneer in cardiac surgery. Christiaan Barnard was the third son of four of a church minister in the rural town of Beaufort West in South Africa, approximately miles inland from Cape Town.
He was born on November 8th, 1,2. Back row, left to right: his mother Maria, oldest brother Johannes Barney , father Adam, and a family friend. Front row: Chris is second from left. After attending the local high school, Chris Barnard did well enough to gain entry to study medicine at the University of Cape Town UCT , where he was financially dependent on two scholarships he had been awarded.
If he failed an examination, he would lose the scholarships and would no longer be able to pursue his goal of becoming a doctor. He enjoyed this work but, when problems arose between him and his two colleagues, he resigned his position and returned to the Cape Town area to study for higher surgical examinations. This proved a difficult period for him as he had no income, but now had two small children to support. Fortunately, a position became available at the local infectious disease hospital and this led to further appointments, first in medicine and then in surgery, at GSH, the major UCT teaching hospital Figure 3.
During this period, in the evenings and nights, he carried out some very innovative research in a canine model of intestinal atresia in neonates 3. Wildebeest graze on the land behind the hospital. In the s, the small houses in front of the hospital were demolished to allow construction of the present hospital. Fortunately, the beautiful original buildings have been retained, and continue to be used for many purposes.
He was then offered a scholarship to gain surgical experience at the University of Minnesota in Minneapolis under the tutorship of the legendary Professor Owen Wangensteen. It was there that he was first exposed to the very new field of open heart surgery, the University Hospital in Minneapolis being only one of a handful of centers in the world where this form of surgery was being carried out.
Barnard immediately saw the potential of the heart-lung machine pump-oxygenator and, under the direction of C. He immediately initiated an open heart surgery program at GSH Figure 5 , which was associated with excellent results and gained him a good reputation from those who followed his progress 4—6. He also designed and implanted a prosthetic valve that was successful for that era Figure 6 10— In the relatively early s, by which time heart surgery could correct most congential heart defects and treat valve disease but not yet coronary artery disease , he began to consider the future of his specialty.
He concluded that heart transplantation would be required if patients with end-stage heart failure were to be helped. At the time, I thought perhaps he was joking but, in retrospect, he clearly was not.
With a view to moving towards heart transplantation in patients who might benefit from it, Barnard and his younger brother, Marius Figure 7 , who was also a cardiac surgeon at GSH, began by gaining experience of the operation of orthotopic heart transplantation in dogs He used an operative technique first described by Russell Brock and a junior colleague in London in 16 , but developed and investigated extensively by Norman Shumway and his research team at Stanford University in the USA 17 Figure 8.
Barnard made little attempt to keep the dogs alive as his main aim was to perfect the surgical technique. He then took a three-month sabbatical to gain experience in immunosuppressive therapy in patients with kidney transplants, which he did by attaching himself to the transplant program headed by David Hume Figure 9 in Richmond, Virginia. There he also gained more experience of experimental heart transplantation in the laboratory of Richard Lower Figure 8 , who had trained with Shumway, but had subsequently been recruited to Richmond by Hume.
With this experience behind him, Barnard returned to GSH and carried out a single successful kidney transplant on a patient who lived for 20 years. Barnard then felt ready to carry out a first heart transplant. They therefore agreed that both recipient and donor should be Caucasian white. Schrire identified Louis Waskansky Figure 10 , a year-old diabetic, who was bedridden in hospital in severe cardiac failure from ischemic heart disease Washkansky readily accepted the opportunity as he knew he had no alternative if he wanted to stay alive.
The surgical team then waited for a suitable donor. In the afternoon of Saturday, December 2nd, , Denise Darvall Figure 11 , a year-old woman, was brought to GSH having suffered a severe brain injury as a result of a traffic accident Within hours, she was certified brain-dead by the hospital neurosurgeons, and her father gave his consent for her heart and kidneys to be used for transplantation.
Both potential recipient and donor were taken to the operating room suite, and the operation took place during the early hours of December 3rd Therefore, Barnard concluded he could use brain death as a criterion for declaring a patient dead.
Nevertheless, to be quite sure that he would not be faced by medico-legal problems, he decided he would wait for the heart to stop beating before he removed it.
He therefore disconnected the ventilator, and waited until the EKG indicated no cardiac output. This took approximately six minutes. The chest was then opened quickly by splitting the sternum. The heart was blue and not beating. The surgical team connected the donor to a heart-lung machine, and circulated cold oxygenated blood through her body, with the aim of reducing the metabolism of the heart while it was transplanted. The heart was rapidly cooled to a low temperature, helping to protect it from further ischemic injury during transplantation.
The donor heart was excised in such a way that the donor heart-lung machine would continue to perfuse it with cooled oxygenated blood while it was carried into the adjacent recipient operating room. Thus, the heart continued to be protected from injury. This approach is rarely followed today when a beating donor heart is simply cooled to a very low temperature by perfusing it with a cold preservation solution, then excised, and covered in ice or cold saline.
However, the continuous perfusion of the donor heart with oxygenated blood in Mr. I found it quite remarkable that the team had not practiced the operation together. Over the previous few years, Mr. It was therefore much larger than a normal healthy heart. Barnard looked at it and wondered whether it was too small to support the circulation in such a relatively big man. This observation must have been very disturbing to him, but he could do nothing about it now.
The surgical team waited for the heart to beat, but for some minutes it refused to do so although it was fibrillating. He electrically defibrillated the heart, and at last it began to contract normally, but only weakly, and would not take over the circulation.
Barnard tried twice to wean the patient from pump-oxygenator support, but the heart was not beating strongly enough to maintain an adequate blood pressure. He allowed more time for the donor heart to gain strength, continuing to keep the patient alive on the heart-lung machine. Steadily the beats became stronger. At the third attempt to discontinue the heart-lung machine , the blood pressure kept rising.
The heart-lung machine could now be switched off, and the chest closed. The operation had been successful. It was 6. When he was satisfied the heart was beating well and the patient would recover, Chris left his colleagues to close Mr. The hospital superintendent, Dr Jacobus Burger, was surprised to learn of the operation, but pleased that the patient was doing well.
The chairman of surgery was equally pleased, but wondered why Barnard had not been in touch with him before he began the operation. However, he must have had some realization that the operation he had just performed was special because he also telephoned an old friend from their medical student days who was a member of the Executive Committee in charge of Hospital and Health Affairs in the Cape Provincial Administration, a political position of some influence This politician immediately recognized the significance of the transplant, and informed the Administrator of the Cape Province similar to a State Governor in the USA who, in turn, telephoned the Prime Minister of South Africa.
The importance of this unique operation to South Africa is evident by the fact that, within about 30 minutes of Barnard leaving the operating room, the Prime Minister of the country had been informed. The politicians had immediately realized its potential impact on the world. It could put South Africa on the medical map. How wrong could he be? Washkansky on the operating table, but, of course, no photographs had been taken. When he had seen Mr.
Washkansky settled safely in his intensive care room, Barnard drove home. It was only an hour later when phone calls came from all over the world. Chris told me many times that he and his colleagues were stunned by the interest the transplant engendered.
So great was the public interest that the entire team was called back into the hospital that afternoon to be photographed Figure Journalists and photographers flew in from all over the world and swarmed over Groote Schuur Hospital.
Radio and television services worldwide provided bulletins and updates on Mr. On the front page of several local newspapers, a photo showed Louis Washkansky, and was transmitted around the world within twenty-four hours Figure After the first week, Mr. Washkansky began to feel tired and less well. In retrospect, it is clear that his recovery was impaired by allowing him to have too many visitors and give too many interviews to the media.
After approximately 12 days, his condition began to deteriorate, and he developed radiographic infiltrates in the lungs. Despite intensive antibiotic treatment, Mr. Washkansky deteriorated rapidly and died in the early hours of Thursday, December 21st, 18 days after the transplant. Exhausted by his efforts to keep his patient alive, Barnard was devastated by this sad outcome.
An autopsy was carried out immediately by the professor of pathology, James Thompson He could find no features of rejection of the heart, and confirmed that death had resulted from pneumonia. By inspecting the suture lines, he ascertained that Barnard had performed the operation faultlessly. Barnard bounced back from his disappointment over the outcome of Mr.
The patient was a retired dental surgeon, Philip Blaiberg Figure 15 , who was in a similar clinical state of terminal cardiac failure as Mr. Washkansky had been. A donor became available on January 2nd, , and the operation proceeded satisfactorily. Dr Blaiburg was discharged from GSH on the 74th post-operative day, and lived a fairly full and active life for almost 19 months 23 , eventually dying from the hitherto unknown condition of graft atherosclerosis chronic rejection
Christiaan Barnard—The surgeon who dared: The story of the first human-to-human heart transplant
Although his achievement, courage and vision should not be underestimated, the transplant was, as Barnard readily admitted, just one more step in the progress of surgery. Unlike many other pioneering surgeons, however, he had charisma - a blend of good looks, intelligence, wit, an often naive honesty and the unashamed expression of emotion - that made others want to see him, talk to him, and be with him. Born in the small country town of Beaufort West, in the Western Cape, Barnard was one of four sons of a pastor who ministered to the local mixed race, or "coloured" congregation. The family was poor but, having done well at school, he went on to the University of Cape Town medical school. He was not an outstanding student, but worked hard and graduated in He soon married, and, after short periods as a country GP, began training in surgery at Groote Schuur hospital, Cape Town, where, working largely at night, he carried out research on the cause of bowel obstruction in infants. In , he went for two years to Minneapolis, a centre of open-heart surgery, where he learnt new surgical techniques and did research on heart-lung machines.
Christiaan Barnard Biography
The daring operation and the charismatic surgeon received immense public attention around the world. Although the patient, Mr. Louis Washansky, died after only 18 days, Barnard soon carried out a second transplant, and this patient led an active life for almost 19 months. Barnard subsequently introduced the operation of heterotopic heart transplantation in which the donor heart acted as an auxiliary pump, with some advantages in that early era. It took great courage to carry out the first heart transplant, and this is why Barnard is remembered as a pioneer in cardiac surgery. Christiaan Barnard was the third son of four of a church minister in the rural town of Beaufort West in South Africa, approximately miles inland from Cape Town. He was born on November 8th, 1,2.
Christiaan Barnard, 78, Surgeon For First Heart Transplant, Dies
The South African surgeon Christiaan Barnard performed the world's first human heart transplant operation in and the first double-heart transplant in Christiaan N. Barnard, along with his three brothers, grew up extremely poor and attended the local public schools. Barnard then went on to the University of Cape Town, where he received a master's degree in Barnard worked for a short time as a doctor before joining the Cape Town Medical School staff as a research fellow in surgery. With the hope of pursuing his research interests and gaining new surgical skills and experiences, he enrolled at the University of Minnesota Medical School in