Chris Barnard: heart of a pioneer


Chris Barnard is one of the best known South Africans of all time.

He became the hero the world needed: the committed, "good doctor" who could pull patients back from where they were teetering on the brink of death, who could give them new hearts – that magical symbol of love and life – and who could give them their lives back.

What's more, at the age of 45 – when he became world famous after the first heart transplant – he looked incredibly young for a professor. His boyish good looks and natural charm did the rest. He dined with movie stars, spent time in the company of princes and princesses, was praised by almost every country on the planet, was crowded by fans at airports, and was revered everywhere he went.

His name was linked to those of Gina Lollobrigida, Sophia Loren and Francoise Hardy. He danced with Princess Grace, conversed with Prince Charles, and was entertained by the Shah of Iran as well as President Lyndon B. Johnson of the United States.

Now, 41 years after the first heart transplant, many foreigners still know of South Africa because, years ago and for a very long time, they linked the country to the names Chris Barnard, Groote Schuur Hospital and Cape Town.

The first heart transplant
The heart transplant on Louis Washkansky, which was done during the night of 2/3 December 1967, was a watershed moment for this surgeon.

His life changed unexpectedly and dramatically. This man who was born in 1922 from missionary parents in Beaufort-West, who had an impoverished upbringing, who qualified in 1946 as doctor at the University of Cape Town and later as a surgeon, who lived in a regular home with his wife and two children, was suddenly famous.

And how he enjoyed the fame! Years later, honest as always, he rightfully remarked that he "feasted on the apples that fell into his lap, and even ate until the tree was stripped of all its fruit". He enjoyed the attention, fame and luxuries immensely.

The media couldn't get enough of him, but many members of the medical community – both here and abroad – disliked the attention Barnard received.

Other brilliant medical breakthroughs
While Barnard will always be remembered for the world's first human heart transplant, he also made other, brilliant breakthroughs before the heart transplant. In fact, his career as doctor is characterised by such brilliant work that it's no surprise that he was the first to succeed.

The world gave him excessive recognition for this procedure, but perhaps this is how things work? Perhaps, through this, the world indirectly acknowledged his earlier, unsung work?

His inner drive, his all-consuming winner instinct, his sharp mind (and tongue), his ability to find answers to questions in a logical and practical way, and his enormous work capacity made him a workaholic doctor and researcher who didn't give up before he found solutions to problems. He was also a perfectionist when it came to surgery and patient care.

On a technical level, he was an extremely skilled surgeon, who also expected perfectionism from his colleagues. His colleagues tell many stories of how he, like a young elephant, trumpeted through the theatre or ward when things didn't go precisely as he wanted them to go.

His aftercare following operations was very precise and contributed to the fact that his success rates were among the highest in the world.

Three wives and six children
The world knows everything about his social life and three wives (Louwtjie, Barbara Zoellner and Karin Setzkorn) and six children (Deirdré and the late André from Louwtjie, Frederick and Christiaan from the late Barbara, and Armin and Lara from Karin), as well as his escapades with other women.

But does the world know that Chris, as a young doctor in his twenties, couldn't stand to see children dying every day from tuberculous meningitis (tuberculosis infection of the meninges) in his ward at the City Hospital for Communicable Diseases in Greenpoint and, as a result, developed a new and successful treatment method for the disease?

Barnard's approach of finding solutions and better treatment methods for diseases meant that, as a young doctor, he was already years ahead of his colleagues.

While other young and older doctors accepted that these children got brain damage and died due to sediment in the brain that blocked the flow of moisture, he started to think of ways in which the sediment could be dissolved and prevented. He found the solution and the treatment, and thus saved the lives of many children.

These research findings also formed the basis of his MD thesis. As a 31-year-old, he received his doctorate in medicine in 1953, and shortly afterwards the MMed degree in internal medicine, and qualified as physician while working at Groote Schuur Hospital.

Even in the planning of his career, he was methodical and purposeful: he wanted to become a surgeon, specifically a heart surgeon, but wanted a more comprehensive knowledge of bodily functions than a general practitioner had. So, in preparation for his surgical training, he first specialised as physician.

While training to become a surgeon, he researched, among other things, the cause of congenital duodenal atresia, as surgeons couldn't find an answer during the 1950s. Even after they removed a piece of the undeveloped small intestine and patched up the healthy areas, they couldn't save the children's lives. Chris immediately knew the answer: the defect was caused by inhibited blood flow to this part of the small intestine.

He confirmed this theory through research on animals, and his findings led to the fact that surgeons now remove greater segments of the small intestine before attaching the healthy parts. The lives of thousands of children have been saved thanks to this insight.

When, at the end of 1955, Barnard got offered a chance to study under the well-known heart surgeon and researcher Prof Wangensteen at the University of Minnesota, Minneapolis, he grabbed the opportunity.

There he saw for the first time how Prof Walt Lillehei and Dr Vince Gott performed open-heart surgery with the help of heart-lung machines. He also learnt how to perform long and complicated open-heart procedures, and learnt how to assemble and operate the heart-lung machine.

During this time, he did research on artificial heart valves and helped build and test new artificial aortic valves, and completed a PhD degree in surgery and an MSc within a mere two years. It took other students five to six years to complete a PhD.

Heart-lung machine brought to SA
Barnard brought a heart-lung machine with him when he returned to South Africa in 1958. The United States government paid for it, thanks to Prof Wangensteen.

He assembled the machine at Groote Schuur hospital, trained technicians to use it, and methodically compiled a team that could assist him in doing long and complicated open-heart procedures for the first time in South Africa.

For several weeks, he first tested the machine on animals to make sure the technicians were completely adept at using it before the first operation was to be performed on a human.

Years of pioneering work and new techniques (some small, others revolutionary) – mostly aimed at correcting congenital heart defects in children – followed. Every time he perfected a technique in the laboratory, it was applied in the theatre.

Barnard tells the story of how one day during a church service he thought of a new technique to correct transposition of the great arteries (where the aorta and pulmonary arteries are switched around). Years later, and a few short hours before he did the first heart transplant, he adapted the technique in his head and applied it successfully that same evening.

Babies with this common defect (transposition) are blue and usually die before they've outgrown their toddler shoes. Barnard repaired the flow of blood – not by merely switching the arteries, as this impaired blood supply of the heart muscle itself – but by switching the blood in the heart by means of a tube. Through this, he laid the foundation for a technique that's still used worldwide.

New technique for another heart defect
He also developed a new technique for the repair of Ebstein's anomaly, where the tricuspid valve of the infant is situated in the right atrium, instead of between the right atrium and right ventricle.

With Ebstein's anomaly, the right atrium gradually grows bigger, eventually resulting in death. The only real solution is to remove the diseased valve and to replace it with an artificial valve in the spot where the valve should've been in the first place. This procedure has become the standard treatment for the condition worldwide.

By 1962, Barnard and his team of researchers started developing a new heart valve. This valve, known as the UCT prosthesis, is still being used today with great success.

In 1963, he started doing experimental heart transplants on dogs, and predicted that heart transplants on humans would follow. "It took us five years to develop the necessary technique for the procedure and the after-care facilities," he wrote in his biography, Christiaan Barnard Een Lewe.

Joy from work on children
The work that he did on children with abnormal hearts gave him the greatest pleasure, and he wanted to be remembered for this work. His success rates for these procedures were among the best in the world.

By the time he did the first heart transplant, he had already done more than a thousand open-heart procedures – most of which were done on children.

After the first heart transplant, he was showered with congratulatory messages from parents – many of whom brought their children from countries such as Italy, Romania, England, Wales and Ireland so that he could perform complicated open-heart procedures on them. Most of these children, who were told by their local doctors that they only had a slim chance of survival, returned to their countries in good health after Barnard corrected their heart defects.

Also the first kidney transplant
Six months before the first heart transplant, Barnard also performed South Africa's first kidney transplant, mainly to get accustomed to using anti-rejection treatment. The patient, a woman, lived more than 20 years with her transplanted kidney.

In retrospect it's clear that Washkansky and Philip Blaiberg, South Africa's second and the world's third heart-transplant patient, were both too sick for the procedure. Nonetheless, Blaiberg lived 18 months with his new heart. Later, another patient – Dirk van Zyl – lived more than 20 years with his transplanted heart.

Other heart-transplanted patients started playing tennis and hiking again. Seven years after the first heart transplant, Barnard also performed the world's first heterotopic heart transplant.

His later life
Barnard gradually lost interest in surgery and, to his later regret, turned to research on cosmetics instead. He regularly spent more time abroad than in the Groote Schuur Hospital, and retired in 1983 as professor of the University of Cape Town.

The heart pioneer authored 14 books and more than 235 scientific articles, received 11 honorary doctorates and 36 international awards in 21 countries, 76 gold, silver and bronze medals, and the freedom of 26 cities. Sixty memorial stones were erected in his name.

But the fact that the lives of many children with abnormal hearts are still saved today, thanks to the techniques he developed, as well as the fact that heart transplants are now a common procedure, are his greatest legacies. Barnard's heart-transplant technique is still used in exactly the same way.

Charming, difficult, demanding, brilliant
He might have been a flirt and a ladies' man, but Barnard still was a brilliant surgeon and researcher.

He was simply made this way, he used to say. He was always honest, sometimes charming, sometimes blunt, and sometimes simply difficult and demanding. And he was very emotional: I remember how sad he was when his son André and his father died.

With regards to his patients and work, however, he was always focused and very methodical. His drive to give his patients his absolute best kept him working almost day and night during his first 25 years as doctor. This drive also led to breakthroughs that have saved, and are still saving, many lives.

Without him, the first heart transplant definitely wouldn't have happened in South Africa. The result would have been that South Africa probably only would have started a heart-transplant programme much later.

Without him, newspapers and magazines would have lost many sensational stories.

Without him, hundreds of children and babies would still have succumbed to tuberculous meningitis and duodenal atresia.

Without him, South Africa wouldn't have had a heart-lung machine by 1958, and we would have waited many more years before long and complicated open-heart surgeries could have been done here.

Without him, many babies, children and even adults with congenital heart defects would have died without undergoing open-heart surgery, and South Africa and the rest of the world would have had to wait for another "Chris Barnard" to develop new and successful techniques and treatment methods.

(Health24, December 2008)

[Excerpt taken and translated from Die 100 invloedrykste Suid-Afrikaners van die Eeu, Tafelberg Publishers. Written by Mari Hudson.]

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