Fifty years after the first heart transplant, the operation remains very expensive with mixed outcomes. A new approach focuses on repair instead of replace

In the early hours of 3 December 1967, Prof Christiaan Barnard gazed down into the void and felt a chill ripple through his veins as he considered the historic nature of what he was about to attempt. The gaping chasm lying before him was the empty chest cavity of a 54-year-old former boxer called Louis Washkansky. Barnard had just removed Washkansky’s heart, a bloated organ left ravaged and scarred by repeated coronary attacks, and now he had just minutes to try to save his life by inserting a heart taken from Denise Darvall, a 25-year-old woman left brain dead after being struck by a car that day.

At the time, cardiac transplant surgery was barely a decade old, pioneered by a handful of individuals who had developed a radical method of switching a heart from one body to another – but all previous transplants had been done in dogs. As they worked to stitch the new organ into Washkansky’s body and then shock it into life, Barnard and his team were improvising, guided only by a few dozen animal studies, the suggestions of scientific papers and their own instinct. But at 6.13am, after almost four hours of surgery, Washkansky’s transplanted heart started to stir. As Barnard would write: “Little by little it began to roll with the lovely rhythm of life.”

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