The Race To Make Medical History

This timeline, structured around the main events leading up to the first human heart transplant, illustrates how the race to make medical history was closely and dramatically run by four of the world’s most skilled and driven cardiac surgeons.

Selected milestones, not sub-headings, are reproduced here by kind permission of Donald McRae, the author of Every Second Counts (2006, Simon and Schuster, London).

The starting post

22 July 1958:

The seeds of the race are sown when the great pioneers of heart surgery, Norman Shumway and Dick Lower, succeed in bringing a dog’s heart back to life after it has been stopped and stored in saline for one hour.

The first lap

28 July 1958:

Six days later Chris Barnard performs his first open heart surgery on 15 year-old Joan Pick by opening her narrowed pulmonary valve.

 Early 1959:

Shumway and Lower experiment with cardiac autotransplantation by removing dogs’ hearts and replacing them into the same animal.

Pulling ahead

Summer of 1959:

Shumway and Lower master the technique of canine heart cross transplantation, although their dogs die after a few hours.

23 December 1959:

Lower and Shumway perform their first successful canine heart transplant – the dog lived for eight days before tissue rejection set in.

Early 1960:

Barnard transplants a dog’s head and visits Demikhov in Russia who tells him: “Nothing is impossible, nothing.”

10 October 1960:

Shumway and Lower present their groundbreaking research, “Orthotopic Homotransplantation of the Canine Heart”, at a forum of the American College of Surgeons at the Clearwater Hotel in San Francisco.

Early 1962:

On their 10th attempt, Kantrowitz and his assistant Yoshio Kondo successfully transplant a heart between puppies: Kantrowitz decides to focus on transplantation between infants in the hope that tissue rejection will not be an issue due to their under-developed immune systems.

The second lap

27 March 1963:
After having proved that a heart can be stored in saline for up to seven hours with no damage to the organ, Shumway announces:“We have the surgical technique now… I am confident that we will be transplanting hearts within the next decade.”

Early 1963:
The start of Shumway’s serious exploration into the detection issue of tissue rejection in cardiac transplantation (with an enormous amount of help from fellow team member, Gene Dong)

Falling behind 1963:
Barnard, believing that his chances of surgical success were slim in a politically reviled country at the bottom of Africa, loses some focus in the race. Instead he projects his ambition onto his 13 year-old daughter Deirdre by investing his time in honing her natural water skiing talent:“Somebody in the family, at least,” said Barnard, “was going to make it.”

23 January 1964:
On this day, at the University of Mississippi Medical Center, Thomas Hardy, the first surgeon in medical history to transplant the human lung, unsuccessfully attempts to replace 68 year-old Boyd Rush’s heart with that of a chimpanzee. Hardy’s failure received a scathing response from Shumway:“Perhaps the cardiac surgeon should pause while society becomes accustomed to resurrection of the mythological chimera.” Hardy drops out of therace as swiftly as he had entered it.

1964:
During this year Barnard, amid his water-skiing obsession, did find the time to experiment with canine renal transplantation, thereby not losing touch totally with the concept of transplantation.

The competition stiffens

1965:
David Hume, chief of surgery at the Medical College of Virginia, becomes desperate to create a medical legacy for his facility by winning the race. He knows he needs a top man and so makes Lower an offer he cannot refuse – to run his own show in cardiac transplant research. Lower and Shumway are now racing each other, each convinced that one of them will be the first to transplant a human heart.

29 June 1966:
Kantrowitz is posed to attempt the world’s first human heart transplant at Brooklyn’s Maimonides Hospital. The recipient, six week-old Miller Stevenson, is an immigrant Hungarian gypsy prince, with five distinct cardiac malformations. His donor is the anencephalic* baby, one day-old Ralph Edward Senz. The operation, however, was doomed to fail before it was begun. In accordance with American law at the time, Kantrowitz had to wait for the donor heart to stop beating before Senz could be declared dead and his small heart excised. This delay proved too much, and the tiny muscle, too long deprived of oxygen, died.* These babies have no cerebrum (the largest and most highly developed part of the brain) but they do have a brain stem which allows respiration and heart beat for a minimal period. The babies cannot see, hear, or feel anything.

2 July 1966:
Kantrowitz and the Hungarian gypsy prince are given a second chance with anencephalic Baby Smith. But unfortunately the donor’s heart begins to falter even before the doctors reach the OR and Kantrowitz’s hopes, once again, fade and die.

Catching up

Early 1966:
Barnard realises that he cannot depend on his daughter, through her water-skiing, to satisfy his own personal craving for ambition: “I began to worry about Deirdre ever reaching the top. She was, I feared, too nice a girl. She did not have the killer instinct needed to become a world champion.”

August – October 1966:
Barnard’s personal ambition kicks in and he flies to America to attend a course at the Medical College of Virginia on rejection and to spend a sabbatical with David Hume, a top renal transplant surgeon, to learn about the prevention and management of organ rejection – a step closer to performing kidney, and then heart, transplantation at Groote Schuur Hospital.

September 1966:
Barnard is fired up further as he witnesses Lower calmly at work transplanting dogs’ hearts. The simplicity and success of the Shumway/ Lower technique excites Barnard and he confides to Carl Goosen (his former laboratory perfusionist now working at the Medical College of Virginia): “I’m going to do it in a human.”

Running safe

October 1966:
Lower is urged by Hume to perform a heart transplant when a potential donor becomes available for a dying patient. The ever-cautious Lower, however, resists the insistent Hume due to ABO blood-type incompatibility

28 May 1967:
Lower performs a ‘reverse Hardy’: Lower removes a heart from a fresh human cadaver and successfully transplants it into a baboon… Lower did not publish the results of this somewhat surreal experiment which was yet another stepping stone towards the real thing.

June 1967:
Marius Barnard and Chris Barnard start to experiment with the transplantation of canine hearts, with no success.

Closing in

14 September 1967:
Louis Washkansky is admitted to Groote Schuur Hospital with a heart reduced to a third of its pumping capacity.

20 September 1967:
The recent successful administration of a new anti-rejection drug, antilymphocyte globulin, in kidney transplants encourages Shumway to announce his intention, once he has the right donor, to perform a human heart transplant. “We think the way is clear for trial of human heart transplantation,” he said in an interview with the Journal of the American Medical Association.

5 October 1967:
At a convention of the American College of Surgeons in Chicago Lower shows a film of one of his tail-wagging mongrels who had lived for 15 months after receiving a new heart. Shumway announces: “The time has come for clinical application.”

8 October 1967:
Barnard successfully performs his first ( and only) kidney transplant. The patient, middle-aged Edith Black, lived a full life for another twenty years. Barnard states: The machinery of the transplant team had functioned perfectly… We [are] ready to undertake a heart transplant.”

The last lap

10 November 1967:
Velva Schrire, Groote Schuur’s chief cardiologist, recommends Washkansky as a potential heart transplant recipient. Barnard begins his impatient wait for a donor.

22 November 1967:
Barnard is potentially hours away from winning when a brain dead coloured man presents as a suitable donor for Washkansky. But where South Africa’s definition of death (“a patient is dead when a doctor says he is”) gave Barnard an advantage over his American competitors, its draconian apartheid laws simultaneously stood in his way: Schrire would not give permission for Barnard to use a coloured donor – a step which would, he felt, cause the rest of the world to view their medical breakthrough as yet another reviled act of apartheid.

24 November 1967:
Kantrowitz is given another chance to win the race with another baby, 6 day-old Jamie Scudero, who is suffering from congestive heart failure. Kantrowitz waits again for an anencephalic donor.

The win

24 November 1967:
Kantrowitz is given another chance to win the race with another baby, 6 day-old Jamie Scudero, who is suffering from congestive heart failure. Kantrowitz waits again for an anencephalic donor.

2 December 1967:
25 year-old Denise Darvall is admitted to Groote Schuur Hospital and declared brain dead. Her blood type is compatible with Washkansky’s and her father gives his permission for the doctors to take her heart. Barnard has is donor.

3 December 1967:
In a four and a half hour operation, Barnard and his team successfully perform the world’s first heart transplant. The boy from Beaufort West had run, and this time won, the most important race of his life. The runners up

6 December 1967:
Kantrowitz overcomes his disappointment and performs his, and America’s, first human heart transplant on little Jamie Scudero. The infant dies after 7 hours. Kantrowitz tells the media: “I think it should be clear to you… that we here consider that this procedure was an unequivocal failure.” 6 January 1968: Shumway, who had borne Barnard’s victory in grim silence, transplants 43 year-old Virginia-Mae White’s heart into 54 year-old Mike Kasperak who also suffered from kidney, gall bladder and lung failure. The patient died 15 days later from a massive stomach haemorrhage. His new heart, however, had pumped strongly.

9 January 1968:
Kantrowitz makes his third unsuccessful attempt by transplanting 29 year-old Helen Krouch’s heart into 58 year-old Louis Block. Kantrowitz, drained and devastated, never again attempted a heart transplant.

25 May 1968:
Lower performs his fateful first heart transplant on Joseph Kleet (who dies a week later) which results, four years later, in a murder charge.