Witness to First Heart Transplant

Pioneer...Dr Christian Bernard (Wikimedia Commons)

I want to tell you a true story about the most memorable experience in my life. It happened in Cape Town on December 3, 1967. Earlier that evening, I had been called to the Casualty Department at Groote Schuur Hospital to see an elderly woman with a very swollen abdomen and she definitely wasn't pregnant. She had an intestinal obstruction, and it was clear that there was no choice but to relieve the obstruction surgically.

At the time, I was surgical registrar to Dr Bill Roberts and on duty for Ward C1, and on intake that evening, and I immediately got on the phone to him and told him all the clinical details. He agreed that she needed a Caecostomy immediately and asked if I knew how to do it and would I do it. Well – an immense feeling of next to panic overwhelmed me and I told him that I did know what to do but had never done one on my own, and he said "Well go ahead then, this is your moment", and that was the end of the conversation.

I admitted my patient to the ward and notified the main operating theater and the Anesthetic Department and the nurses and my houseman rolled up their sleeves to get her ready for theater. I rushed to the little library in the ward and started reading up on the surgical procedure manual for Caecostomy. the operation that I was going to have to perform in an hour.

Oh my word! In truth, I had assisted at three or four such procedures before, so I knew what to do, but it is another matter all together to be faced with this major operation as the chief surgeon on your own. My stint in General Surgery was part of my training in Orthopedic Surgery. I was 'on the circuit' at the hospital, and had already done time in Urology, Neurosurgery and Plastics and I had already passed the Primary Surgical Exam, the first stage towards a Surgical Fellowship.

Having now read about the Caecostomy procedure, I headed for the B Floor theaters and found my little team of theater scrub nurse, anesthetist and assistants assembled. I said hello to my patient with what I hoped was an encouraging smile. I scrubbed up, put on my green gown and surgical gloves following the strict surgical sterile routine. I entered the operating room where the scrub sister was ready with her array of instruments, the patient already being intubated by the anesthetist. I asked for the scalpel and the sister slapped it into my palm. I made my incision.

I won't go into the details here to spare your feelings, but I opened the belly and quickly identified the caecum. I thought the operation went very well and I was satisfied with what I had done. My assistant closed up and this gave me a chance to glance around at the others.

Suddenly I heard a commotion coming from the adjacent theater. Raised voices. 'What's going on next door, Sister?'

'Don't you know? – Barnard's going to do a heart transplant!

Oh my goodness. I knew that Professor Barnard had been doing experiments on dogs and that there was an excellent cardiology department lead by Professor Val Schrire – but to do a human heart transplant was something else.

The operating rooms at Groote Schuur Hospital have a visitor's gallery built into them, so that students can observe the proceedings. I slipped inside and sat there all night transfixed. The patient was Mr Louis Washkansky, who was suffering from gross heart failure and was prepared to take the chance of a transplant. A young woman, Denise Darval, had been struck by a car and suffered severe brain damage. Her father did not hesitate when approached to donate her organs. From my elevated seat, I could make out the patient's chest as the surgical team revealed his faintly beating heart. Nearby was the heart lung machine which Professor Barnard had brought back with him from the United States. Its task was to take over the circulation until the new heart was in place.

Soon there was an empty cavity where a heart had been, yet the patient was still alive. The donor heart was brought in lying motionless in a stainless steel dish from the adjacent theater, and the long process began of sewing its main vessels to those of the patient. The temperature in the theater rose. The anesthetic team was busy with monitoring equipment, medications and gases, and sending blood samples to be tested. After seven hours of very hard work, the moment of truth had arrived because the new heart had to be started. It lay still in the patient's chest.

'Give a little Calcium, man' said Barnard.

Nothing happened!

'Christ man what are you playing at, what's his temperature?' A great deal of swearing. Nothing.

'We'll try a little shock then'. A tiny flutter! 'More Calcium Ozinsky'. Suddenly a stronger beat and no leakage. It was working! I had seen the world's first transplant, and couldn't get out of there fast enough to phone my father at seven in the morning. Before I left the hospital, I went into C1 to check on my Caecostomy patient. She was sleeping peacefully but I knew that I would have to back in a few hours for the ward round and to tell Dr Roberts what I had done.

Mr Washkansky survived for 18 days, succumbing in the end to pneumonia. His new heart beat strongly to the end. But the operation was a sensation, and put the hospital where I did my training on the map. The operating theater where Professor Barnard did the world's first heart transplant has become a museum, dedicated to those pioneers of medicine and to the first donor and recipient.

One evening, a few months before this story began, I was working as a casualty officer in the same place where I had examined my Caecostomy patient. It was midnight, and I was alone on duty. I comforted myself that I had the whole hospital to call on if I needed help.

In comes Barnard.

'Christ, Adler! What are you doing here? Why don't you come and work for me?'

Now Professor Barnard had a vicious temper and worked his staff like slaves. I didn't want any of that – and besides I had set my heart on Orthopedic Surgery.

'Thank you sir – but I can't at the moment as I am on the surgical rotation". I said something like that, but if I had accepted, I might have ended up in theater with him doing the world's first heart transplant.