“A thing is not necessarily true because a man dies for it.”



Oscar Wilde 1854-1900 in Sebestian Melmoth (1904 ed)






It is time to ask the question if Hippocrates was right in proclaiming the above dictum* for all future followers of his craft? The more I learn about our profession the less I have faith in the truth of the Hippocratic oath. People are after fame, mystery, falsehood, and false prestige and, of course, money. I can understand the latter but why the former? Life has taught me that it is the former that facilitates the latter. The man, who does genuine hard work, using his own special powers of thinking and comes up with an innovative idea rarely, if ever, gets his due credit. It is the crafty ones that could steal that wisdom and use it to perform “miracles,” that get the limelight and all that goes with it. It is not the one whose genius discovers something that gets the limelight but the one who somehow or the other convinces the world about it gets all the benefits. That is life! The story keeps repeating itself again and again.



Here is the true story behind the “first” heart transplant that the world has come to believe in. Time was when South Africa, with its despicable apartheid policy, was getting totally isolated in the international community, it needed to achieve something that the world could be proud of. It is a fact that South Africa had one of the best medical care delivery systems in the world at that time coupled with full time teachers doing excellent basic research in the medical school. To cap it, they did not have much of a consumer awareness and ethical committees’ hindrance for any kind of research. That was the time that a young man, Christian Barnard, came back after having had training in cardiac surgery both in the UK and the USA to join the team of researchers. He was itching to make it big and get to limelight at any cost. In the words of one of his close associates: he was “ruthless, egocentric, hardworking, clever, ambitious, brash, and downright arrogant.”



One example of his qualities of head and heart manifesting could be shown in the following anecdote. When a Russian surgeon reported an operation where he had transplanted an extra head to a dog, Barnard repeated that feat with great difficulty to show that “he could do anything that anyone else did.” He was very proud of his grotesque operation with the dog having two heads and got it widely publicized! Barnard’s arrogance was responsible for the “truly” first transplant patient paying for the operation through his own life. After the heart transplant operation Barnard irradiated his patient with whole body radiation to suppress the immune rejection, while it was an established practice with kidney transplants not to have total body irradiation in 1967. Barnard deliberately rejected that practice to show that his patient’s graft rejection was negligible. He was right that the graft did not get rejected but, the patient died of severe infection in both his lungs due to iatrogenic (doctor induced) immune deficiency.



It was 3rd December 1967 at the Groote Schuur Hospital, South Africa, where a young female accident victim was admitted for observation. The following day the doctors “decided” that she had no chance of survival at all. Christian Barnard was impatiently waiting to immediately grab the opportunity to do his “truly” first heart transplant operation on a middle-aged man suffering from terminal heart failure. The heart of the young lady was still beating normally when removed to be used for the man! Unfortunately for all concerned, the patient died in a few days’ time with massive bilateral pneumonia. This was never reported in the media.



Two weeks later there was another golden opportunity that came looking for Barnard. He was to be later acclaimed to be the most heroic of surgeons in the eyes of the public. He also earned tons of money. Of course, the heroes in the game were the hapless accident victims and the poor recipients! A young white man was admitted after having gone swimming, brought to the hospital unconscious. He had sub-arachnoid haemorrhage. He was not making any progress. Dr (now Sir) Raymond Hoffenberg was the physician in charge. Pressure was being brought upon Sir Raymond to declare the young man brain dead, but he was not in fact brain dead at all. Even the then definition of brain death looks so flawed today that most of the declared brain dead donors could well have lived on for many years with normal life! Even the present definition of brain death is far from satisfactory.



The medical wisdom at that time was that transplants could survive only with beating hearts and not cadaver hearts. So Barnard was looking for beating hearts all over the place. Poor patients admitted at that time in South Africa must have been really unlucky. In the company of a man with a hammer who wants to use it badly every thing there would look like a nail needing hammering. Every accident victim was a potential donor for Barnard. Sir Raymond Hoffbenberg was to be deported under the “suppression of communism” act of South Africa the following day. Early morning he was somehow or other “forced” (I would not know for certain what went through his mind at that time, although he claimed later that most of the patient’s reflexes were unelicitable by the time he decided to declare her brain dead, but her heart was still healthy and beating.) to sign a declaration that the accident victim was brain dead. Before that the Head of surgery was very unhappy with Sir Raymond. “What sort of a heart are you going to give us eventually”? he once asked angrily.



Soon the whole hospital was electrified. Everyone was excited, as they were to make history of sorts! Dr. Philip Blaiberg, a South African dentist, was in hospital with intractable heart failure. He received this accident victim’s heart “successfully”. This was proclaimed to the world as the FIRST heart transplant. Another lie indeed! Blaiberg lived for 18 months. The media was told that he lived a near normal life. He is said to have indulged in sexual intercourse with his wife. He was shown to be swimming in the sea to prove to the world that heart transplants are very useful. The fact is that Blaiberg was almost as ill as he was before the operation. The whole publicity was a hoax. He was taken to the sea in a “hi-tech ambulance” and lowered to the level of the water by a team of doctors and nurses. The latter stood away for a fraction of a second for the photographers to click. Blaiberg was immediately lifted up before he went under the waves. As far as the sexual act was concerned, I feel the press did not press for the photographs, if ever it happened! The syndicated photograph of Blaiberg swimming in the sea made so many cardiac surgeons all over the world so jealous that in one year in 1968, one hundred and seven “copycat” operations were done in 24 countries by sixty-four surgical teams, most of them with disastrous consequences.



One such operation was done that year in the then Bombay City. The operation was successful but the patient, of course, died almost at the end of the operation. The surgeon was a good man, Dr. P.K.Sen, who did not believe in publicity. Prof. Sen was a great researcher, having had many innovative procedures to his credit. He openly told the press that the patient died immediately after the operation. Anyone else in his place would have told a lie and kept the patient artificially breathing for sometime at least.



Govt. of South Africa needed this shot in the arm very badly at a time when it was literally isolated in the world community. There was a change for the better for the government because of Barnard’s feat. On the 30th December 1967, the South African Medical Journal brought out a special issue in commemoration of the event with many articles and an editorial on heart transplantation, making Christian Barnard a cult figure. Basically a showman Barnard “indulged in impetuous, flamboyant, global lap of honour.” Once again the Govt. of South Africa sent him on a world tour with his wife and some of his teammates for another big television show round the world. Money and fame followed soon after. I feel he must have lost his head after that if he had not done so before.



To give you an idea of how these great feats are accomplished at the cost of the poor patients and then given wide publicity, I shall quote another event in Barnard’s life that will show the man in his true colour. The Time magazine was to honour the first man who initiated the artificial heart. An American showman wanted to grab that honour, but Michael DeBakey, a Lebanese born American, had been the father of artificial hearts, having devised it first. To outwit Debakey this actor surgeon got a letter written by Christian Barnard to him antedated six months earlier, congratulating him for inventing the artificial heart, thus making sure that The Time magazine gave equal, if not better, credit to him! Arrogant as he was Barnard could not keep this secret. He told his friends about it in his department. He also told his associates that he did this favour as he expected the other gentleman to reciprocate similar favours.





I could give you another example of frauds that the so-called great people commit. DeBakey, the innovative surgeon, was operating on a middle-aged patient trying to replace his badly damaged aortic valve. When he went in he found that the valve was badly calcified with the mouths of the coronary arteries almost closed up. He wondered as to how he could make this man live after the valve replacement without good blood supply to his heart muscle. Here he tried his new idea successfully. He had been toying with the idea of bypassing a blocked coronary artery with leg veins. He did not venture into that area, as he was not convinced that it is very good physiological solution to the problem! He must be a brilliant man. His doubts have been proved to be true now. However, with the patient on the table he had to something on the spot, however bad it could be in the long run. Pressed to the wall, he harvested the saphenous vein of the patient from the leg and reversed it to make a “jump-graft” from the proximal aorta to the distal portion of the patient’s coronaries-the first bypass surgery in a patient in 1963.



The patient did very well but, DeBakey did not tell the world what he did, as he wanted to study what happens to the patient in the long run, a real scientific way. To his bad luck, another surgeon did a successful copycat bypass surgery in 1967 learning the technique from Fulvero. This was reported in the same year making it the first operation of that kind. It was only in 1968, after five years’ observations, did DeBakey tell the world about the bypass surgery and showed that patient could live that long, as it was not known at that time. This is true science. Many people in our country also try to sell themselves in the media claiming such firsts to their credit, while there are a few real good cardiac surgeons in India (may their tribe increase) who have done milestone innovative studies in India. Unfortunately, it is the first category of copycats that get all the media publicity. It is true all over the world, if you try to get to the bottom of medical history. Most celebrated events are only medical claptrap.



In the whole bargain the man who struggled to discover the methods of heart transplant and many other innovating methods in cardiac surgery, Norman Shumway, the chief of cardiac surgery at Stanford, was forgotten. He quietly worked to perfect the technique that Barnard learnt from him and waited till such time those basic scientific advances were made to have safer human transplants. He waited till cadaver hearts could be successfully transplanted, as he did not want to “kill” the donor to harvest a beating heart to be transplanted. Since then he probably has the largest number of successful heart transplants done without fanfare and media publicity. The one time Barnard was dumbfounded in his rhetoric was when the ITV interviewer, the famous David Frost, confronted him with two uncomfortable questions. One “did you not kill the donor for Blaiberg to get publicity for you? And the other “did you not ride piggyback on your mentor Norman Shumway and steal his secrets?



Barnard the showman, did wriggle out by saying that he did not get the secrets from Norman, but from an article that the father of British cardiac surgery, Sir Russel Brock, wrote about the feasibility of heart transplants years ago. For the other question he said that the definition of brain death at that time allowed him to take a beating heart. That much for probity in medical research. My request to the public is not to be misled by publicity about medical miracles. If they are genuine they do not need publicity. My suggestion to medical students is not believe every printed word as gospel truth. There is a lot that does not get to the textbooks for obvious reasons. Truth is the first casualty in a world that runs on money and false glamour. Falsehood and mystery would drag millions by the nose. Truth, on the contrary, can influence only a score of people in a century. This was the opinion of Aristotle.



“ ‘Tis strange-but true; for truth is always strange; ”Stranger than fiction………………………………………………”

Lord Byron 1788-1824: in Don Juan 1819-1824.