Christiaan Barnard performed the first human-to-human heart transplant on December 3, 1967, at Groote Schuur Hospital in Cape Town, South Africa. The recipient, Louis Washkansky, survived 18 days before dying of pneumonia, raising an immediate question that still echoes in transplant medicine: what counts as “successful”? The operation itself was a technical triumph, but keeping a patient alive long afterward required breakthroughs in immunology and intensive care that were still years away.
What Happened on December 3, 1967
Washkansky was a 54-year-old grocer with end-stage heart failure. His donor was Denise Darvall, a 25-year-old woman fatally injured in a car accident. Barnard and a team of about 30 medical staff worked through the night, removing Darvall’s heart and transplanting it into Washkansky’s chest. The new heart began beating on its own, and Washkansky initially recovered well enough to sit up in bed and talk to visitors. Within days, though, infection set in. The drugs used to prevent his immune system from attacking the donor heart also left him defenseless against pneumonia, and he died on December 21.
Barnard carried out a second transplant early the following year. That patient, Philip Blaiberg, survived for almost 19 months and lived an active life during that time, a far more encouraging result.1PubMed Central. Christiaan Barnard-The surgeon who dared: The story of the first human-to-human heart transplant Over the next few years, four of Groote Schuur Hospital’s first ten heart transplant patients survived more than a year, with two of them living 13 and 23 years respectively.2PubMed Central. The first human heart transplant and further advances in cardiac transplantation at Groote Schuur Hospital and the University of Cape Town Those longer-term survivors helped shift the conversation from whether heart transplantation was a publicity stunt to whether it could become a standard treatment.
Decades of Animal Experiments That Made It Possible
Barnard did not work in a vacuum. The surgical techniques he used had been refined over more than half a century of animal research. At the beginning of the twentieth century, the French surgeon Alexis Carrel demonstrated that blood vessels could be stitched together end-to-end. His triangulation suturing technique for joining blood vessels is still the foundation of vascular surgery today.3PubMed. Alexis Carrel (1873-1944): visionary vascular surgeon and pioneer in organ transplantation Without a reliable method for connecting a donor heart to a recipient’s blood supply, transplantation would have been impossible.
The next major leap came from the Soviet surgeon Vladimir Demikhov, who performed the world’s first experimental heart and lung transplants in animals. Beginning in 1946, Demikhov carried out heart transplants in dogs at the Surgical Institute of the Moscow Academy of Sciences, and by 1947 he had completed the first orthotopic lung transplant as well.4PubMed. Vladimir P. Demikhov, a pioneer of organ transplantation His work proved that a transplanted heart could function in a new body, even though his animal subjects did not survive long. Demikhov’s monograph on experimental organ transplantation, published in Russian in 1960 and later translated into English and German, became essential reading for surgeons worldwide.5PubMed Central. At the cutting edge of the impossible: a tribute to Vladimir P. Demikhov
At Stanford University in California, Norman Shumway and Richard Lower refined what became the standard surgical technique. Working with dogs, they developed the orthotopic method of cardiac transplantation, in which the donor heart is placed in the normal anatomical position after removing most of the recipient’s diseased heart.6PubMed Central. Norman Shumway Many in the field expected Shumway to be the first to perform a human heart transplant, but Barnard moved faster. Shumway went on to perform more transplants than anyone else in the early era and became central to solving the immunological problems that plagued the procedure.
The Heart-Lung Machine Changed Everything
Open-heart surgery of any kind is impossible without a way to keep a patient alive while the heart is stopped. That technology arrived on May 6, 1953, when John Gibbon successfully used a heart-lung machine during surgery on an 18-year-old woman with a hole between the upper chambers of her heart.7PubMed. John H. Gibbon, Jr. Part I. The development of the first successful heart-lung machine The machine took over the job of pumping blood and adding oxygen, giving the surgeon time to work on a motionless, bloodless heart. Without cardiopulmonary bypass, as the technique is called, a transplant surgeon would have no way to remove a failing heart and sew a new one in its place.
Gibbon had spent more than two decades developing the device, starting with crude prototypes in the 1930s. The successful 1953 case opened the door to the entire modern era of cardiac surgery, from valve replacements to coronary artery bypass grafts to transplants. By the time Barnard attempted his transplant in 1967, bypass technology had matured enough that keeping Washkansky alive during the swap was technically routine, even if the transplant itself was not.
The Race and Its Near-Misses
Barnard was not the only surgeon preparing for a human heart transplant in the 1960s. In January 1964, James Hardy at the University of Mississippi transplanted a chimpanzee heart into a dying man, the first time a heart from any species had been placed in a human chest.8PubMed Central. In Memoriam: James D. Hardy The chimpanzee heart was too small to sustain a human circulation, and the patient died within hours. Hardy faced intense criticism, both scientific and ethical, for the attempt, but the case demonstrated that a transplanted heart could at least briefly take over for a human heart.
Just three days after Barnard’s operation in Cape Town, Adrian Kantrowitz at Maimonides Medical Center in Brooklyn attempted the first infant heart transplant.9PubMed. Origins of neonatal heart transplantation: an historical perspective The baby did not survive. Shumway performed his first human heart transplant in January 1968, and over the next year more than a hundred transplants were attempted at hospitals around the world. The results were grim. Most patients died within weeks or months, and by the early 1970s nearly every transplant program except Shumway’s at Stanford had shut down.
Why Most Early Patients Died
The human immune system treats a transplanted organ as an invader and attacks it. This process, called rejection, was the central problem of early transplantation. Surgeons knew it was coming, but the tools available to suppress the immune system in the 1960s were blunt instruments. High doses of steroids and azathioprine could slow rejection, but they also crippled the patient’s defenses against ordinary infections. Washkansky died of pneumonia precisely because the drugs keeping his new heart alive left him unable to fight off bacteria.
This trade-off between rejection and infection defined the first fifteen years of heart transplantation and nearly killed the field entirely. Programs closed, funding dried up, and public enthusiasm faded. Stanford’s program persisted largely on Shumway’s conviction that the immunological puzzle was solvable.
The turning point came with cyclosporine, a drug derived from a soil fungus. Cyclosporine suppresses the immune response more selectively than older drugs, dampening the rejection process without leaving the patient completely defenseless. After it was introduced into heart transplant programs in the early 1980s, one-year survival rates jumped to about 81%, and five-year survival reached roughly 60%, both significantly better than in the pre-cyclosporine era.10PubMed. Eight-year results of cyclosporine-treated patients with cardiac transplants The drug did not just improve heart transplant outcomes; it made lung transplantation clinically viable for the first time.11Transplantation Proceedings. Cyclosporine in thoracic organ transplantation Within a few years of cyclosporine’s adoption, transplant centers that had closed their programs reopened, and heart transplants went from rare experiments to an accepted treatment for end-stage heart failure.
Redefining Death to Save Lives
A heart transplant requires a donor heart, and a donor heart has to come from someone who has died. But in the 1960s, the legal and medical definition of death was tied to the cessation of heartbeat and breathing, not brain function. This created a paradox: if you waited for a donor’s heart to stop beating, the organ would be damaged by the time you removed it. To get a viable heart, surgeons needed to take it while it was still beating in a body whose brain had permanently stopped working.
Barnard’s transplant put this issue in the global spotlight. In 1968, a committee at Harvard Medical School published criteria for defining “irreversible coma,” what we now call brain death. The Harvard criteria required that a patient show no receptivity, no responsiveness, no movements or spontaneous breathing, no reflexes including brainstem reflexes, and a flat brainwave recording repeated after 24 hours with no change. Conditions like severe hypothermia or drug effects had to be ruled out first.12PubMed. How Harvard Defined Irreversible Coma
The adoption of brain death criteria was not instantaneous or universal. Different countries adopted variations at different speeds, and ethical debates continue in some communities to this day. But for transplant medicine, the Harvard criteria were transformative. They gave surgeons a legal and ethical framework for retrieving hearts that were still functional, dramatically improving the quality of donor organs and the outcomes for recipients.
Children and Newborns
Pediatric heart transplantation followed a slower, more painful trajectory than adult transplants. After Kantrowitz’s failed attempt in December 1967, sixteen years passed before anyone tried transplanting a heart into a newborn again. In 1984, two separate attempts were made, one in London and one in Loma Linda, California. The Loma Linda patient, known publicly as “Baby Fae,” received a baboon heart rather than a human one and survived about three weeks. Neither infant lived a month, but the media coverage around both cases gradually shifted public attitudes toward the idea of infant organ donation.9PubMed. Origins of neonatal heart transplantation: an historical perspective
The first successful neonatal heart transplant took place at Loma Linda on November 15, 1985. The recipient was a baby born with hypoplastic left heart syndrome, a condition in which the left side of the heart is so underdeveloped that it cannot pump blood to the body. That child survived into adulthood. After this breakthrough, the number of infant and pediatric heart transplants gradually increased, and programs around the world began accepting young children as candidates.9PubMed. Origins of neonatal heart transplantation: an historical perspective
Defining “success” in pediatric transplantation has always been tricky. The first child reported to the international registry who survived beyond one year was transplanted in 1968, the year after Barnard’s operation. Survival for these earliest patients was considerably shorter than in later eras, and retransplantation was more common, but the experience of managing them laid the groundwork for the pediatric programs that followed.13PubMed. The first successful pediatric heart transplant and results from the earliest era
What “Successful” Actually Means
The question “when was the first successful heart transplant” is deceptively simple because “successful” can mean very different things. If success means the transplanted heart functioned in the recipient’s body and the patient woke up, Barnard’s December 1967 operation qualifies, and Washkansky’s 18 days of survival are part of the answer. If success means long-term survival, Barnard’s second patient, who lived almost 19 months, or the later Groote Schuur patients who survived more than a decade, might be better candidates.
In the broader history of the procedure, the real transformation happened not with any single operation but with the convergence of better immunosuppression, brain death legislation, and improving surgical and postoperative care through the 1980s. By the end of that decade, one-year survival after a heart transplant had reached levels that made the procedure clearly worthwhile for patients who would otherwise die. The single dramatic moment in a Cape Town operating room mattered enormously as proof of concept, but it took nearly twenty more years of incremental progress before heart transplantation became a reliable therapy rather than a daring experiment.
Pig Hearts and Where Transplantation Goes Next
The biggest constraint on heart transplantation has always been the supply of donor organs. Far more people need hearts than die in circumstances that allow donation. This gap has driven interest in xenotransplantation, the transplantation of organs between species. In January 2022, a team at the University of Maryland transplanted a heart from a genetically modified pig into a 57-year-old man with end-stage heart failure who was not eligible for a conventional transplant. The pig had ten individual gene edits designed to prevent the human immune system from rejecting the organ, and the immunosuppression regimen used a newer approach based on blocking a specific immune signaling pathway. The transplanted heart functioned normally and showed no signs of rejection in the initial period.14PubMed Central. Genetically Modified Porcine-to-Human Cardiac Xenotransplantation
The patient, David Bennett, ultimately died about two months after the surgery. Researchers later identified a pig virus in the transplanted heart that may have contributed to his decline. Despite that outcome, the case demonstrated that a genetically engineered pig heart could sustain a human being for a meaningful period. Several more pig-to-human heart transplants have since been attempted, and the timeline for making xenotransplantation routine remains uncertain. But the parallel to Barnard’s era is striking: a first case that proved the concept, followed by setbacks that clarified how much more work remained.
Whether pig hearts eventually become a practical alternative to human donors depends on solving problems that rhyme with the ones Shumway and Barnard faced in the 1960s: managing the immune response, preventing infection, and keeping the transplanted organ healthy long-term. The tools are more sophisticated now, from gene editing to targeted immunosuppression, but the fundamental challenge of persuading one body to accept tissue from another has not gone away. Each era of transplantation has been defined less by its landmark first surgery than by the years of painstaking work that followed.