On December 3, 1967, 53-year-old Louis Washkansky receives the first human heart transplant at Groote Schuur Hospital in Cape Town, South Africa.
Washkansky, a South African grocer dying from chronic heart disease, received the transplant from Denise Darvall, a 25-year-old woman who was fatally injured in a car accident. Surgeon Christiaan Barnard, who trained at the University of Cape Town and in the United States, performed the revolutionary medical operation. The technique Barnard employed had been initially developed by a group of American researchers in the 1950s. American surgeon Norman Shumway achieved the first successful heart transplant, in a dog, at Stanford University in California in 1958.
After Washkansky’s surgery, he was given drugs to suppress his immune system and keep his body from rejecting the heart. These drugs also left him susceptible to sickness, however, and 18 days later he died from double pneumonia. Despite the setback, Washkansky’s new heart had functioned normally until his death.
In the 1970s, the development of better anti-rejection drugs made transplantation more viable. Dr. Barnard continued to perform heart transplant operations, and by the late 1970s many of his patients were living up to five years with their new hearts. Successful heart transplant surgery continues to be performed today, but finding appropriate donors is extremely difficult.
Fifty years of human heart transplants
Fifty years ago, at 6.13am (GMT) on 3 December 1967 at the Groote Schuur Hospital, Cape Town, history was made with the first successful human to human heart transplant.
South African surgeon, Christiaan Barnard stunned the world as news broke out that he had carried out the operation to place Denise Darvall’s heart into Louis Washkansky’s chest.
The Cape Times from 4 December 1967 © Heart of Cape Town Museum
This news was ground-breaking and became forever embedded in the public consciousness.
Over the last couple of months, I have lost count of the conversations I’ve had with people, including my parents, about what it was like. Barnard’s achievement was so often compared to climbing Mount Everest.
Up until this point, kidney, liver, and lung transplants had been performed, but without the same media attention.
The heart was and is forever intertwined with ideas of love, emotion, and personality. There was also no backup plan if the heart transplant failed, so the operation was fraught with risk.
A quote that captures the intrepid pioneers of the sixties comes from Donald McRae’s book Every Second Counts: The Race to Transplant the First Human Heart:
‘Even the idea of touching the human heart, let alone cutting it out and placing it inside another living body, had been considered impossible.’
Research into the procedure had been happening for years, notably by American surgeon Norman Shumway a man who many thought would perform the operation first.
However, Barnard remained adamant that he owed nothing to Shumway.
Heart-lung machine from Royal Postgraduate Hospital Hammersmith c.1958
To commemorate this historic milestone in medicine we are looking at human heart transplants then and now – told by the people who have that unique experience, accompanied by objects that support their stories today.
The first donor: Denise Darvall
Denise Darvall © Heart of Cape Town
‘If you can’t save my daughter, you must try and save this man.’ Edward Darvall
Twenty-five-year-old Denise Darvall had irreversible brain damage following a car accident. Her father made the decision to donate her heart in just four minutes.
Much of the technical expertise to do this operation had been developed years beforehand. What halted most surgeon’s efforts was finding a donor.
Many legal definitions of death were defined by the stopping of the heart and in South Africa, two doctors had to agree. Barnard used a simple definition of what we now know as ‘brain death’– no reaction to light or pain, including an examination by a neurosurgeon.
However, he still faced opposition in his own surgical team. So, they waited for her heart to stop beating before removing it.
The first recipient: Louis Washkansky
Louis Washkansky, the first recipient of the world’s first human to human heart transplant. © Heart of Cape Town Museum
‘I was petrified at what I’d find. Like everyone else I thought the heart controls all your emotions and your personality.’ – Louis Washkansky
Louis Washkansky had heart failure following three heart attacks. When approached by Barnard about the risky surgery he replied: ‘I can’t go on living like this.’
Following his transplant, newspapers reported on his condition daily. Even the ECG of Louis’s new heart starting up was headline news. Unfortunately, he died 18 days later from pneumonia because his immune system had been extremely weakened.
The first surgeon: Christaan Barnard
Christiaan Barnard. © Heart of Cape Town Museum
Barnard’s historic operation kicked off what became known as ‘a year of transplants’ where surgeons attempted the same operation. Over 100 operations happened in 50 different hospitals worldwide with varying degrees of success. Although, high mortality rates and the high cost meant many surgeons turned their back on the procedure.
By the end of the 1970s, with brain death passing into law and new immunosuppressant drugs, transplants became more widely practiced again.
Barnard’s own transplant record is impressive reading: his second patient, dentist Philip Bleiberg lived for 18 months another Dorothy Fisher lived for 12 years and Dirk Van Zyl lived for 23 years. All the more incredible when some of the widely used immunosuppressants only came in to use years after their operations.
Heart transplants today
Today over 200 heart transplants happen each year in the UK without the media fanfare but forever change the lives of the people who receive them. I have been lucky enough to talk to people involved in heart transplants with the help and support of Papworth Hospital – one of five transplant centres in the UK.
Heart surgeon, Catherine Sudsharan says:
‘The heart is such a fascinating organ that it never seizes to amaze me. Technically, it may be one of the easiest operations that I perform. But, the fact that this beautiful organ that belonged to one individual, removed and then plumbed into another person, starts to beat and subsequently works within minutes of completing the operation irrespective of class, race, age or sex continues to enthuse me.’
Meeting Eric Scoones, who had a heart transplant in 2013, was one of the most memorable days I have had during my time at the Science Museum.
His openness about his story was moving and the objects on display tell just a small part of that story – a month’s worth of medication boxes taken to stop his body rejecting his new heart and the t-shirt he wears while running to inspire others to think about becoming an organ donor.
Gallery view of Eric Scoones t-shirt
Unlike the first human heart transplant, Eric will never know who his donor was as all donations in the UK are anonymous, but he often thinks of them:
‘At first, I actually couldn’t sleep because my new heart felt like it was beating so hard! I often remind myself of the precious gift that I’ve received, thanks to my anonymous donor and the generous spirit of his family at a time of tragedy for them.’
You can see the free display 50 years of Heart Transplants at the Science Museum from today.
This display would not have been possible without the support of Papworth Hospital, Eric Scoones, and the Choudhrie Family Foundation.
As part of the medical curatorial team, Selina works on the medical galleries redevelopment project and has a broad interest in the history of medicine and medical science. During her time at the museum, Selina has worked on meteorites, clocks, climate science and almost everything in between.
This blog will take you behind the scenes at the Science Museum, exploring the incredible objects in our collection, upcoming exhibitions and the scientific achievements making headlines today.
Heart Transplants: A History that Spans a Century
The history of heart surgery spans more than a hundred years and has seen many challenges and triumphs, including the treatment of various congenital heart defects, the development of the heart-lung machine, animal and artificial heart transplantation, and finally, human heart transplantation. Dr. Norman E. Shumway (known as the “Father of Heart Transplantation”), performed the first successful cardiac transplant in 1968 at the Stanford University School of Medicine. However, before this landmark event, many other scientists and physicians contributed to the development of the surgery, including those who initially worked on animals and those who attempted to transplant other organs such as the kidneys. Dr. Christiaan Barnard, a South African cardiac surgeon, was the first to perform a successful kidney transplant in 1953 and was also the first to perform a human heart transplant in 1967 in South Africa. The development of immunosuppressant drugs, which help prevent the body’s rejection of transplanted organs, was also an important factor in the ultimate success of these surgical procedures. Today, the only factor that limits the number of people whose lives are saved by cardiac transplants is the availability of healthy heart donors.
Here are some resources that will help describe the interesting history of heart transplants:
The first attempts to transplant human hearts extended the lives of ailing patients for only short periods of time, but these paved the way for further research, which has brought medical science to where it is today. Here are some of the dramatic stories regarding the success of human heart transplants:
The first transplant
On the night of 2/3 December 1967, Barnard performed the world’s first human-to-human orthotopic heart transplant in his patient, Louis Washkansky. Today, when heart transplantation has become a relatively routine and commonplace procedure, one may be inclined to underestimate Barnard’s immense courage in undertaking this first operation. Washkansky, a 53-year-old man with severe coronary insufficiency, was far from an ideal recipient by today’s standards, being a diabetic and a smoker with peripheral vascular disease. Furthermore, his massive dependent oedema had required drainage by needles placed into the subcutaneous tissues of the lower legs, and these puncture sites and accompanying stasis ulcers had become infected.
On 2 December, a young white woman, Denise Darvall, sustained a massive head injury after being hit by a car and was certified as having a lethal brain injury without any chance of recovery, by the neurosurgeon who had been called to treat the patient and who eventually referred her as an organ donor. There were no laws relating to brain death and organ transplantation in South Africa at that time, as elsewhere, and Barnard elected to take no chances. He invited the State’s forensic pathologist to the operating room, where ventilation of the donor (already prepared and draped for surgery) was discontinued. The blood pressure steadily fell and the heart arrested. The medical examiner pronounced that death had occurred. Barnard’s assistants then rapidly opened the chest, initiated pump-oxygenator support, cooled the heart to a low temperature and excised it.
The recipient had been prepared in the adjacent operating room and Barnard proceeded with the transplant. The enormity of what he was attempting was impressed upon him when, for the first time in his life, he looked into the chest and saw an empty pericardial cavity. The procedure went well and the heart functioned satisfactorily. No photographs were taken during the operation and so there is no visual record of this historic surgical procedure.
Within 48 hours the world’s press had descended on Cape Town and Barnard had become a household name. This intense public interest resulted in the appearance of Barnard and his transplant on the front covers of Time, Life, Newsweek and many other major foreign magazines within two to three weeks of the transplant. The world’s most publicised medical event had taken place.
Washkansky’s daily progress was followed intensely around the world, with almost every aspect of his care being made public. His early recovery was excellent, and the team was impressed with how rapidly the patient’s peripheral oedema was lost as his new heart functioned strongly. This excellent progress continued for almost two weeks, when Washkansky’s condition began to deteriorate and he developed radiographic infiltrates in the lungs. The surgical team was uncertain whether these were due to pulmonary oedema associated with cardiac failure from rejection, or with infection. Mistakenly, they initially elected to treat for rejection, intensifying the immunosuppressive therapy. This step was a lethal error as the patient had developed bilateral pneumonia, which was aggravated by the enhanced immunosuppression, and he unfortunately succumbed from severe pneumonia and septicaemia on the 18th day post-operatively.
One major and controversial issue was that of brain death. An ad hoc committee rapidly convened at Harvard Medical School in 1968 to address this topic, and their recommendations had seemingly freed doctors from the thorns of this dilemma (11). The Harvard committee enumerated and specified attributes that qualifies irreversible coma to be the ‘new criterion of death.’ Tests to evoke the presence or absence of reflexes and central nervous system activities, spontaneous respiration and movements have been recommended. A repetition of these tests after 24 hours has also been advocated assuming that there has no change in the person’s status. The two reasons included in the report on the need to modify the definition of death at this time were: (I) patients could still have a beating heart although with an irreversible brain damage due to refinements in resuscitation and support management (11), which is an event imposing a tremendous load not only on these patients themselves but also to their families as well as to the institutions with regards to bed allocations, and (II) to address the controversial issue of obtaining donor organs for transplantation with regards to the classical criteria for ascertaining death (11). The Harvard report advocated then that a patient could be pronounced dead before discontinuance of mechanical ventilatory support- a decision performed by doctors who were not concerned in transplantation to obviate any conflicts of interest and ethical repercussions (11). This counsel sanctioned harvesting of organs while the heart still beats. However, the predicament came to the forefront one final time in 1973, and again Norman Shumway was involved. Shumway had used a donor organ from a shooting victim. When the murderer came to trial, the accusing lawyer shrewdly asserted that it had been Shumway disconnecting the respirator, rather than his client pulling the trigger, as the reason for death (12).
For 30 seconds on the afternoon of Jan. 6, 1968, in an operating room at Stanford Hospital, two human hearts lay very still in two separate basins near the unconscious body of a 54-year-old patient, and time froze. “We both stood there and stared into this huge, empty cavity for a good half a minute,” says Edward Stinson, MD, chief resident at the time. “It was a magical moment.”
Norman Shumway, seated right center, On Jan. 6, 1968, performed the first U.S. adult heart transplant. Edward Stinson, seated across from him, and Nurse Bernadine Hartman assisted in the surgery. (Photo: Stanford Medical History Center)
The young surgeon was assisting his mentor Norman Shumway, MD, PhD, chief surgeon, who had just removed Mike Kasperak’s diseased heart in an effort to save the retired steelworker’s life. It was the first attempted heart transplant of an adult in the United States.“Do you think this is really legal?” Stinson asked Shumway.“I guess we’ll see,” Shumway said.
One of the two hearts, diseased beyond repair, would never beat again. But the other, if transplanted into Kasperak’s chest within the next hour or two, could start up again and save his life. It was an outrageous act that was being followed with bated breath by the world as a frenzied press corps, camped out in the hallways of the hospital’s basement, issued moment-by-moment reports.
“I just remember thinking the future was going to be different if they can transplant a heart,” Tom Brokaw, the anchor and managing editor of NBC Nightly News for 22 years, says in a recent interview. On that day, he was one of the reporters at the hospital, waiting for the news to break.
That surgery, 50 years ago, captured a moment in history when transplantation of a human heart was so hard to fathom, so bizarre, it was considered shocking, almost indecent.
The heart, more than any other organ, holds a unique place in the public imagination, seen as the seat of the soul, the symbol of love and compassion. So, what happens if it’s cut out and replaced with a stranger’s? Does a man become a woman if transplanted with a woman’s heart? Was it even legal? These types of questions hung over the surgery, as Shumway and Stinson paused for a moment to consider the enormity of their actions.
Today in the United States, death is defined by law as the cessation of electrical activity in the brain — although this definition is not without controversy. In 1968, the legal moment of death was murkier. Was it when the brain stopped working or when the heart stopped beating? For those pioneering surgeons and cardiologists, using the still-beating heart of a brain-dead donor was just common sense if it gave a dying patient a second chance at life. Sick hearts must be replaced with healthy hearts to save lives.
On that cold, bright winter day in 1968, the spell broke and the surgeons got back to work. There was no turning back.
Race to transplant
In the race to be the first to transplant the human heart — and a race it was — Shumway, a tall, lanky country boy from Michigan, was considered the leader of the pack. His decades-long research working with Richard Lower, MD, in dogs in the laboratory, ultimately led to what remains the standard surgical technique for heart transplantation.
The researchers’ first big success occurred in 1959, when Shumway and Lower — a surgical resident who later joined the faculty of the Stanford School of Medicine — successfully performed the first dog heart transplantation. Shumway, along with a gang of rotating residents, continued studies in the lab for eight more years and in the process developed a method of preserving the donor heart by placing it in a solution of ice-cold saltwater to reduce its metabolism. They learned about the transplant rejection response, which would become the key stumbling block to successful heart transplants.
Then, on Nov. 20, 1967, Shumway and his team announced that Stanford was finally ready to conduct the first human heart transplant, and the wait for a suitable patient and a donor began. A potential patient had been identified in October, but died before a donor could be found.
Two weeks after Shumway’s announcement, on Dec. 3, 1967, South African surgeon Christiaan Barnard, MD, surprised not only Shumway, but also the entire world, by giving Louis Washkansky, a grocer dying of heart disease, a new heart. Using Shumway’s simple surgical technique, Barnard forever cemented himself into the annals of history as the first to transplant an adult human heart. Washkansky lived 18 days.
Heart recipient Mike Kasperak, left, and his wife, Ferne. Surgeon Norman Shumway and cardiologist Ed Harrison speak to the media, below, after the historic surgery. (Photos: AP Newswire and Stanford Medical History Center)
It was a shock to the Stanford program. Everyone had expected Shumway to be the first. In fact, Shumway’s first human heart transplant would be the world’s fourth. On Dec. 6, 1967, in New York, the first pediatric heart transplant was performed. The infant’s heart stopped beating after seven hours. Barnard performed a second transplant on Jan. 2, 1968.
Not until Jan. 5, 1968, were both a donor and a transplant recipient found at Stanford. At 2 p.m. Jan. 5, Kasperak had a massive heart attack at his home in East Palo Alto. He’d been living with heart disease for several years, and the prognosis wasn’t good.
“He had been referred to me,” says Don Harrison, MD, a Stanford cardiologist. “He had end-stage heart disease and was not going to live very long. I remember talking to his wife about this transplant surgery. I explained to her that this was a new procedure that had only been done once in the world before. I had to explain to her that her husband was terminally ill, and there was nothing we could do.”
According to news reports, Kasperak asked his wife, Ferne, if he should go ahead with the operation.“Go ahead,” she said. “I want you alive with me.”
Just four hours after Kasperak’s heart attack and 7 miles west of his home, another tragedy occurred. Virginia-Mae White, a 43-year-old housewife and mother of two from Mountain View, suffered a brain hemorrhage that left her in a coma at nearby El Camino Hospital. Physicians had confirmed that she was brain-dead by the time they placed her on a respirator, which pumped air in and out of her lungs and kept her heart beating.
Part of the pathos surrounding the drama of each of the 2,000 heart transplants routinely done each year in the United States comes from the reality that for one person to live, another must die. Today, more than 4,000 people in the United States are waiting for a donor heart at any given time. Each case evokes the same emotional quandary that Shumway felt when he picked up the phone just before noon Jan. 6, 1968, to call Bill White, Virginia’s husband, to ask him for his wife’s heart.
The couple lived in a modest home and had two children, an 18-year-old daughter and a 12-year-old son. They had recently celebrated their 25th wedding anniversary. Shumway was typically light-hearted and quick-witted. In his lab, the professor of cardiothoracic surgery was upbeat, confident, somewhat irreverent and brilliant. His team members loved him. For him, as for anyone, this wasn’t going to be an easy conversation.
In his book Every Second Counts: The Race to Transplant the First Human Heart, author Donald McRae describes the conversation between Shumway and Bill White that day: “Once Shumway had explained the mechanics of transplantation and discussed the concept of brain death, White revealed that his wife had been fascinated by the South African transplant. She and Bill had recently talked to friends about Edward Darvall — who had allowed his daughter’s heart to be used for the Washkansky transplant. ‘How marvelous,’ Virginia White said, ‘to give someone else a chance to live.’
“White needed only 30 minutes to discuss the transplant with his children. His answer to Shumway was decisive. They wanted him to proceed.”
“Knowing that she is helping another is easing our grief,” Bill White said later in news reports. “I’ve got two of the proudest children you ever knew.”
It was time to round up the surgical team.
Bringing the donor to Stanford
That afternoon, Stinson was sent to pick up Virginia White at El Camino Hospital in an ambulance and deliver her, with her heart still beating, to Stanford Hospital at 3:30 p.m. Shumway received a neurologist’s confirmation of brain death to proceed, and the surgery began.
Two surgical teams were set up in two adjoining rooms on the second floor of the east wing of the hospital. Stinson removed White’s heart in Room 12, then walked it over in a basin filled with cold saltwater to Room 13, where Shumway was waiting. Kasperak was connected to a heart-lung machine that kept his blood circulating while Shumway cut out his diseased heart.
White’s heart, just a third the size of Kasperak’s, which was swollen by disease, was then lifted out of its basin and placed inside the empty chest cavity. Shumway sutured White’s heart into Kasperak’s chest, connecting the major heart vessels — the vena cava, the aorta, the pulmonary artery — and the left atrium.
In all, the surgery took about 3½ hours. White’s heart had been motionless for two hours. Now, there was nothing to do but wait and see if it would beat again.
It generally takes about 20 or 30 minutes for a transplanted heart to begin to beat after surgery. The surgeon triggers the electrical system of the heart with a single shock from a defibrillator, then waits for it to “pink up” as blood flows back into it. The recipient remains attached to the heart-lung machine until the heart starts to beat effectively again and can take over to keep the blood circulating.
“The excitement was palpable,” Harrison says. Ten, 20 minutes passed. At 25 minutes, the new heart faintly pulsed and then grew stronger. “We were all elated.”
Edward Stinson, MD, assisted cardiatric surgeon Norman Shumway in the first U.S. adult heart transplant. (Timothy Archibald photography)
‘A three-ring circus’
Downstairs, all hell broke loose. Fifty or so journalists had arrived even before surgery began, according to an article in Stanford Report by Spyros Andreopoulos, director of the medical center’s news office at the time. He had converted two classrooms into an impromptu press room.
“The tip actually came from a reporter from the San Jose Mercury News who was at a wedding reception with members of the transplant team,” Andreopoulos wrote. “When they received an emergency call from the hospital, he deduced that the transplant operation was imminent.” The news spread fast. Television reports aired that night.
“My friends and I were on the phone that night saying, ‘Oh my gracious, did you hear they did the transplant?’” says Joan Miller, RN, who was at home after finishing her shift on the third floor of the hospital, just above the surgical rooms.
“When I arrived at work it was chaos. It was like a three-ring circus. People were everywhere. It was just great fun and exciting. On break, we’d race down to the basement to see it all — the cameras, the equipment, the news anchors.”
By the time the operation was complete and Kasperak was moved on a gurney down the hall to the intensive care unit, reporters were literally scaling the hospital walls trying to snap photos of him through the window of his room.
“I remember thinking they were going to break their necks!” says Stinson, who saw them climbing when he stepped outside. Kasperak’s nurses, though, were quick to close the curtains, preventing any photos, and the defeated reporters climbed back down.
The next morning, Shumway, with Harrison by his side, stood with arms folded over a wrinkled, white lab coat and faced the crowd of several hundred reporters at a news conference held in one of the medical school’s amphitheaters.
“We have reached first base, so to speak, but our work is just beginning,” Shumway said, cameras clicking. “The heart transplant patient, Mike Kasperak, awakened in satisfactory condition.” Harrison, the patient’s cardiologist, presented diagrams of cardiac functioning measurements collected through the night showing that the heart was functioning well.
Shumway, known to be shy of the media, would later turn down offers to appear on Face the Nation, Meet the Press and the Today show, but that morning he appeared calm and in high spirits.
“Shumway looked just a little bit like a guy who had just got off the gridiron,” Brokaw says. “Exhausted, but pleased with himself. He looked the part — handsome, white jacket, just a built-in charisma. Here was this monumental moment, and he handled it with such modesty.”
A fight to keep the patient alive
During the next few weeks, Stinson, who later joined the School of Medicine faculty, led the fight to keep Kasperak alive. The first five nights post-surgery, Stinson remained sleepless by his patient’s side. Meanwhile, the Stanford press office issued daily bulletins on Kasperak’s condition.
“The patient, Mike Kasperak, 54 years old, was reported to be awake and alert,” the New York Times reported three days after surgery. “He was allowed a first visit with his wife yesterday evening and slept during the night.” Two days later, it followed up with: “Mr. Kasperak managed to scribble an ‘I love you’ note and hand it to his wife.”
For the first few days post-surgery, Kasperak’s condition remained hopeful, but then he slipped into a semi-comatose state. Extensive bleeding of the stomach led to worries that his liver and kidneys had been too severely damaged by years of heart disease to keep him alive.
“In retrospect, he was too ill at the time of surgery,” Stinson says. “His lungs, liver, kidneys, GI tract weren’t functioning well. His body didn’t tolerate the stress of the operation well.” Fifteen days after the surgery, Kasperak died of severe hemorrhaging. Stinson, making certain he was given enough morphine that he was never in pain, was there by his side.
In the aftermath of the Stanford transplant, the world hit near-hysteria in its fascination with heart transplants. Nearly 100 medical institutions jumped in to attempt the operation. The surgery itself proved fairly simple, but the inability to prevent recipients’ bodies from rejecting foreign hearts quickly led to alarming death rates. Sensationalized accounts of these operations appeared in newspapers like the National Enquirer. One paper ran with this headline: “Docs give her a man’s heart — now she puffs stogies and rants and raves at TV wrestlers.”
At the same time, lawsuits against heart surgeons became something of a fad worldwide, with defense attorneys claiming their clients were not guilty of murder despite having, for example, shot a victim in the head. It was the surgeons, who removed the victims’ hearts, who were guilty of the murder, they argued.
The Santa Clara County coroner threatened to bring murder charges against Shumway after his first transplant, but the district attorney refused. Shumway did testify in the 1974 murder trial in Oakland of Andrew Lyons, who had shot one of Shumway’s transplant donors in the head.
“I’m saying anyone who is brain-dead is dead,” Shumway testified, according to a story in the New York Times. Lyons was found guilty.
Not until 1976 would the issue of cause of death be resolved in California, with the establishment of a state law on brain death that made it clear doctors could legally remove a beating heart from the body of a brain-dead patient.
In 1970, on the third anniversary of Barnard’s first transplant, exhausted by this near madness and frightened by the soaring death rates, the medical establishment, led by the American Heart Association, called for a moratorium on heart transplants. All major institutions complied, except for one: Stanford.
A 1971 Life magazine cover story, “A new report on an era of medical failure: The tragic record of heart transplants,” reported the numbers: of the 166 heart transplants performed, only 23 recipients were still alive, giving the procedure an overall mortality rate of 85 percent.
“Shumway had been the man who American medicine thought would usher in the era of transplanted hearts,” the magazine reported. “Instead he became the principal surgeon to survive it. Mercifully, the race was no longer a race. The spectators had gone home all the runners save one had dropped out. He could afford to take all the time he needed to reach the finish line.”
Refining the work
“We just ignored it all,” says John Schroeder, MD, a professor of cardiovascular medicine who in 1968 was a member of the Shumway team as a cardiology resident. He helped write the grant proposals that kept Stanford’s research program alive following Kasperak’s transplant.
Returning to the laboratory, the Stanford physician-scientists continued to methodically publish scientific papers and conduct heart transplants, slowly establishing new protocols for the selection of patients and for measuring and treating rejection that would lead to the success of heart transplantation.
Today, Stanford Medicine’s reputation is firmly established as the research center responsible for leading to the thousands of successful transplants carried out annually around the world. But that first surgery remains a magical moment, for Stinson at least, and an essential one, along the journey toward making heart transplantation a standard operation.
“We learned a lesson,” Stinson says. “Patient selection would be key to the success of this operation. Mr. Kasperak was just too sick to survive. At the time of his death, the heart was probably the only functioning organ he had.” Shumway, who died of cancer in 2006, for many years kept a slogan hanging on his wall that said: “Where there is death, there is hope.”
The year following Mike Kasperak’s death, Ferne Kasperak was asked by a reporter at the Palo Alto Times about the decision that led to her husband undergoing the first adult heart transplant in the United States.
“He had 15 days extra that I don’t think he would have had,” she reportedly said. “I have no regrets, and I don’t think Mike did either.”
Christiaan Barnard and the First Heart Transplant
On December 3 , 1967 at the Groote Schuur Hospital in Cape Town South Africa , Christiaan Barnard performed the world‘s first adult heart transplant on Louis Washkansky . Although Norman Shumway is widely regarded as the father of heart transplantation , it was the young South African Christiaan Barnard utilizing the techniques developed and perfected by Norman Shumway and Richard Lower , who performed the world’s first adult human heart transplant .
Christiaan Barnard Background
Christiaan Barnard grew up in South Africa and sadly, one of his four brothers suffered from a heart disease and passed away at the age of five. Two of the remaining children, Marius and Christiaan Barnard took this incisive event to influence their career development and they both studied medicine years later. Christiaan Barnard served as a family physician after his graduation and later received his master degree at the University of Cape Town, where he also finished his dissertation on tuberculous meningitis. He made his first experiences with cardiothoracic surgery in the mid-1950’s in Minnesota, which highly influenced Barnard. He returned to South Africa, as a specialist in cardiothoracic surgery and was able to make up a great reputation, wherefore he was promoted several times in the next years.
Barnard performed several transplantations, mainly on kidneys before and the great breakthrough came on December 3, 1967. Louis Washkansky suffered an incurable heart disease and diabetes. He chose the surgery with a survival-chance of 80 percent, which Barnard later commented on: “For a dying man it is not a difficult decision 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 a chance to swim to the other side.” The surgery itself was assisted by his brother Marius and lasted more than nine hours. The donor heart came from a young woman who had turned brain dead after an accident the day before the surgery. The operation was successful insofar as Washkansky survived it. In order to prevent his body from rejecting the foreign organ, Washkansky’s immune powers were largely suspended. After 18 days he died of pneumonia as a result of an infection. An important member of Barnard’s team was also the South African Hamilton Naki, who made considerable contributions to the development of the surgical technique, which had to be concealed due to Apartheid at the time. The second patient, Philip Blaiberg, was operated on January 2, 1968 and lived with the transplanted heart for 18 months.
The operation depicts a milestone for the field of medicine. Barnard became instantly famous and was admired for his accomplishments and loved by the hundreds he treated without any charges. He performed more heart transplants in the 1960’s and 70’s, and one patient even survived 23 years after his transplant. In the 1980’s his health fainted and due to his rheumatoid arthritis, Barnard was not able to give surgery anymore, but remained in the community as a consultant.
Christiaan Barnard passed away on September 2, 2001 in Paphos, Cyprus.
At yovisto academic video search you can learn more about the cardiovascular diseases in the lecture of Dr. Nicholas Leeper of Stanford University on ‘Cardiovascular Disease, Prevention, and the Future’.
The History of Heart Transplants: Stanford Innovation
A few months ago for national Donate Life Month, we shared information on our SBC blog (HemoBLOGin) about organ donation and the critical role SBC’s Histocompatibility & Immunogenetics Laboratory (HLA Lab) plays in making sure donated organs can be transplanted successfully. And while our blog and website contain plenty of information on the innovative donor-patient matching we do today, few know about the rich history of transplantation, much of which was cultivated right here at Stanford!
One great example of innovation throughout the years is in heart transplantation. Today, the situation in which a heart transplant occurs would typically be something like this: A patient in heart failure has been unresponsive to other medical or surgical treatment options and now must receive a heart transplant for survival. They are put on the waiting list until someone who is registered as an organ donor passes away. If the deceased donor’s heart is viable for a transplant, the heart transplant candidate might receive the allograft based on histocompatibility in the two major blood type systems (ABO and HLA), as determined by an HLA lab. The histocompatibility — or the degree of matching between donor and recipient — is assessed before transplantation by several technologies, including ABO and HLA typing, alloantibody detection/identification and donor-recipient crossmatching. The HLA lab also performs post-transplant monitoring of humoral and cellular alloimmune response to make sure that the organ is not rejected. Based on this strategy, heart transplants today have an impressive 85% survival rate at one year and 53% at 10 years.
What is now a fairly successful and standardized transplant process, however, was not always so safe or straightforward. The first heart transplant was attempted in 1905 with two canines. The heart was transplanted immediately from the smaller donor dog into the neck of the larger recipient dog, who lived only two hours after the procedure. Experiments like these would come to be fairly common in the medical transplant community for many decades, with transplants between dogs serving as the backbone of heart transplant research through the early 1960s. Though surgical techniques were improved during this time, no canines lived longer than a few days, with most still living only a few hours.
After a failed attempt at transplanting a large chimpanzee’s heart into a human in 1964, the first human-to-human transplant was performed in 1967. Though the recipient died within the month from pneumonia, the transplant itself was considered to be successful. While the surgery was performed by a doctor in South Africa, the techniques and research used to support this transplant were largely attributed to Dr. Norman Shumway of Stanford University. His published research based on experiments with animals paved the way for other transplants around the world, with Stanford performing the fourth ever human-to-human transplant the next year. Despite many institutions closing their transplant programs during the late ’60s and into the ’70s, Stanford was one of four main institutions that continued to perform these groundbreaking operations and advance the field in critical ways.
For example, one of the main issues doctors had been having previously was lack of an ability to properly store an organ for transplant. The procedures had to be done quickly, and it was believed that some of the early failures were a result of the organ having been non-functioning for too long before the surgery. In the early 1970s, Stanford researchers revolutionized transplantation when they discovered that storing organs, including hearts, in a “chilled, high-potassium electrolyte solution” helped preserve it for hours, which enabled transport of organs and thereby more accessibility and success for patients.
Two major milestones that followed shortly thereafter addressed rejection of heart transplants — the very thing our current HLA Lab seeks to prevent as well! In 1972, Drs. Philip Caves and Margaret Billingham at Stanford developed an instrument that could be inserted through a patient’s neck vein and guided down into the heart, where it could withdraw small samples of the heart to be analyzed for early signs of rejection — something doctors had previously not been able to detect until it was often too late. Then in 1980, Dr. Shumway was back on the scene, this time with a cyclosporine drug that, when taken after transplantation, was shown to lower the chance of the heart being rejected. Only a year later, Dr. Shumway went on to perform the first-ever simultaneous heart and lungs transplant (which was also the very first successful lung transplant).
Since the ’80s, Stanford researchers have continued to make major innovations in heart transplantation and in creating medications and even DNA testing to predict and prevent organ rejection. Clinical research in histocompatibility and immunogenetics at Stanford has also made significant contributions in alloantigen and alloantibody discrimination, as well as in functional assays to support desensitization and rejection therapy. Now, just over 50 years after the first human-to-human transplant at Stanford, we are proud to continue our legacy of innovation in health care and, above all, provide services that give local patients hope for healing.
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Impressive as the technique was, it made little difference to patients suffering from more serious heart defects—for instance, children born with congenital heart disorders, breathless and blue and condemned to an early death, and victims of rheumatic fever whose heart valves were narrowed or stuck. If surgeons couldn't work on the heart from the inside, nothing could be done. But how could surgeons open up the heart without their patients bleeding to death? Temporarily stopping a patient's circulation only gave doctors about four minutes to work before brain damage from oxygen deprivation took place.
At the University of Minnesota, a young Canadian surgeon named Dr. Bill Bigelow came up with the first workable, if highly bizarre, answer. He had noticed how hibernating animals, like ground hogs, survived the bitterly cold Canadian winters. Their hearts beat slower, allowing them to survive for months without food. Wondering if cold might be the key to operating inside the heart, Bigelow began animal experiments and found that when dogs were cooled, open heart surgery could be done for long periods—much longer than four minutes—and they didn't die. He showed that at lower temperatures, the tissues of the body and brain didn't need as much oxygen, and could survive without oxygenated blood for longer.
On September 2, 1952, two University of Minnesota surgeons, Dr. Walton Lillehei and Dr. John Lewis, attempted the first open heart surgery on a five-year-old girl who had been born with a hole in her heart. Anaesthetized to stop her shivering, the girl was cooled by a special blanket until her body temperature reached 81 degrees F. At this temperature, she could survive without a pumping heart for 10 minutes, not four. Clamping the inflow to her heart so that it emptied of blood, Lillehei and Lewis cut open her heart, which was still slowly beating, and quickly sewed up the hole. With the repaired heart working properly for the first time in her life, the girl was then immersed in a bath of warm water to bring her body temperature back to normal. The operation was a success.
Four physicians aided by several technicians perform open heart surgery in this photo from the mid-1950s.
The "hypothermic approach" became very successful in treating small heart defects. But all too often, surgeons opened hearts to find more complex defects—defects that couldn't be repaired in 10 minutes. With the clock ticking away, they did what they could, but it was clear that a better approach needed to be found.
The dream of building a machine to take over the function of the heart and lungs during surgery had existed before World War II. Early prototypes, built by pioneers like Dr. John Gibbon in Great Britain, were cumbersome and dangerous—often leaking blood, damaging blood cells and causing air embolisms. It wasn't until 1958, when a system that involved bubbling blood was perfected, that "heart-lung" machines came of age. Dr. Dennis Melrose of London further increased chances for success when he pioneered an injection that stopped the heart from beating during surgery.
During the risky operation, a large mechanical device performs the functions of the heart.
Now surgeons had time to work on a heart that was not only empty of blood, but which wasn't moving. And they had time to correct the most serious abnormalities. Holes which were too big to be sewn up were patched. Where valves were damaged beyond repair, artificial valves were put in. Blocked arteries were bypassed. Weakened arteries were replaced altogether. Modern heart surgery seemed unstoppable.
But a major problem still remained—what to do for patients whose very heart muscle was diseased beyond repair? Could these patients be given new hearts? By 1966, heart surgeons were ready to take on the challenge. Most, like Dr. Michael DeBakey of Houston, thought the answer lay in artificial hearts. But the future would lie in a different direction: heart transplants. Kidneys had been transplanted successfully as early as 1963, after the complexities of tissue rejection were solved with drugs that suppressed the immune response. If the barrier had been breached for the kidney, why not for the heart?
In December of 1967, a South African surgeon, Dr. Christiaan Barnard, transplanted the heart of a 23-year-old woman killed in a motor vehicle accident into the chest of a middle-aged man. He lived for 18 days, until the powerful drugs used to suppress rejection weakened him and he died of pneumonia. The second patient to receive a heart transplant, at the hands of Dr. Adrian Kantrowitz in the United States, lived only six hours. But Dr. Barnard's next heart-transplant patient lived for 18 months and became a symbol of hope for victims of heart disease. All over the world patients were asking and receiving the new miracle operation.
But these surgical triumphs proved short-lived. Patients began dying of either rejection or infection. By 1971, 146 of the first 170 heart transplant recipients were dead. What first looked like another surgical miracle had turned into a disaster. Heart surgeons who had promoted the operation admitted defeat.
A NEW DAWN FOR TRANSPLANT SURGERY
Only one American surgeon would continue—Dr. Norman Shumway. Throughout the 1970's, he built a team of scientists and doctors to tackle the complex biological problem of tissue rejection in a careful, scientific manner. His team devised a way of spotting rejection attacks, by feeding a catheter into the heart and removing a piece of heart muscle for examination. Only when signs of rejection were seen were doses of the dangerous immuno-suppressive drugs increased. Shumway also benefited from a chance discovery made in another part of the world.
Dr. Norman Shumway rose to prominence in the high-profile world of heart surgery in the late 1960s.
In the soil of Norway's Hardaangerfjord a fungus was found which contained a compound that would revolutionize transplant surgery. The substance, called cyclosporin, appeared to have exquisite immuno-suppressant properties—controlling organ rejection without knocking out all resistance to infection. In the hands of Dr. Shumway, cyclosporin transformed the picture for heart transplant recipients. Hospitals around the world began to re-open their heart transplant units and their patients began to survive and prosper.
But this breakthrough has come with limitations, too. The problem with heart transplants now has become finding enough hearts. Today in the United States alone, two million people suffer from congestive heart failure. When drug treatments fail, transplants are the best hope. But fewer than 2,500 donor hearts are available each year, leaving thousands of patients desperate for an alternative.
In 1994, Dr. Randas Batista of Brazil devised a radical new surgical technique to treat a common form of heart failure for people with enlarged hearts. Normally, oxygen-rich blood flows into the left side of the heart from the lungs (see Map of the Human Heart). The left ventricle is responsible for pumping the blood out to the rest of the body. When the heart becomes diseased, it sometimes dilates or swells. The contractions become sluggish and the left ventricle is unable to squeeze out enough blood. Blood backs up in the heart and the lungs, resulting in congestive heart failure.
Batista's idea was to cut a swath out of the left ventricle and sew the chamber back together, thereby reducing its size and increasing its efficiency. Gradually, news of Batista's radical approach spread and, currently, a small number of surgeons around the world are experimenting with the procedure. Their results, so far, have been mixed. More time and innovation are needed before it's known whether this technique will be the next milestone in the history of heart surgery.
Whether Batista's new surgical technique, which diminishes the size of the diseased heart, will be widely adopted remains to be seen.
This Day in History – first human heart transplant
Did you know that on this day (December 3) in 1967, a 53-year-old male traded his heart for that of a 25 year old female?
It was the first human heart transplant. (Read more.)
The man’s heart was bad, his body sick and dying. The woman’s body was fatally injured in a car accident, but her heart was good.
Good for bad. Life for death. Hope for the hopeless. Strength for weakness. A new heart for the old heart.
For 18 days her heart beat inside of his chest.
No, his body didn’t reject her heart. Her heart remained strong and continued to work as it should until he drew his last breath.
Trading his heart for hers isn’t what killed him.
The medication given him to prevent his body from rejecting her heart weakened his immunity and raised his risk of infection.
Double pneumonia is what killed him.
Some would say he was dead anyway, for without the immunosuppressive drug, he would have rejected her heart.
Her heart in his body – that’s an odd thought, isn’t it. A female heart beating in a male body – alien and impossible. Everything within him was male/male except for her heart.
Would you believe…some questioned if having the heart of a woman would change him? …make him less of the man he was and more like the one whose heart now beat within him.
And I will give you a new heart, and I will put a new spirit in you. I will take out your stony, stubborn heart and give you a tender, responsive heart.*
God offers us all a heart transplant.
New for old. Good for bad. Healthy for hardened. Life eternal for a living death.
What an intriguing, alien, impossible thought – God’s heart for my own.
As all new things do, this brings about questions. (Remember those asked about the first human heart transplant?)
If my heart is traded for God’s heart…I wonder…will I be different? Will I change? Will I become less of who I am and more like the one whose heart beats within me?
Therefore, if anyone is in Christ, the new creation has come: The old has gone, the new is here! **