End & Beginning

Eighteen days after Louis Washkansky received history's first transplant of a human heart, the Cape Town grocer died of double pneumonia. The underlying cause of the process that ended in death was clouded and likely to become the subject of medical dispute, but one thing was clear: it was not the failure of the transplanted heart. To the last, that organ functioned with a surprisingly strong and regular beat.

The complications that eventually killed Washkansky, 55, began twelve days after he had received the heart of Denise Ann Darvall, 25. He first showed signs of trouble by coughing up sputum and running a fever. X rays revealed a shadow, indicating what doctors call "infiltrates" in the lungs. One possible cause was a pulmonary embolism (a traveling blood clot). But the doctors at Groote Schuur Hospital concluded that the likeliest cause was pneumonia, and they attacked vigorously with heroic doses of penicillin.

25 Billion Cells. If pneumococci were indeed involved, the penicillin should have killed them. But Washkansky did not get better. Instead, his white-blood-cell count plummeted alarmingly. As is usual after major surgery, it had been high--about three times the normal. Now it fell within a few hours to a low normal. In an effort to keep the count from dropping fatally close to zero, the hematologists centrifuged eight pints of fresh blood to separate the white cells and infused an estimated 25 billion of them into an arm vein. Even then Washkansky's white count did not rise. Destruction of cells was obviously continuing.

Why? No one could be certain. In the hope of protecting the heart against attack by the immune reaction, doctors had dosed Washkansky heavily with half a dozen drugs, and at least two of these, in addition to radiation, might have made his white cells vulnerable.

After Washkansky died, the man who had made the transplant possible was despondent. Said Edward Darvall: "There was at least part of my daughter alive, and now it's all gone. I feel empty." (In fact, one of her kidneys, transplanted to Jonathan Van Wyk, 10, was still working well.) Brooklyn's Dr. Adrian Kantrowitz, whose own heart-transplant operation had failed two weeks earlier, expressed his sorrow, then added: "However, I believe that the operation performed by Dr. Christiaan Barnard represents a great step forward."

Post-mortem examination disclosed patches of pneumonia, caused by "a very virulent form of germ," in both of Washkansky's lungs. Drugs given to suppress the immune reaction had inevitably made the patient more susceptible to such an infection. Chief Surgeon Barnard summed up: "I wouldn't like to call this operation an experiment--it was treatment of a sick patient. Although Washkansky died, I don't think we have any evidence that transplantation is not good treatment for certain heart diseases. And we certainly have not found any evidence to discourage us from continuing."

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