

The Heart Beats On: The Unlikely Story Behind the World's First Heart Transplant

Fifty years ago, an ambitious South African doctor performed the world’s first open-heart transplant, a procedure that has since saved thousands of lives.

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At about 10 p.m. on Saturday, December 2nd, 1967, Dene Friedmann’s phone rang. The young student perfusionist—someone who operates a heart-lung machine—had been expecting this call for weeks and didn’t need to pick it up to know who it was. Friedmann quickly made her way to Groote Schuur Hospital on the east side of Cape Town, South Africa.

In a few hours, she would assist Christiaan Barnard in performing the first human heart transplant in history. “There were many surgeons who could have done the first heart transplant,” Friedmann told Popular Mechanics, “but he was the one who had the courage to take the opportunity and do it.”

December 3, 2017, marks the 50th anniversary of that South African summer day when cardiac surgeon Christiaan Barnard took the risk that no one had yet dared. “He had a brilliance about him,” says Donald McRae, author of the book Every Second Counts: The Race to Transplant the First Human Heart. “It takes a bold and audacious person to leap into the dark.”

Building a Machine Heart

A heart-lung machine is prepped at the University of Minnesota hospital, 1957.
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In 2017, more than 3,000 heart transplants will be successfully completed across the globe. Although still a risky procedure, it’s been performed nearly 70,000 times over the last 50 years by hundreds of doctors around the world—but this wasn’t always the case.

In the 1930s, operating on delicate and small heart vessels was hard enough for even the most nimble of surgeons, but it was even tougher with the heart's steady beating. And the risks were high—any lack of blood flow for a prolonged period of time leads to brain damage and death.

Patent for the Extracorporeal Circulation Device.
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Some 30 years before Barnard’s historic operation, the Philadelphia surgeon John Heysham Gibbon built the first prototype machine that would revolutionize heart surgery. The Extracorporeal Circulation Device, or more simply the “heart-lung machine,” solved tricky heart procedures by simulating the function of the heart and lungs. Looking like a stainless steel bar cart, it essentially pulled blood away from the heart, circulated it into the machine, added oxygen, and then pumped it back through the body.

Originally tested on cats, he enlisted the help of Thomas Watson, engineer and chairman of International Business Machines, also known as IBM. After two decades of tinkering and perfecting, Gibbons used it for the first time during an operation in 1953 to repair a teenage girl’s heart defect. For 45 minutes, the machine acted as her heart and lungs. The operation was a success and the girl would go on to outlive Gibbon himself.

By the late 1950s, with the heart-lung machine as an industry standard, heart transplants were no longer an impossible fantasy. While the problem of how to keep a patient alive during heart surgery was solved, keeping the heart alive when it was outside of the body was a completely different question.

Norman Shumway, 1967.
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But two surgeons at Stanford University—Norman Shumway and Richard Lower—were already trying to tackle the problem. After experimenting with dogs, they created a method called “topical (or selective) hypothermia,” which lowers the body temperature to 32 degrees centigrade (89.6 Fahrenheit), then circulating an ice cold isotonic saline solution through the heart to cool it to near freezing levels. This causes the heart’s pumping to slow, but not stop. After initial tests, the doctors discovered that they could keep the heart in this state for up to an hour without damage.

As the two Stanford doctors continued to perfect selective hypothermia on dog hearts in Northern California, surgeons around the world knew fame would grace the first person to perform a human heart transplant.

“The heart was considered a mystical organ,” says McRae. “It holds this mythology.”

One of those was South African doctor Christiaan Barnard.

The Underdog Doctor

Christiaan Barnard
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Growing up impoverished in rural Cape Province, he was the son of a missionary who catered to a racially diverse population. As a result, the family was often shunned by the area’s white population. But Barnard and his brothers prospered with family legends claiming that Christiaan once ran a record mile in his bare feet and won a school tennis championship with a borrowed racquet and shoes made of cardboard.

Dreaming of becoming a doctor, he studied for his exams by firelight, and despite the challenges, graduated from the University of Cape Town. In 1955, he traveled abroad to the University of Minnesota to learn how to become a surgeon under Owen Wangensteen, and soon went into cardiac surgery and even observed Lower’s transplant experiments on dogs. Over the next decade, Bernard earned a reputation for being a talented and relentless surgeon but not in the same class as Lower, Shumway, or Adrian Kantrowitz, who would perform the first heart transplant in the U.S.

“He was an underdog,” says McRae, “Barnard was a genuine figure in world cardiac surgery, but not in transplantation. But, then he shocked them all.”

For much of 1966 and 1967, the world was anticipating that the first heart transplant could happen at any moment. In fact, several times Lower and Shumway were presented with opportunities, but fears about weak recipients or high-risk rejections delayed the procedures.

“He was an underdog...But, then he shocked them all."

There was also the matter of ethics because surgeons had to remove someone’s still-beating heart. The question of what was the definition of death was a fiercely debated topic in the medical community. In the U.S. it was illegal to take a beating heart from a body even if the person had been declared brain dead.

Meanwhile, in South Africa, Barnard didn’t face as many of these ethical barriers. He was confident that with the right drugs, the recipient’s body would accept the new heart. Also, according to McRae, the South African government’s adamant policy of apartheid led to little attention being paid to medical legislation in the country and a looser definition of death.

Barnard did have to deal with government-sanctioned racism and would later say he had a donor and recipient lined up earlier in the year, but the donor had been black and the Groote Schuur Hospital hospital did not allow it to proceed further.

In November 1967, Barnard and his team alerted their patient, Louis Washkansky, that he would be the first recipient of a heart transplant. A few tense weeks later, the call finally came: 25-year-old Denise Duval had been killed walking across the street and her blood type matched Washkansky’s. Her heart was now going to be his.


Christiaan Barnard examines Louis Washkansky’s chest X-Ray, 1967.
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Dene Friedmann remembers walking into the change room late that Saturday night and seeing some of the female nurses still in fancy cocktail dresses having come straight from a party. “There was quite a lot of excited chatter,” says Friedmann, “but as soon as we all got in our scrubs, the atmosphere became very serious and quiet.”

Then she saw Duval.

“She was a young girl, about my age, and it was very sad to see (her) laying on the operating table and knowing shortly we were going to take her heart.”

Louis Washkansky, on the cover of Life, awaking from surgery.

Despite it not being legally necessary, Barnard made the decision to wait for her heart to stop beating. It took 12 minutes until the EKG flatlined. Next, Washkansky was wheeled in and the team began the process of selective hypothermia. He was then connected to the heart-lung machine that Friedmann helped monitor, and for the next five hours, Barnard and his team moved swiftly and meticulously. Finally, with the young woman’s new heart sutured into place, Barnard instructed the team to start warming him back up.

“[The heart] started to show signs of life," Friedmann says. "It started to quiver. We all realized that this was going to work.”

The successful operation was featured on the cover of Life Magazine and made Barnard one of the most famous people in the world. Days after the surgery, Washkansky famously called Barnard “the man with the golden hands.” It became, and remains to this day, a source of immense pride for the southern African nation.

“It was kind of a mythical event for us South Africans,” says McRae, a South African who was a child when Barnard performed his historic surgery. But reflecting on that time, it’s clear that the government used this surgical feat as propaganda to promote apartheid, something that Barnard unfortunately did not discourage.


After initial optimism, Washkansky died 18 days after his surgery, not from rejection of the heart but from pneumonia. Three days later, Kantrowitz performed the second heart transplant in history at Maimonides Hospital in Brooklyn on a two-week-old baby. Shumway did one the following week and Lower early the next year.

In 1968, the year after Barnard’s surgery, 107 transplants were carried out by 64 different surgical teams in 24 countries. But the best a patient could expect was a two-year survival rate of only 10 percent. Two years later in 1970, the number of worldwide heart transplants dropped staggeringly from 107 to 16 due to the high mortality rates. There was even a call to ban heart transplants outright. It wasn’t until the early 1980s that immunosuppression research, studying how the body rejects transplant organs, would help substantially lift survival rates.

Today, the five-year survival rate is upwards of 78 percent.

Silicon mannequins, and some original equipment, stand in for the historic surgery performed 50 years ago at the Heart of Cape Town museum, 2017.
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Barnard’s operation remains the first human heart transplant ever performed, but the question remains if it should have been.

“The bold person can shatter the glass ceiling,” says McRae, “but ultimately it is was the more methodical, painstaking approach that made [heart transplants] a routine procedure.”

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