Surgery & Anesthesia · 1967
First Human Heart Transplant
On the evening of December 2, 1967, Christiaan Barnard and a team of more than thirty surgeons and nurses at Groote Schuur Hospital in Cape Town began an operation that had never been attempted in a human being. The donor was Denise Darvall, a 25-year-old woman fatally injured in a car accident earlier that day. Her heart was arrested, cooled, and transplanted into Louis Washkansky, a 54-year-old diabetic grocer with end-stage ischemic cardiomyopathy whose own heart was failing beyond any medical remedy. The new heart began beating independently within hours of reperfusion.
Barnard had prepared for this moment at the University of Minnesota under Norman Shumway and Richard Lower, who had spent years refining the surgical technique in dogs. The operative approach itself was not improvised; Shumway and Lower had published reproducible methods for orthotopic cardiac transplantation throughout the early 1960s. 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 survived the surgery and regained enough strength to speak with his wife and give press interviews in the days after the operation. He died 18 days post-transplant from bilateral Pseudomonas pneumonia, his immune defenses suppressed by the high-dose azathioprine and corticosteroids required to prevent cardiac 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. Within months, cardiac transplants were performed in the United States, France, Britain, and Brazil. Norman Shumway at Stanford began the most rigorous and sustained program, collecting the outcome data that showed just how poor early survival was without better immunosuppression. Most programs suspended their efforts by the mid-1970s after one-year survival rates hovered below 20 percent.
The introduction of cyclosporine in the early 1980s changed the arithmetic. By blocking T-cell activation more selectively than azathioprine, cyclosporine reduced rejection rates without the same degree of global immunosuppression, and one-year survival after cardiac transplantation climbed above 80 percent by 1990. The operation Barnard had demonstrated in December 1967 became standard care for end-stage heart failure at transplant centers worldwide, with more than 5,000 procedures performed annually by the 2000s.
Key People
- Christiaan Barnard — South African surgeon who performed the first human cardiac transplant.
- Louis Washkansky — First human heart transplant recipient; survived 18 days.
- Denise Darvall — Donor whose heart was transplanted into Washkansky.
- Norman Shumway — Stanford surgeon whose laboratory technique formed the basis for human cardiac transplantation.
S Afr Med J. 1967;41(48):1271-1274.
Related landmarks
- 1966 · National Halothane Study (Surgery & Anesthesia)
- 1968 · Coronary Artery Bypass Grafting (CABG) (Surgery & Anesthesia)
- 1978 · Ciclosporin in solid-organ transplantation (Calne) (Surgery & Anesthesia)
- 1954 · First Successful Kidney Transplant (Surgery & Anesthesia)