How Did Dr. Christiaan Barnard's Life Changed?

On December 3, 1967, medicine was changed forever. On that day, Dr. Christiaan Barnard and a team of twenty surgeons revolutionized the way we treat infirmities such as cancer, heart failure, and cardiomyopathy. Every year, five thousand people worldwide undergo a heart transplant. Without Dr. Barnard, it’s very possible they would all be dead. Dr. Christiaan Barnard’s discovery not only saved thousands of lives, but inspired other doctors and researchers around the world to conduct similar studies. Barnard is originally from South Africa, but did work in many other countries, including the United States. He earned his medical degree from University of Cape Town in 1953, which at the time was one of the best universities in South Africa.
Following his time in college, he became a general medicine doctor, but that wasn’t fulfilling enough for him. He wanted to continue learning, so he decided to go into a more specialized field. Dr. Barnard chose surgery and took a fellowship position at Cape Town School of Medicine. Even at a young age, Dr. Barnard was brilliant. During his short time in a surgical fellowship, he made a name for himself by discovering what causes intestinal atresia, which was plaguing newborns across the world at the time. About one in every three thousand babies born developed the birth defect and died from it. Intestinal atresia is a small tear or blockage in the intestine, but at the time, nobody knew what caused it or how to fix it. Barnard learned that the congenital disease is caused by lack of blood flow while the child was in the womb. Once he identified the cause of the disease, he invented his own surgical procedure to fix it. Now in 2017, doctors use ultrasounds to screen for intestinal atresia, although it is less prevalent in the 21st century. Once the child is born, surgeons use the technique designed by Christiaan Barnard to fix the congenital gap. Pediatrics wasn’t Barnard’s main interest though. He moved to America in 1953 shortly after his discovery. At University of Minnesota Medical School, he furthered his medical education by earning a Ph.D. Once he returned to South Africa, he began his career as a cardiothoracic surgeon. After returning from America, he had gained valuable knowledge in the surgical field and introduced open heart surgery to South Africa, which wasn’t a concept in his country at the time. He also studied artificial heart valves and performed heart transplants on dogs. The research he did in his early careers eventually built up into him performing the first heart transplant a few years later. Barnard relocated to Groote Schuur hospital around the time of the transplant.
He received an immense amount of media attention and on the day of the transplan hundreds of cars were lined up in the hospital parking lot on the nights of December 2nd and 3rd to see Louis Washkansky receive a new heart. Louis Washkansky was a South African grocer with coronary insufficiency. Coronary insufficiency is the lack of blood flow through the coronary arteries and without the transplant, he would die. Although he knew the risk of fatality with the transplant, Louis knew he would die without it. Christiaan Barnard once said, “For a dying man it is not a difficult decision to agree to become the first heart transplant...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 the chance to swim to the other side. But you would not accept the odds if there were no such lion.” In the quote, the lion refers to the heart disease, and the crocodiles refer to the
transplant. Louis Washkansky received the heart of Denise Darvall. After being hit by a car she suffered a fatal brain injury and was declared brain dead by neurosurgeons at the hospital. In 1967, South Africa didn’t have laws involving brain death and organ transplantation. Dr. Barnard wanted to be one hundred percent sure Darvall was brain dead and there was no way to reverse that. The state forensic pathologist for South Africa was invited by Dr. Barnard to confirm brain death. Once brain death was declared, Christiaan Barnard and his team of surgeons worked as fast as they could to remove the heart. Denise Darvall also donated her kidneys, although kidney transplants had already been around for awhile at that point. Again, at the time there were no guidelines set for transplant recipients. Now, anybody waiting for a heart transplant must not have a list of select underlying conditions that can compromise the organ, must not have a history with alcohol or tobacco abuse, and must be drug free. In 2017, Louis Washkansky without-a-doubt would have been denied the opportunity for an organ transplant. He was a profuse smoker and had diabetes. Washkansky was also plagued with edema, which are excessive fluids in any part of the body. His edema had to be drained and the drainage sites had infection, another big no-no in modern day organ transplants. At the time, Christiaan Barnard didn’t know the effects those things could have on whether or not an organ transplant is successful.

Barnard and his team knew the human body had a tendency to reject foreign objects. He predicted that since Louis Washkansky was receiving a heart that didn’t belong to him, there was a chance his body wouldn’t accept it and the surgery would be ineffective. The team of doctors developed a drug to help him accept the heart. Later on though, the drug had detrimental effects on Mr. Washkansky, but at the beginning of the process, the doctors were not aware of this. The drugs given to Louis Washkansky by Dr. Barnard were designed to restrain his immune system from making the decision to reject the heart.

When the operation was about to begin, the doctors deliberately placed Denise Darvall and Louis Washkansky in nearby rooms.
Denise Darvall’s heart was put on a pump-oxygenator. The pump-oxygenator allowed Dr. Barnard to transplant a heart that was still able to function successfully. It also made the operation easier because the heart didn’t move since it wasn’t beating. Without the invention of the pump-oxygenator a few years before the surgery, the way Dr. Barnard performed it would have been very different. That’s why we thank John Gibbon, the inventor of the pump-oxygenator for his contribution to the surgery. When Christiaan Barnard took out the diseased heart and saw an empty chest cavity, he was shocked as to how large it was. It took twenty surgeons to complete the operation and was performed over the span of two days. The surgery was fantastic and everything went according to plan. Early on the morning of December 3, 1967, the operation was
complete.

Once the operation was over, Louis Washkansky was given anti-rejection drugs. He gained consciousness on December 4th and had a short conversation with Dr. Barnard. On December 5th, he ate a hardboiled egg and said he was feeling much better. Barnard said that if Louis got better by Christmas, he could go home. A few days later, things took a turn for the worse. Louis’s temperature rose and he reported having stomach pains. His condition worsened for about of week. On the day before Louis died, his lab cultures came back positive for pneumonia. The anti-rejection drugs he was put on negatively affected him. Since they restrained the body’s immune system from performing its own actions, it also made the body more susceptible to infection and disease. In the last few hours of his life, Barnard pleaded with Washkansky, “Louis, you must fight for us, a bit longer, hold on.” Reports say that Louis smiled at Barnard, and passed away a few hours later. Although Louis Washkansky died, Christiaan Barnard still got credit for performing the first successful heart transplant, since the procedure wasn’t flawed. He became a name known around the world overnight, with the story being published in countless popular news sources. Even with all of his recognition, Barnard wasn’t finished with his research. He took a few months to tweak his procedure and modified the anti-rejection medication. Barnard decided to use some of the techniques he developed whilst experimenting on dogs. The second transplant recipient’s name was Philip Blaiberg. He was a surgeon like Christiaan. Dr. Barnard used some techniques created by doctors at Stanford in California, which resulted in the surgery going smoothly. In between Barnard’s first and second heart transplants, many other cardiothoracic surgeons from other countries attempted their own variation on his procedure, but they all failed. Blaiberg on the other hand, was the first patient to actually leave the hospital. Philip Blaiberg received even more media attention than Louis Washkansky. Unfortunately, nineteen months after the transplant, Philip died from transplant coronary artery disease. To this day, it is still the leading cause of death after heart transplantation. By 1970, only about eleven percent of transplant recipients survived, this gained mixed reactions from critics. Some said that heart transplants were unethical because of the failure rate, but others applauded the doctors bold enough to try such a thing.