50th Anniversary of the first Human Heart Transplant—How is it

the event

on december 3, 1967, a large medical, nursing and technical team led by surgeon christiaan barnard performed the world’s first human-to-human heart transplant, placing groote schuur hospital in cape town, south africa, on the international map. this led to unprecedented media coverage. in fact, this first heart transplant was the most widely reported medical event in the world, resulting in celebrity status for a previously unknown physician. In addition to its medical significance, the first human-to-human heart transplant was of great political significance, as this moment in medical history contributed substantial publicity for the increasingly isolated apartheid state. Why did the first human heart transplant lead to a media frenzy never before seen or anticipated by christiaan barnard and his colleagues around the world?

For centuries, the heart has been equated with the soul of human beings. this concept was p. present among various pre-Columbian indigenous populations, including the Aztecs. By far the most common form of human sacrifice in the fifteenth-century Aztec empire was the removal of the heart, which seems to be related to the Aztec belief that the heart was both the seat of the individual’s soul and a fragment of the heat of the earth. sun. as such, heart transplantation was seen as “the surgical equivalent of climbing Everest,” as the era put it.

There will probably never be a similar medical achievement in the public eye again.

the team

History does not seem to have given enough credit to the exceptional team of specialized OR nurses, technologists, biochemists, anesthetists, perfusionists and others who contributed to the achievement of this monumental medical breakthrough. In addition to the lack of recognition of the entire team of people responsible for the success of the surgery, the fundamental importance of the basic research carried out not only by Barnard but by other researchers in prominent laboratories was not always sufficiently emphasized.

It may not alleviate criticism that Barnard himself is less well known for his other truly novel concepts, from congenital heart disease to aortic aneurysm surgery, culminating in the so-called piggyback heterotopic heart transplant, which used the approach of adding a donor heart. to the sick heart of the patient. however, does low recognition of entire research teams or contributing technologists, regardless of race or gender, reduce the role of the pioneering individual investigator? probably not.

A truly innovative researcher has to face the fact that fame and shame go hand in hand in developing exceptionally novel concepts. had this first heart transplant gone wrong, save for late-stage pneumonia, the voices would have been even louder, claiming that the procedure was reckless and premature and that failure could have been predicted from the start. Chris Barnard and other famous researchers have taken this risk. received immediate recognition for this success, but there are many examples in history where researchers have been isolated and victimized by colleagues for many years before the uniqueness of their research and contribution to the betterment of humanity was recognized.

there was also little mention of hamilton naki, in the media. Naki was a black gardener who, drawing on his enthusiasm and gifted hands, worked in the famous animal laboratory at Groote Schuur Hospital and participated in the research that led to the first and subsequent human heart transplants. Naki, who came from a relatively wealthy family in rural Transkei, had no access to higher education due to the political situation in South Africa at the time.

chris barnard stated in several interviews how important naki was for his experience in running the animal laboratory and training a whole generation of future surgeons. ‘I stole with my eyes’ said Hamilton Naki when asked how he learned his formidable surgical skills without any formal training (refs 1 & 2) In 2003, Naki received his honorary M.D. from the University of Cape Town, in recognition to a man who might have ended up with a different career were it not for the limitations imposed by apartheid. Laudatory obituaries appeared after his death in the press, suggesting that he was the surgeon who removed the donor heart in the first epoch-making human heart transplant.

inevitably, comparisons were made to vivian-thomas’s role in the so-called blalock-taussig procedure. The original procedure, which provides palliation for patients with cyanotic heart defects that commonly cause blue baby syndrome, was named for Alfred Blalock, a surgeon, and Helen Taussig, a cardiologist at Johns Hopkins Hospital in Baltimore, USA, in the 1990s. 1940. Thomas, Blalock’s African American lab technician, was instrumental in developing that procedure, performing the operation on only about 200 lab dogs and adapting surgical instruments for the first human operation. However, due to racial prejudice in the United States at the time and the academic custom that prevented mention of lab assistants without college degrees that persists into modern times, Thomas did not receive recognition for his contributions until much later. late.

However, claiming that Hamilton Naki was involved in the first real heart transplant and even performed the donor heart removal procedure did a disservice to the legacy of a great man, as it did not reflect the truth. these claims were strongly refuted by those present at the operation. Among those who set the record straight were several who praised Naki for his contribution, including Marius Barnard, the surgeon who had performed the removal with Terry O’Donovan.

innovation in the context of time

While pioneering milestones in human history are accomplished by strong-willed and curious individuals, they occur within the context of enabling background developments. cardiac surgery had only been performed for less than 10 years. Fueled by the high burden of rheumatic heart disease in Europe and North America in the postwar era, technological advances have finally allowed for the replacement of diseased heart valves in patients who would have died without surgery. the first patients received a replacement valve only 9 years before the first heart transplant. The invention of the heart-lung machine in 1953 made this possible, overturning the dogma of Theodor Billroth, the pioneer of gastric surgery in the 19th century. he said that the one who touches the heart would lose his respect. Much as general surgery had its founding and flourishing in Europe a hundred years earlier, cardiac surgery naturally saw its cradle in the technologically booming United States of the 1950s.

the man

times magazine (ref. 3) published a personal letter from christiaan barnard the day after his death. This letter offers a reflection of his personal life in the context of his upbringing and achievements, and portrays a different image of the “glamorous man” as seen by many. Christiaan Barnard was born in Beaufort West in the harsh but strikingly beautiful Karroo. his father was a missionary who did not accept differences between ethnic groups in his church, and barnard says his tolerance for people of diverse backgrounds came from his father. His father also taught him his love of nature, pointing out plants and animals that led to Christiaan’s love of the savannah and wilderness of this vast special region of South Africa.

after retiring in 1983, he was able to purchase a farm outside of beaufort west, returning to his roots. In this letter, he describes his challenges and his truly remarkable career from being a general practitioner for a few years in Ceres, the Western Cape, until he was turned down for a fellowship in England, leading to his general surgical training in the United States. With Professor Wagensteen, University of Minnesota. When his application for a job at the National Heart Institute in London was unsuccessful, he returned to South Africa to establish his own cardiac surgery unit, culminating in the first heart transplant in 1967.

in his letter, chris barnard writes that he retired quite early because he no longer felt like working and arthritis was more of an excuse. He wrote several books, started speaking tours, and created the Chris Barnard Foundation. he felt that medical technology had replaced the personal doctor-patient relationship.

days before his death, at the age of almost 79, he stated that he has no regrets.

the celebration

To mark this anniversary within the cardiovascular community, a high-profile event titled: ’50 Years of Heart Transplantation: Courage and Innovation’, is being held at Groote Schuur Hospital, Cape Town, South Africa, from the December 2-4, 2017. The world’s first human-to-human heart transplant, performed by christiaan barnard and his team 50 years ago in cape town, was a truly iconic event. positioned the African region at the forefront of medical innovation and inspired the next generation of healthcare professionals in Africa and around the world. Developments in cardiac surgery have continued to be impressive in the 50 years since. Many of the inventors on this trip will have gathered in Cape Town.

However, an event that celebrates the foremost example of courage and innovation in cardiac surgery must also address the current need for a quantum leap of comparable magnitude. Rather than surgical, contemporary challenges are socioeconomic in the developed and developing world. both “northern” lifestyle cardiovascular diseases, such as obesity and its associated metabolic syndrome, abound, and “southern” endemic rheumatic heart disease, which primarily affects the poor. while access to cardiac surgery may be suboptimal for some of these patients in the “north,” it is often absent in the “south.”

Long planned with the active support of all major international cardiothoracic societies as well as humanitarian organizations, the editors-in-chief of major journals and the highest levels of the industry will participate in a day-long event. ‘South-North dialogue’ to address the plight of the ‘many’, ie the millions of rheumatic heart disease patients who do not have access to life-saving heart valve surgery.

this was also highlighted recently at the first african summit held by the world heart federation in khartoum, sudan, october 10-11, 2017. data recently presented in new eng j med report (ref 4) reported that central sub-Saharan Africa has one of the highest age-standardized prevalences of adults living with rheumatic heart disease. South Africa has a prevalence of 220/100,000 people compared to 415/100,000 in Ghana and 360/100,000 in Nigeria.

It is timely as the who executive board, supported by the world heart federation, unanimously recommended a world health assembly resolution on rheumatic heart disease to be adopted in may 2018. the event ’50 years of heart transplantation: courage and innovation’, will bring together leaders in cardiothoracic surgery, cardiologists, policy makers and representatives of the device industry, condensing their vision of the way forward into a ‘cape town declaration’.

It is the intent of all participants to create a focused and prioritized plan for all stakeholders, to improve awareness, education, and access, for a deadly disease that can affect more than twice the number of patients infected with hiv.

conflict of interest: none declared.

references

references are available as supplementary material in the european journal of the heart online.