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The lasting legacy of Dr Christiaan Barnard (1922-2001)

The New Straits Times, September 16, 2001

By Professor Dzulkifli Abdul Razak

Mention the name Christiaan Bernard, a famous Paris-based jeweller, offering a top range of gems, comes to mind.

Gems that one holds dearly to the heart and remains sparkling throughout the ages, indestructible in so many ways.

This is perhaps best symbolised by the axiom, diamonds are forever.

Now, mention another similar sounding name, Christiaan Barnard, a fabled heart surgeon leaps to mind, a gem of different sort but equally very dear to one's heart.

He is, South African-born Christiaan Neethling Barnard who has created history by pioneering the world's first human-to-human heart transplant.

Through him, heart transplant is by now well-refined and accepted so that about 90 per cent of patients who undergo the procedure will survive, with 70 to 75 per cent chance of lasting five years. One of Barnard's patient, in fact, survived beyond two decades before dying of diabetes, unrelated to his heart condition.

No doubt, the life-extending surgical wonders introduced by the then little known Dr. Barnard are indeed, like the diamonds, forever too.

Today, heart transplantation has become commonplace for patients with terminal heart failure.

More so of late, just like the recurring beating of the heart, history repeats itself when another astonishing feat of yet another type of heart transplant was introduced.

This time an artificial plastic and-titanium heart is used to replace the heart of a dying man, simply known initially as 'the patient". It is a pioneering effort performed to experiment if the new heart device would somehow work in human subjects.

The immediate goal was rather modest: "to keep the man alive for 60 days" (Newsweek, Sept.3).

The operation clearly spun many achievements. "The patient", Robert Tool, not only beat the 60-day goal, he is also the first person using the world's first fully implantable artificial heart.

By no means though, could this be possible if not for the crowning work of Christiaan Barnard more than three decades ago.

To recall, some 30 years ago, the first patient to receive a heart transplant was a 53-year old grocer, Louis Washkansky.

He was a diabetic with an incurable heart condition, and on December 3, 1967 Barnard successfully replaced Washkansky's heart, in a five-hour operation. Thanks to the heart of a woman who had just died in a motor vehicle accident.

But Washkansky was to live for only 18 days post-surgery, dying of pneumonia related to his suppressed immune system.

It all happened in the Groote Schuur Hospital in Cape Town, South Africa where Barnard used to work as a medical registrar, after practicing family medicine in a nearby rural community. It was at same hospital that he carried out some highly ingenious research on neonatal intestinal problems, before becoming interested in heart transplantation techniques.

According to Profiles in cardiology published in Clinical Cardiology (July 2001), in 1956 he took up a scholarship to study under two US heart surgeons at the University of Minnesota.

And on returning to Cape Town, he developed an excellent heart surgical unit, and performed outstandingly in surgery involving children with heart defects which he viewed this as the highlight of his career.

Philip Blaiberg was Barnard's first heart transplant recipient to leave the hospital and lead an active life for 19 months. Blaiberg died of unknown complication associated to chronic rejection.

Barnard's next two attempts were even more successful. The patients survived for 13 years and 24 years respectively. In other words, even at the early stages, there was already sustained optimism that "heart transplantation would eventually become a reliable therapeutic option for patients with end stage cardiac failure", as recorded in Clinical Cardiology.

For Barnard, however, this is not the ultimate. He predicted that someday the human hearts will be grown artificially to suit patients. "There is now tremendous progress in genetic engineering and it may be possible eventually to grow a human heart, he was quoted as saying.

Unfortunately, Barnard will not be able to know how accurate his prediction is. Earlier this month, on Sunday, September 2, the world lost one of its invaluable gems; Christiaan Barnard. He died at 78, leaving behind a legacy which is truly unforgettable.

Needless to say, the legacy of Christiaan Neethling Barnard, the heart surgeon, will go on beating, adding to it the sparkling shine of the most precious gem there is, for all time.

For his bold and courageous life-saving act, we can only echo Robert Tool's "Thank you, God".

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