Christiaan Neethling Barnard (November 8, 1922 - September 2, 2001)
In Memoriam Christiaan Neethling Barnard:
Professor Chris Barnard died in Cyprus, where he was on holiday, on September 2, 2001, shortly before he was to complete 79 years of life. Ironically, he was faulted by the organ that was the objective of his professional life.
Christiaan Neethling Barnard was born in the small town of Beaufort West, in the Western Cape, South Africa, on November 8, 1922. Son of a church pastor, one of his four brothers died from heart disease at the age of five, which probably had an influence in Chris' choice of profession. His younger brother, Marius, was also to follow in his steps, and eventually became his right-hand man in the Department of Cardiac Surgery.
In 1946 he graduated (MB, ChB) from the University of Cape Town, where he was not considered an outstanding student. This was followed by his internship at the Groote Schuur Hospital. He then served as a family physician in the Western Cape until 1951. Subsequently, he moved back to Cape Town and worked at the City Hospital as a Senior Resident Medical Officer, and in the Department of Medicine at the Groote Schuur Hospital as a Registrar. In 1953, he received the degree of Master of Medicine (MMed) from the University of Cape Town, and in the same year he was awarded a MD (Doctor of Medicine) degree from the same university for a dissertation on tuberculous meningitis. He was then appointed Registrar (resident) in the Department of Surgery, at the Groote Schuur Hospital.
In 1956, he received a scholarship for a two-year postgraduate training in cardiothoracic surgery at the University of Minnesota, Minneapolis, USA. In 1958 he received a Master of Science in Surgery for a thesis entitled, "The aortic valve - problems in the fabrication and testing of a prosthetic valve." The same year he was awarded Doctor of Philosophy degree for his dissertation entitled "The aetiology of congenital intestinal atresia."
Barnard described the two years he spent in the USA as "the most fascinating time in his life." He returned to South Africa triumphantly and continued to work at the Groote Schuur Hospital as a specialist in cardiothoracic surgery. He was promoted to full-time lecturer and Director of Surgical Research at the University of Cape Town. Three years later he was appointed Head of the Division of Cardiothoracic Surgery at the teaching hospitals of the University of Cape Town. He rose to the position of Associate Professor in the Department of Surgery at the University of Cape Town in 1962. In the subsequent years, he became known as a brilliant surgeon with many contributions to the treatment of cardiac diseases, such as the Tetralogy of Fallot and Ebsteins' malformation. He was promoted to Professor of Surgical Science in the Department of Surgery at the University of Cape Town in 1972. Among the many awards he has received over the years, he received the title of Professor Emeritus (1984).
On the night of December 2, 1967, Professor Barnard performed the first human heart transplantation. The patient was Louis Washkansky, who had diabetes and incurable heart disease. Washkansky could either wait for certain death or risk transplant surgery with an 80 percent chance of surviving. He chose the surgery. As Barnard later wrote, "For a dying man it is not a difficult decision because he knows he is at the end. 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."
Although the patient survived only 18 days, this feat was a milestone in a new field of life-extending surgery. Barnard became an international superstar overnight and was celebrated around the world for his daring accomplishment. "On Saturday, I was a surgeon in South Africa, very little known. On Monday, I was world renowned." That's how he recalled events in December of 1967. He was later to be also the first to perform a heterotopic heart transplant, an operation that he himself devised. Forty-nine consecutive heterotopic heart transplants were performed in Cape Town between 1975 and 1984. And when many surgeons, disillusioned by poor results, gave up cardiac transplantation, he persisted in his efforts until the advent of Cyclosporin helped revive the operation throughout the world. He was also the first surgeon to attempt xenograft transplantation in a human patient, in a desperate move to save the life of a young girl he could not wean from the pump after a redo aortic valve replacement. He was later accused of wrongdoing by her parents.
He became known as the "film star surgeon". He was loved by his patients throughout the world, hundreds of whom were treated free of charge, and hated by many other persons, who were jealous of his instant success. He was accused by some colleagues in the profession of "stealing " the idea and the opportunity to perform the first heart transplantation.
Often considered as a spoiled and arrogant personality, he was nonetheless kind and considerate. Soon after the first transplant, when I was an unknown fourth-year medical student in a different country, I wrote to him with questions about the ethical and legal problems arising from heart transplantation, which were the theme of a dissertation I had to present to my faculty. To the surprise of many around me, I received a personal letter from him, answering my questions one by one. Despite his fame, he cared. When I first met him personally 13 years later, he still remembered this episode.
In 1969, he divorced his first wife, with whom he had two children, and in 1970 married again, to a beautiful fashion model. They had two boys, but became divorced in 1982. He remarried in 1988 to another fashion model, and this union also produced two children, but they were divorced in 2000.
In 1983, because of the rheumatoid arthritis that affected his hands and thus prevented him from operating, he retired as Head of the Department of Cardiothoracic Surgery in Cape Town. He then spent two years as the Scientist-In-Residence at the Oklahoma Transplantation Institute in the USA and acted as consultant for other institutions. His medical reputation would later be damaged by his endorsement in 1986, of an "anti-ageing" skin cream that turned out to be of dubious effectiveness and was withdrawn from the U.S. market one year later. He also spent time as a research advisor to the Clinique la Prairie, in Switzerland, where the controversial "rejuvenation therapy" was practiced.
He divided the remainder of his years between Austria, where he established the Chris Barnard Foundation, dedicated to helping underprivileged children throughout the world, and his game-farm in Beaufort West, in South Africa. He wrote a cardiology text, and several novels, including a thriller about organ transplantation. Earlier, he had penned his autobiography, One Life, which sold worldwide and whose royalties he generously donated to the Chris Barnard Fund, for the support of research in heart disease and organ transplantation in Cape Town. Twenty years later, he traced his subsequent life in The Second Life.
I last met Chris in Paris in July of last year, where he was feted as one of the Pioneers of Cardiac Surgery. He clearly was still enjoying life, and, more than that, was happy that he had lived a good and worthwhile existence. With his passing, we have lost a great surgeon and a fine personality. He definitely influenced my own choice of a professional career, as I am sure he did for many other surgeons around the globe
Manuel J Antunes, MD, PhD, DSc.
Hospitais Da Universidade