To the 199th anniversary of a great person, an honoured doctor of ONMedU Christian Barnard

Christian Neethling Barnard was born on November 8, 1922 in a small town in South Africa, the fourth son in the family of a priest of Danish origin. In 1946, he obtained the doctor of medicine degree at the medical school at the University of Cape Town.

After the young specialist worked for some time as a primary care doctor, he managed to complete his first scientific dissertation on the treatment of tuberculous meningitis. However, his true vocation became cardiac surgery, which he began to study in residency at the Groot Shur hospital, a clinical base of the University of Cape Town.

A few years before his prime time, Barnard was already a well-known specialist in the world, and leading heart surgeons counted on his opinion. He earned this respect thanks to his achievements in the field of correction of congenital heart defects. He operated at the Red Cross Children’s Hospital, was engaged in the development of artificial heart valves.

After 10 years of open-heart surgery, Barnard felt ready to take on the ultimate challenge. Against the background of successful experiments, it no longer seemed like a fantasy. The successfully tested artificial hypothermia of the body and an effective heart-lung machine opened up a technical possibility. In preparation for the operation, Christian and his brother Marius, who was also a heart surgeon and “right hand” in all endeavors, practiced orthotopic transplantation on dogs for a long time using the bitrial technique developed at Stanford University by the pioneers of American transplantology, Richard Lower and Norman Shumway. In addition, Barnard spent three months at the Medical College of Virginia, gaining experience in the use of immunosuppressive therapy in kidney transplant patients.

Finally, on December 3, 1967, Barnard led a team of cardiac surgeons who performed the first orthotopic heart transplant at the Groot Schuur Hospital. The hopelessly ill 54-year-old merchant Luisa Vashkanski was transplanted with the organ of a young woman who suffered life-threatening injuries in a car accident. Until now, no achievement in medicine has caused such a public outcry. With the first beats of the transplanted heart, loud fame entered the life of Christian Barnard.

Although the first patient lived with a transplanted heart for only 18 days, it was a success. The cause of death was not related to organ failure or early rejection: Vashkanski died of bilateral pneumonia, which developed as a result of the use of high doses of immunosuppressants. The first experience revealed a lot of “white spots”, gave rise to important professional and public discussions on issues of legal support, ethics, selection of recipients, donors, criteria of brain death. The world community was faced with the question: should there be heart transplantation as a field of surgery, or will it remain a whimsical experiment?

Less than two months after the first attempt, Barnard performs the second heart transplantion using a slightly modified surgical technique. The incision of the right atrium of the donor heart now did not affect the sinus node, which is located near the root of the superior vena cava. Subsequently, this technique was inherited by almost all cardiac surgeons who wanted to perform transplantation.

In January 1968, Barnard successfully replaced the diseased heart of 58-year-old dentist Philip Bleiberg. The doses of immunosuppressive therapy this time were not so high, the patient lived with the donor heart for 20 months. Autopsy revealed severe and widespread coronary artery disease—the first example of graft atherosclerosis, which remains the leading cause of late heart failure in the transplanted heart.

However, the second patient managed to complete his mission. After being discharged from the hospital, he became a living testimony of the dawn of a new era, forcing skeptics to believe in the result of a grandiose experiment.

Between 1967 and 1973, Barnard’s team performed 10 orthotopic heart transplants. The results, which seem modest by today’s standards, were exceptionally successful for that time, if we take into account the primitive immunosuppressive therapy and the pioneers’ lack of experience in the diagnosis and treatment of rejection syndrome. The first four patients lived an average of 300 days, but the next two for already 13 and 23 years.

In 1974, Barnard and his young colleague Lozman developed the technique of heterotopic heart transplantation, according to which the donor organ does not replace its own heart, but joins the blood circulation next to it, playing the role of an auxiliary pump.

Between 1974 and 1983, the team performed 49 heterotopic transplants, achieving good clinical results. The advantage of this transplant option in the days of imperfect immunosuppressive therapy was that acute rejection of the transplant would not be fatal for the patient, because his own heart would be able to perform its function for some time. Advances in the development of new immunosuppressants in the early 1980s put an end to the heterotopic transplant program.

Unfortunately, rheumatoid arthritis with severe damage to the hands forced Barnard to stop operating early. Another role of this unique personality was the activity of a writer and public figure. As a public world celebrity, he speaks before audiences of professionals and citizens of different countries. He also lectured many times at Odessa National Medical University.

His books are published, devoted to transplantology, medicine, and the difficult social and political situation in his native South Africa. Funds from the sale of books Barnard directs to the foundation he founded in Cape Town to promote research in the field of cardiovascular surgery and transplantology.

Until the end of his life, Barnard consulted other heart surgeons who continued his life’s work, participated in the organization of the Oklahoma Institute of Transplantology in the USA. In the hearts of millions, he remained a leader of progressive ideas, humanism and wisdom in medical practice, an example of an active life position. “I was never attracted to the role of an observer. Either I’m in the game or I’m not interested,” Barnard said about himself.

Christian Barnard died on September 2, 2001 of a heart attack while on vacation in Cyprus. Shortly before his death, in an interview to the “Times” magazine, he left these inspiring words to the world: “A heart transplant was not such a big surgical task. The main thing was to prepare yourself for the risk. My philosophy is that the biggest risk in life is not taking a risk.”