1967: Reflections on the first human heart transplant and its impact on medicine,media and society

The first heart transplant

The human heart transplant was a daring world-first in medicine, performed by a largely unknown surgeon in a hospital far away from leading medical centres around the world where other surgeons were working towards the same goal. The main contenders were Norman Shumway at Stanford, Richard Lower in Virginia and Adrian Kantrowitz in New York. Having done just a fraction of their research, Barnard was a late entrant and an unlikely contender (McRae, 2006). The fact that an outsider won this race added to the media appeal.

On 2 December 1967, the 25-year-old Denise Darvall and her mother Myrtle were crossing a street when both were hit by a speeding car. Myrtle died instantly and Denise was rushed to Groote Schuur Hospital with fatal brain injuries (McRae, 2006). In the same hospital, the 54-year old Louis Washkansky was in the final stages of heart failure. The Darvall family tragedy delivered what Washkansky needed and Barnard was waiting for – a dying patient with a healthy heart. The surgery was performed during the night, marking 3 December 1967 as the historic date (Barnard and Pepper, 1969).

No photos were taken during the surgery, but it is not clear whether Barnard simply did not think about it, did not have time to arrange for a photographer or whether he did not want the surgery to be documented, thereby allowing him more freedom to reconstruct the event afterwards. However, he clearly realised that the surgery was highly significant and historic, since he called the hospital superintendent immediately afterwards to inform him. Within an hour, the South African Prime Minister was informed and the political media machinery of the country kicked in to spread the news (Logan, 2003).

The politicians saw the historic surgery as a godsend that they could use to improve the image of South Africa at a time when the country was politically isolated and vilified for its apartheid politics (Brink and Hassoulas, 2009). Instead of stories about oppression and violence, here was a story about a remarkable achievement that offered hope and made South Africans collectively proud. So, the politicians argued, ‘things couldn’t be too bad in a country that produced such an outstanding first in medicine’ (Hoffenberg, 2001: 1479). At the time, few people knew that the historic surgery could have taken place weeks earlier when a suitable black donor was found, but the medical team refused in order to avoid the expected criticism ¹ of experimenting on black people (Barnard, 1993; McRae, 2006).

The media response

For the first photo shoot after the surgery, Barnard posed with his team. The photo was published on the front page of the Cape Times on 4 December 1967 and syndicated globally. After that, there was no stopping the media interest. Foreign correspondents, local journalists and photographers descended on Groote Schuur Hospital and offered significant sums of money for visuals relevant to the heart transplant (Digby and Phillips, 2008). Every post-operative photo or news morsel about Washkansky instantly became front-page news. Sterilised wires, microphones and telephones were installed in his hospital room to allow brief radio interviews. On 15 December 1967, Barnard featured on the cover of Time magazine, the first of numerous prominent cover stories featuring him in the weeks, months and years to come.

Having lived just 18 days with his new heart, Washkansky succumbed to pneumonia on 21 December 1967. Despite this, the media continued to frame the story as a ‘triumph’ (Nathoo, 2009: 69) and Barnard remained defiant about the future of heart transplants (Logan, 2003). Well aware of the power of the media to advance his own agenda and reputation, Barnard took off on a whirlwind US media tour that included an appearance on the CBS television show ‘Face the Nation’ on 24 December 1967 and an audience with President Lyndon B. Johnson (Barnard, 1993).

Just one month after completing his second human heart ² transplant on 2 January 1968, Barnard was the focal point of a special edition of a BBC1 television show called ‘Tomorrow’s World’, with a studio audience including some of his fiercest critics. The show drew 10 million viewers, meaning that Barnard faced expert scrutiny on a very public stage. The official title of the show was ‘Barnard faces his critics’, but it was widely labelled ‘The Chris Barnard Show’, bearing testimony to his success in handling the criticism and his growing celebrity status (Nathoo, 2009). For the most part, the media hailed Barnard as a ‘hero’ and a ‘heart-throb’ (Malan, 1968: 79) and even framed his achievement as a miracle, thereby attributing God-like status to him (Moloney and Walker, 2000). Such lavish media attention for a surgeon was unknown until Barnard appeared on the scene.

Understanding the media response

From the time that the news about the first heart transplant broke, and throughout subsequent events over the following months, the unprecedented media interest in this historic surgery was heightened by ethical debates, political undercurrents and commercial interests, as well as by Barnard’s charismatic personality and media flair. The symbiosis between these factors created a new network of meanings associated with the medical profession. Over and above the public enthralment with Barnard, the idea of heart transplant both fascinated and threatened social thinking. Questions inevitably surfaced about moral, ethical and legal issues related to human heart transplants. The mass media provided an unparalleled public platform for this debate, thereby elevating public awareness of these issues (Hoffenberg, 2001; Moloney and Walker, 2000; Nathoo, 2009). Overall, the media’s framing of a heart transplant as ‘the ultimate gift of life’ helped to make it socially more acceptable (Nathoo, 2009), while Barnard’s detailed explanations to the press took away some of the mystery and helped to familiarise people with the surgical procedure. He never hesitated to explain that the heart was ‘just a pump’ (Logan, 2003: 14). As such, the first human heart transplant constituted a medical as well as a psychological breakthrough.

Prior to 1967, media coverage of organ transplants was rare (Moloney and Walker, 2000). Doctors had been transplanting kidneys and livers for some time, but it was the first human heart transplant that ignited media interest in this kind of surgery and the surgeons who performed it (Nathoo, 2009). Subsequent heart transplants were both celebrated and criticised on the mass media stage. Over time, media coverage of heart transplants in the 1960s was pinpointed as a turning point in the medialisation of medicine and a transition towards sensationalised media coverage of medical procedures and the celebrification of star performers that would characterise the last decades of the 20^th century (Conboy, 2011).

Reactions to the media coverage

The extensive global media coverage of the first human heart transplants gave rise to a number of debates and disagreements – in medical circles and the broader society. At the time, professional codes of medicine forbade any form of advertising, and medicine was steeped in professional secrecy (Logan, 2003). As could be expected, some of Barnard’s peers were dismayed by the way he indulged the press and complained that he was breaking the ‘no advertising’ rule (Malan, 1968). Moreover, the intrusive and intimate reporting of the first human heart transplant challenged existing professional codes of how medical specialists were identified in public, how medical procedures were reported in the media and the extent of patients’ details that were disclosed. At the time, Barnard insisted that the hospital played no part in revealing the identities of the first heart donor and recipient, but that they became known as a result of the unstoppable media interest (Logan, 2003). On their part, the media insisted that ‘public interest’ demanded the release of patient details that would previously have been considered a gross intrusion of privacy, but the nature of the coverage suggests that they were also driven by commercial imperatives in an increasingly competitive media environment (Conboy, 2011; Nathoo, 2009). Evidently, media coverage of the heart transplant fundamentally changed the way the mass media would cover medical procedures in future, and the way medical professionals would start to use the media to publicise themselves.

Barnard’s own position and career prospects at Groote Schuur were strengthened by his high public profile, since it enabled him to attract generous donations and turned Groote Schuur into a sought-after training institution in cardiac surgery (Digby and Phillips, 2008). In future, the prospect of boosting institutional reputations and competing for collaborators and funds would become a major motivator for scientists to seek media exposure for their achievements (Weingart and Guenther, 2016).

In the immediate aftermath of Barnard’s historic surgery, ongoing and intensive media coverage of heart transplants was blamed as a contributing factor leading to a ‘flurry of ego’ among cardiac surgeons and creating unrealistic public expectations about the potential of heart transplants to save lives (Kantrowitz, 1998: 246). For example, the New York surgeons who attempted to transplant a heart just days after Barnard’s feat were accused by prominent peers of hurting the medical profession by taking unnecessary chances and ‘playing for the gallery’ (Kantrowitz, 1998: 250).

In conclusion, the first human-to-human heart transplant turned out to be a pivotal event in terms of its ability to attract and focus global media attention. For its part, the mass media exemplified the multiple meanings of this historic and dramatic first in medicine and transformed the key role players in the event. Chris Barnard was transformed from an unknown surgeon to a global superstar who was in demand by world leaders and royalty; wherever he went, he drew crowds of people desperate to touch him or get hold of an autograph or photo. Denise Darvall became immortalised in medical history as the first person to give the ultimate gift of life – a human heart. Louis Washkansky will be remembered as the first person who walked, talked, smiled and ate with someone else’s heart beating in his chest. Even the heart itself took on a new meaning – from the unmovable seat of our emotions to a mechanical pump that could be transplanted from one person to another. Public audiences, too, were transformed in the sense that people were challenged to reconsider their definitions of life and death, the morality of organ transplants and their own willingness to declare themselves as organ donors. In the political context of South Africa in 1967, the media coverage of Barnard’s second and third heart transplants highlighted the immorality of the country’s racial policies where black and white people were not allowed to sit next to each other on a bus, but a black person’s heart could save a white person’s life.

Through this series of transformations that constitutes the first heart transplant, the mass media coverage of the first human heart transplant has fundamentally influenced the way we view and remember this event 50 years later.