The unlikely story behind the world’s first heart transplant – tech2.org

The unlikely story behind the world’s first heart transplant



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Approximately at 10 p.m. On Saturday, December 2, 1967, the telephone of Dene Friedmann rang. The young perfusionist-someone who runs a heart and lung machine-had been waiting for this call for weeks and did not need to look for it to know who it was. Friedmann quickly made his way to the Groote Schuur Hospital on the east side of Cape Town, South Africa.

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In a few hours, she would help Christiaan Barnard perform the first human heart transplant in history. "There were many surgeons who could have performed the first heart transplant," said Friedmann Popular Mechanics "but it was he who had the courage to seize the opportunity and do it."

December 3, 2017, marks the 50th anniversary of that summer day in South Africa, when cardiac surgeon Christiaan Barnard took the risk that no one had dared yet. "He had a brilliance about him," says Donald McRae, author of Every Second Counts: The Race to Transplant the First Human Heart. "It takes a brave and bold person to jump into the dark."

Building a machine heart

A heart and lung machine is prepared in the hospital of the University of Minnesota, 1957.

Getty Al Fenn / The Life Pictures Collection

In 2017, More than 3,000 heart transplants will be completed successfully throughout the world. Although it is still a risky procedure, it has been performed almost 70,000 times over the last 50 years by hundreds of doctors around the world, but this was not always the case.

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In the 1930s, operating on delicate and small cardiac vessels was difficult enough even for the most nimble surgeons, but it was even more difficult with the constant beat of the heart. And the risks were high: any lack of blood flow over a prolonged period of time causes brain damage and death.

About 20 years before Barnard's historic operation, Philadelphia surgeon John Heysham Gibbon built the first prototype machine that would revolutionize heart surgery. The Extracorporeal Circulation Device, or more simply the "heart-lung machine", solved the complicated procedures of the heart simulating the function of the heart and the lungs. It looked like a stainless steel bar cart, essentially drawing blood from the heart, circulating it in the machine, adding oxygen and then pumping it back through the body.

Originally tested on cats, he recruited the help of Thomas Watson, an engineer and president of International Business Machines, also known as IBM. After two decades of retouching and refinement, Gibbons used it for the first time during an operation in 1953 to repair a teenager's heart defect. For 45 minutes, the machine acted like his heart and lungs. The operation was a success and the girl survived Gibbon.

In the late 1950s, with the heart-lung machine as an industry standard, heart transplants were no longer an impossible fantasy. While the problem of how to keep the patient alive during cardiac surgery was solved, keeping the heart alive when it was outside the body was a completely different question.

Norman Shumway, 1967.

Getty Bettmann

But two surgeons from Stanford University-Norman Shumway and Richard Lower-ya were trying to tackle the problem. After experimenting with dogs, they created a method called "topical (or selective) hypothermia", which lowers body temperature to 32 degrees Celsius (89.6 Fahrenheit), and then circulates an icy isotonic saline solution through the heart to cool it down to almost Freeze levels. This causes the pumping of the heart to decrease, but it does not stop. After the initial tests, the doctors discovered that they could keep the heart in this state for up to one hour without damage.

While the two Stanford doctors continued to perfect selective hypothermia in dog hearts in Northern California, surgeons worldwide knew the fame would thank the first person to perform a human heart transplant.

"The heart was considered a mystical organ," says McRae. "He has this mythology."

One of them was the South African doctor Christiaan Barnard.

The Underdog Doctor

Christiaan Barnard

Getty Bettmann

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Growing up impoverished in the rural province of Cape Town , he was the son of a missionary serving a racially diverse population. As a result, the white population rejected the family often. But Barnard and his brothers thrived on family legends claiming that Christiaan once ran a mile of barefoot registration and won a school tennis championship with a borrowed racket and cardboard shoes.

Dreaming of becoming a doctor, he studied for his exams in the light of fire, and despite the challenges, he graduated from the University of Cape Town. In 1955, he traveled abroad to the University of Minnesota to learn how to become a surgeon under Owen Wangensteen, and soon underwent cardiac surgery and even observed Lower transplant experiments in dogs. During the following decade, Bernard gained the reputation of being a talented and implacable surgeon but not of the same clbad as Lower, Shumway or Adrian Kantrowitz, who would perform the first heart transplant in the US. UU

"He was a helpless," says McRae, "Barnard was a genuine figure in world cardiac surgery, but not in transplant, but then he surprised everyone."

For much of 1966 and 1967, the world was anticipating that the first heart transplant could happen at any time. In fact, opportunities were often presented to Lower and Shumway, but fears about weak receptors or high-risk rejections delayed procedures.

"He was a helpless … But then he surprised everyone"

There was also the question of ethics because surgeons had to take the heart of someone who was still beating. The question of what was the definition of death was a subject fiercely debated in the medical community. In the USA UU It was illegal to extract a pulsating heart from a body even if the person had been declared brain dead.

Meanwhile, in South Africa, Barnard did not face so many of these ethical barriers. He trusted that with the right drugs, the recipient's body would accept the new heart. In addition, according to McRae, the inflexible policy of apartheid by the South African government caused little attention to be paid to medical legislation in the country and a more flexible definition of death.

Barnard had to deal with racism sanctioned by the government and later said he had a donor and a receiver lined up this year, but the donor had been black and the hospital Groote Schuur Hospital did not allow it to go ahead.

In November 1967, Barnard and his team alerted their patient, Louis Washkansky, that he would be the first recipient of a heart transplant. A few weeks later, the call finally arrived: Denise Duval, 25, had been murdered while crossing the street and her blood type matched Washkansky's. His heart was now going to be his.

Heart-to-Heart

Christiaan Barnard examines the chest x-ray of Louis Washkansky, 1967.

Getty Bettmann

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Dene Friedmann recalls entering the Changing room later that Saturday night and seeing some of the nurses still wearing elegant badtail dresses that came straight from a party. "There was a lot of animated talk," says Friedmann, "but as soon as we all got into our bushes, the atmosphere became very serious and silent."

Then he saw Duval.

"I was a little girl, about my age, and it was very sad to see (put) on the operating table and know that we were going to take her heart"

Louis Washkansky, on the cover of the Life, waking up from surgery.

Life

Although it was not legally necessary, Barnard made the decision to wait for his heart to stop beating. It took 12 minutes until the EKG crushed. Then, Washkansky entered with a wheelchair and the team began the process of selective hypothermia. Then he connected to the lung and heart machine that Friedmann helped monitor, and for the next five hours, Barnard and his team moved quickly and meticulously. Finally, with the new heart of the young woman sutured in place, Barnard ordered the team to begin warming it up again.

"[The heart] began to show signs of life," says Friedmann. "It started to shake, we all realized that this was going to work."

The successful operation appeared on the cover of Life Magazine and made Barnard one of the most famous people in the world. Days after the surgery, Washkansky called Barnard "the man with the golden hands." It became, and continues to be, a source of immense pride for the nation of southern Africa.

"It was a kind of mythical event for us, the South Africans," says McRae, a South African who was a child when Barnard performed his landmark surgery. But in reflecting on that moment, it is clear that the government used this surgical feat as propaganda to promote apartheid, something that Barnard unfortunately did not discourage.

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After the initial optimism, Washkansky died 18 days after his surgery, not because of heart rejection but because of pneumonia. Three days later, Kantrowitz performed the second heart transplant in history at Maimonides Hospital in Brooklyn in a two-week baby. Shumway made one the following week and went down early the following year.

In 1968, one year after Barnard's surgery, 107 transplants were performed by 64 different surgical teams in 24 countries. But the best a patient could hope for was a two-year survival rate of only 10 percent. Two years later, in 1970, the number of heart transplants worldwide decreased from 107 to 16 due to high mortality rates. There was even a call to ban heart transplants directly. It was not until the early 1980s that immunosuppression research would help to substantially raise survival rates.

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The silicone mannequins and some original equipment represent the historical surgery made 50 years ago in the heart of the museum in Cape Town, 2017.

Getty Rodger Bosch / AFP

Barnard's operation remains the first human heart transplant ever performed, but the question remains whether it should have been.

"The audacious person can shatter the glbad ceiling," says McRae, "but ultimately it was the most methodical and meticulous approach that made [heart transplants] a routine procedure."

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