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The man who gave heart

Rasheeda Bhagat

``I DID not want to touch this girl until she was conventionally dead -- a corpse. I felt we could not put a knife into her until she was truly a cadaver.''

-- Christiaan N. Barnard, who pioneered heart transplant surgery in 1967.

The South Africa-born heart surgeon, Dr Christiaan Barnard, was often criticised for pioneering the heart transplant operation in the late 1960s, at a time when proper immuno-suppressant drugs were not available. His critics felt he had erred in performi ng a heart transplant before medical science knew enough about preventing organ rejection by the body. Cyclosporin came much later in 1974.

Dr Barnard made medical history in December 1967 when he put the heart of Denise Darvall, who died in a road accident, into 56-year-old Louis Washkansky. Though Washkansky survived only 18 days, eventually dying of pneumonia, the operation made an instan t international celebrity of Dr Barnard, who was born in 1922 to a struggling missionary family. His second patient survived longer, for about a year.

On being criticised for operating on Washkansky, a Reuters report quoted Dr Barnard as saying that the patient had diabetes and incurable heart disease and faced certain death without the operation. Moreover, he was aware of what he faced.

``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. But you would nev er accept such odds if there were no lion,'' Dr Barnard wrote later.

Though a celebrity, Dr Barnard excited controversy too. Apart from his medical and surgical skills, he was known to be a playboy in his early years and was seen with the likes of movie stars Sophia Loren and Gina Lollobrigida. He divorced his third wife in 1999.

Controversy surrounded his work too. Around the time of the transplant, there were a number of rumours doing the rounds in the medical community. According to reports just before the path-breaking transplant, Dr Barnard had gone to Stanford to look at th e work of a senior and respected American heart surgeon, Dr Shumway, who had been working in this area for long. He and his team had already developed the technique and done a lot of transplant work on animals.

Dr M. R. Girinath, chief cardiovascular surgeon at Apollo Hospitals, Chennai, says that despite this controversy ``he still made the grade because he was an innovator and a pioneer. He was the first one to have the guts to go ahead and do a human transpl ant.'' He added that an Indian surgeon -- Dr P. K. Sen -- too did a heart transplant within a few months of Dr Barnard. But his patient died within 24 hours.

Dr Girinath, who met Dr Barnard for the first time in the early 1960s when the latter visited Delhi's AIIMS, recalled that Dr Barnard had designed his own heart valve and it was called the University of Cape Town Valve as it had been developed in his hos pital laboratory. ``He came and did one or two operations at AIIMS, but then somebody leaked this information to the media and questions were raised in Parliament on how a South African surgeon was allowed to operate on Indian patients! After that he was not allowed to do any more operations.''

But, said Dr Girinath, ``the saddest thing about Dr Barnard's career was that after he did the heart transplant, and to a certain extent even when he did the first transplant, he had fairly advanced rheumatoid arthritis. So he was not doing much surgical work. Instead, he travelled all over the world promoting the cause of heart transplants and other things. But he himself did not do too much surgical work because his hands were pretty bad. He had a long fight with rheumatoid arthritis. But, of course, his team members continued to do transplant work.''

On what he admired most about the surgeon, Dr Girinath says, ``He was an innovator and in his own time made very significant contributions. But in his later life he was more involved in promoting the cause. All his innovation and contribution were much e arlier in life. The transplant was really a culmination of his professional life. He was a very handsome, affable and articulate man. He not only broke barriers when it came to a heart transplant in a human being, but also made substantial contributions in valve surgery too.''

Among Indian cardiac surgeons, probably the closest to Dr Barnard was Dr K. M. Cherian of the Madras Medical Mission. Paying the transplant-pioneer a tribute, Dr Cherian told Business Line, ``Both he and his wife Karen were good friends of mine. He was a n outstandingly skilled surgeon apart from being a great innovator and thinker. As it is well known, he did not only perform the first human heart transplant, he also pioneered many novel techniques such as the de novo transplant and piggy-back transplan t.''

The MMM has had a close relationship with Dr Barnard and ``his passing away will be a personal loss to us as he was one of the members of the international advisory board of our proposed Institute of Medical Sciences at Pondicherry''.

Dr Barnard had visited the MMM's institute of Cardio Vascular Diseases in Chennai when it was inaugurated in December 1995 and spent a week there. At that time he complimented Dr Cherian and his team for doing ``excellent work''. ``They are doing not onl y complicated acquired heart diseases but also very complicated congenital heart surgery. Now I have always said that congenital heart surgery separates the men from the boys because it is there that the skill of the heart surgeon is really tested,'' Dr Barnard had said.

Dr Cherian recalled that about six months ago Dr Barnard had had minor surgery performed on his nose in Austria and ``I had talked to him in the hospital immediately after the surgery. We spoke for about 20 minutes and he asked me about our Institute, th e work we are doing and also our Pondicherry Institute. He was very keen to come back to India and wanted to participate in the inaugural function.''

Ultimately the 78-year-old died of asthma, while lounging by a swimming pool in a hotel in Cyprus. A quiet way to go...without tubes or life-support systems making feeble attempts to coax his heart back to life.

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