The 50th anniversary of the heart transplant

Jan 30, 2019 11:22:39 AM

Fifty years ago, the first adult human heart transplant was performed in Cape Town, Africa. It was perhaps the epoch advance in science.2019Jan

 Mr. Barney Clark, a retired dentist with end-stage heart failure, received the world’s first permanent mechanical heart in 1982, and his wife worried that he might not still be able to love her.

A heart transplant is the definitive treatment for many severe stages of heart failure that afflict 6 million Americans. Until the early ’60s, transplanting a human heart seemed like a dream. Organ rejection and life-threatening infections posed prohibitive risks. By the second half of the decade, however, animal research had pointed a path toward human transplantation.

The story of the race to transplant a human heart was recounted in Donald McRae’s book in 2006, “Every Second Counts.” Four surgeons were mentioned in that article, and two among them were Christiaan Barnard at Groote Schuur Hospital in Cape Town and Norman Shumway at Stanford in the United States. Both were surgical residents at the University of Minnesota.

Dr. Shumway had a great deal of experience with animal transplants. In 1959, Dr. Shumway and Richard Lower, a Stanford resident, performed the first dog heart transplant. The dog lived for eight days. By 1967, about 60 percent of Dr. Shumway’s research dogs were able to live for a year or more. At that point, Dr. Shumway had performed about 300 transplants in dogs and Dr. Barnard had done only about 50 animal transplants.

Dr. Shumway was at a disadvantage to do a human transplant as American regulations at the time prohibited organ collection from brain-dead patients if their hearts were still beating. The heart had to stop completely before organs could be harvested. Otherwise, a surgeon could theoretically be charged with murder. More liberal laws in South Africa, which allowed a neurosurgeon to confirm death if a patient showed no response to light or pain, allowed Dr. Barnard easier access for donor hearts.

It was a close race between Dr. Shumway and Dr. Barnard. Finally, Dr. Barnard succeeded with the first transplant on Dec. 3, 1967. His patient, Louis Washkansky, was a 55-yearold grocer who received the heart of a young woman who suffered brain damage after an auto accident. The patient lived for 18 days before he died of lung infection believed to be due to immune suppression from drugs to prevent rejection.

Dr. Shumway performed the first heart transplant in the United States a month later, on Jan. 6, 1968. His patient, a 54-year-old steel worker, lived for 14 days after several complications.

Today, with the refinement of drugs that help prevent the body from rejecting a foreign organ, the long-term outcomes following heart transplantation are excellent.

About 85 percent of patients live for at least a year after the procedure. The median long-term survival is probably greater than 12 years, and it’s about 14 years if the patient survives the first year.

Though heart transplants have saved many lives, many more continue to be lost while patients wait for a viable organ. Only about 3,000 Americans receive a heart transplant each year, though roughly 4,000 are on the transplant list and perhaps 10 times that number would benefit from a transplant.

Despite public campaigns to increase organ donation, the number of available organs has remained relatively constant over the years. (That’s partly good news: Seatbelt and motorcycle helmet laws have resulted in fewer road fatalities.)

“A heart transplant is the answer a heart failure the way the lottery is the answer to poverty,” Lynne Warner Stevenson, a heart failure specialist at Vanderbilt, has said.

Though permanent artificial hearts were introduced in the 1980s, they remain fraught with complications.

The most reliable mechanical support today is the left-ventricular assist device, which attaches to the native heart, pumping blood directly into the aorta, thus essentially bypassing the failing heart. However, these devices have drawbacks, too – they cause blood clots, strokes and bleeding, and they are ineffective for patients with severe failure of both sides of the heart.

For many patients, the best hope remains a transplant, a hope introduced to the world 50 years ago through the skill, determination and, yes, heart of a South African surgeon.