Baylor University Medical Center Proceedings October 2017 - 475

Fiftieth anniversary of the first heart transplant:
The progress of American medical research, the ethical
dilemmas, and Christiaan Barnard
Peter A. Alivizatos, MD

his year marks the 50th annia
b
versary of the ﬁrst heart transplant by South African heart
surgeon Christiaan Barnard
in Cape Town that caught the world
completely unawares. Surprise was
succeeded by admiration and idolworshipping of the protagonist,
who became famous overnight.
Newspapers and television channels
competed to interview him and reputable scientiﬁc associations to recruit
him as the principal speaker at their
conferences. The jet-set of the time
embraced him and famous movie
stars adored him. But was Barnard
the one who was expected to do it,
the "chosen" for this procedure?
Transplanting a heart had been
the dream of surgeons from the beginning of the 20th century. In spite Figure 1. Two pioneers in heart transplantation: (a) Norman E. Shumway from Stanford University and (b) Richard
of Russian Vladimir Demikhov's R. Lower from Medical College of Virginia.
brilliant techniques in the experimental laboratory in the 1950s,
laboratory. Genius, however, does not require luxury; on the
the problem remained unsolved: the invention of a simple yet
contrary, it performs its miracles with want and deprivation.
reliable and reproducible method of implantation so the heart
So in 1958 Lower was taken on as Shumway's ﬁrst trainee
would immediately take over the circulation. All this concerned and together they began to experiment on dogs, looking for a
the technical part, since the problem of rejecting the "foreign"
way to operate with the heart stopped and dry, but also withorgan still had to be addressed (1).
out compromising myocardial function, which would afterThe ﬁrst hurdle was cleared in the late 1950s at Stanford
wards take over the circulation. Shumway created a bath in
University by Professor Norman Shumway and his close associate the pericardium in which a cold saline infusion continuously
Richard Lower (Figure 1), when they achieved the survival of
circulated as a preservative. They stopped the heart, therefore,
dogs by combining an ingeniously simple surgical technique with
clamping the aorta, and, after waiting an hour, released it to let
local cooling to protect the transplanted heart. Lower came from
the blood again circulate in the myocardium. While waiting,
Michigan; as a Midwesterner, he was a man of few words, with a
they would sit idly around the table until Shumway had the idea
strong accent and simple manners. After a brief period at Cornell
that perhaps they could cut into the heart at about the level of
University in New York, Dick, as he was known to his friends,
the ventricles and suture it together again before opening the
moved to California and Stanford, where cardiac surgery under
Norman Shumway was still in its infancy. Shumway came from
From Baylor University Medical Center at Dallas, Dallas, Texas, and the Onassis
the famous Minnesota School, which under Owen Wangensteen
Cardiac Surgery Center, Athens, Greece. Dr. Alivizatos was founder of cardiothohad made a name for pioneers in heart surgery, like John Lewis
racic transplantation at Baylor University Medical Center.
and C. W. Lillehei (2). Shumway, another Midwesterner, diCorresponding author: Peter A. Alivizatos, MD, FACS, FACC, 3600 Gaston
vided his time between surgery and a primitive experimental
Avenue, Suite 404, Dallas, TX 75246 (e-mail: paliviz2013@gmail.com).
Proc (Bayl Univ Med Cent) 2017;30(4):475-477

475

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings October 2017