From ancient myths to a world-first in Cape Town, Cybershrink gives his take on the story of heart transplants.
Only old folks may remember the international delirium with which the news of the first heart transplants, here in South Africa, was greeted; and the media frenzy which surrounded the surgeon, Chris Barnard, for so many years afterwards.
Ancient myths refer to apparent heart transplants, but as miraculous rather than practical events. From the 19th century on, surgeons experimented in their labs with various types of transplantation, as it was obvious that to be able to replace a damaged or failing organ could be life-saving.
They learned that transplants between different species always failed, those between different members of the same species usually failed but sometimes succeeded, especially when donor and recipient were closely related; and those within the same person (such as skin grafts from one part of the body to another) almost always succeeded.
In the 1930s heart transplants were performed in dogs, but they died a week later from the inevitable rejection of the new organ.
The surgeon and the aviator
French surgeon Alexis Carrel, who won a Nobel Prize for related work, collaborated in the 1930s with the celebrated aviator Charles Lindbergh to develop a mechanical heart that would circulate fluid through excised organs, enabling them to be kept alive for extended periods.
Norman Shumway and colleagues at Stanford developed heart-lung machines and essential techniques enabling the field of surgery to correct damaged heart valves. These included cooling of the heart to enable it to survive short periods without blood flow, so repairs could be done without blood obscuring sight of the relevant parts.
Autotransplantation was perfected in animals, where the heart was removed and stitched back into place. By the mid-1960s the major remaining obstacle was dealing with immunological rejection of a foreign heart. Some tried to avoid this problem by using artificial hearts or implanted pumps.
In 1967 Michael DeBakey, in Houston, implanted an artificial left ventricle in a patient.
The real barriers
There were two obstacles to a successful human heart transplant - the need to control rejection was well recognised. The often ignored barrier was whether the lure of surgical bravado and a place in the history books would override ethical principles and actual benefit to patients.
In 1964, Dr James Hardy in Jackson, Mississippi, transplanted a chimpanzee heart into a dying human - and the heart beat for only 70 minutes before stopping.
The first transplant
The first human heart transplant was done in Cape Town by Dr Christiaan Barnard on 3 December 1967.
The heart of a woman of 25 (Denise Darvall) who had died in a car crash, was removed and replaced the failing heart of Louis Washkansky, 55. He survived for only 18 days, dying of a severe infection. This was always a risk with the crude methods of immune suppression available then.
Philip Blaiberg, a retired dentist, transplanted in January 1968, lived for another 20 months.
Many surgeons jumped on the bandwagon, and 100 such operations were done in 1968, by 65 different teams, falling to only 18 in 1970, as so many of the patients died so soon after surgery, from the natural tendency of the body to reject new and foreign tissue placed into it.
Only 15% of patients survived a year post-op, and enthusiasm for the procedure waned.
Over the following 20 years researchers patiently brought about advances in tissue typing, so as to better match donor and recipient, and developed immunosuppressant drugs that substantially improved the survival and quality of life of patients.
The longest survivors
The longest surviving heart transplant patient I find on record is Tony Huesman, who has lived for 29 years post-op. His operation was done in 1978 by Dr Norman Shumway. Europe's longest survivor lived 25 years, dying at the age of 75.
The longest survivor from Groote Schuur has survived over 28 years. Other recipients have been notable for publicising their degree of health. Kelly Perkins climbs mountains, and has Fuji, Kilimanjaro, the Matterhorn and others under her belt, 12 years post-op. Dwight Kroening finished an Iron Man contest 22 years post-op.
(Professor M.A. Simpson, Health24, December 2008)