On This Day: First human-to-human heart transplant performed - Dec. 3, 1967
(edited from Wikipedia)
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Louis Washkansky
Louis Washkansky (1912-1967) was a South African man who was the recipient of the world's first human-to-human heart transplant, and the first patient to regain consciousness following the operation. Washkansky lived for 18 days and was able to speak with his wife and reporters.
Medical background
Washkansky's health [had] declined substantially: he was diabetic, and had an incurable heart disease, causing him to suffer three heart attacks. The last of these heart attacks led to congestive heart failure.
In April 1966, Washkansky visited Groote Schuur Hospital due to his pre-existing illness. He was first seen by Barry Kaplan, who in July 1966 had asked if Christiaan Barnard would be willing to treat Washkansky. Barnard had performed a number of laboratory tests and an in-depth examination on Washkansky and came to the conclusion that nothing could be done to help him. In January 1967, Washkansky underwent cardiac catheterisation confirming severe heart failure, and was subsequently referred [back] to Barnard for possible surgery.
On 10 November, Washkansky [was put forward] as a possible heart transplant candidate. When Barnard met with Washkansky, Barnard explained the possibility of a transplant and Washkansky was agreeable to the possibility. Afterwards, Ann found her husband Louis to be "oddly buoyant." When Barnard later explained the possibility of a transplant to both of them, the idea was so new that Ann initially worried her husband might absorb some of the personality of the donor heart.
Barnard stated to Ann and Louis Washkansky that the proposed transplant had an 80% chance of success, which has been criticised as "misleading". Part of the pre-op procedure was to take swabs from Washkansky's skin, nose, mouth, throat, and rectum to find out what bacteria lived on and in his body, so that the most effective antibiotics could be given after the transplant. He was also frequently washed down with Phisohex.
Operation
Washkansky received his heart transplant on 3 December 1967, at the Groote Schuur Hospital in Cape Town, South Africa. The operation lasted approximately six hours, with Christiaan Barnard leading a team of thirty surgeons, anaesthetists, nurses and technicians. His brother Marius Barnard assisted with the surgery.
[Denise Darvall]
25-year-old Denise Darvall and her mother had been struck by a drunk driver while crossing a busy street on a Saturday afternoon. Her mother died at the scene. Denise was taken to Groote Schuur. Her brain had no sign of electrical activity. A blood transfusion and respirator maintained the beat of her heart.
Coert Venter and Bertie Bosman were the doctors who approached Denise's father Edward Darvall and asked for permission to use her heart for a possible transplant. He had been at the scene of the original accident and had been sedated after being brought to the hospital. As he waited, he thought they were still trying to save his daughter's life. Bosman told him there was a man in the hospital who was desperately ill and in need of a heart transplant, and perhaps Edward could do him a great kindness if they would allow them to transplant his Denise's heart. Bosman and Venter withdrew from the room, saying that he should take as long as needed to consider their request and that they would understand if he declined to give his consent.
In the four minutes Edward Darvall took to reach his decision he thought of his daughter, a birthday, and a gift she had given to him from a first salary. He began to cry and decided what needed to be done. He composed himself and summoned the doctors back to the small room. He told them that if they could not save his daughter, they must try to save this man.
Outcome
Although Washkansky died of pneumonia eighteen days after the transplant because of a weakened immune system, Barnard regarded the surgery as a success because the heart was "not being stimulated by an electrical machine". As Barnard related in his book, One Life, a decision was made on the fifth postoperative day to bombard Washkansky's system with immunosuppressants to guard against a potential rejection of the new heart. As later heart transplants would reveal, the signs noted at that time were part of a resettling program for the new heart and not necessarily an indication of rejection.
[Heart transplantation]
A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. As of 2018, the most common procedure is to take a functioning heart, with or without both lungs, from a recently deceased organ donor (brain death is the standard) and implant it into the patient. The patient's own heart is either removed and replaced with the donor heart (orthotopic procedure) or, much less commonly, the recipient's diseased heart is left in place to support the donor heart (heterotopic, or "piggyback", transplant procedure).
Approximately 3,500 heart transplants are performed each year worldwide, more than half of which are in the US. Post-operative survival periods average 15 years. Heart transplantation is not considered to be a cure for heart disease; rather it is a life-saving treatment intended to improve the quality and duration of life for a recipient.
History
Worldwide, more than 100 transplants were performed by various doctors during 1968. Only a third of these patients lived longer than three months.
The next big breakthrough came in 1983 when cyclosporine entered widespread usage. This drug enabled much smaller amounts of corticosteroids to be used to prevent many cases of rejection (the "corticosteroid-sparing" effect of cyclosporine).
Cedars-Sinai Medical Center in Los Angeles, California, currently is the largest heart transplant center in the world, having performed 132 adult transplants in 2015 alone. About 800,000 people have NYHA Class IV heart failure symptoms indicating advanced heart failure. The great disparity between the number of patients needing transplants and the number of procedures being performed spurred research into the transplantation of non-human hearts into humans after 1993. Xenografts from other species and artificial hearts are two less successful alternatives to allografts.
The ability of medical teams to perform transplants continues to expand. In recent years, donor heart preservation has improved and Organ Care System is being used in some centers in order to reduce the harmful effect of cold storage.
Recently, Australian researchers found a way to give more time for a heart to survive prior to the transplant, almost double the time. Heart transplantation using donation after circulatory death (DCD) was recently adopted and can help in reducing waitlist time while increasing transplant rate. Critically ill patients that are unsuitable for heart transplantation can be rescued and optimized with mechanical circulatory support, and bridged successfully to heart transplantation afterwards with good outcomes.
On January 7, 2022, David Bennett, aged 57, of Maryland became the first person to receive a gene-edited pig heart in a transplant at the University of Maryland Medical Center. Before the transplant, David was unable to receive a human heart due to the patient's past conditions with heart failure and an irregular heartbeat, causing surgeons to use the pig heart that was genetically modified. Bennett died two months later at University of Maryland Medical Center.
Contraindications
Patients who are in need of a heart transplant but do not qualify may be candidates for an artificial heart or a left ventricular assist device (LVAD).
Rejection
Since the transplanted heart originates from another organism, the recipient's immune system typically attempts to reject it. The risk of rejection never fully goes away, and the patient will be on immunosuppressive drugs for the rest of their life. These drugs may cause unwanted side effects, such as an increased likelihood of infections or the development of certain cancers. Recipients can acquire kidney disease from a heart transplant due to the side effects of immunosuppressant medications. Many recent advances in reducing complications due to tissue rejection stem from mouse heart transplant procedures.
People who have had heart transplants are monitored in various ways to test for the development of rejection.
A 2022 pilot study examining the acceptability and feasibility of using video directly observed therapy to increase medication adherence in adolescent heart transplant patients showed promising results of 90.1% medication adherence compared to 40-60% typically. Higher medication variability levels can lead to fewer organ rejections and other poor outcomes.
Prognosis
The prognosis for heart transplant patients following the orthotopic procedure has improved over the past 20 years, and as of June 5, 2009 the survival rates were:
1 year: 88.0% (males), 86.2% (females)
3 years: 79.3% (males), 77.2% (females)
5 years: 73.2% (males), 69.0% (females)
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https://en.wikipedia.org/wiki/Louis_Washkansky
https://en.wikipedia.org/wiki/Heart_transplantation
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