Review: Vivien Horler

Heartbreaker – Christiaan Barnard and the first heart transplant, by James-Brent Styan (Jonathan Ball Publishers)

Chris Barnard, the first man to perform a heart transplant, wasn’t a particularly nice man.

Answering a question in a TV interview about the fact he had left his first wife, Louwtjie, who was in her 40s, to marry the 19-year-old heiress Barbara Zoellner, Barnard replied with a broad smile: “Why eat biltong when you can have fillet steak?”

Interestingly, Louwtjie’s own book about her marriage was titled Heartbreak.

He loved women and was serially unfaithful to all his three wives. He also kissed and told: in his autobiography One Life he wrote that after he and the Italian film star Gina Lollobrigida had “celebrated several times” one night in London, she took him back to his hotel in her Jaguar. “Besides a fur coat, she wasn’t wearing anything else.”

Fortunately lack of niceness is not a bar to great achievement – in fact it may mitigate against it. His daughter Deirdre, formerly a top waterskier who competed internationally, was at one point far more famous than her father.

She is by all accounts a very nice woman, but her father, who was her coach, frustratedly said in a magazine interview she lacked the killer instinct. Himself a driven man, Barnard said in the interview that it was a relief to him when he abandoned Deirdre’s career and focused on his own.

And he was talented: determined, clever, occasionally ruthless, ambitious to a fault, and extremely good looking. What’s more, he came from behind: he beat a poverty-stricken background as one of five sons of a Karoo Calvinist missionary to qualify as a doctor at UCT.

His father Adam worked among Beaufort West’s 7 000-strong coloured population for 37 years, and was looked on with disdain by the white townsfolk. This background meant that Barnard, and later his brother Marius, also a heart surgeon and later an MP, entirely rejected apartheid’s strictures.

Their wards were desegregated, with black nurses treating white patients and vice versa. When an American patient Barnard operated on said he hoped he would get a white heart, Barnard replied he couldn’t say as he could not tell them apart.

The family was very poor – the Barnard brothers were able to study at UCT only thanks to a fund set up to help Afrikaner children’s academic studies. But it did not cover all his fees, and certainly didn’t pay for transport, so that Barnard, who was staying with a brother and his wife in Pinelands, had to walk about 13km to and from classes daily.

Ironically, Abraham, the brother one up from Chris, died of a heart condition before his third birthday. Afterwards Chris and Marius would say Abraham had probably had a hole in the heart, a condition easily fixed today. Years later Chris and Marius operated on many hole-in-heart children both in South Africa and abroad.

Author James-Brent Styan readably covers Chris’s early career in South Africa and the US, but Heartbreaker becomes a page-turner when he reaches the run up to the first heart transplant at Groote Schuur Hospital.

In late 1967 Barnard was of course not the only cardiac surgeon preparing to perform a heart transplant; several doctors in the US were also ready. The problem was a legal one: when could a donor be classified as dead?

Hearts have to be transplanted quickly, because once the donor has died, the heart rapidly deteriorates. In the US and Europe it was accepted that a patient was dead when their heart stopped beating. Another definition of death was brain death, but there was a fear among US doctors that if they removed a beating heart from a brain-dead patient they could be accused of murder.

In South Africa brain death was legal, so the Groote Schuur heart team had an advantage there. But they also faced a disadvantage: apartheid. There was a fear that if either the donor or recipient was not white, there would be a terrible fall-out, with accusations of “experimenting” on black people.

By late November the team had a white patient, Louis Washkansky, and this meant they needed a white donor. Styan says without this concern, the first transplant might have been done two weeks earlier, when a coloured donor heart became available.

Heartbreaker is not a hagiography of Barnard, who comes across as a flawed but brilliant man. Styan also does not shy from other controversies, including that of the role of Hamilton Naki, a man of no formal education who had started his Cape Town career as a gardener at UCT in 1940. A professor of cardiovascular research later employed him as a laboratory assistant, and he became a proficient anaesthetist with animals who were being used in research.

Following Naki’s death in 2005 he became famous after a documentary on his role was released, followed by obituaries in international magazines like The Economist and Time. It was claimed Naki’s vital part in the first transplant had been covered up, and even that he had removed donor Denise Darvall’s heart from her body.

“Nothing could be further from the truth,” writes Styan. He quotes Emeritus Professor Anwar Mall of UCT, who said while Naki and the other laboaratory assistants played a significant role in the UCT research and were involved in preparatory work for the transplant, they did not take part in the actual operation.

Mall is quoted: “Sadly the image of Hamilton Naki was damaged by the misinformation that was spread after his death… He was never involved with human patients. It would have been illegal since he was not a qualified medical doctor.”

The Economist and other publications including medical journals like The Lancet had to publish corrections.

Today, reports Styon, 210 people die every day of heart-related disease. More worryingly, heart disease is the leading cause of death among South African children under five. And at any one time there are about 4 300 South Africans waiting for organ donations.

We read all the time of the deterioration of the service provided in South Africa’s state hospitals, but Styan points out UCT’s Cardiology Division is still doing world class research. He cites the development of a new artificial heart valve that can be implanted into the heart without open-heart surgery, a breakthrough announced in the media late last year.

And one of the predecessors of the people who are making a difference today was Chris Barnard, flawed, not always nice, but brilliant, daring, and a hero of our time.

• This review was published in Weekend Argus on Sunday on February 4.