Pioneer Heart Surgeon Christiaan Barnard Dies

TIMES MEDICAL WRITER

Dr. Christiaan Barnard, the South African cardiologist who performed the world's first heart transplant but whose surgical successes were ultimately overshadowed by his playboy celebrity, died Sunday at age 78.

Barnard suffered a fatal asthma attack after a morning swim at a resort in the coastal town of Paphos, Cyprus, where he often vacationed. Physicians at the resort tried to revive him, but he was pronounced dead on arrival at Paphos General Hospital.

Barnard stunned the world on Dec. 3, 1967, when he transplanted the heart of a young woman who had died in an auto accident into the chest of Louis Washkansky, a 55-year-old businessman whose heart was failing rapidly. The operation took place at Groote Schuur Hospital in Cape Town.

Washkansky lived only 18 days before his body rejected the donor heart. But the fact that he stayed alive at all made Barnard an international star and led to transplants throughout the world.

Barnard's second patient, who received a transplant four weeks after Washkansky, survived for 18 months. His longest-lived patient, Dirk van Zyl, survived for 23 years before dying of diabetes in 1996.

Today, an estimated 2,400 patients undergo heart transplants every year in the United States alone--a number limited only by a lack of donors. About 87% of them survive for at least a year after the surgery and 75% for at least five years.

Barnard did not introduce any new surgical techniques in his procedure, nor did he identify any new drugs to block rejection of the donor heart.

His special contribution, according to Dr. Hillel Laks of the UCLA Medical Center, was having the courage to perform the procedure in the face of stiff questioning by some researchers.

"He reasoned that if people were clearly going to die, you were justified in starting a [transplant] trial even when you don't have all the answers," Laks said. "Because he started, other investigators were spurred to work to find answers to the problems. The speed of progress would have been far slower if not for the clinical trials begun by Chris Barnard."

In addition to his transplant work, Barnard developed a new mitral valve for use in heart surgery and was the first to explain how congenital intestinal atresia--lack of development of the bowels--occurs in newborns.

Tributes began to pour in Sunday afternoon.

Former South African President Nelson Mandela praised him as "one of our main achievers." Current President Thabo Mbeki cited Barnard's "scientific excellence and humanism. . . . I think really he ought to serve as an inspiration to our people, to the youth generally, to strive for that discovery, that excellence."

Barnard's life was transformed by celebrity. Immediately after Washkansky's transplant, the surgeon's face was on the cover of newsmagazines around the world. He flew first class to the U.S. to appear on all the major television news shows.

Tall and handsome, the Afrikaner surgeon, son of a humble church pastor from a backwater town, hobnobbed with popes, presidents, movie stars and other celebrities. He had notorious trysts with Sophia Loren, Gina Lollobrigida, an unidentified Miss South Africa and countless others. He was "consumed and intoxicated" by fame, he wrote in his autobiography.

The Guinness Book of World Records estimated that Barnard received more fan mail than anyone on Earth. If he had been short, fat and bald, he always said, transplantation wouldn't have created such a sensation.

But the celebrity took its toll. His first wife, Aletta, who had worked as a nurse to support him in his early years, divorced him after discovering a love letter from Lollobrigida. He married twice more, once to a woman young enough to be his granddaughter.

But those marriages also failed, and he was single at his death. He had five children. His eldest son, Andre, died--purportedly from a drug overdose--in 1984 at age 31. "It was probably because of lack of support from me," Barnard wrote in his autobiography.

Barnard further damaged his reputation in 1986 when, for a great deal of money, he endorsed an alleged anti-aging cream called Glycel, manufactured in Switzerland. Glycel was never found to be effective and was forced off the U.S. market. Barnard later said he had been taken advantage of by unscrupulous businessmen and denied endorsing it.

He had better luck as a writer. After crippling arthritis forced him to retire from surgery in 1983, he wrote a distinguished cardiology text, several lesser nonfiction books about cardiology, a scandalous autobiography and four novels that received a lukewarm reception. His last novel, "The Donor," deals with the transplant of a pig's heart into a human.

Christiaan Neethling Barnard was born in the dusty town of Beaufort West on Nov. 8, 1922, son of the church pastor and the church organist. The family was poor and often subsisted on a diet of home-baked bread and lard from fried sheep's tails.

Young Chris often had to carry wood for the family's stove and perform a variety of other chores. "That part of my life influenced me tremendously," he later said. "It taught me to persevere, to have a goal and reach it."

Barnard had to walk the five miles to the University of Cape Town each day until he received his bachelor of surgery and bachelor of medicine degrees in 1946. Friends and teachers said he was not an outstanding student but that he worked very hard.

He interned at Groote Schuur Hospital in Cape Town, spent three years as a family physician, then returned and earned his full medical degree.

In 1956, he received a fellowship to travel to the University of Minnesota, where he studied cardiothoracic surgery. He called the two years he spent in the U.S. away from his family in South Africa the most fascinating time in his life.

His teachers were Dr. Norman Shumway and Dr. Richard R. Lower, who had been performing heart transplants in dogs. The Americans were reluctant to proceed into human trials, however, for two primary reasons. One was that they didn't think the immunosuppressive drugs then available were adequate for the job.

The second involved the legal and philosophical definition of death. At the time, the concept of brain death was not widely accepted. Death was generally assumed to occur when the heart stopped beating--at which point the organ was not much good for a transplant. U.S. physicians were reluctant to unplug life support from a potential heart donor. In fact, Shumway and Lower were later tried for murder--and acquitted--for doing just that.

But Barnard plunged ahead without legal repercussions. After his initial--albeit brief--success, surgeons around the world took up their scalpels. Shumway performed the first successful American heart transplant in 1968.

More than 170 transplants were attempted over the next couple of years. But Shumway and Lower had been right in their reservations about the immunosuppressive drugs: Most of the patients died within a few days or weeks. All of the heart transplant surgeons around the world stopped performing the procedure, with the exception of Shumway, who was then at Stanford, and Barnard.

By 1973, Barnard's team had performed 10 heart transplants, but he was discouraged by the high failure rate. He began thinking along different lines when the son of a patient whose donor heart failed to start asked why the man's original heart could not be reimplanted, even though it was weak.

Intrigued, Barnard began implanting the donor heart without removing the original, leaving the patient with two functioning hearts. He performed 49 such transplants, with a 50% one-year survival rate and 20% five-year survival. Several of these patients lived for more than 10 years.

But immunosuppression techniques improved, particularly with the introduction of cyclosporine in 1982. Barnard reverted to his original transplant procedure, and the field began to flourish once more.

Barnard personally performed 75 heart transplants and his team did more than 150 before he retired in 1983, no longer able to hold a scalpel. In addition to writing books, he spent his last years consulting, giving lectures and operating his South African farm.

Although Barnard had fought with hospital administrators who wanted him to keep his patients in racially separate wards, he was sometimes ostracized abroad because he was South African.

He was careful to use the heart of a white donor in his first transplant so as not to be accused of experimenting on blacks, but eventually he used whatever donor tissue became available. In his second transplant, he used the heart of a mixed-race stroke victim to extend the life of a white retired dentist. In his third operation, he stitched the heart of a pregnant black woman into the chest of a white former policeman.

His greatest regret, he sometimes said, was that he did not fight harder against his country's policy of apartheid. "I opposed it whenever I could," he said, "but I didn't stick my neck out."

A few years ago, Barnard told an interviewer that he had no regrets about the roller coaster turns his life had taken. "When I die," he said, "I can say, 'Thank you, God, I have had a great opportunity in life.' "

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