Christiaan Barnard Biography (1922-)
- South, African
Dr. Christiaan Barnard became internationally famous on December 3, 1967, when he performed the first human-to-human heart transplant. Many other surgeonshad been struggling to prepare for this same historic operation, but Barnard's personal drive and fascination with his field propelled him onto the worldstage as the first to undertake such ground-breaking surgery. Barnard was born and raised in the arid South African countryside known for its sheep farms. His father was a Dutch Reformed missionary and the family of six lived veryhumbly. Barnard, known for his excellent academic performance and photographic memory, graduated from the University of Cape Town medical school in 1946.During his residency, he devoted most of his studies to tubercular meningitis, writing his doctoral thesis on the subject in 1953. When he was transferred to Groote Schuur Hospital--the site of his historic operation--Barnard became interested in surgery. A grant in 1955 to study cardiothoracic surgery atthe University of Minnesota enabled him to work under the guidance of the prominent surgeon C. Walton Lillehei, one of the many researchers around the world attempting to develop techniques that would lead to the first human hearttransplant. Together, Barnard and Lillehei performed experimental open-heartsurgery in animals.
When Barnard returned to South Africa, he and his surgeon brother, Marius, began a rigorous series of heart transplant experiments in dogs using a methodcalled the Shumway technique. By the end of 1967, Barnard felt ready to perform the transplant operation on humans, and it was only a matter of time before the right donor and the right patient appeared. Barnard performed the innovative and, to many, shocking surgery on Louis Washkansky, a fifty-three-year-old grocer with debilitating heart disease. Washkansky received the heart oftwenty-five-year-old Denise Darvall, who had been killed by an automobile. Almost immediately, controversy spread, and people worldwide voiced moral, legal, and ethical objections to this operation. Of particular concern was the question of how to define the death of a potential donor, since comatose patients can be maintained by artificial means for an indefinite period. Barnard'sreaction to the uproar was one of steely determination to hold his ground; hehad no second thoughts and intended to continue with more transplants. WhenWashkansky first awoke from his surgery, he is reported to have said, "I am the new Frankenstein." He survived with his new heart for eighteen days, at which point the infections that ravaged his body became lethal. It became evident that the surgical methods for accomplishing transplantation had been achieved, but in order to suppress the body's fundamental mechanism of rejecting foreign tissue, powerful antirejection medications had to be administered. These drugs, called immunosuppressants, lower the body's resistance to foreign tissue but simultaneously suppress its overall immune response, or natural ability to fight viral and bacterial infection. Patients are prone to severe infections as a result.
After Barnard's initial heart transplant operation, many other surgeons undertook the same operation in the following weeks, but with very poor results. Survival rates were unacceptably low--doctors still could not control infections which flourished in their patients. Barnard's second heart transplant recipient, Philip Blaiberg, survived a remarkable 593 days, but Barnard recognized that this case was an aberration rather than the rule. After a total of four transplant attempts, he decided to stop until more research could be done.On November 25, 1974, Barnard tried a new technique, the first double-heart transplant, in which he implanted the heart of a ten-year-old girl into a fifty-eight-year-old man without removing the patient's diseased heart. He performed this operation again in 1975, but both patients lived only a few months.Only a handful of centers continued cardiac transplantation after 1969. Manyexperts felt that research should be directed toward developing the artificial heart, since the heart is a simple pumping mechanism and relatively easy toreplicate as opposed to other organs, such as the kidney. It remained imperative, however, to develop a successful method for controlling post-transplantation infections. The development in the 1970s of cyclosporin, a specific immunosuppressive agent, once again turned the tide toward organ transplantation. Cyclosporin, which suppresses only certain aspects of the immune system allowing the body to receive a new organ but also fight off the more virulent infections, is by no means a wonder drug but it has clearly reduced the rate ofmortality associated with transplants. In the 1990s, investigations into tolerance induction and chimerism (the coexistence of donor and recipient cells), particularly through simultaneous donor bone marrow infusionwith the organ transplant and the role of dendritic cells, hold promise for transplants without the need for immunosuppressive drugs. Barnard's landmark surgery forced many issues surrounding transplantation, legal, ethical, and medical, and he remains a symbol of tenacity and daring in pursuing his goal.