The Man Who Touched His Own Heart

by Rob Dunn

  In the middle of the night, Mary Shelley woke up, her mind swollen with an idea. She had what she called a waking dream. In it, she saw a pale scientist “kneeling beside the thing he had put together.” He was looking down on the “hideous phantasm of a man stretched out,” which then, thanks to some powerful engine, “showed signs of life” and stirred “with an uneasy, half vital motion.” To Shelley, this scientist mocked the magic of life, the mechanism that lay hidden inside the body.

  She would write an entire book about the ghosts of progress; she would write about the ends to which science might go. England was turning dark with technology, industry, and the hope of progress. This, to Shelley, was one of the scariest things she could imagine, a story in which the monster was both the creature set in motion by science and the science itself. Her monster would be built out of the parts of other creatures. It would be assembled, piece by piece, until ultimately it was given the final elements that bestowed upon it life.

  In the book, Mary Shelley did not describe just what it was that reanimated the monster, but in the science of the time, only one organ could do the job she required, that of giving biological life and emotion:4 the heart. The monster Shelley created was Frankenstein’s monster. This monster would go on, because of his emotional heart, to look for love and kindness among humans, and then—failing to find either—to terrify the society and the scientist who created it.

  For the heart surgeons, comparisons to Dr. Frankenstein’s love of progress were unflattering, but nonetheless, they were made almost as soon as Shumway and Lower took the heart from one dog and put it into another. The criticism implicit in such comparisons would continue over the next decade as other surgeons readied themselves for the possibility of performing a heart transplant on humans. One of the most outspoken critics of heart transplantation was Werner Forssmann. Forssmann, the guy who put a catheter into his own heart without even trying the procedure on a cadaver first, was urging moderation.5 Forssmann warned that without understanding the potential for rejection of organs by the bodies of recipients, it was too soon to contemplate transplants. It was progress without consideration. Yet Shumway and Lower were considering. They were waiting and trying to understand when and why transplants worked; they were trying to understand rejection. In their way, they intended to heed Forssmann’s recommendation to wait until everything was just right. But it wasn’t up to just them; as time went on, other surgeons began to contemplate transplants, surgeons including Christiaan Barnard.

  Barnard was born in a small town in South Africa. He was South African in the time of apartheid, and he thought that both he and his country deserved more respect than either was given. If he was to transplant a heart, it would bring him fame; it would bring his country fame. Barnard wanted to do this the way a little boy might see a fireman and want to be one. He was a good surgeon and a hard worker, but he was not trained in heart surgery, much less in the intricacies of heart transplants. He did not know the history of the heart; he stepped into its story abruptly without taking the time to catch up.

  After standard medical training in South Africa, Barnard had gone for graduate training to the lab of Dr. Walt Lillehei at the University of Minnesota, where he imagined he would learn the best techniques in American surgery, techniques he could take back to South Africa. Barnard’s doctoral dissertation focused on a congenital intestinal disorder. But he briefly met Shumway while working for their shared mentor. Lillehei had been a pioneer in the exploration of the heart, but he had done so by breaking every conceivable rule. On multiple occasions, he was nearly imprisoned for his actions. In relatively few months of training with Lillehei, Barnard learned three things. He learned how rapidly advances were occurring in heart surgery. He learned that one did not need to follow the rules. And he learned that Shumway and Lower, two men he had never heard of before, were slowly taking the steps necessary to one day transplant a human heart.

  Barnard returned to South Africa after his stay in Minnesota and, while there, became convinced that he could and would perform a heart transplant. In 1958, the same year Lower and Shumway first removed the heart from a dog and then put it back, he was appointed as a surgeon at the Groote Schuur Hospital in Cape Town, South Africa. There, despite his relative inexperience with the heart, he established a heart unit. Soon he was promoted to lecturer of surgical research and then head of the division of cardiothoracic surgery. Locally, his star was beginning to rise.

  Years passed and eventually Barnard decided he wanted to see the progress Lower and Shumway had made. He visited Lower’s laboratory at the Medical College of Virginia (now part of Virginia Commonwealth University) in 1966. Barnard stayed three months with one of Lower’s colleagues, David Hume (who had made advances in kidney transplants), during which time he learned rapidly and aggressively. Barnard watched Hume, carefully noting the drugs he used as immunosuppressants. He also watched, with numbed amazement, as Lower performed a heart transplant on a dog. To some men, such an event would have seemed a horror or a miracle, or both. To Barnard, it was a lesson. In watching Lower, Barnard was now sure that heart transplants were ready for humans. He was sure, too, that he could do one. He even confided to one of Lower’s assistants that this was his intent. When the assistant told Lower, Lower was unworried. Barnard, after all, knew almost nothing about heart transplants. How could he possibly contemplate doing one?

  At this point, Barnard’s brother, Marius, joined his program in Cape Town; he would work alongside Christiaan. When Christiaan Barnard returned to South Africa after his trip to Virginia, with Marius at his side, he was ready to do a heart transplant. He wanted his hospital and South Africa to be first. He began to prepare everything for such a surgery. This would take more work than it might have elsewhere, for the simple reason that in South Africa, Barnard did not have the resources other hospitals had. He did not have a team of cardiologists. Nor did he have all of the right equipment. For example, he did not have an autoclave large enough to sterilize the big equipment. He would make do.

  What Barnard needed most was a patient in need of a heart, and a body that could donate one. Then a patient came to the hospital who clearly would not live long with the heart he had. Louis Washkansky was in bad shape, and when Barnard explained the possibility of a heart transplant to Louis, he (and eventually his wife) agreed to the procedure. Louis’s wife, Ann, asked Barnard pointedly what the chances of her husband’s survival were, and he responded, “Eighty percent.” This despite the reality that in the transplants that Christiaan Barnard and his brother had by then attempted on dogs, nearly all of the recipient dogs had died during the procedure, and none of those that survived had lived more than a week.

  What was next was simply to wait for a donor to turn up. Until this point, the donors for other kinds of transplants had all been individuals who were dead, but Barnard was ready to consider something more radical, donors whose bodies were still living but whose brains were dead. This improved the odds of finding a donor dramatically because one did not have to “capture” a heart in the seconds after death. But the idea of using brain-dead patients (patients that would, with time, come to be called “living heart cadavers”) pushed heart transplants onto even newer ethical ground.6 Barnard was ready for new ground. In much of the world, the law clearly stated that death occurred when the heart stopped, and so the hearts of heart-transplant donors needed to actually stop before they could be used, but in South Africa, the law was more ambiguous. If Barnard could find a donor, he would not have to wait for his or her heart to stop—all he needed was for the donor to be brain-dead. He just had to wait for someone in this condition to appear; he just had to wait for someone’s brain to die.

  By the fall of 1967, with Washkansky’s condition deteriorating, Barnard felt everything was in place to do a transplant. He didn’t yet know how to deal with the problems that might emerge in the recipient’s body. He had done little in the way of experimentation, and yet he knew that others were getting ready to do
their own transplants, and so if he wanted to be first, now was the time. The increasing successes of Lower and Shumway with dogs were being publicized. Shumway had announced his readiness to perform a human heart transplant. Adrian Kantrowitz at Maimonides Medical Center was ready too, just waiting on bodies, one in need of a heart and one with a heart to give. Two surgeons in Texas, Denton Cooley and Michael DeBakey, were beginning, separately, to consider the possibility of doing transplants. Donald Ross, a former classmate of Barnard’s at Cape Town University, was at the National Heart Hospital in London, and he was ready too. What was more, in Mississippi, James Hardy, a talented surgeon, had already done something astonishing. Whereas most surgeons focused on transplanting organs from one human into another, Hardy had another idea. He purchased four chimpanzees and had them shipped to the University of Mississippi Medical Center, where they were cared for as Hardy waited for a patient in need of a heart transplant. Then one arrived, Boyd Rush. Rush was comatose and had only a weak pulse. His left leg was gangrenous and his face was pocked with blood clots. His heart was unable to move enough blood through his body; it was failing, and it apparently had been failing for a while. Rush appeared to have just hours or, at most, days, to live. On January 22, 1964, Hardy amputated part of the man’s left leg and readied him to receive a chimpanzee heart. Later that same day, Hardy opened up Rush’s chest and pulled out his heart. It was, Hardy would later say, “an awesome sight,” the empty space where a heart should be inside a still-living body. The next step was to stitch in a chimpanzee’s heart, which Hardy proceeded to do; it took him nearly an hour. Hardy’s surgery, we know in retrospect, had very low odds of success. Rush was in terrible condition, but more importantly, he would almost certainly have an immune reaction to the chimpanzee heart. Yet the experiment worked. After an initially unsteady beat, the chimpanzee heart beat in the man’s chest for ninety minutes. Rush was, for those moments, alive with a chimpanzee heart inside him, though he soon died of unrelated causes. Hardy’s experiment horrified the public—people questioned the ethics of transplanting chimpanzee parts into humans. But with time, it would also serve to embolden the other surgeons, the men standing, in the fall of 1967, on the precipice of trying the same with a human donor heart.

  If Barnard was going to perform the first human-to-human heart transplant, he was going to have to hurry. Three years had already passed since Hardy’s surgery, and nine years had passed since the first heart transplant in a dog, years during which, it seemed, ever more surgeons had had the time to consider the basics of the procedure. On November 22, Barnard received a call about a potential donor, but an EKG suggested that the man’s heart might be damaged, though it appears the man’s race—he was black, the prospective recipient was white, and this was apartheid South Africa—also played a role in the decision to decline his heart. Then, on December 3, 1967, Barnard got another call. A twenty-five-year-old woman, Denise Darvall, and her mother, Myrtle, had been walking across the road after having bought sticky caramel cake at their favorite bakery when they were hit by a truck driven by Frederick Prins, a police reservist who had had too much to drink. The impact killed Myrtle and critically injured Denise. By pure chance, Ann Washkansky happened to be driving down the same road and saw the scene of the accident. She shuddered at the tragedy, not yet understanding the dark complexity of its consequences. Denise Darvall was taken from the scene directly to Groote Schuur Hospital so she might be resuscitated, but that was not possible. It was decided that her brain’s life could not be saved, but her heart’s could. Machines were set up to keep her body alive as long as possible.7 Her heart beat normally, pumping blood to every one of her functioning organs, and even to her damaged brain.

  Barnard raced to the hospital. Once there, just to be on the safe side, legally, he, his brother, and a colleague (all of whom swore never to speak of it again) surreptitiously administered potassium to Denise’s heart, which temporarily stopped it, allowing Barnard to say that her heart had stopped before he removed it. It was 2:20 a.m.; it was going to be a long night. Denise’s sternum was then cut with a saw and Marius Barnard connected her to a heart-lung machine. There she waited, open. Denise’s body and heart were cooled to 28 degrees centigrade to maximize how long the heart could wait. Next, in another room, Washkansky’s heart was removed, and he too was connected to a heart-lung machine and cooled. Then Barnard went back to the first room and removed Denise’s heart, placed it in a small container, and carried it to the room where Washkansky and his open chest waited. He lifted the small heart up and placed it into the great cavity in Washkansky’s chest, where he stitched it to Washkansky’s arteries and veins. At 5:43 a.m., Barnard undid the clamps and allowed the blood from Washkansky’s body to flow into Denise’s heart. The heart turned pink and, after some more interventions, at 6:13 a.m., Barnard announced that it was time to turn off the heart-lung machine. The heart beat normally, and as it did, Barnard’s heart raced. It was going to work.

  The next day, December 4, the result was announced in the South African newspaper the Star: “Transplanted Heart Is Beating!” Who knew South Africa had a heart-surgery program? (It didn’t; it just had Barnard and his brother.) Barnard’s achievement was on the front page of almost every paper in the world. As Barnard made his way home, calls had come in from France, London, and nearly everywhere else. By Monday, CBS and the BBC had news teams in Cape Town. Everyone knew about it. Washkansky could speak; he could eat breakfast. Although he now had the heart (and, many would say, soul) of a twenty-five-year-old woman beating in his body, he was still the man he had been. Washkansky’s wife feared that with a new heart, he would no longer love her, but it seemed he loved her just the same, perhaps more. On December 15, Washkansky was on the cover of Life magazine, smiling, slightly. On the same day, Barnard was on the cover of Time, a drawing of his head and shoulders in front of an illustration of a heart, as though the heart had been transplanted into him. Barnard would go on to live a new kind of life. He was famous. He began to describe the “years of animal research that it took to build up to performing a human heart transplant,” failing to mention that that research was done by Shumway and Lower, not himself. He socialized with and slept with movie stars. He traveled the world. The New York Times noted, “This is one of the peaks of modern scientific achievement, fully comparable to the heights scaled earlier in such fields as space exploration or modern biology.” Barnard bathed in the praise. He loved it.

  As for the actual heart-transplant recipient, Washkansky lived another day and then another. It was a seeming miracle. A week went by, and then two, but then things took a turn for the worse. By day fifteen, Washkansky’s immune system, it appeared, had started to react to the transplant and to attack Washkansky’s own lungs. Washkansky was given massive doses of drugs that would suppress his immune system, Imuran and prednisone, but at great expense. Bacteria already dwelling in his lungs, both klebsiella and pseudomonas, began to grow unchecked. By day eighteen, Washkansky was dead.

  Here is where the story of heart transplants departed tragically from that of the moon landing. The first moon landing was an unqualified success. Not so with the first heart transplant. Yet, after a brief period of sadness, Barnard continued with his celebration. Just a few days after Washkansky’s burial, Barnard was sitting in first class on a plane drinking champagne en route to TV interviews in New York and Washington, DC. He traveled the world giving talks and interviews. He went to Hollywood parties. Meanwhile, several groups of surgeons who had spent years preparing to do what Barnard had done8 continued the race to transplant hearts themselves. From the perspective of long-term survival, there had still not been a successful transplantation of the heart.

  Days after Barnard’s surgery, on December 7, Adrian Kantrowitz performed a heart transplant on an infant. Kantrowitz had been ready to do a transplant a year and a half before Barnard, but when an opportunity came, the donor heart was in poor condition, and so he had decided to wait. After several near misses, a healthy
donor heart arrived when he also had a needy recipient. Kantrowitz had performed heart transplants on more than four hundred puppies. Other than Shumway, he was the best prepared in the world to perform a heart transplant. But the recipient infant lived just six hours. Kantrowitz, in a moment of dejected humility, pronounced the surgery an “absolute failure.” He performed a second operation, with the same result, and so, after hundreds of puppies, great patience, and a decade of getting ready to perform that heart transplant, he gave up on the entire field.9 A month later, Shumway transplanted a heart into a man named Mike Kasperak; Kasperak lived just fifteen days. In Texas, Denton Cooley would perform seventeen heart transplants in the next year. All of the recipients died within the year, though in many cases, not before they had a chance to talk to the press. The race to transplant hearts had become a deadly circus. Barnard had sped everything up—everyone credited him with that—but at what cost?10

  By December 1970, a mere three years after the first heart transplant, 175 transplants had been performed. Just twenty-three recipients (including Barnard’s second patient) were still alive; perhaps, some speculated, more patients would have been alive if none of the transplants had been performed in the first place, if those in need of hearts had simply been left alone.11 Most had died in the days or months following the surgery. Here was an amazing, awe-inspiring surgery. It was a technological miracle, but one that created lives that, like Frankenstein’s monster’s, were fated to end badly. No one had yet figured out how to keep bodies from rejecting donor hearts or how to reliably ward off infection, so except where good luck and fate intervened, hearts could be transplanted into people who needed them, but the donated hearts and their recipients would soon die. In competing, the early heart-transplant surgeons were pushing a field faster than it was capable of going.