When the South African surgeon Christiaan Barnard performed the first human heart transplant on 3 December 1967 at Groote Schuur Hospital in Cape Town, he won an immediate international fame never before granted to a doctor. Before the coming of Barnard, doctors occasionally got their pictures on showbiz pages if they were photographed with well-known actors; after Barnard, lesser-known actors, and especially actresses, could get themselves noticed by being photographed with him.
The strange thing about this episode was that Barnard won his celebrity by performing an unsuccessful operation. The first patient to receive a transplanted heart, 53-year-old Louis Washkansky, died of pneumonia eighteen days later. And when his condition started to deteriorate, as many experienced transplant surgeons had predicted it would, Barnard was out of the country, jetting round the world on a publicity tour, described by one of his fellow consultants at Groote Schuur as ‘a rather impetuous, flamboyant and undignified global lap of honour’.
Dr Donald Gould, then editor of New Scientist, always treasured an issue of the South African Medical Journal that appeared soon after the operation and was devoted wholly to the miracle that had taken place at Groote Schuur. One of the articles, signed by Barnard and his team, was headed ‘successful human heart transplant’, while the front page, edged in black, regretfully announced the death of Louis Washkansky. As Gould said, it breathed life into the old joke that the operation was successful but the patient died.
Significantly, as one of Barnard’s fellow consultants pointed out, the journal contained ‘no mention of the ethical or even legal issues surrounding removal of the heart from the donor and no suggestion that she might have been regarded as living when she was taken into the theatre for the removal of her heart’.
The condition of the donor was not the only source of ethical and legal concern. Any surgeon wanting to transplant a human heart in the 1960s faced a technical barrier that had nothing to do with the surgical techniques that were given much publicity at the time. These were within the competence of any experienced heart surgeon. A more serious problem, amply demonstrated in animals, was that the body’s defences would reject and destroy the tissue of the ‘alien’ heart.
When Barnard chose to go ahead, that problem had not been solved. Yet the instant fame accorded to him spurred other surgeons, no nearer than the South African team to solving the rejection problems, to go ahead with hazardous operations in which science appeared to run second place to hype. Within 48 hours of the South African operation, two heart transplants had taken place in America, soon followed by one in India and three in quick succession in France.
When Frederick West became Britain’s first heart transplant patient, British newspapers carried pictures of the transplant team from the London Heart Hospital grinning at the camera and proudly displaying Union Jacks overprinted with ‘We’re Backing Britain’. Mr West died 46 days later. Two months later, Gordon Ford became Britain’s second heart transplant patient and the world’s 24th. When he died 57 hours later, only six of the remaining 23 were still alive, most having died within days or hours.
During this spell of media frenzy, surgeons in Houston, Texas, put a sheep’s heart into a 47-year-old man, who died on the spot, the British team attempted to implant pigs’ hearts into two dying patients, and Barnard prepared to transplant a baboon heart into a five-year-old boy. Once he’d opened the boy’s chest, however, he decided that a valve replacement would suffice.
After the early death of Britain’s third heart transplant patient, the Department of Health, on the advice of the government’s chief medical officer, Sir George Godber, made it clear that the operation was unacceptable in NHS hospitals. Yet Barnard continued to radiate the glow of celebrity. He was lionised in Washington and appeared on coast-to-coast American television. France-Soir named him Man of the Year, and the French nation voted him the third most popular man in the world – after President de Gaulle and Pope John Paul II.
Yet, though the world awarded Barnard a grade-A celebrity rating, the man who established heart transplantation as an acceptable and effective treatment was the American surgeon Norman Shumway. He and Richard Lower, his colleague at the Stanford Medical Center in California, had been the first people to transplant a dog’s heart successfully. They then embarked on eight years’ intensive research into ways of preventing, detecting and treating tissue rejection. Shumway decided his team would not operate on a human until a dog with a transplanted heart had survived for at least a year. Barnard came to Stanford during their experimental programme and learned the operative technique, which makes no great demands on a surgeon. Observers at Stanford think he then went back to South Africa and ‘jumped the gun’ knowing the rejection problems hadn’t been solved.
Because Shumway, a cool, laid-back Westerner, didn’t want contentious publicity to get in the way of his scientific work, he was reluctant to criticise Barnard at the time of the disastrous South African operation. Even nine years later, the nearest he got to criticism came when I asked him to define the best way to determine whether a surgical team was ready to perform a human heart transplant. ‘You should ask them to produce an animal that has lived for six months after the operation,’ he said. Then he added, ‘That condition was not fulfilled in South Africa. They never had any animal that lived more than a few hours.’
Despite the setbacks caused by the precipitate action of Barnard and others, Shumway and his Stanford team eventually made heart transplantation not just an acceptable but a routine operation. When I visited them in 1976, they were offering patients for whom the only alternative was an early death a greater than 70 per cent chance of surviving the hazardous six months after the operation. And the survivors were able to resume active lives, returning to school or to the work they were doing before they became ill, or moving into a comfortable retirement. The team’s objective, enunciated by Shumway, was to offer additional life rather than extend the process of dying.
Meanwhile, in his book Heart Attack: You Don’t Have to Die, published in 1972, Christiaan Barnard had written:
Where controversy exists, we should seek and act upon the advice of the established corps of top rate scientists, and we should give less weight to what the amateurs have to say. [He made quite a thing of dividing his colleagues into amateurs and professionals.] The traditional values of conservative or orthodox science have been toppled by tuppenny-ha’penny hicks with big mouths, a slick line on television, and a fantastic ability for diverting the scientific issue into irrelevant polemic territory where emotionalism takes over from rational argument.
Some who read that paragraph asked themselves who on earth he had in mind. The obvious answer was too strange for belief.