Eighteen days
The largest counter on the Ledger is heart attacks and strokes. The operation people remember is a footnote to it.
This counter is the largest on the Ledger, about 18.6 million deaths a year. Almost all of it is two events. The arteries that feed the heart muscle narrow, and a part of that muscle dies. Or a blood vessel in the brain blocks or bursts. High blood pressure feeds both. Heart transplants are a footnote to that number. They are also the reason a lot of people think they know this story.
Cape Town, South Africa
In the early hours of 3 December 1967, at Groote Schuur Hospital in Cape Town, South Africa, Christiaan Barnard put a heart into Louis Washkansky. Washkansky was a grocer in his fifties. His own heart had been ruined by repeated heart attacks, which is the ordinary business of this card. He was bloated, breathless, and out of other options. Surgeons in the United States had already rehearsed the operation on animals. Barnard was the first to do it with a human donor and a human recipient.
The donor was Denise Darvall. On the afternoon of 2 December, she and her mother had stopped at a bakery in Observatory, a suburb of Cape Town. They were hit crossing the road. Her mother was killed. Denise was brought to the same hospital and declared brain-dead. Her father agreed that her heart could be used. Just before six on the morning of the 3rd, the borrowed heart was shocked into a beat.
Eighteen days later
For nearly two weeks Washkansky did well. The swelling left him. The new heart worked. Newspapers treated the operation as a success while he was still in the ward. Around 15 December, he weakened, with fever and trouble in his lungs. The team could not tell infection from rejection. They chose rejection, and increased the drugs that switch the immune system down. That choice let a pneumonia take both lungs. He died on 21 December, eighteen days after the operation. At the post-mortem, the heart had not been rejected. It was the last organ to fail.
Barnard called the operation a success because the heart had beaten on its own, without a machine driving it. The next patient lived almost a year and a half. Later ones lived for many years. In hospitals that do this work, a transplanted heart is now an established operation, and recipients are chosen far more carefully than a diabetic grocer who was already dying.
What the counter is counting
That is a real change, and it barely touches the counter. The 18.6 million are heart attacks and strokes in ordinary life, most of them in people who will never be on a transplant list. A new heart is a rare rescue, available where there is a donor, a surgical team, and a health system that can keep the drugs going afterwards. The ticking number is the disease Washkansky already had before anyone opened his chest.
Smoke feeds the same number. The study that made cigarettes hard to dismiss is told in Several diseases, one slot, and the week a city's air killed through the heart as well as the lungs is told in Five days of coal smoke.
This is not health advice. It is a story about a population statistic. It says nothing about any one person's risk. If you have concerns about your health, speak to a doctor.
Sources
- Christiaan Barnard's own report, reprinted from the South African Medical Journal of 30 December 1967.
- The University of Cape Town's account of the operation at Groote Schuur Hospital in Cape Town, South Africa.
- “Christiaan Barnard — the surgeon who dared”, a 2018 review of the operation and the patients who followed.
- The annual figure used on the counter is the Ledger's own rounding, set out on the methodology page.