On Dec. 3, 1967, Christiaan Neethling Barnard and a team of 30 people performed the first human heart transplant in Capetown, South Africa.

The first successful organ transplant, a kidney transplant between identical twins, which reduced the risks of rejection, was performed on Dec. 23, 1954, by Joseph Murray and J. Hartwell Harrison. And the first lung transplant was performed in 1963 by James Hardy in Jackson, Miss.

A heart transplant was more difficult because, in addition to rejection issues, the heart deteriorates very rapidly as soon as blood flow stops, and special equipment needed to be developed, like a heart-lung machine. Hardy attempted a heart transplant in 1964. That attempt failed when the recipient’s heart failed before a donor heart was available; Hardy used a chimpanzee heart, which failed very quickly.

Barnard did a fellowship at the University of Minnesota in 1956, where he met Vanderbilt University Medical School graduate Norman Shumway, who became a pioneer and founded the Department of Cardiothoracic Surgery at Stanford University. Shumway performed the first heart transplant in the U.S., in 1968.

In October 1967, Barnard did the first successful kidney transplant in South Africa, and prepared a team for a heart transplant. The Barnard team was one of several around the world prepared to perform a heart transplant.

His patient, Louis Washkansky, was 54, had diabetes, advanced heart disease, and was not expected to live long. When Denise Darvall was struck by a drunk driver on Dec. 2, and fractured her skull, Barnard had a donor for Washkansky. Darvall was driving with her mother after tea with friends when their car was hit; her mother was killed, and Darvall suffered severe brain injury. That evening, doctors ceased efforts to revive her. In 1967, there was no medical definition of “brain death,” that came in 1968 with the Harvard Criteria of Brain Death. Forty years after the surgery, Marius Barnard, who assisted on the transplant, revealed that his brother injected potassium into Darvall’s heart to paralyze it and render a declaration of death so that her father could grant permission to harvest her organs. Washkansky got her heart, and 10-year-old Jonathan Van Wyk, in a controversial decision for apartheid South Africa, because he was not white, got her kidneys.

Barnard later said: "For a moment I stared at it, wondering how it would ever work. It seemed so small and insignificant -- too tiny to handle all the demands that would be put upon it. The heart of a woman is 20% smaller than a man's, and the heart of Washkansky had created a cavity twice the normal size. All alone, in so much space, the little heart looked much too small -- and very lonely." (from “Every Second Counts,” by Donald McRae, published in 2006)

Washkansky lived for 18 days before dying from pneumonia.

Barnard performed ten orthotopic transplants between Dec. 3, 1967, and 1973. Dirk Van Zyl, who received a new heart in 1971, lived for 23 years.

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