How politics influenced the first human heart transplant

di Marina Joubert, PUS blog

3 December 1967 will forever be marked as the day when South African surgeon Chris Barnard astounded the world by becoming the first person to transplant a human heart. The historic surgery captured the world’s imagination and was hailed by 20th-century historians as on par with the moon-landing in 1969 in terms of its social and scientific significance. During my research into this defining moment in medical history, I was reminded of how different things were in my home country at that time.

PHOTO 1 CHRIS BARNARDIn 1967, South Africa was in the midst of its apartheid regime that lasted more than 40 years. The country’s policies of segregation along racial lines extended into its health system. There were separate hospital wards and services, including separate ambulances, for black and white patients. Black doctors and nurses were not allowed to tend to white patients. South Africa was loathed by the world and Cape Town was considered as part of the medical backwater at the time. Under these conditions, it would be understandable if Barnard would accept an offer to stay on at the University of Minnesota after completing his Ph.D. there in 1958. But, with a wife and two young children waiting in South Africa, he returned to his home country to establish a cardiac surgery unit at Groote Schuur Hospital.

Noticing Barnard’s passion for research into open heart surgery, one of his US mentors, Professor Owen Wangensteen, donated a heart-lung machine that Barnard could ship back to South Africa, as well as a generous research grant of $2 000 dollars per year for three years. This allowed Barnard to start experimenting with heart transplants on stray dogs brought in from the city pound and to gain the expertise and confidence that was needed in order to proceed to heart transplants on humans. With the heart-lung machine, Barnard was able to perform the first open heart surgery on the African continent in 1958. The same heart-lung machine was used in the donor theatre during the first human heart transplant.

Barnard spent many nights and weekends in the animal laboratories at Groote Schuur Hospital and built up a strong technical team around him. Hamilton Naki, a former gardener at the hospital, became so skilled at heart transplants that he could eventually transplant dog hearts without any assistance from Barnard. Naki demonstrated dissection and surgical procedures to a long list of trainees who eventually became surgeons. However, because of his skin color and lack of formal qualifications, Naki was not allowed to assist in the hospital’s operating theatres. He was not part of the team that transplanted the first human heart. In fact, due to the country’s politics, there were no black doctors, nurses or technicians in the heart transplant team featured on the front page of the Cape Times on 4 December 1967. Also missing in this photo is Chris’s brother Marius, an integral member of the transplant team, who opted to go to church that Sunday morning when the surgical team was called to the hospital for this photo.

PHOTO 2 HEART TRANSPLANT TEAM

The issue of race, however, was a determining factor in the first heart transplant. Ten days before the transplant would eventually take place, a heart from a black person was available. Barnard was keen to proceed, since the patient identified to receive a new heart – the 53-year old Louis Washkansky – was desperately ill and struggling to breathe. However, Barnard’s superiors insisted that both the donor and recipient in the first heart transplant would be white, since they feared being accused of experimenting on black people in a country where black people were politically and socially oppressed.

When a registrar at Groote Schuur Hospital called Barnard on the afternoon on 2 December 1967 to inform him that they may have a suitable donor and confirmed that she was white, Barnard knew it was time to head to the hospital.

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28 novembre 2017 | in: Contributi,