Cape Town's Second

Like most South Africans, regardless of color and social status, Clive Haupt was stirred by Louis Washkansky's heart transplant. When Washkansky died, Garment Worker Haupt, 24, said to a neighbor: "I hope the next transplant succeeds." If the statement was obvious and unremarkable then, it soon gained poignancy. For the next transplant involved Haupt's own heart.

While Surgeon Christiaan N. Barnard was visiting the U.S. during Christmas week, he got reports from Cape Town that the patient next in line for a transplant, Philip Blaiberg, 58, was getting weaker. Several coronary occlusions had compelled Blaiberg to give up his practice as a dentist and caused irreparable damage to his heart, which was steadily failing. On Dr. Barnard's return, the transplant team at Groote Schuur Hospital was ready. So was Blaiberg, who insisted that he wanted the next transplant even when Barnard told him of Washkansky's death. But where would the heart come from? And would it come soon enough for a man who was clearly going downhill?

Color & Consent. It was a hot New Year's Day when Clive Haupt and his bride of three months went with friends to Fish Hoek Beach. Haupt played pickup rugby, then lay down to rest. Suddenly a friend called that Haupt was ill, with frothy blood coming from his mouth. From a local hospital, he was shuttled fast to the better-equipped Victoria Hospital, where doctors concluded that he had suffered a stroke--a massive brain hemorrhage. They saw little hope that he could survive. But since Haupt had apparently been fit, his heart was probably in good condition, so they telephoned the surgeons at Groote Schuur, who did not hesitate to say "Bring him in."

Dr. Barnard now had a delicate problem. Haupt was of a complicated racial mixture (part white, part Bantu, part Malay, perhaps even part Hottentot) that is classified as "Colored" under South Africa's race laws. Dr. Barnard asked Blaiberg whether he would object to receiving a Colored man's heart. No, replied the desperate patient--who, like Washkansky, happened to be Jewish. Then the surgeons had to get consent from Haupt's next of kin. His wife Dorothy collapsed when she was told he could not survive. To protect themselves, the doctors asked Haupt's mother. Widowed three years ago (her husband died of a stroke), she agreed to donate her son's heart.

While Haupt lingered through the night, pathologists and hematologists compared his blood type and cells with Blaiberg's. By a 12-to-l chance, both had type B, Rh-positive. Droplets of serum containing Haupt's white cells were pipetted onto dime-size disks in a plastic tray, each disk containing a cell-reagent preparation. The intensity of the reactions on different disks was noted, and compared with those already obtained from Blaiberg's cells. The cells, concluded Pathologist Martinus C. Botha, were a fairly good match. Not identical--that is impossible--but similar enough to suggest that Blaiberg's rejection mechanism would not react too strongly against a transplant.

No Shock. It fell to Dr. Raymond Hoffenberg, the duty doctor at Groote Schuur at the time, to assess Haupt's condition and his chances of survival. Hoffenberg concluded that even if extreme measures were used to support breathing, the patient could not live long. He lay in a deepening coma. When Haupt's heart stopped, it was Dr. Hoffenberg who certified that he was legally dead. That came at 10:35 a.m. Tuesday. One group of surgeons began to remove Haupt's heart. In the operating room where Washkansky had received his transplant other surgeons had Patient Blaiberg almost ready.

At 11:30 a.m. they opened his chest and made the necessary connections to a heart-lung machine to supply oxygenated blood to his body (except the heart) and brain. Then they removed his heart. In its place, Dr. Barnard installed Haupt's heart, using essentially the same technique as in Washkansky's case (TIME, Dec. 15). There was, however, a different atmosphere. The 30-man team of surgeons, physicians and nurses were less tense. As Barnard put it: "We are not going into the unknown--we are going where we have been before." Another difference was encouraging. The transplanted heart began beating spontaneously when it was hooked into Blaiberg's circulation, needing no electric shock to start it.

The operation, to the time Blaiberg's chest was closed, took five hours. When he regained full consciousness next morning, his first words were: "I'm thirsty. Please give my regards to my wife." Almost immediately Blaiberg was moved to a new hospital wing where, to guard him against an infection such as that which killed Washkansky, he was as isolated as antiseptic ingenuity could make him. Doctors and nurses en tering his room had first to undress in one antechamber, then scrub, then mask and robe themselves in sterile garments. Warned by experience that they might have overtreated Patient Washkansky, the doctors were giving Blaiberg fewer immunosuppressive drugs and in smaller doses. "Perhaps we treated the last patient too early for rejection," Dr. Barnard said. "We are not going to make the same mistake again." Four days after the transplant, the doctors could see no sign of either infection or a rejection reaction. Blaiberg's condition was better than Washkansky's had been at the same stage, with good circulation and all organ functions returning toward normal. He was eating well, and making small talk. Said Barnard: "I would say he is definitely going to live longer than he would without the operation. I cannot say how many months or how many years, but he will live a much more comfortable life than before. This is going very well and I am very glad of it."

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