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50 Years Ago This Week: Inside the First Heart Transplant

7 minute read

Milestone moments do not a year make. Often, it’s the smaller news stories that add up, gradually, to big history. With that in mind, in 2017 TIME History will revisit the entire year of 1967, week by week, as it was reported in the pages of TIME. Catch up on last week’s installment here.

Week 50: Dec. 15, 1967

It was a medical breakthrough generations in the making. For as long as doctors had understood the crucial role of the heart, they had dreamed of using transplants to save people whose heart problems would otherwise doom them to death. Earlier attempts, especially before the discovery of blood types, had failed. Now, in late 1967, there were suddenly not one but two real-life examples to point to.

Though one of the operations (a transplant between babies, in Brooklyn) failed, the other — performed in South Africa by Dr. Christiaan Barnard on Dec. 3, 1967 — actually worked. They were able to successfully transplant a heart donated by the family of Denise Ann Darvall, a young woman killed by a speeding car, to a man named Louis Washkansky, a grocer with progressive heart failure who had been given weeks to live. Barnard and his team had, as TIME put it, “reached the surgical equivalent of Mount Everest, followed automatically by the medical equivalent of the problem of how to get down — in other words, how to keep the patient and transplant alive.”

Here’s how TIME described the surgery itself:

Though Denise Darvall’s heart had stopped beating and she was dead, her heart could not be allowed to degenerate. Irreparable cell damage begins at the temperature of a naturally cooling cadaver in 30 minutes. It can be postponed for two to three hours by cooling. The Barnard team took no chances. By this time, Denise’s body was in an operating room a few feet from the operating room in which Washkansky lay. A surgeon opened her chest by a midline incision, snipped some ribs and exposed the heart with its attached blood vessels.

Near the arch of the aorta (see diagram) he inserted a plastic catheter tube, which was connected to a heart-lung machine. Another catheter, similarly connected, went into the right auricle. At this point, the whole body was perfused with oxygenated blood. The surgeons then clamped the aorta beyond the catheter and clamped the pulmonary artery and venae cavae, thus isolating the heart from the rest of the body, which thereafter received no circulation.

With the heart-lung machine set at a low flow rate, the heart continued to have oxygenated blood pumped through it. And it was cooled to 73° F.

Meanwhile, Pathologist M. C. Botha was working in his laboratory with a sample of Denise’s blood. Washkansky’s type was A-positive; Denise’s was O-negative. She was the ideal “universal donor.” There was no time for Dr. Botha to try matching their white blood cells so that the surgeons could estimate how strong a rejection reaction Washkansky’s system would mount against the foreign protein of Denise’s heart.

Simultaneously, Washkansky was anesthetized, and at 2:15 a.m. Sunday one of the surgeons opened his chest. Assisting Christiaan Barnard, in addition to his brother Marius, were Drs. Rodney Hewitson and Terry O’Donovan. The main blood vessels were clamped in much the same way as Denise’s had been, but in this case the heart-lung machine was to serve a directly opposite purpose: to circulate oxygenated blood through all of Washkansky’s body except his about-to-be-discarded heart.

Exercising the captain’s prerogative, Dr. Christiaan Barnard moved into the first operating room and cut eight blood vessels to free Denise Darvall’s heart; then he severed it from its ligament moorings. It was disconnected from the pump, and was carried to Washkansky’s room, where it was connected to a small-capacity heart-lung machine. There it lay, chilled and perfused with oxygenated blood, while Surgeon Barnard removed most—but not quite all —of Washkansky’s heart. He left in place part of the outer walls of both the auricles, the right carrying the two entrance holes of the venae cavae, the left carrying the four entrance holes of the pulmonary veins. The rest of the heart, flabby and scarred, he set aside.

In painstaking sequence, Dr. Barnard stitched the donor heart in place. First the left-auricle, then the right. He joined the stub of Denise’s aorta to Washkansky’s, her pulmonary artery to his. Finally, the veins. Assistant surgeons removed the catheters from the implant as Barnard worked.

Now, almost four hours after the first incision, history’s first transplanted human heart was in place. But it had not been beating since Denise died. Would it work? Barnard stepped back and ordered electrodes placed on each side of the heart and the current (25 watt-seconds) applied. The heart leaped at the shock and began a swift beat. Dr. Barnard’s heart leaped too. Through his mask, he exclaimed unprofessionally but pardonably, “Christ, it’s going to work!” Work it did.

This amazing medical advance raised a new kind of moral and ethical problem. The need to keep the donor heart healthy enough might require keeping it beating after the donor’s brain and other bodily functions ceased, which would mean that the surgeons were in one sense killing the donor. Still, the life-saving potential of the operation, and the goal of eventually achieving success with an artificial heart, made the news something to celebrate. The patient, Washkansky, died a few weeks later — from illness compounded by the immune-suppression drugs he was on to avoid rejecting the new heart — but the transplant itself is still considered a success.

White House wedding: As first daughter Lynda Bird Johnson wed Marine Captain Charles Spittal Robb at the White House, TIME noted that the gifts they received included “a $6,770 silver tea and coffee service from the Washington diplomatic corps, a nest of teak tables from Chiang Kaishek, a color sketch of Eeyore by Winnie-the-Pooh Illustrator Ernest Shepard (Lynda is a Pooh buff), and—from Republican Senate Minority Leader Everett McKinley Dirksen, of course—a small silver elephant.”

Generation gap: This week’s TIME Essay looks at the state of the American parent at a paradoxical moment in history: young people appeared to be breaking away from their homes and parents, becoming a generation of the disillusioned, and yet by many objective measures young Americans “work harder, think deeper, love more and even look better than any previous generation.” Though the story certainly indulges in ideas about families that are now out of date (for example, tsk-tsking at mothers who are “preoccupied” with their the parts of their lives that weren’t about the children), it also takes a rather modern approach to finding solutions, encouraging communication between parents and children as the most important element in a healthy family.

Criminal justice concerns: A grand-jury investigation of conditions in Chicago’s Cook County Jail resulted in an unusual level of exposure for the terrible “catalogue of depravity” faced by those who were held even for relatively minor and nonviolent crimes. This year, ProPublica Illinois launched an investigation into the very same jail, which remains notorious.

Guess Who: TIME’s movie critic took on Guess Who’s Coming to Dinner this week, a timely story in the year when the Supreme Court legalized interracial marriage. Though the movie would win two Oscars (and be nominated for several more, including Best Picture), the review was middling, calling it one of producer Stanley Kramer’s “cinematic bouquets of platitudes about important-sounding social issues” and focusing on its standing as Spencer Tracy’s final film — he died a few weeks after filming wrapped — rather than what it said about society.

Great vintage ad: A reminder from the post office that readers in 1967 still had to be told how to find out their own zip codes.

Coming up next week: Bob Hope

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Write to Lily Rothman at lily.rothman@time.com