A change of heart

With the deft hand of a skilled surgeon, Christiaan Barnard sliced open the chest of Louis Washkansky, lying on the operating table in front of him. It was not the doctor's first heart surgery. But when he reached in and took out Washkansky's weak heart, he realised that it was the first time he was staring at an empty chest cavity. The enormity of what he was doing hit him (bit.ly/heart-surgeon).

Hours earlier, on the afternoon of December 2, 1967, 25-year-old Denise Darvall had been hit by a drunk car driver close to the hospital where Barnard practised, the Groote Schuur Hospital (GSH) in Cape Town, South Africa. With her skull fractured, she was declared brain-dead, but her heart was still beating. Barnard seized the chance to do something he had been planning for years: transplant a heart from one human to another.

Early in his medical practice, Barnard had found ways to treat congenital intestinal obstructions. In 1955, he got a scholarship to spend two years at the University of Minnesota in the U.S., where he became fascinated by open-heart surgery pioneered by physician Walton Lillehei. Over the next few years, he closely studied heart transplantation techniques that physicians Norman Shumway at Stanford University and Richard Lower at the Medical College of Virginia were testing in animals. At GSH, he and his brother, Marius, began doing heart transplants in dogs. After a successful human kidney transplant, Barnard felt ready. He lined up Washkansky, who was in the final stages of heart disease, as a recipient. When Darvall's father consented to the procedure, Barnard and his 30-member team set to work.

At 2.20 am on December 3, the ventilator hooked up to Darvall was switched off. Barnard injected potassium to paralyse her heart until it stopped beating, cut it out and cooled it down. The team then inserted Darvall's tiny heart into Washkansky's large chest and connected it to a heart-lung machine that imbued it with fresh blood. For a few anxious minutes, the heart remained still. Then, "like a bolt of light", the heart muscles began to contract (bit.ly/transplant-Barnard). After a few attempts to keep the heart beating without the machine, at 6.13 am, the surgery was declared a success.

News travelled fast: the South African Prime Minister himself heard of it within an hour of Barnard leaving the operating room. Journalists descended on GSH, demanding photos and hourly updates on the recipient's condition. Politicians capitalised on the attention, seeing a chance to repair the country's image dented by apartheid.

Although Washkansky died of pneumonia 18 days later, Darvall's heart stayed healthy inside him till the end. Barnard, who soon became a globe-trotting celebrity, later pioneered an auxiliary transplantation technique in which the recipient's heart was retained next to the donor's. After years of clinical service that included treating heart diseases in many young children, rheumatoid arthritis forced Barnard to retire early in 1983. In 2001, while vacationing in Cyprus, he died of an asthma attack at the age of 78.

Ranjini Raghunath is a Bengaluru-based science writer and editor.

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