The Chimp & The Surgeon: A History of Heart Transplants

Today isn’t just Valentine’s Day. It’s also the end of Congenital Heart Defects Awareness Week. With that in mind, here’s a short piece on the history of heart transplants.

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When Boyd Rush, aged 68, was admitted to the University of Mississippi Medical Center on 23 January 1964, Dr James Hardy [below] was waiting for him. Hardy, who had been conducting research on organ transplantation since the mid-1950s and had successfully performed a lung transplant the year before, wanted to replace Rush’s heart with a human equivalent. Unfortunately, strict medical regulations did not recognise brain cessation as a sign of death, which meant that a surgeon had to wait till a person’s heart stopped before it could be used for transplantation.

_100On the day Rush was brought to the hospital, none were available. As the minutes passed, the situation became more and more critical.

‘The prospective recipient went into terminal shock at approximately 6 p.m., with a blood pressure of 70 and virtually without respiration except for the continued use of the mechanical ventilation through a tracheotomy tube’, Hardy later recalled in his memoirs. ‘Death was clearly imminent and it was obvious that if heart transplantation was to be performed, it had to be done at once’. [1]

Rush was wheeled into the operating theatre, where Hardy polled his surgical team about whether or not a transplant attempt should be made using a chimpanzee’s heart.

‘I polled each of the five primary members of the transplant team individually, and their votes were recorded. Four voted to proceed with transplantation… The fifth abstained’. [2]

The surgery went ahead even though everyone in the room was ‘well aware that any transplantation of a heart in man would be followed by public consternation’ and that ‘the use of a chimpanzee heart would augment the criticism immeasurably’. Hardy later described it as a ‘profoundly sober moment for all’. [3]

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Several hours later, Hardy and his team made history by performing the first ever heart transplant. The chimp’s heart beat for 90 minutes inside Rush’s chest, but unfortunately proved too small to keep its new human body alive. Hardy’s patient died shortly after the operation was complete.

Hardy’s decision to use a chimpanzee’s heart fell under immediate attack from both the public, as well as those within the medical community. The operation ‘precipitated intense ethical, moral, social, religious, financial, governmental and even legal concerns’, Dr. Hardy wrote years later. ‘We had not transplanted merely a human heart, we had transplanted a subhuman heart’. [4]

_100Undeniably, the heart is one of the most vital organs in the human body. Without it, we would die. However, the controversy that arose in the 1960s when Hardy implanted a chimpanzee’s heart into Rush had less to do with physiology than it had to do with philosophy. For thousands of years, the heart was considered to be the seat of the human soul. Over time, the scientific community came to recognise the role the brain played in human consciousness. Nevertheless, people continued to equate emotions with the heart. Indeed, to some extent, we still do this today.

The ‘criticism from the media and our peers was vicious’, Hardy’s daughter remembered. ‘Many believed that if you transplanted the heart, you transplanted the soul. Even at school, we were aware that people were upset. As a child, it was difficult to understand why’. [5]

Hardy’s systematic murder of chimpanzees for use of their organs was also controversial. Invited to speak at a surgical conference in New York City several days after the historic operation, Hardy was shocked when the moderator introduced him by saying: ‘In Mississippi, they keep the chimpanzees in one cage and the Negroes in another cage, don’t they, Dr. Hardy?’ [6]

_100Over the next several months, some of the criticism within the medical community waned after Hardy published a paper in the Journal of the American Medical Association in which he described the strict ethical guidelines he and his team had followed when evaluating both donor and recipient. [Note: for more about the use of animals in medicine, click here].

It wasn’t until 1967 that the first human-to-human heart transplant took place at the Groote Schuur Hospital in Cape Town, South Africa, where a young surgeon named Christiaan Barnard was experimenting with pioneering surgical procedures. Barnard’s patient was 55-year-old Louis Washkansky, who was suffering from incurable heart disease. Washkansky could either wait for death, or risk undergoing surgery.

‘For a dying man it is not a difficult decision because he knows he is at the end’, Barnard later recalled. ‘If a lion chases you to the bank of a river filled with crocodiles, you will leap into the water convinced you have a chance to swim to the other side. But you would never accept such odds if there were no lion’. [7]

So the surgeon and his patient waited for the right moment. Then one day in early December, a woman named Denise Darvall was brought to Barnard’s hospital after incurring fatal injuries in a car accident. She and Washkansky shared the same blood type; her heart was still healthy. On the 3rd, Barnard prepped his patient for surgery. Over the next 5 hours, he would successfully replace Washkansky’s diseased heart with Darvall’s healthy one.

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Washkansky’s new heart beat strongly and steadily. Unfortunately, due to a suppressed immune system, he contracted double pneumonia and died 18 days later. Nevertheless, his case would signal a turning point in the history of medicine.

Years later, Barnard recalled how the landmark surgery changed his life: ‘On Saturday, I was a surgeon in South Africa, very little known. On Monday, I was world-renowned’. [8] Barnard, more than Hardy, was celebrated for his accomplishments, appearing on the covers of magazines and touring the world with stories of his success.

_100Christiaan’s brother, Dr Mario S. Barnard, published a paper in the South African Medical Journal describing the historic operation. In it, he credited Hardy and the Mississippi team for paving the way, arguing that this earlier operation proved that ‘the feasibility of cardiac transplantation was now irrefutable’. [9]

Even after the first successful human-to-human heart transplant, surgeons continued to experiment with animal hearts. Between 1964 and 1977, sheep, baboon and chimpanzee hearts were transplanted into at least four adults, all of whom died within a few days of the operation. It wasn’t until 20 years after Hardy’s operation on Rush that surgeons were somewhat successful with a cross-species heart transplant.

On 14 October 1984, Stephanie Fae Beauclair was born prematurely with hypoplastic left heart syndrome, a rare congenital defect in which the left ventricle is severely underdeveloped. Baby Fae’s parents took her to Loma Linda University Medical Center in California, where they met with Dr Leonard Bailey.

‘In those days, the advice to parents was to leave the baby here to die or take it home to die’, Bailey recalled. [10]

Bailey, who had performed more than 150 heart transplants on various species over the past 6 years, offered the grief-stricken parents a second option. He proposed replacing their daughter’s defective heart with that of a baboon. On 26 October 1984, Bailey and his surgical team did just that.

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Baby Fae lived for 21 days, two weeks longer than any previous baboon heart transplant recipient. At a news conference following the child’s death, Bailey told reporters: ‘Infants with heart disease yet to be born will some day soon have the opportunity to live, thanks to the courage of this infant and her parents’. [11]

Shortly after this feat, surgeons abandoned inter-species heart transplants due to the high risk of infection that followed such operations.

Today, approximately 3,500 human heart transplants are performed annually worldwide. The vast majority of these are done in the United States. Due to the development of powerful anti-rejection drugs, 85% of patients survive up to one year after surgery; 75% make it to their third year.

And it all began on 23 January 1964 with the heart of a chimpanzee.

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1.James Hardy, According to The World of Surgery 1945-1985: Memoirs of One Participant.
2. Ibid.
3. Ibid.
4. Ibid.
5. Quoted in Lynne Jeter, ‘Having a Heart-to-Heart’,
Mississipi Medical News (2008).
6. Quoted in Tony Stark, Knife to the Heart: The Story of Transplant Surgery (1996), p. 162.
7. Quoted in D. McRae, Every Second Counts: The Extraordinary Race to Transplant the First Human Heart (2007).
8. Quoted in Fred C. Pampel & Seth Pauley, Progress Against Heart Disease (2004), p. 78.
9. M. S. Barnard, ‘Heart Transplantation: An Experimental Review and Preliminary Research’, South African Medical Journal (30 December 1967), p. 12.
10. Quoted in Ansel Oliver, ‘Surgeon Bailey Reflects 25 Years After “Baby Fae”’, Adventist News Network.
11. Quoted in Claudia Wallis, ‘Medicine: Baby Fae Loses Her Battle’, Time Magazine (26 November 1984), p. 88.

19 comments on “The Chimp & The Surgeon: A History of Heart Transplants

  1. Juan Rodriguez says:

    I am searching for a story where in the 60s or 70s a animal, chimp or ape heart was transplanted into a human being named Barney

  2. […] Source: The Chimp & The Surgeon: A History of Heart Transplants […]

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  4. […] La primera persona que recibió un trasplante de corazón lo obtuvo de un chimpancé y sobrevivió p…. Vía David […]

  5. […] first person to get a heart transplant received a chimp heart. He died. An incredibly historical story by Lindsey […]

  6. juliaergane says:

    I remember most of this history as current events/news of the day. My most sincere wish, though, is that anti-rejection drugs be made safer and with much better results. Possibly, we will all grow our own extra organs in the future; but, that state of the art is not yet here.

  7. […] The Chirurgeon’s Apprentice: The Chimps & The Surgeon: A history of Heart Transplants […]

  8. […] The Chimp & The Surgeon: A History of Heart Transplants « The Chirurgeon's Apprentice […]

  9. Shruti says:

    Lindsay i really really want to ask u this. Do u by any chance follow ‘Grey’s Anatomy’? The name ‘bailey’ just reminded me of ‘Dr. Bailey’. I love that show and I love ur blog too.:)

  10. […] The chimp & the surgeon: a history of heart transplants. […]

  11. Cristian says:

    Quick question (and correct me if I’m wrong): wouldn’t the chimp/baboon hearts present the danger of hemolysis, allergic reaction and anaphylaxis due to the specific antigens of their blood types?
    I’m guessing they would have been tested, but don’t the monkeys have race-specific antigens, which would definitely make a freaking heart a big ol’ target for the “friendly” human IgM’s and/or IgE’s or, even better, for the T and B cells?

    • Andy says:

      While the actual mechanisms of rejection (antigen targets, etc) are multiple, the general thesis of your point is correct. Foreign antigens (whether from another species, or from another individual of the same species) will serve as targets of immune rejection, necessitating a massive dose of immunosuppressant drugs that will kill the patient later on, assuming he/she survives the surgery or whatever precipitating condition required the transplant. The only tissue transplant that comes with an absolute guarantee to be free of immune rejection is a transplant from the patient’s own body (look up “autologous stem cell transplants” for more information). Everything else, whether from a brother, sister, parent, random donor of identical blood type or tissue type, always requires a variable degree of pharmacologic immunosuppression to prevent rejection, either in the short- or long-term.

      The big takeaway from these early operations was not in the study of transplant rejection…rather, they demonstrated that transplantation could be successful even if only for a short while. Later advances (understanding of the role of blood type, tissue type, auto/allo/xenografting, immunosuppression) were then made that brought us to where we are today.

      • Cristian says:

        And thus we ended up on the path to discovering and using Cyclosporin A, Tacrolimus and Sirolimus and monoclonal antibodies and so on.
        My question was: by that time didn’t they know that the xenotransplanted organs will surely kill the patient quite fast, given the limited amount of immunosuppresive drugs they had (glucocorticoids?) and the highly likely possibility that the foreign organ would have a boatload of antigens that would cause the human immune system to go berserk?
        I mean: Christiaan Barnard at least knew (I’m guessing) that he “only” had to worry about human antigens.
        This wasn’t the XVIIth century, when french and english doctors experimented with blood transfusions from sheep and cattle to humans. They knew very well about blood types, antigens, they had potent (for their time) microscopes and technology.
        Wasn’t this somewhat unethical from the beginning? Not because of religious or whatnot reasons, but because they must have known the patient would soon reject the organ and die.

      • Andy says:

        Not sure if this reply is going to be nested correctly, but Cristian – this is in response to your most recent post:

        Presumably, yes, they would have known that immediate rejection or death were not far off. I’m not one to dive too much into the ethics, but I can say that the standard we (USA) use in cases of terminal illness is that if death is the only other option, a consenting patient can accept treatment that might confer a benefit (survival, quality of life, etc) even if only short-lived. Essentially, would you rather die today, or 18 days from now? This is a little outside my realm of knowledge though; there is probably someone more qualified to comment on the ethics.

        One point I would add though…I don’t know how much these types of considerations (ethical ones) played into these decisions when these surgeries were being performed….medical ethics, as I understand it related to patient protection and research anyway, really evolved after the Tuskegee Syphilis experiments, where researchers knowingly infected citizens from the Southern USA with Syphilis, then lied to them about the treatments they were to receive. I know this was a groundbreaking study in ethics, but again, there’s probably someone better suited to address these points than I am.

        Interesting, either way.

  12. carolynloyel says:

    This reminds me of that movie “Untamed Heart” with Christian Slater from the 90s. Man I loved that movie and Christian Slater. Sorry this is pretty unrelated, but I just had to share!

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