Louis Joshua Washkansky (12 April 1912 – 21 December 1967) was a South African man who was the recipient of the world's first human-to-human heart transplant, and the first patient to regain consciousness following the operation. Washkansky lived for 18 days and was able to speak with his wife and reporters.1967 Year In Review
/ref>''S Afr Med J'',
A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town
, Barnard CN, 1967 Dec 30; ''41''(48): 1271–74.Louis Washkansky (1913 – 1967)
Science Museum. Louis was born in Lithuania in 1913 and moved to South Africa in 1922. Washkansky was actually the second human recipient of a heart transplant overall, in that James Hardy had done a transplant in 1964 in which Boyd Rush received a chimpanzee's heart, although the patient in that case only survived an hour and did not regain consciousness.Heart Transplantation in Man: Developmental Studies and Report of a Case
''JAMA'' (''Journal of the American Medical Association''), James D. Hardy, MD; Carlos M. Chavez, MD; Fred D. Kurrus, MD; William A. Neely, MD; Sadan Eraslan, MD; M. Don Turner, PhD; Leonard W. Fabian, MD; Thaddeus D. Labecki, MD; 188(13): 1132-1140; 29 June 1964.Donald McRae, ''Every Second Counts: The Race to Transplant the First Human Heart'', Chapter 7 "Mississippi Gambling," Penguin Group (G.P. Putnam's Sons), 2006
pages bottom 122 through 127

Biography

Washkansky was a Lithuanian Jew, the youngest of the four children of Abe Washkansky and his wife, Chana Yentel Kemelgor. In 1912, when Washkansky was three months old, his father emigrated to South Africa without his family and started a business as a produce merchant. As a result of

World War I World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was List of wars and anthropogenic disasters by death toll, one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, ...

and its aftermath, Chana and the children were not able to re-unite with Abe in Cape Town until 1923. Washkansky attended Cape Town High School, where he passed the standard eight, before entering the grocery business in

Cape Town Cape Town ( af, Kaapstad; , xh, iKapa) is one of South Africa's three capital cities, serving as the seat of the Parliament of South Africa. It is the legislative capital of the country, the oldest city in the country, and the second largest ...

. He saw active service in

World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the World War II by country, vast majority of the world's countries—including all of the great power ...

East East or Orient is one of the four cardinal directions or points of the compass. It is the opposite direction from west and is the direction from which the Sun rises on the Earth. Etymology As in other languages, the word is formed from the fac ...

and

North Africa North Africa, or Northern Africa is a region encompassing the northern portion of the African continent. There is no singularly accepted scope for the region, and it is sometimes defined as stretching from the Atlantic shores of Mauritania in ...

and Italy. Washkansky was an avid sportsman. He took part in

football Football is a family of team sports that involve, to varying degrees, kicking a ball to score a goal. Unqualified, the word ''football'' normally means the form of football that is the most popular where the word is used. Sports commonly ...

swimming Swimming is the self-propulsion of a person through water, or other liquid, usually for recreation, sport, exercise, or survival. Locomotion is achieved through coordinated movement of the limbs and the body to achieve hydrodynamic thrust that r ...

, and

weightlifting Weightlifting generally refers to activities in which people lift weights, often in the form of dumbbells or barbells. People lift various kinds of weights for a variety of different reasons. These may include various types of competition; pro ...

. Later on in life, he suffered heart problems and required a heart transplant.

Medical background

However, later in Washkansky's life his health declined substantially: he was

diabetic Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level (hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

, and had an incurable heart disease, causing him to suffer three

heart attack A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which ma ...

s. The last of these heart attacks led to

congestive heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, ...

. In April 1966, Washkansky visited

Groote Schuur Hospital Groote Schuur Hospital is a large, government-funded, teaching hospital situated on the slopes of Devil's Peak in the city of Cape Town, South Africa. It was founded in 1938 and is famous for being the institution where the first human-to-huma ...

due to his pre-existing illness. He was first seen by Barry Kaplan, who in July 1966 had asked if

Christiaan Barnard Christiaan Neethling Barnard (8 November 1922 – 2 September 2001) was a South African cardiac surgeon who performed the world's first human-to-human heart transplant operation. On 3 December 1967, Barnard transplanted the heart of accident-v ...

would be willing to attend Washkansky. Barnard had performed a number of laboratory tests and an in-depth examination on Washkansky and came to the conclusion that nothing could be done to help him. In January 1967, Washkansky was referred to

Mervyn Gotsman Mervyn S. Gotsman is Professor Emeritus of Cardiology at the Hebrew University of Jerusalem and Hadassah Medical Center in Jerusalem, Israel. Biography Mervyn Samuel Gotsman was born in 1935 in the town of Hermanus in South Africa to Benjamin, ...

, a cardiologist at the Cardiac Clinic in Groote Schuur Hospital, due to refractory heart failure. Washkansky underwent cardiac catheterisation confirming severe heart failure, and was subsequently referred to Barnard for possible surgery. Washkansky was re-admitted to Groote Schuur on 14 September 1967, which was also the Jewish New Year. As a result of heart attacks in 1965, approximately only one third of his heart was still functioning. In late October, he went into a diabetic coma, but regained consciousness. Once, when he was swollen with fluid and in considerable pain, his wife Ann asked him in a whisper how he was doing. He managed a smile and whispered, "I'm on top of the world." He was also suffering from kidney and liver failure. On 10 November, Val Schrire put forward Washkansky as a possible heart transplant candidate. When Barnard met with Washkansky, Barnard explained the possibility of a transplant and Washkansky was agreeable to the possibility. Afterwards, Ann found her husband Louis to be "oddly buoyant." When Barnard later explained the possibility of a transplant to both of them, the idea was so new that Ann initially worried her husband might absorb some of the personality of the donor heart. Barnard stated to Ann and Louis Washkansky that the proposed transplant had an 80% chance of success,Calculated Risks: How to Know When Numbers Deceive You
Gerd Gigerenzer, Simon & Schuster, 2002. which has been criticised as "misleading".A Companion to Bioethics, Second Edition
Helga Kuhse, Peter Singer, Wiley-Blackwell, 2012. Part of the pre-op procedure was to take swabs from Washkansky's skin, nose, mouth, throat, and rectum to find out what bacteria lived on and in his body, so that the most effective antibiotics could be given after the transplant. He was also frequently washed down with Phisohex.

Potential transplant in November 1967

In late November 1967, a potential donor was identified. A young black man had fallen off a truck and suffered a catastrophic head injury. Although the Chief of Cardiology, Val Schrire, had previously expressed a strong preference to avoid a "coloured" donor, police approached the young man's family for permission for him to be a heart donor. McRae writes that the family was "in shock after they were confronted by a policeman". The EKG of the donor heart, however, showed depressed ST segments, meaning that it might have been damaged or was not receiving enough oxygenated blood and gave the reluctant Val Schrire a medical reason not to continue with the transplant of a "

coloured Coloureds ( af, Kleurlinge or , ) refers to members of multiracial ethnic communities in Southern Africa who may have ancestry from more than one of the various populations inhabiting the region, including African, European, and Asian. South ...

" donor heart in apartheid South Africa. Washkansky, who had been cleaned and shaved for the possible attempt, felt let down and disappointed when it did not go forward. He felt his future chances were slim.

Operation and outcome

Washkansky received his heart transplant on 3 December 1967, at the

South Africa South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring coun ...

. The operation lasted approximately six hours,1967: First Heart Transplant Patient Goes Under the Knife
''Haaretz'', This Day in Jewish History, David B. Green, 3 December 2013. " . . When he was 9, his mother took him ouis Washkanskyand his three siblings to Cape Town, to join their father, who had come ahead of the family . . "Christiaan Neethling Barnard
South African History Online, updated 11 January 2017. beginning at 01:00, with

leading a team of thirty surgeons, anaesthetists, nurses and technicians. His brother Marius Barnard assisted with the surgery. 25-year-old

Denise Darvall __NOTOC__ Denise Darvall (27 February 19423 December 1967) was the donor in the world's first successful human heart transplant, performed at Groote Schuur Hospital, South Africa, by a team of surgeons led by Christiaan Barnard. Accident and ...

and her mother had been struck by a drunk driver while crossing a busy street on a Saturday afternoon. Her mother died at the scene. Denise was taken to Groote Schuur. Peter Rose-Innis, the hospital's senior neurosurgeon, attended to her. A skull X-ray showed two serious fractures. She showed no sign of pain when ice water was poured in her ear. In addition, her brain had no sign of electrical activity. A blood transfusion and respirator maintained the beat of her heart. Coert Venter and Bertie Bosman were the doctors who approached Denise's father Edward Darvall and asked for permission to use her heart for a possible transplant. He had been at the scene of the original accident and had been sedated after being brought to the hospital. As he waited, he thought they were still trying to save his daughter's life. Bosman told him there was a man in the hospital who was desperately ill and in need of a heart transplant, and perhaps Edward could do him a great kindness if they would allow them to transplant his Denise's heart. Bosman and Venter withdrew from the room, saying that he should take as long as needed to consider their request and that they would understand if he declined to give his consent. In the four minutes Edward Darvall took to reach his decision he thought of his daughter, a birthday, and a gift she had given to him from a first salary. He began to cry and decided what needed to be done. He composed himself and summoned the doctors back to the small room. He told them that if they could not save his daughter, they must try to save this man.''Every Second Counts'', McRae
page 189
Although Washkansky died of

pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severit ...

eighteen days after the transplant because of a weakened immune system, Barnard regarded the surgery as a success because the heart was "not being stimulated by an electrical machine". As Barnard related in his book, ''One Life'', a decision was made on the fifth postoperative day to bombard Washkansky's system with immunosuppressants to guard against a potential rejection of the new heart. As later heart transplants would reveal, the signs noted at that time were part of a resettling program for the new heart and not necessarily an indication of rejection.

References

External links

South African history: Louis WashkanskyWorld's First Heart Transplant1World's First Heart Transplant2Denise Darvall the donor for the World's First Heart TransplantArticle from Life Magazine, 15 December 1967
{{DEFAULTSORT:Washkansky, Louis 1912 births 1967 deaths Heart transplant recipients People from Cape Town South African Jews South African people of Lithuanian-Jewish descent Deaths from pneumonia in South Africa Lithuanian emigrants to South Africa White South African people 1967 in medicine Grocers South African military personnel of World War II Lithuanian Jews nl:Louis Washkansky