Christiaan Barnard
Christiaan Neethling Barnard was a South African cardiac surgeon who performed the world's first human-to-human heart transplant operation. On 3 December 1967, Barnard transplanted the heart of accident victim Denise Darvall into the chest of 54-year-old Louis Washkansky, who regained full consciousness and was able to talk easily with his wife, before dying 18 days later of pneumonia, largely brought on by the anti-rejection drugs that suppressed his immune system. Barnard had told Mr. and Mrs. Washkansky that the operation had an 80% chance of success, an assessment which has been criticised as misleading. Barnard's second transplant patient, Philip Blaiberg, whose operation was performed at the beginning of 1968, returned home from the hospital and lived for a year and a half.
Born in Beaufort West, Cape Province, Barnard studied medicine and practised for several years in his native South Africa. As a young doctor experimenting on dogs, Barnard developed a remedy for the infant defect of intestinal atresia. His technique saved the lives of ten babies in Cape Town and was adopted by surgeons in Britain and the United States. In 1955, he travelled to the United States and was initially assigned further gastrointestinal work by Owen Harding Wangensteen at the University of Minnesota. He was introduced to the heart-lung machine, and Barnard was allowed to transfer to the service run by open heart surgery pioneer Walt Lillehei. Upon returning to South Africa in 1958, Barnard was appointed head of the Department of Experimental Surgery at the Groote Schuur Hospital, Cape Town.
He retired as head of the Department of Cardiothoracic Surgery in Cape Town in 1983 after rheumatoid arthritis in his hands ended his surgical career. He became interested in anti-aging research, and in 1986 his reputation suffered when he promoted Glycel, an expensive "anti-aging" skin cream, whose approval was withdrawn by the United States Food and Drug Administration soon thereafter. During his remaining years, he established the Christiaan Barnard Foundation, dedicated to helping underprivileged children throughout the world. He died in 2001 at the age of 78 after an asthma attack.
Early life
Barnard was born on November 8, 1922 and grew up in Beaufort West, Cape Province, Union of South Africa. His father, Adam Barnard, was a minister in the Dutch Reformed Church. One of his four brothers, Abraham, was a "blue baby" who died of a heart problem at the age of three. The family also experienced the loss of a daughter who was stillborn and who had been the fraternal twin of Barnard's older brother Johannes, who was twelve years older than Christiaan. Barnard matriculated from the Beaufort West High School in 1940, and went to study medicine at the University of Cape Town Medical School, where he obtained his MB ChB in 1945.His father served as a missionary to mixed-race people. His mother, the former Maria Elisabeth de Swart, instilled in the surviving brothers the belief that they could do anything they set their minds to.
Career
Barnard did his internship and residency at the Groote Schuur Hospital in Cape Town, after which he worked as a general practitioner in Ceres, a rural town in the Cape Province. In 1951, he returned to Cape Town where he worked at the City Hospital as a Senior Resident Medical Officer, and in the Department of Medicine at Groote Schuur as a registrar. He completed his master's degree, receiving Master of Medicine in 1953 from the University of Cape Town. In the same year he obtained a doctorate in medicine from the same university for a dissertation titled "The treatment of tuberculous meningitis".Soon after qualifying as a doctor, Barnard performed experiments on dogs while investigating intestinal atresia, congenital, life-threatening obstructions in the intestines. He followed a medical hunch that this was caused by inadequate blood flow to the fetus. After nine months and forty-three attempts, Barnard was able to reproduce this condition in a fetus puppy by tying off some of the blood supply to a puppy's intestines and then placing the animal back in the womb, after which it was born some two weeks later, with the condition of intestinal atresia. He was also able to cure the condition by removing the piece of intestine with inadequate blood supply. The mistake of previous surgeons had been attempting to reconnect ends of intestine which themselves still had inadequate blood supply. To be successful, it was typically necessary to remove between 15 and 20 centimeters of intestine. Jannie Louw used this innovation in a clinical setting, and Barnard's method saved the lives of ten babies in Cape Town. This technique was also adapted by surgeons in Britain and the US. In addition, Barnard analyzed 259 cases of tubercular meningitis.
Owen Wangensteen at the University of Minnesota in the United States had been impressed by the work of Alan Thal, a young South African doctor working in Minnesota. Wangensteen asked the Groote Schuur Head of Medicine John Brock if he might recommend any similarly talented South Africans, and Brock recommended Barnard. In December 1955, Barnard travelled to Minneapolis, Minnesota to begin a two-year scholarship under Chief of Surgery Wangensteen, who assigned Barnard more work on the intestines, which Barnard accepted even though he wanted to move onto something new. Simply by luck, whenever Barnard needed a break from this work, he could wander across the hall and talk with Vince Gott who ran the lab for open-heart surgery pioneer Walt Lillehei. Gott had begun to develop a technique of running blood backwards through the veins of the heart so Lillehei could more easily operate on the aortic valve. In March 1956, Gott asked Barnard to help him run the heart-lung machine for an operation. Shortly thereafter, Wangensteen agreed to let Barnard switch to Lillehei's service. It was during this time that Barnard became acquainted with fellow future heart transplantation surgeon Norman Shumway. Barnard also became friendly with Gil Campbell, who had demonstrated that a dog's lung could be used to oxygenate blood during open-heart surgery. Barnard and Campbell met regularly for early breakfast. In 1958, Barnard received a Master of Science in Surgery for a thesis titled "The aortic valve – problems in the fabrication and testing of a prosthetic valve". The same year he was awarded a Ph.D. for his dissertation titled "The aetiology of congenital intestinal atresia". Barnard described the two years he spent in the United States as "the most fascinating time in my life."
Upon returning to South Africa in 1958, Barnard was appointed head of the Department of Experimental Surgery at Groote Schuur hospital, as well as holding a joint post at the University of Cape Town. He was promoted to full-time lecturer and Director of Surgical Research at the University of Cape Town. In 1960, he flew to Moscow in order to meet Vladimir Demikhov, a top expert on organ transplants In 1961 he was appointed Head of the Division of Cardiothoracic Surgery at the teaching hospitals of the University of Cape Town. He rose to associate professor in the Department of Surgery at the University of Cape Town in 1962. Barnard's younger brother Marius, who also studied medicine, eventually became Barnard's right-hand man at the department of Cardiac Surgery. Over time, Barnard became known as a brilliant surgeon with many contributions to the treatment of cardiac diseases, such as the Tetralogy of Fallot and Ebstein's anomaly. He was promoted to Professor of Surgical Science in the Department of Surgery at the University of Cape Town in 1972. In 1981, Barnard became a founding member of the World Cultural Council. Among the recognition he received over the years, he was named Professor Emeritus in 1984.
Historical context
Following the first-ever successful kidney transplant in 1953, in the United States, Barnard performed South Africa's second kidney transplant in October 1967, the first having been done in Johannesburg the previous year.On 23 January 1964, James Hardy at the University of Mississippi Medical Center in Jackson, Mississippi, performed the world's first heart transplant and world's first cardiac xenotransplant by transplanting the heart of a chimpanzee into a desperately ill and dying man. This heart did beat in the patient's chest for approximately 60 to 90 minutes. The patient, Boyd Rush, died without regaining consciousness.
Barnard had experimentally transplanted forty-eight hearts into dogs, which was about a fifth the number that Adrian Kantrowitz had performed at Maimonides Medical Center in New York and about a sixth the number Norman Shumway had performed at Stanford University in California. Barnard had no dogs which had survived longer than ten days, unlike Kantrowitz and Shumway who had had dogs survive for more than a year.
With the availability of new breakthroughs introduced by several pioneers, also including Richard Lower at the Medical College of Virginia, several surgical teams were in a position to prepare for a human heart transplant. Barnard had a patient willing to undergo the procedure, but as with other surgeons, he needed a suitable donor.
During the Apartheid era in South Africa, non-white persons and citizens were not given equal opportunities in the medical professions. At Groote Schuur Hospital, Hamilton Naki was an informally taught surgeon. He started out as a gardener and cleaner. One day he was asked to help out with an experiment on a giraffe. From this modest beginning, Naki became principal lab technician and taught hundreds of surgeons, and assisted with Barnard's organ transplant program. Barnard said, "Hamilton Naki had better technical skills than I did. He was a better craftsman than me, especially when it came to stitching, and had very good hands in the theatre". A popular myth, propagated principally by a widely discredited documentary film called Hidden Heart and an erroneous newspaper article, maintains incorrectly that Naki was present during the Washkansky transplant.