Christiaan Neethling Barnard

8 November 1922 - 2 September 2001 Doctor Chris Barnard got his MD (Doctor of Medicine) degree from the University of Cape Town for a dissertation entitled "The Treatment of Tuberulous Meningitis" in 1953. Leaving his small family behind, he travelled to the United States where he spent, according the man himself, the most fascinating time in his life. He was trained in cardiothoracic surgery at the University of Minnesota, Minneapolis in Minnesota and received his Master of Science in Surgery in 1958, for a thesis entitled, "The Aortic Valve - problems in the fabrication and testing of a prosthetic valve". In the same year he was awarded Doctor of Philosophy for his dissertation entitled "The Aetiology of Congenital Intestinal Atresia". The surgical technique for what he did at Groote Schuur Hospital on December 3 1967 was basic and had been worked out and perfected by other surgeons using experimental animals. Barnard practised this technique in the laboratory until he mastered it, but he didn't pioneer it. When his younger brother Marius told doctors at a cardiac pathology meeting at the University of Cape Town medical school that Barnard's team of surgeons was going to transplant a human heart, there was a notable lack of excitement. The reaction of one doctor was: "Why would they want to do such a thing?" The outpouring of adulation was beyond anyone's imaginings, and certainly not what Barnard himself expected. When he told close friends he was just waiting for the right donor, they asked if the transplant would be world news. "Probably there will be a ripple in the medical world," Barnard replied. He was not trying to be facetious. According to his chief nurse, Barnard had no idea that the operation he began performing at 3pm that Saturday would have anything like the impact it did. There was no prepublicity. Before going into theatre he was overheard telling the minister of the interior on the phone not to publicise the operation. His words to the minister were: "moenie met my twis nie" ("don't argue with me"). When Barnard's team finished their operation on Louis Washkansky they quietly shook hands and went their separate ways, none dreaming of the drama that lay ahead. They wondered if they should inform a hospital authority of what they'd done. It was decided Barnard had better phone the medical superintendent, even if it was 3am on a Sunday by this time. The superintendent was surprised that Barnard should wake him "at this ungodly hour" to tell him about "another operation on a dog". When Barnard said he'd transplanted a human heart this time, the superintendent thanked him for the call and went back to sleep. At dawn, while on his way home, Barnard was surprised to hear the operation reported on radio news, in the form of a bland statement from the hospital that "a group of surgeons at Groote Schuur Hospital have transplanted a heart". The report was picked up and within a couple of hours the first media calls started coming in from around the world. Barnard probably deserved to be acknowledged for his courage above anything else. Others may have done more of the research, but he alone had the courage to take what had been learned in laboratories and apply it to his patients. This willingness to put his reputation on the line with decisive action was probably the most distinguishing feature of his career as a surgeon, while others kept grinding away in their laboratories in a bid for more and more certainty, and less risk of failure. It had made him a leader in the field of congenital heart surgery even before he did the heart transplant. A man who was close to his son had to have his heart transplanted. But, for some inexplicable reason, the replacement failed and the man died. His distraught son, who was pacing outside the operation theatre, asked him, "If the new heart failed, why didn't you put his heart back?" Unable to sleep that night, he saw reason in his son's passion. Indeed, why didn't he put the old one back. Or better, did he have to remove it at all? The mental stage was set for Barnard's second pioneering effort, when he put a second heart into a patient, leaving the first also in place. He became the first to do this so-called "piggyback" transplant in 1971, and then the first to do a heart-lung transplant. Barnard was criticised for rushing into the first heart transplant while there was still so much to be learned about immunosuppression. The fanfare that greeted his transplant opened the floodgates and within a year 100 heart transplants had been attempted by 64 different teams in 22 countries. Because so little was known about immunosuppression the failure rate was horrendous. The British government actually banned further heart transplants and they resumed only 10 years later, when it was felt enough was known about immunosuppression to give them a realistic chance of success. In the midst of growing doubt, Barnard's belief in the potential of heart transplantation to save lives never wavered. His own results were spectacularly successful by world standards, and justified his faith even while other surgeons were losing theirs. Four of his first 10 patients lived for more than a year, two for more than 10 years, and one (who returned to work three months after surgery) was still going strong more than 20 years later. "...for a dying person, a transplant is not a difficult decision. If a lion chases you to a river filled with crocodiles, you will leap into the water convinced you have a chance to swim to the other side. But you would never accept such odds if there were no lion." Apart from the fact that he was assisted by probably the best team of heart surgeons in the world, Barnard's successes owed much to the system of post-operative intensive care that he pioneered. His concept of intensive care for individual patients spread to other areas, and many regard this as a more important contribution to medicine than doing the first heart transplant. Barnard is also credited with developing a new design for artificial heart valves, doing heart transplanting on animals, and correcting the problem of the blood supply to the foetus during pregnancy. Barnard's enduring fame had as much to do with his film-star qualities as his medical achievements. He was highly articulate, had a quick wit, a mischievous sense of humour, youthful good looks, huge charm and the kind of charisma that reminded Americans of John F Kennedy. Even his life story, enhanced if anything by a scalpel-sharp Afrikaans accent, was the stuff of Hollywood - a barefoot boy from dusty, rural Beaufort-West, raised in poverty by a strict mother who demanded nothing but the best, and a father who ministered to souls. The first casualty of Barnard's fame was his 20-year marriage. He arrived back from a visit to the US to find a friend waiting for him, in Barnard's car, with all Barnard's clothes in the back and a message from his wife that she wanted nothing more to do with him. Her main complaint (as it was to be with all his next wives) was his increasingly notorious infidelity. Famously, of course, his name was linked to Gina Lollobrigida and Sophia Loren. "...as a boy I collected pets, I didn't cut them up. I collected scorpions and the thing that fascinated me was that after they mated, the female killed the male. I'm glad that isn't the case in human terms otherwise I would have been dead many times already." He was a figure that always courted controversy, be it clashing with the South African authorities over issues of apartheid, or admitting he had practised passive euthanasia on terminally ill patients, including his own mother. Barnard never stopped working, writing scientific books and novels, and in later life spending much of his time at the Baptist Medical Centre in Oklahoma, where he tried to find a way of slowing the ageing process. It seemed he was searching for a miracle to match his first. He died of an acute asthma attack in his hotel room in the coastal town of Phapos, Cyprus, where he was holidaying. Former president Nelson Mandela said of him: "He was one of our main achievements."