Christiaan Barnard

IntroSouth-African physician
A.K.A.Christiaan Neethling Barnard
Was Surgeon 
Physician 
Cardiac surgeon 
From South Africa 
Type Healthcare 
Gendermale
Birth 8 November 1922 
, Beaufort West
Death 2 September 2001 
, Paphos
(aged 78 years)

Christiaan Neethling Barnard (8 November 1922 – 2 September 2001) was a South African cardiac surgeon who performed the world’s first human-to-human heart transplant and second overall heart transplant (Hardy did a xenotransplant in 1964). Growing up in Beaufort West, Cape Province, he studied medicine and worked in that field for several years in his native country. In 1956, he received a scholarship for postgraduate training in the US under open heart surgery pioneer Walt Lillehei, where he first became aquainted with the future heart transplantation surgeon Norman Shumway. Upon returning to South Africa in 1958, Barnard was appointed cardiothoracic surgeon at the Groote Schuur Hospital, establishing the hospital’s first heart unit.
On 3 December 1967, Barnard transplanted a heart from a person who had just died from a head injury, with full permission of the donor’s family, into the chest of a 54-year-old Louis Washkansky. Washkansky regained full consciousness and lived for eighteen days, even spending time with his wife, before he died of pneumonia, with the reduction of his immune system by the anti-rejection drugs being a major contributing factor. However, Barnard’s second transplant patient Philip Blaiberg at the beginning of 1968 lived for nineteen months and was able to go home from the hospital.
He retired as Head of the Department of Cardiothoracic Surgery in Cape Town in 1983 after developing rheumatoid arthritis in his hands which ended his surgical career. He became interested in anti-aging research, and in 1986 his reputation suffered when he promoted Glycel, an expensive “anti-aging” skin cream, whose approval was withdrawn by the United States Food and Drug Administration soon thereafter. During his remaining years, he established the Christiaan Barnard Foundation, dedicated to helping underprivileged children throughout the world. He died in 2001 at the age of 78 after an asthma attack.

Early life

Barnard grew up in Beaufort West, Cape Province, Union of South Africa. His father, Adam Barnard, was a minister in the Dutch Reformed Church. One of his four brothers, Abraham, died of a heart problem at the age of five. Barnard matriculated from the Beaufort West High School in 1940, and went to study medicine at the University of Cape Town Medical School, where he obtained his MB ChB in 1945.

Career

Barnard did his internship and residency at the Groote Schuur Hospital in Cape Town, after which he worked as a general practitioner in Ceres, a rural town in the Cape Province. In 1951, he returned to Cape Town where he worked at the City Hospital as a Senior Resident Medical Officer, and in the Department of Medicine at the Groote Schuur Hospital as a registrar. He completed his master’s degree, receiving Master of Medicine in 1953 from the University of Cape Town. In the same year he obtained a doctorate in medicine (MD) from the same university for a dissertation titled “The treatment of tuberculous meningitis”.

In 1956, he received a two-year scholarship for postgraduate training in cardiothoracic surgery at the University of Minnesota, Minneapolis, United States under open-heart surgery pioneer Walt Lillehei. It was during this time that Barnard first became acquainted with fellow future heart transplantation surgeon Norman Shumway, who along with Richard Lower did much of the trailblazing research leading to the first successful human heart transplant. In 1958 he received a Master of Science in Surgery for a thesis titled “The aortic valve – problems in the fabrication and testing of a prosthetic valve”. The same year he was awarded Doctor of Philosophy degree for his dissertation titled “The aetiology of congenital intestinal atresia”. Barnard described the two years he spent in the United States as “the most fascinating time in my life.”

Upon returning to South Africa in 1958, Barnard was appointed cardiothoracic surgeon at the Groote Schuur Hospital, establishing the hospital’s first heart unit. He was promoted to full-time lecturer and Director of Surgical Research at the University of Cape Town. In 1960, he flew to Moscow in order to meet Vladimir Demikhov, a top expert on organ transplants (later he credited Demikhov’s accomplishment saying that “if there is a father of heart and lung transplantation then Demikhov certainly deserves this title.”) In 1961 he was appointed Head of the Division of Cardiothoracic Surgery at the teaching hospitals of the University of Cape Town. He rose to the position of Associate Professor in the Department of Surgery at the University of Cape Town in 1962. Barnard’s younger brother Marius, who also studied medicine, eventually became Barnard’s right-hand man at the department of Cardiac Surgery. Over time, Barnard became known as a brilliant surgeon with many contributions to the treatment of cardiac diseases, such as the Tetralogy of Fallot and Ebstein’s anomaly. He was promoted to Professor of Surgical Science in the Department of Surgery at the University of Cape Town in 1972. In 1981, Barnard became a founding member of the World Cultural Council. Among the many awards he received over the years, he was named Professor Emeritus in 1984.

Historical context

Following the first successful kidney transplant in 1953, in the United States, Barnard performed the second kidney transplant in South Africa in October 1967, the first being done in Johannesburg the previous year.

On 23 January 1964, James Hardy at the University of Mississippi Medical Center in Jackson, Mississippi, performed the world’s first heart transplant and world’s first cardiac xenotransplant by transplanting the heart of a chimpanzee into a desperately ill and dying man. This heart did beat in the patient’s chest for approximately 60 to 90 minutes. The patient, Boyd Rush, died without ever regaining consciousness.

Barnard had experimentally transplanted forty-eight hearts into dogs, which was about a fifth the number that Adrian Kantrowitz had performed at Maimonides Medical Center in New York and about a sixth the number Norman Shumway had performed at Stanford University in California. Barnard had no dogs which had survived longer than ten days, unlike Kantrowitz and Shumway who had had dogs survive for more than a year.

With the availability of new breakthroughs introduced by several pioneers, also including Richard Lower at the Medical College of Virginia, several surgical teams were in a position to prepare for a human heart transplant. Barnard had a patient willing to undergo the procedure, but as with other surgeons, he needed a suitable donor.

First successful heart transplant

Barnard performed the world’s first human-to-human heart transplant operation in the early morning hours of Sunday 3 December 1967. Louis Washkansky, a 54-year-old grocer who was suffering from diabetes and incurable heart disease, was the patient. Barnard was assisted by his brother Marius Barnard, as well as a team of thirty persons. The operation lasted approximately six hours.

Barnard stated to Washkansky and his wife Ann Washkansky that the transplant had an 80% chance of success. This has been criticized by the ethicists Peter Singer and Helga Kuhse as making claims for chances of success to the patient and family which were “unfounded” and “misleading.”

Barnard later wrote, “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 donor heart came from a young woman, Denise Darvall, who had been rendered brain dead in an accident on 2 December 1967, while crossing a street in Cape Town. On examination at Groote Schuur hospital, Darvall had two serious fractures in her skull, with no electrical activity in her brain detected, and no sign of pain when ice water was poured into her ear. Coert Venter and Bertie Bosman requested permission from Darvall’s father for Denise’s heart to be used in the transplant attempt. The afternoon before his first transplant, Barnard dozed at his home while listening to music. When he awoke, he decided to modify Shumway and Lower’s technique. Instead of cutting straight across the back of the atrial chambers of the donor heart, he would avoid damage to the septum and instead cut two small holes for the venae cavae and pulmonary veins. Prior to the transplant, rather than wait for Darvall’s heart to stop beating, at his brother Marius Barnard’s urging, Christiaan had injected potassium into her heart to paralyse it and render her technically dead by the whole-body standard. Twenty years later, Marius Barnard recounted, “Chris stood there for a few moments, watching, then stood back and said, ‘It works.'”

Washkansky survived the operation and lived for 18 days. However, he succumbed to pneumonia as he was taking immunosuppressive drugs.

Additional heart transplants

Barnard was celebrated around the world for his accomplishment. He was photogenic, and enjoyed the media attention following the operation.

Worldwide, approximately 100 transplants were performed by various doctors during 1968. Only a third of these patients lived longer than three months. A U.S. National Institutes of Health publication states, “Within several years, only Shumway’s team at Stanford was attempting transplants.”

However, Barnard’s second transplant operation was conducted on 2 January 1968, and the patient, Philip Blaiberg, survived for 19 months. Dirk van Zyl, who received a new heart in 1971, was the longest-lived recipient, surviving over 23 years.

Between December 1967 and November 1974 at Groote Schuur Hospital in Cape Town, South Africa, ten heart transplants were performed, as well as a heart and lung transplant in 1971. Of these ten patients, four lived longer than 18 months, with two of these four becoming long-term survivors. One patient lived for over thirteen years and another for over twenty-four years.

Full recovery of donor heart function often takes place over hours or days, during which time considerable damage can occur. Other deaths to patients can occur from pre-existing conditions. For example, in pulmonary hypertension the patient’s right ventricle has often adapted to the higher pressure over time and, although diseased and hypertrophied, is often capable of maintaining circulation to the lungs. Barnard designed the idea of the heterotopic (or “piggy back” transplant) in which the patient’s diseased heart is left in place while the donor heart is added, essentially forming a “double heart.” Barnard performed the first such heterotopic heart transplant in 1974.

From November 1974 to December 1983, forty-nine consecutive heterotopic heart transplants on 43 patients were performed at Groote Schuur. Survival rates for patients at one year were over 60% as compared to less than 40% with standard transplants, and survival rates at five years were over 36% as compared to less than 20% with standard transplants.

Many surgeons gave up cardiac transplantation due to poor results, often due to rejection of the transplanted heart by the patient’s immune system. Barnard persisted until the advent of cyclosporine, an effective immunosuppressive drug, which helped revive the operation throughout the world. He also attemptedxenograft transplantation in a human patient, while attempting to save the life of a young girl unable to leave artificial life support after a second aortic valve replacement.

Public life

Barnard was an outspoken opponent of South Africa’s laws of apartheid, and was not afraid to criticise his nation’s government, although he had to temper his remarks to some extent to travel abroad. Rather than leaving his homeland, he used his fame to campaign for a change in the law. Christiaan’s brother, Marius Barnard, went into politics, and was elected to the legislature on an anti-apartheid platform. Barnard later stated that the reason he never won the Nobel Prize in Physiology or Medicine was probably because he was a “white South African”.

Personal life

Barnard’s first marriage was to Aletta Gertruida Louw, a nurse, whom he married in 1948 while practising medicine in Ceres. The couple had two children — Deirdre (born 1950) and Andre (1951–1984). International fame took a toll on his personal life, and in 1969, Barnard and his wife divorced. In 1970, he married heiress Barbara Zoellner when she was 19, the same age as his son, and they had two children — Frederick (born 1972) and Christiaan Jr. (born 1974). He divorced Zoellner in 1982. Barnard married for a third time in 1988 to Karin Setzkorn, a young model. They also had two children, Armin (born 1990) and Lara (born 1997), but this last marriage also ended in divorce in 2000.

Barnard described in his autobiography The Second Life a one-night extramarital affair with Italian film star Gina Lollobrigida, that occurred in January 1968. During that visit to Rome he received an audience from Pope Paul VI.

In October 2016, U.S. Congresswoman Ann McLane Kuster (D-NH) stated that Barnard sexually assaulted her when she was 23 years old. According to Kuster, he attempted to grope her under her skirt, while seated at a business luncheon with Rep. Pete McCloskey (R-CA), whom she was a staffer for at the time.

Retirement

Barnard retired as Head of the Department of Cardiothoracic Surgery in Cape Town in 1983 after developing rheumatoid arthritis in his hands which ended his surgical career. He had struggled with arthritis since 1956, when it was diagnosed during his postgraduate work in the United States. After retirement, he spent two years as the Scientist-In-Residence at the Oklahoma Transplantation Institute in the United States and as an acting consultant for various institutions.

He had by this time become very interested in anti-aging research, and his reputation suffered in 1986 when he promoted Glycel, an expensive “anti-aging” skin cream, whose approval was withdrawn by the United States Food and Drug Administration soon thereafter. He also spent time as a research advisor to the Clinique la Prairie, in Switzerland, where the controversial “rejuvenation therapy” was practised.

Barnard divided the remainder of his years between Austria, where he established the Christiaan Barnard Foundation, dedicated to helping underprivileged children throughout the world, and his game farm in Beaufort West, South Africa.

Death

Christiaan Barnard died on 2 September 2001, while on holiday in Paphos, Cyprus. Early reports stated that he had died of a heart attack, but an autopsy showed his death was caused by a severe asthma attack.

Books

Christiaan Barnard wrote two autobiographies. His first book, One Life, was published in 1969 and sold copies worldwide. Some of the proceeds were used to set up the Chris Barnard Fund for research into heart disease and heart transplants in Cape Town. His second autobiography, The Second Life, was published in 1993, eight years before his death.

Apart from his autobiographies, Dr Barnard also wrote several other books including:

  • The Donor
  • Your Healthy Heart
  • In The Night Season
  • The Best Medicine
  • Arthritis Handbook: How to Live With Arthritis
  • Good Life Good Death: A Doctor’s Case for Euthanasia and Suicide
  • South Africa: Sharp Dissection
  • 50 Ways to a Healthy Heart
  • Body Machine
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