Christiaan Barnard First human-to-human heart transplant Who was the recipient of the heart? Louis Washkansky, a 54-year-old grocer who was suffering from diabetes and incurable heart disease, was the patient. Was it successful? Washkansky survived the operation and lived for 18 days, having succumbed to pneumonia as he was taking immunosuppressive drugs.
How was Barnard chosen to do the transplant?
How was Christiaan Barnard chosen to do the first heart transplant?
Barnard performed the world's first human-to-human heart transplant operation in the early morning hours of Sunday 3 December 1967. Louis Washkansky, a 54-year-old grocer who was suffering from diabetes and incurable heart disease, was the patient. Barnard was assisted by his brother Marius Barnard, as well as a team of thirty persons. The operation lasted approximately five hours.  Barnard stated to Washkansky and his wife Ann Washkansky that the transplant had an 80% chance of success. This has been criticised by the ethicists Peter Singer and Helga Kuhse as making claims for chances of success to the patient and family which were "unfounded" and "misleading".  Barnard later wrote, "For a dying man it is not a difficult decision because he knows he is at the end. If a lion chases you to the bank of a river filled with crocodiles, you will leap into the water, convinced you have a chance to swim to the other side." The donor heart came from a young woman, Denise Darvall, who had been rendered brain dead in an accident on 2 December 1967, while crossing a street in Cape Town. On examination at Groote Schuur hospital, Darvall had two serious fractures in her skull, with no electrical activity in her brain detected, and no sign of pain when ice water was poured into her ear. Coert Venter and Bertie Bosman requested permission from Darvall's father for Denise's heart to be used in the transplant attempt. The afternoon before his first transplant, Barnard dozed at his home while listening to music. When he awoke, he decided to modify Shumway and Lower's technique. Instead of cutting straight across the back of the atrial chambers of the donor heart, he would avoid damage to the septum and instead cut two small holes for the venae cavae and pulmonary veins. Prior to the transplant, rather than wait for Darvall's heart to stop beating, at his brother Marius Barnard's urging, Christiaan had injected potassium into her heart to paralyse it and render her technically dead by the whole-body standard. Twenty years later, Marius Barnard recounted, "Chris stood there for a few moments, watching, then stood back and said, 'It works.'"  Washkansky survived the operation and lived for 18 days, having succumbed to pneumonia as he was taking immunosuppressive drugs. CANNOTANSWER
CANNOTANSWER
Christiaan Neethling Barnard (8 November 1922 – 2 September 2001) was a South African cardiac surgeon who performed the world's first human-to-human heart transplant operation. On 3 December 1967, Barnard transplanted the heart of accident-victim Denise Darvall into the chest of 54-year-old Louis Washkansky, with Washkansky regaining full consciousness and being able to talk easily with his wife, before dying eighteen days later of pneumonia, largely brought on by the anti-rejection drugs that suppressed his immune system.  Barnard had told Mr. and Mrs. Washkansky that the operation had an 80% chance of success, an assessment which has been criticised as misleading. Barnard's second transplant patient, Philip Blaiberg, whose operation was performed at the beginning of 1968, lived for a year and a half and was able to go home from the hospital.

Born in Beaufort West, Cape Province, Barnard studied medicine and practised for several years in his native South Africa. As a young doctor experimenting on dogs, Barnard developed a remedy for the infant defect of intestinal atresia. His technique saved the lives of ten babies in Cape Town and was adopted by surgeons in Britain and the United States. In 1955, he travelled to the United States and was initially assigned further gastrointestinal work by Owen Harding Wangensteen at the University of Minnesota. He was introduced to the heart-lung machine, and Barnard was allowed to transfer to the service run by open heart surgery pioneer Walt Lillehei. Upon returning to South Africa in 1958, Barnard was appointed head of the Department of Experimental Surgery at the Groote Schuur Hospital, Cape Town.

He retired as head of the Department of Cardiothoracic Surgery in Cape Town in 1983 after rheumatoid arthritis in his hands ended his surgical career. He became interested in anti-aging research, and in 1986 his reputation suffered when he promoted Glycel, an expensive "anti-aging" skin cream, whose approval was withdrawn by the United States Food and Drug Administration soon thereafter. During his remaining years, he established the Christiaan Barnard Foundation, dedicated to helping underprivileged children throughout the world. He died in 2001 at the age of 78 after an asthma attack.

Early life 
Barnard grew up in Beaufort West, Cape Province, Union of South Africa. His father, Adam Barnard, was a minister in the Dutch Reformed Church. One of his four brothers, Abraham, was a "blue baby" who died of a heart problem at the age of three (Barnard would later guess that it was tetralogy of Fallot).  The family also experienced the loss of a daughter who was stillborn and who had been the fraternal twin of Barnard's older brother Johannes, who was twelve years older than Chris. Barnard matriculated from the Beaufort West High School in 1940, and went to study medicine at the University of Cape Town Medical School, where he obtained his MB ChB in 1945.

His father served as a missionary to mixed-race people.  His mother, the former Maria Elisabeth de Swart, instilled in the surviving brothers the belief that they could do anything they set their minds to.

Career
Barnard did his internship and residency at the Groote Schuur Hospital in Cape Town, after which he worked as a general practitioner in Ceres, a rural town in the Cape Province. In 1951, he returned to Cape Town where he worked at the City Hospital as a Senior Resident Medical Officer, and in the Department of Medicine at Groote Schuur as a registrar. He completed his master's degree, receiving Master of Medicine in 1953 from the University of Cape Town. In the same year he obtained a doctorate in medicine (MD) from the same university for a dissertation titled "The treatment of tuberculous meningitis".

Soon after qualifying as a doctor, Barnard performed experiments on dogs while investigating intestinal atresia, a birth defect which allows life-threatening gaps to develop in the intestines.  He followed a medical hunch that this was caused by inadequate blood flow to the fetus.  After nine months and forty-three attempts, Barnard was able to reproduce this condition in a fetus puppy by tying off some of the blood supply to a puppy's intestines and then placing the animal back in the womb, after which it was born some two weeks later, with the condition of intestinal atresia.  He was also able to cure the condition by removing the piece of intestine with inadequate blood supply.  The mistake of previous surgeons had been attempting to reconnect ends of intestine which themselves still had inadequate blood supply.  To be successful, it was typically necessary to remove between 15 and 20 centimeters of intestine (6 to 8 inches).  Jannie Louw used this innovation in a clinical setting, and Barnard's method saved the lives of ten babies in Cape Town.  This technique was also adapted by surgeons in Britain and the US.  In addition, Barnard analyzed 259 cases of tubercular meningitis.

Owen Wangensteen at the University of Minnesota in the United States had been impressed by the work of Alan Thal, a young South African doctor working in Minnesota.  Wangensteen asked Groote Schuur Head of Medicine John Brock if he might recommend any similarly talented South Africans and Brock recommended Barnard.  In December 1955, Barnard travelled to Minneapolis, Minnesota to begin a two-year scholarship under Chief of Surgery Wangensteen, who assigned Barnard more work on the intestines, which Barnard accepted even though he wanted to move onto something new.  Simply by luck, whenever Barnard needed a break from this work, he could wander across the hall and talk with Vince Gott who ran the lab for open-heart surgery pioneer Walt Lillehei.  Gott had begun to develop a technique of running blood backwards through the veins of the heart so Lillehei could more easily operate on the aortic valve (McRae writes, "It was the type of inspired thinking that entranced Barnard").  In March 1956, Gott asked Barnard to help him run the heart-lung machine for an operation.  Shortly thereafter, Wangensteen agreed to let Barnard switch to Lillehei's service.  It was during this time that Barnard first became acquainted with fellow future heart transplantation surgeon Norman Shumway.  Barnard also became friendly with Gil Campbell who had demonstrated that a dog's lung could be used to oxygenate blood during open-heart surgery.  (The year before Barnard arrived, Lillehei and Campbell had used this procedure for twenty minutes during surgery on a 13-year-old boy with ventricular septal defect, and the boy had made a full recovery.)  Barnard and Campbell met regularly for early breakfast.  In 1958, Barnard received a Master of Science in Surgery for a thesis titled "The aortic valve – problems in the fabrication and testing of a prosthetic valve". The same year he was awarded a Ph.D. for his dissertation titled "The aetiology of congenital intestinal atresia". Barnard described the two years he spent in the United States as "the most fascinating time in my life."

Upon returning to South Africa in 1958, Barnard was appointed head of the Department of Experimental Surgery at Groote Schuur hospital, as well as holding a joint post at the University of Cape Town.  He was promoted to full-time lecturer and Director of Surgical Research at the University of Cape Town. In 1960, he flew to Moscow in order to meet Vladimir Demikhov, a top expert on organ transplants (later he credited Demikhov's accomplishment saying that "if there is a father of heart and lung transplantation then Demikhov certainly deserves this title.") In 1961 he was appointed Head of the Division of Cardiothoracic Surgery at the teaching hospitals of the University of Cape Town. He rose to the position of Associate Professor in the Department of Surgery at the University of Cape Town in 1962. Barnard's younger brother Marius, who also studied medicine, eventually became Barnard's right-hand man at the department of Cardiac Surgery. Over time, Barnard became known as a brilliant surgeon with many contributions to the treatment of cardiac diseases, such as the Tetralogy of Fallot and Ebstein's anomaly. He was promoted to Professor of Surgical Science in the Department of Surgery at the University of Cape Town in 1972. In 1981, Barnard became a founding member of the World Cultural Council. Among the many awards he received over the years, he was named Professor Emeritus in 1984.

Historical context 

Following the first successful kidney transplant in 1953, in the United States, Barnard performed the second kidney transplant in South Africa in October 1967, the first having been done in Johannesburg the previous year.

On 23 January 1964, James Hardy at the University of Mississippi Medical Center in Jackson, Mississippi, performed the world's first heart transplant and world's first cardiac xenotransplant by transplanting the heart of a chimpanzee into a desperately ill and dying man.  This heart did beat in the patient's chest for approximately 60 to 90 minutes.  The patient, Boyd Rush, died without ever regaining consciousness.

Barnard had experimentally transplanted forty-eight hearts into dogs, which was about a fifth the number that Adrian Kantrowitz had performed at Maimonides Medical Center in New York and about a sixth the number Norman Shumway had performed at Stanford University in California.  Barnard had no dogs which had survived longer than ten days, unlike Kantrowitz and Shumway who had had dogs survive for more than a year.

With the availability of new breakthroughs introduced by several pioneers, also including Richard Lower at the Medical College of Virginia, several surgical teams were in a position to prepare for a human heart transplant. Barnard had a patient willing to undergo the procedure, but as with other surgeons, he needed a suitable donor.

During the Apartheid era in South Africa, non-white persons and citizens were not given equal opportunities in the medical professions.  At Groote Schuur Hospital, Hamilton Naki was an informally taught surgeon.  He started out as a gardener and cleaner.  One day he was asked to help out with an experiment on a giraffe.  From this modest beginning, Naki became principal lab technician and taught hundreds of surgeons, and assisted with Barnard's organ transplant program.  Barnard said, "Hamilton Naki had better technical skills than I did.  He was a better craftsman than me, especially when it came to stitching, and had very good hands in the theatre".  A popular myth, propagated principally by a widely discredited documentary film called Hidden Heart and an erroneous newspaper article, maintains incorrectly that Naki was present during the Washkansky transplant.

First human-to-human heart transplant 
Barnard performed the world's first human-to-human heart transplant operation in the early morning hours of Sunday 3 December 1967. Louis Washkansky, a 54-year-old grocer who was suffering from diabetes and incurable heart disease, was the patient.  Barnard was assisted by his brother Marius Barnard, as well as a team of thirty staff members.  The operation lasted approximately five hours.

Barnard stated to Washkansky and his wife Ann Washkansky that the transplant had an 80% chance of success. This has been criticised by the ethicists Peter Singer and Helga Kuhse as making claims for chances of success to the patient and family which were "unfounded" and "misleading".
 
Barnard later wrote, "For a dying man it is not a difficult decision because he knows he is at the end. If a lion chases you to the bank of a river filled with crocodiles, you will leap into the water, convinced you have a chance to swim to the other side." The donor heart came from a young woman, Denise Darvall, who had been rendered brain dead in an accident on 2 December 1967, while crossing a street in Cape Town. On examination at Groote Schuur hospital, Darvall had two serious fractures in her skull, with no electrical activity in her brain detected, and no sign of pain when ice water was poured into her ear.  Coert Venter and Bertie Bosman requested permission from Darvall's father for Denise's heart to be used in the transplant attempt. The afternoon before his first transplant, Barnard dozed at his home while listening to music.  When he awoke, he decided to modify Shumway and Lower's technique.  Instead of cutting straight across the back of the atrial chambers of the donor heart, he would avoid damage to the septum and instead cut two small holes for the venae cavae and pulmonary veins.  Prior to the transplant, rather than wait for Darvall's heart to stop beating, at his brother Marius Barnard's urging, Christiaan had injected potassium into her heart to paralyse it and render her technically dead by the whole-body standard. Twenty years later, Marius Barnard recounted, "Chris stood there for a few moments, watching, then stood back and said, 'It works.'"

Washkansky survived the operation and lived for 18 days, having succumbed to pneumonia as he was taking immunosuppressive drugs.

Additional heart transplants 

Barnard and his patient received worldwide publicity.
 As a 2017 BBC retrospective article describes, "Journalists and film crews flooded into Cape Town's Groote Schuur Hospital, soon making Barnard and Washkansky household names."  Barnard himself was described as "charismatic" and "photogenic."  And the operation was initially reported as "successful" even though Washkansky only lived a further 18 days.

Worldwide, approximately 100 transplants were performed by various doctors during 1968.  However, only a third of these patients lived longer than three months.  Many medical centers stopped performing transplants.  In fact, a U.S. National Institutes of Health publication states, "Within several years, only Shumway's team at Stanford was attempting transplants."

Barnard's second transplant operation was conducted on 2 January 1968, and the patient, Philip Blaiberg, survived for 19 months. Blaiberg's heart was donated by Clive Haupt, a 24-year-old black man who suffered a stroke, inciting controversy (especially in the African-American press) during the time of South African apartheid.  Dirk van Zyl, who received a new heart in 1971, was the longest-lived recipient, surviving over 23 years.

Between December 1967 and November 1974 at Groote Schuur Hospital in Cape Town, South Africa, ten heart transplants were performed, as well as a heart and lung transplant in 1971.  Of these ten patients, four lived longer than 18 months, with two of these four becoming long-term survivors.  One patient, Dorothy Fischer, lived for over thirteen years and another for over twenty-four years.

Full recovery of donor heart function often takes place over hours or days, during which time considerable damage can occur.  Other deaths to patients can occur from preexisting conditions.  For example, in pulmonary hypertension the patient's right ventricle has often adapted to the higher pressure over time and, although diseased and hypertrophied, is often capable of maintaining circulation to the lungs.  Barnard designed the idea of the heterotopic (or "piggy back" transplant) in which the patient's diseased heart is left in place while the donor heart is added, essentially forming a "double heart".  Barnard performed the first such heterotopic heart transplant in 1974.

From November 1974 through December 1983, 49 consecutive heterotopic heart transplants on 43 patients were performed at Groote Schuur. The survival rate for patients at one year was over 60%, as compared to less than 40% with standard transplants, and the survival rate at five years was over 36% as compared to less than 20% with standard transplants.

Many surgeons gave up cardiac transplantation due to poor results, often due to rejection of the transplanted heart by the patient's immune system. Barnard persisted until the advent of cyclosporine, an effective immunosuppressive drug, which helped revive the operation throughout the world. He also attempted xenotransplantation in two human patients, utilizing a baboon heart and chimpanzee heart, respectively.

Public life 

Barnard was an outspoken opponent of South Africa's laws of apartheid, and was not afraid to criticise his nation's government, although he had to temper his remarks to some extent to travel abroad.  Rather than leaving his homeland, he used his fame to campaign for a change in the law. Christiaan's brother, Marius Barnard, went into politics, and was elected to the legislature from the Progressive Federal Party. Barnard later stated that the reason he never won the Nobel Prize in Physiology or Medicine was probably because he was a "white South African".

Shortly before his visit to Kenya in 1978, the following was written about his views regarding race relations in South Africa;
"While he believes in the participation of Africans in the political process of South Africa, he is opposed to a one-man-one-vote system in South Africa".

In answering a hypothetical question on how he would solve the race problem were he a "benevolent dictator in South Africa", Barnard stated the following in a long interview at the Weekly Review:
 While "I would abolish Social discrimination", political discrimination would continue. 
 He favoured the total division of the country along racial lines. His words were; "I somehow feel ... but we may have to divide South Africa into two equal divisions". In a follow-up question about where the coloured people would end up in that scenario, he replied that 'I would include them in the white South Africa".
 That coloured people have "always been accepted" among whites.
 That "the black man will not accept this view" of universal suffrage.
 That "we are still out of the Olympic games" despite the fact that "in the field of sports where we have virtually integrated completely."
 Regarding the Soweto uprising, he claimed "there was ... a lot of external stirring up of turbulence". Regarding the anger from the black population when Steve Biko was murdered, he said that "I think that something like $50,000 came in from outside to work up feelings at that funeral."
 He stated that the National Party members were as upset about Biko's murder as were blacks; "The white community was thoroughly upset, let me tell you. The nationalists themselves were very upset."

The interview ended with the following summary from he himself;
"I often say that, like King Lear, South Africa is a country more sinned against than sinning."

Personal life 
Barnard's first marriage was to Aletta Gertruida Louw, a nurse, whom he married in 1948 while practising medicine in Ceres. The couple had two children: Deirdre (born 1950) and Andre (1951–1984). International fame took a toll on his personal life, and in 1969, Barnard and his wife divorced. In 1970, he married heiress Barbara Zoellner when she was 19, the same age as his son, and they had two children: Frederick (born 1972) and Christiaan Jr. (born 1974). He divorced Zoellner in 1982. Barnard married for a third time in 1988 to Karin Setzkorn, a young model. They also had two children, Armin (born 1989) and Lara (born 1997), but this last marriage also ended in divorce in 2000.

Barnard described in his autobiography The Second Life a one-night extramarital affair with Italian film star Gina Lollobrigida, that occurred in January 1968. During that visit to Rome he received an audience from Pope Paul VI.

In October 2016, U.S. Congresswoman Ann McLane Kuster (D-NH) stated that Barnard sexually assaulted her when she was 23 years old. According to Kuster, he attempted to grope her under her skirt, while seated at a business luncheon with  Rep. Pete McCloskey (R-CA), whom she worked for at the time.

Retirement 
Barnard retired as Head of the Department of Cardiothoracic Surgery in Cape Town in 1983 after developing rheumatoid arthritis in his hands which ended his surgical career. He had struggled with arthritis since 1956, when it was diagnosed during his postgraduate work in the United States. After retirement, he spent two years as the Scientist-In-Residence at the Oklahoma Transplantation Institute in the United States and as an acting consultant for various institutions.

He had by this time become very interested in anti-aging research, and his reputation suffered in 1986 when he promoted Glycel, an expensive "anti-aging" skin cream, whose approval was withdrawn by the United States Food and Drug Administration soon thereafter. He also spent time as a research advisor to the Clinique la Prairie, in Switzerland, where the controversial "rejuvenation therapy" was practised.

Barnard divided the remainder of his years between Austria, where he established the Christiaan Barnard Foundation, dedicated to helping underprivileged children throughout the world, and his game farm in Beaufort West, South Africa. In his later years he had Basal-cell carcinoma (skin cancer) on his face, for which he was treated in Parow, South Africa.

Death 
Christiaan Barnard died on 2 September 2001, while on holiday in Paphos, Cyprus. Early reports stated that he had died of a heart attack, but an autopsy showed his death was caused by a severe asthma attack.

Books
Barnard wrote two autobiographies. His first book, One Life, was published in 1969 () and sold copies worldwide. Some of the proceeds were used to set up the Chris Barnard Fund for research into heart disease and heart transplants in Cape Town. His second autobiography, The Second Life, was published in 1993, eight years before his death ().

Apart from his autobiographies, Barnard wrote books including:
The Donor
Your Healthy Heart
In The Night Season
The Best Medicine
Arthritis Handbook: How to Live With Arthritis
Good Life Good Death: A Doctor's Case for Euthanasia and Suicide
South Africa: Sharp Dissection
50 Ways to a Healthy Heart
Body Machine

See also 
 Bartley P. Griffith
 René Favaloro
 Pierre Grondin
 Hamilton Naki
 Geoffrey Tovey

References

Further reading

External links 

 Christiaan Barnard: his first transplants and their impact on concepts of death
 To Transplant and Beyond : First Human Heart Transplant
 In Memoriam : Christiaan Neethling Barnard
 40th anniversary of first human heart transplant
 Official Heart Transplant Museum – Heart Of Cape Town

1922 births
2001 deaths
Deaths from pneumonia in Cyprus
People from Beaufort West
South African expatriates in the United States
Afrikaner people
South African cardiac surgeons
South African transplant surgeons
University of Cape Town academics
University of Cape Town alumni
University of Minnesota alumni
Founding members of the World Cultural Council
Deaths from asthma
20th-century surgeons
20th-century South African physicians
Louis Joshua Washkansky (12 April 1912 – 21 December 1967) was a South African man who was the recipient of the world's first human-to-human heart transplant, and the first patient to regain consciousness following the operation. Washkansky lived for 18 days and was able to speak with his wife and reporters.

Washkansky was actually the second human recipient of a heart transplant overall, in that James Hardy had done a transplant in 1964 in which Boyd Rush  received a chimpanzee's heart, although the patient in that case only survived an hour and did not regain consciousness.

Biography
Washkansky was a Lithuanian Jew, the youngest of the four children of Abe Washkansky and his wife, Chana Yentel Kemelgor. In 1912, when Washkansky was three months old, his father emigrated to South Africa without his family and started a business as a produce merchant. As a result of World War I, Mrs Washkansky and the children only re-united with her husband in Cape Town during 1923. Washkansky attended Cape Town High School, where he passed the standard eight, before entering the grocery business in Cape Town. He saw active service in World War II in East and North Africa and Italy.

Washkansky was an avid sportsman. He took part in football, swimming, and weightlifting. Later on in life, he suffered heart problems and required a heart transplant.

Medical background
However, later in Washkansky's life his health declined substantially: he was diabetic, and had an incurable heart disease, causing him to suffer three heart attacks. The last of these heart attacks led to congestive heart failure.

In April 1966, Washkansky visited Groote Schuur Hospital due to his pre-existing illness. He was first seen by Barry Kaplan, who in July 1966 had asked if Christiaan Barnard would be willing to attend Washkansky. Barnard had performed a number of laboratory tests and an in-depth examination on Washkansky and came to the conclusion that nothing could be done to help him. In January 1967, Washkansky was referred to Mervyn Gotsman, a cardiologist at the Cardiac Clinic in Groote Schuur Hospital, due to refractory heart failure. Washkansky underwent cardiac catheterisation confirming severe heart failure, and was subsequently referred to Barnard for possible surgery.

Washkansky was re-admitted to Groote Schuur on 14 September 1967, which was also the Jewish New Year. As a result of heart attacks in 1965, approximately only one third of his heart was still functioning. In late October, he went into a diabetic coma, but regained consciousness. Once, when he was swollen with fluid and in considerable pain, his wife Ann asked him in a whisper how he was doing. He managed a smile and whispered, "I'm on top of the world." He was also suffering from kidney and liver failure. On 10 November, Val Schrire put forward Washkansky as a possible heart transplant candidate.

When Barnard met with Washkansky, Barnard explained the possibility of a transplant and Washkansky was agreeable to the possibility. Afterwards, Ann found her husband Louis to be "oddly buoyant." When Barnard later explained the possibility of a transplant to both of them, the idea was so new that Ann initially worried her husband might absorb some of the personality of the donor heart.  Barnard stated to Ann and Louis Washkansky that the proposed transplant had an 80% chance of success, which has been criticised as "misleading".  Part of the pre-op procedure was to take swabs from Washkansky's skin, nose, mouth, throat, and rectum to find out what bacteria lived on and in his body, so that the most effective antibiotics could be given after the transplant. He was also frequently washed down with Phisohex.

Potential transplant in November 1967
In late November 1967, a potential donor was identified. A young black man had fallen off a truck and suffered a catastrophic head injury. Although the Chief of Cardiology, Val Schrire, had previously expressed a strong preference to avoid a "coloured" donor, police approached the young man's family for permission for him to be a heart donor. McRae writes that the family was "in shock after they were confronted by a policeman". The EKG of the donor heart, however, showed depressed ST segments, meaning that it might have been damaged or was not receiving enough oxygenated blood and gave the reluctant Val Schrire a medical reason not to continue with the transplant of a "coloured" donor heart in apartheid South Africa. Washkansky, who had been cleaned and shaved for the possible attempt, felt let down and disappointed when it did not go forward.  He felt his future chances were slim.

Operation and outcome
Washkansky received his heart transplant on 3 December 1967, at the Groote Schuur Hospital in Cape Town, South Africa. The operation lasted approximately six hours, beginning at 01:00, with Christiaan Barnard leading a team of thirty surgeons, anaesthetists, nurses and technicians. His brother Marius Barnard assisted with the surgery.

25-year-old Denise Darvall and her mother had been struck by a drunk driver while crossing a busy street on a Saturday afternoon. Her mother died at the scene. Denise was taken to Groote Schuur. Peter Rose-Innis, the hospital's senior neurosurgeon, attended to her. A skull X-ray showed two serious fractures. She showed no sign of pain when ice water was poured in her ear. In addition, her brain had no sign of electrical activity. A blood transfusion and respirator maintained the beat of her heart. Coert Venter and Bertie Bosman were the doctors who approached Denise's father Edward Darvall and asked for permission to use her heart for a possible transplant. He had been at the scene of the original accident and had been sedated after being brought to the hospital. As he waited, he thought they were still trying to save his daughter's life. Bosman told him there was a man in the hospital who was desperately ill and in need of a heart transplant, and perhaps Edward could do him a great kindness if they would allow them to transplant his Denise's heart. Bosman and Venter withdrew from the room, saying that he should take as long as needed to consider their request and that they would understand if he declined to give his consent.

In the four minutes Edward Darvall took to reach his decision he thought of his daughter, a birthday, and a gift she had given to him from a first salary. He began to cry and decided what needed to be done. He composed himself and summoned the doctors back to the small room. He told them that if they could not save his daughter, they must try to save this man.

Although Washkansky died of pneumonia eighteen days after the transplant because of a weakened immune system, Barnard regarded the surgery as a success because the heart was "not being stimulated by an electrical machine".  As Barnard related in his book, One Life, a decision was made on the fifth postoperative day to bombard Washkansky's system with immunosuppressants to guard against a potential rejection of the new heart. As later heart transplants would reveal, the signs noted at that time were part of a resettling program for the new heart and not necessarily an indication of rejection.

References

External links 
South African history: Louis Washkansky
World's First Heart Transplant1
World's First Heart Transplant2
Denise Darvall the donor for the World's First Heart Transplant
Article from Time Magazine, 29 December 1967
Article from Life Magazine, 15 December 1967

1910s births
1967 deaths
Heart transplant recipients
People from Cape Town
South African Jews
South African people of Lithuanian-Jewish descent
Deaths from pneumonia in South Africa
Lithuanian emigrants to South Africa
White South African people
1967 in medicine
Grocers
South African military personnel of World War II
Lithuanian Jews

nl:Louis Washkansky Hamilton Naki (26 June 1926 – 29 May 2005) was a laboratory assistant to cardiac surgeon Christiaan Barnard in South Africa. He was recognised for his surgical skills and for his ability to teach medical students and physicians such skills despite not having received a formal medical education, and took a leading role in organ transplant research on animals.

A controversy arose after his death in that at least five periodicals and the Associated Press retracted statements in their obituaries of Naki that claimed that he participated in the world's first human-to-human heart transplantation in 1967; the incident has been cited as an example of inadequate fact checking by the newsmedia and delayed corrections of the errors.

Early life
Naki was born to a rich family in Ngcingwane, a village in Centani in the Eastern Cape province of South Africa. He received six years of education up to the age of 14, after which he moved to Cape Town. Beginning about 1940, he commuted from Langa, Cape Town to the University of Cape Town to work as a gardener, specifically rolling grass tennis courts.

Medical career and retirement
In 1954 Robert Goetz of the University's surgical faculty asked Naki to assist him with laboratory animals. Naki's responsibilities progressed from cleaning cages to performing anaesthesia. Most of Naki's work under Goetz involved anaesthetising dogs, but Naki also assisted in operating on a giraffe "to dissect the jugular venous valves to determine why giraffes do not faint when bending to drink."

Several years after Goetz left, Naki started working for Christiaan Barnard in the laboratory as an assistant. Barnard had studied open-heart surgery techniques in the United States and was bringing those techniques to South Africa.  Naki first performed anaesthesia on animals for Barnard, but was then "appointed principal surgical assistant of the laboratory because of his remarkable skill and dexterity." Barnard was quoted as saying "If Hamilton had had the opportunity to study, he would probably have become a brilliant surgeon" and that Naki was "one of the great researchers of all time in the field of heart transplants".

In 1968, Barnard's cardiac surgical research team moved out of the surgical laboratory, and Naki helped develop the heterotopic or "piggyback" heart transplantation technique. In the 1970s, Naki left Barnard's team and returned to the surgical laboratory, this time working on liver transplantation. His contributions at this time were described as follows:
 Rosemary Hickman, transplantation surgeon whom Naki assisted and taught in the laboratory, and who worked with Naki for nearly 30 years:  "Despite his limited conventional education, he had an amazing ability to learn anatomical names and recognize anomalies. His skills ranged from assisting to operating and he frequently prepared the donor animal (sometimes single-handedly) while another team worked on the recipient."
 Del Khan, head of Groote Schuur Hospital's organ transplant unit, whom Naki taught in the laboratory: "A liver transplant on a pig in the U.S. would involve a team of two or three medically qualified surgeons… Hamilton can do this all on his own."
 Ralph Kirsch, head of the Liver Research Centre at the University of Cape Town: “He was one of those remarkable men who really come around once in a long time. As a man without any education, he mastered surgical techniques at the highest level and passed them on to young doctors."
 Barnard: "A liver transplant is much more difficult than a heart transplant… [doctors who work with Naki] tell me that Hamilton can do all the various aspects of liver transplantation, which I can't do. So technically, he is a better surgeon than I am."

Naki taught many students during his career; although newsmedia accounts placed the number of students in the thousands, Hickman said that that number appears to have been exaggerated. Naki assisted Hickman until his retirement in 1991, after which he received "a gardener's pension: 760 rand, or about $275, a month."

Personal life, post-retirement activities and recognition, and death
Naki was reported to be married with four sons and one daughter. He lived in a small one-room house without electricity or running water and sent "most of his pay to his wife and family, left behind in Transkei," but "could pay for only one of his five children to stay to the end of high school."  He was active in his church and read the Bible frequently.

After retirement, Naki helped the community of Kentani, where part of his family lived, for example "in the construction of a school and in the provision of a mobile clinic" by soliciting donations from his "medical contacts".  He received public recognition of his medical work after his retirement, including:
 Metropolitan Eastern Cape Award, 2002.
 The Bronze Order of Mapungubwe, 2002, presented by President Thabo Mbeki. One of the highest South African civil honours, this Order is "awarded to South African citizens for excellence and exceptional achievement."
 BTWSC Black S/Heroes Award, 2003.
 An honorary master's degree from the University of Cape Town in 2003, presented by Chancellor Graça Machel. The honorary degree was described as MMed (Master of Medicine) in some sources and MSc (Master of Science) in others.
 Inclusion in a "senior civil guard of honour" at the 2004 opening of the Parliament of South Africa.
 In August 2017, the plain opposite the Christian Barnard Hospital in Cape Town was renamed from Salazar Plain to Hamilton Naki Square.

He died in Langa on 29 May 2005, aged 78, of "heart trouble."

Controversy concerning participation in 1967 heart transplantation
After Naki's death, obituaries published 9 June 2005 to 2 July 2005 in at least two medical journals (BMJ and The Lancet), one magazine (The Economist), two newspapers (The Independent and The New York Times), and an unknown number of newspapers publishing Associated Press stories, printed obituaries that made the following claims about Naki's participation in the world's first human-to-human heart transplantation:
 That Barnard had asked Groote Schuur Hospital for permission for Naki to be on the transplant team, and that permission was given in secret because of hospital rules and apartheid laws. Under apartheid, black health care providers could not have contact with white patients.
 That on 3 December 1967, Naki removed the heart of the deceased Denise Darvall, who was white, for transplantation into Louis Washkansky by Barnard.

Between 14 July 2005 and 3 September 2005, the five aforementioned periodicals and the Associated Press issued formal retractions of statements in their obituaries of Naki that claimed that he participated in the world's first human-to-human heart transplantation. The reasons given for the initial mistakes included:
 The Economist stated that its obituary was based on Naki's "own words in interviews," but that Naki's role "was gradually embellished in post-apartheid, black-ruled South Africa" and that Naki came to believe the story himself. Furthermore, the magazine reported that the University of Cape Town did not initially deny the story because it appeared "ridiculous."
 The author of the BMJ and The Independent obituaries wrote that she had "relied on secondary sources" such as The Economist.
 In an article published the same day as its correction, the New York Times concluded that reports that Naki was involved in the 1967 transplantation emerged "most prominently" in a 2003 article in The Guardian.  The 2003 article mentioned that "a team led by Mr. Naki went to work, a 48-hour marathon" to remove the donor heart.
 The Associated Press cited a reliance on previous (1993 and 2003) Associated Press articles.

Evidence cited in 2005 that Naki was not present at the first transplant included:
 Surgeons at the hospital where the 1967 transplantation was performed "assured" The Economist that Naki "was nowhere near the operating theatre."
 The Economist reported that "a source close to" Naki said that Naki said that he had heard of the first heart transplant "on the radio."
 The chief of the laboratory in which Naki worked as of 1967 stated that Naki at the time was a scrub nurse and that Victor Pick was the surgical assistant; Naki became surgical assistant only after Pick died in the early 1970s and only "at the experimental surgical operating table."
 Hickman was quoted as saying that Naki "was an honest man and he wouldn't have made that claim [of being present at the 1967 transplanation]".
 Filmmaker Dirk de Villiers stated that he heard Naki "tell other people" that he assisted in the transplant but did not say this to de Villiers in private.
 David Dent, Acting Dean of the Faculty of Health Sciences at Cape Town University as of 2005, asserted that he worked with Naki "on transplanting pigs' livers" in 1967, but that technicians such as Naki did not perform surgeries in hospitals.
 In a letter to BMJ, Dent wrote that Naki "did not participate in the first heart transplant, did not ever operate on humans, nor ever work in Groote Schuur Hospital…. The suggestion that Hamilton Naki performed the donor operation was never mentioned in life by the man himself, by the department of cardiac surgery, or by the university in his citation for his honorary degree in 2003. It was not mentioned after his death at his family funeral, or at the memorial service in the medical school experimental laboratory."
 Chris Logan, author of a biography of Barnard, wrote that Naki "did not at any stage assist in the first or subsequent human heart transplant operations, nor could he have done under the apartheid laws at the time".
 It was effectively illegal for blacks to do surgery on whites under apartheid, and it is beyond the bounds of probability that an untrained black technician would have been permitted to undertake such an operation, or that his participation in such a high-profile operation at a leading white hospital could have avoided public notice during  apartheid.

Instead, the surgeons who removed the heart from the donor were Marius Barnard (Christiaan Barnard's brother) and Terry O'Donovan.

Despite the retractions, the claim that Naki participated in the 1967 heart transplantation has been perpetuated in journal articles and books published after 2005. Examples include:
 "In December 1967… Naki, with amazing dexterity, removed the donor heart from Darval, irrigated it with electrolyte solution and passed it to Barnard."
 "1967 Dr. Christiaan N. Barnard of South Africa performed the world's first human heart transplant operation… Working with a team that included… black South African surgeon Hamilton Naki…."
 "One of the most interesting people I learned and read about was Hamilton Naki. He assisted Dr. Barnard with the first transplant in 1967…."

A 2007 book traced the origin of the incorrect story to a 1993 article in the Associated Press that stated "Barnard had Naki on his heart-transplant backup team. … When Barnard performed the first heart transplant in 1967, Naki was part of the backup team at Groote Schuur Hospital in Cape Town." The story's "blossom[ing] into accepted fact" was partly attributed to neither Barnard's nor Naki's taking steps to refute the story. The 2007 book noted that the 2005 corrections in the newsmedia "did not include any statement about adopting new procedures to prevent the same thing from happening again."

A documentary film Hidden Heart which was released widely in 2009 included interviews with Christiaan Barnard and Naki suggesting that Naki was present at the 1967 heart transplantation. Marius Barnard was quoted as describing the claims in the film that Naki removed the donor heart as "rubbish, a joke, it’s a total distortion of the facts" and as stating that Naki was at the time "in his bed, about 8 km away from Groote Schuur". The co-director of the film "acknowledge[d] that Naki was not present the night of the operation." A South African Broadcasting Corporation investigation after the release of the film quoted five people about the event:
 Tollie Lambrechts, a member of the transplantation team, said Naki "was definitely not in the operating room on that night."
 Dene Friedmann, a member of the transplantation team, said Naki "was not here that night, the only people here were the ones that would actually do the work. Hamilton never worked in the theatres. He wasn’t allowed to operate on a human being without a medical and surgical degree."
 Hickman said that Naki's being there was "highly unlikely."
 The former wife of Barnard stated that Barnard "never mentioned Naki was there the evening of the first transplant."
 Naki’s youngest son said that Naki was "the one who took out the heart and gave it to Chris Barnard." However, his son could not have been a witness to the operation, and was more likely to have heard the myth later.

References

Further reading

 Pendergast S, Pendergast T.  Contemporary Black biography. Volume 63. Profiles from the international Black community. Detroit, MI: Gale, 2008. .
 Williams M. Black scientists & inventors. Book 3. London: BIS Publications, 2007. .

External links
 Hidden heart: the true story of the first heart transplant: Christian Barnard and Hamilton Naki. (Official site for the film.)
 Jonker-Bryce T. Our forgotten surgical pioneer. Daily Dispatch (South Africa) 3 August 2002.
 Jonker-Bryce T. Our forgotten hero honoured, at last. Daily Dispatch (South Africa) 20 June 2003.

 Smith D. Film on black surgeon in first heart transplant team rekindles controversy. The Guardian 1 June 2009.
 South African History Online. Hamilton Naki 1930–2005. 

1926 births
2005 deaths
People from the Eastern Cape
South African surgeons
20th-century surgeons