First Human Heart Transplant

In the early hours of December 3, 1967, Christiaan Barnard and his team at Groote Schuur Hospital in Cape Town carried out the first transplant of a heart from one human being to another. The donor was Denise Darvall, a 25-year-old woman who had been struck by a car earlier that day and suffered a fatal brain injury; her mother died at the scene. Barnard waited until her heart stopped beating, then kept it perfused with cold oxygenated blood from a heart-lung machine and transplanted it into Louis Washkansky, 54, whose heart was failing after several heart attacks linked to diabetes and smoking. The operation took nearly five hours, and the new heart worked well.

Barnard had trained in heart surgery with Walton Lillehei at the University of Minnesota from 1956 to 1958. The transplant technique itself came from Norman Shumway and Richard Lower at Stanford, who had performed hundreds of experimental heart transplants in dogs since the late 1950s, using the heart-lung machine and topical cooling. What Barnard did in Cape Town was apply that technique in a human patient, at a time when the immunology of organ rejection remained poorly understood and the drugs available to prevent it were crude by later standards.

Washkansky received local irradiation, azathioprine, prednisone and actinomycin to prevent rejection. He developed severe pneumonia and septicemia and died on the 18th day after the operation, having been given stronger immunosuppression for what was thought to be rejection. That outcome defined the central clinical problem the field would struggle with for the next fifteen years: the immunosuppression needed to prevent graft loss was itself lethal when infection arrived.

The global reaction was intense. Three days after Barnard's operation, Adrian Kantrowitz transplanted a heart into an 18-day-old infant, and Shumway performed the first adult heart transplant in the United States in January 1968. Between 1968 and 1970, 64 surgical teams in 24 countries performed 166 heart transplants, but one-year survival was only 18 percent. The American Medical Association recommended a moratorium in 1970, and most major centers stopped; a few, including Shumway's program at Stanford, persisted.

The FDA's approval of cyclosporine in 1983 changed the arithmetic. By inhibiting T-cell activation selectively, cyclosporine prevented rejection with fewer systemic side effects than earlier regimens, and one-year survival after heart transplantation rose from less than 50 percent to more than 80 percent. The operation Barnard had first performed in December 1967 became a standard treatment for end-stage heart failure.