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Page 6 of 17 Singh et al. Vessel Plus 2018;2:33 I http://dx.doi.org/10.20517/2574-1209.2018.28
[45]
for heterotopic heart transplantation in 21 canines, and prolonged survival up to 26 post-operative days .
Blumenstock mimicked the findings of Reemtsma’s group with one canine in their cohort surviving for up
[46]
to 42 days in 1963 .
The first ethical dilemma faced by the fraternity was the concept of the donor as “the definition of irrevers-
ible coma” was only established in 1968 by an Ad Hoc Committee of Harvard Medical School on Brain
[47]
Death . The likelihood of a potential donor dying at exactly the same time as a recipient needing a heart
was minute and a decision was made that the team would not halt ventilation of the patient in January
[48]
1964, but instead would utilise a chimpanzee as a donor . A patient presented with a large thrombus that
had embolised to the left side of the heart and placed on mechanical coronary perfusion. The chimpanzee
heart was explanted and implanted into the patient. Despite initially beating well, it became apparent that
the heart was not able to support the larger volume of a human circulation and the patient died within an
hour of weaning from cardiopulmonary bypass.

Dr. Christiaan Barnard had worked alongside Shumway in Minnesota. He had also performed the first
successful kidney transplant in South Africa to understand transplant immunology and geared for a heart
transplantation. On 14th September 1967, Louis Washkansky was admitted in the Groote Schuur Hospital
in Cape Town, South Africa. Dr. Velva Schrire (Chief Cardiologist) recommended Washkansky as the ap-
propriate case for transplant. On 2nd December 1967, a 24-year-old female, Denise Ann Darvall was pro-
nounced dead after sustaining a massive cerebral injury following a collision. Both patients were brought
[49]
to theaters A and B where and mutual consent was obtained .

“If you can’t save my daughter, you must try and save this man.” Edward Darvall (Denise’s Father).

On 3rd December 1967, Dr. Christiaaan Barnard performed the first successful human-to-human or-
thotopic heart transplantation. Her heart was taken via the Shumway technique with the heart cooled to
10 °C. He used a combination of local irradiation, azathioprine, prednisone, and actinomycin C as his im-
munosuppression regime. The post-operative course of the patient was very promising, he contracted Pseu-
[50]
domonas pneumonia and died on the 18th post-operative day .

Dr. Adrian Kantrowitz and his team performed the 2nd heart transplant (the first in a paediatric patient)
in Brooklyn. Kantrowitz was already well known for designing the first intra-aortic balloon pump and
had conducted considerable laboratory experiments in puppy hearts believing that the immune system of
a younger heart may offer less allogenic resistance. On 6th December 1967, He transplanted a anenceph-
alic donor heart into a 3 week-old patient diagnosed with tricuspid atresia. He performed the operation in
hypothermic conditions under circulatory arrest. Despite initial recovery into sinus rhythm, the recipient
[51]
developed irreversible acidosis and died .
Norman Shumway and his team performed their first heart transplant a month after Kantrowitz. The re-
cipient developed chronic and progressive heart failure after “post-viral myocardial fibrosis” and coronary
artery disease. The procedure was complicated by size mismatch with the donor heart being much smaller
than the recipient’s. The recipient received a combination of methylprednisolone and azathioprine preop-
eratively and post-operatively with the addition of prednisolone. However, the patient did not succumb to
rejection. Shumway noted that in the initial post-operative period the patient was mildly hypotensive and
oliguric into the second postoperative day despite administration of isoproterenol and temporary digitali-
zation. The patient developed a consumptive coagulopathy before succumbing to multiorgan dysfunction
[52]
and bronchopneumonia .
Across the Atlantic, Dr. Donald Ross, who trained under Lord Russell Brock, performed the first heart
transplant in the United Kingdom. The patient, a 45-year-old man, survived for 46 days before succumbing