Opinion

Not the year to be half-hearted about Barnard's legacy

02 July 2017 - 00:00 By Ray Hartle

December 3 this year will mark the 50th anniversary of the world ’s first human - to - human heart transplant, performed at Cape Town’s Groote Schuur Hospital by Professor Christiaan Barnard and his team.
The recipient was Louis Washkansky, a middle-aged businessman suffering from coronary artery disease. The donor, Denise Darvall, a 25-year-old bank clerk who had been knocked down in a hit-and-run on Observatory's Main Road, was declared brain dead and her father, Edward, agreed to the organ donation.
News of the successful transplant raced around the globe and the mass of humanity marvelled at the achievement. University of Cape Town medical school graduate Barnard's place in history was secured.
He was feted at home and internationally. He met kings, presidents and prime ministers, was given the seal of approval by a papal audience and consorted with the rich and famous.
Sadly, Washkansky died 18 days after receiving Darvall's heart.It is a human tendency at the death of someone to speak so highly of them so as to diminish, even ignore, their faults. This has been true of Barnard since he died in 2001 and, I dare say, will be evident in the sycophancy we can expect as we edge towards memorialising his achievement later this year.
South Africans, especially our politicians, will bask in the glory of past achievements.
Let's be clear. Barnard was highly intelligent and an incredibly hard worker.
Early in his career, he did far-reaching research into tuberculosis meningitis. Later, he did extensive research into intestinal atresia or bowel obstruction in newborn infants.
His work in lowering mortality in children with heart disease pegged the output of the best medical facilities in the world.
A big part of his medical legacy remains patient care, especially the intensive-care approach required after heart procedures.
An early mentor, US surgeon Walt Lillehei, widely regarded as "the father of open-heart surgery", said Barnard had the courage to proceed with transplantation when others, most notably Norman Shumway, hesitated, because of legal and ethical considerations.Barnard had prepared to the last detail in the years before the operation, including researching anti-organ rejection medication, critical for the survival of recipients. In addition, South African law left the decision on death up to the doctors.
Barnard's legacy sadly remains distorted by his support for apartheid. His achievement 50 years ago had huge positive spin-offs for the National Party regime.
While his individualism kept him from giving blind allegiance to his many NP friends, including prime minister John Vorster, he was an unequivocal apologist for apartheid, even as he repeatedly stated he was opposed to the policy.
He worked actively in promoting the government's policies internationally and was well rewarded for it, not least in having huge freedom and financial resources to continue his work at UCT and Groote Schuur. The biggest shortcoming of Barnard's legacy is not his fault, however.
Despite heart transplantation remaining the best viable treatment for end-stage heart failure, South Africa today performs a minuscule number of these procedures out of the roughly 5,000 performed worldwide each year, because of government funding cuts for tertiary treatment at public facilities like Groote Schuur.
In the Eastern Cape, for example, until recently there was only one cardiologist in the province's public sector. The rest of the country is marginally better.There is no better time than now for South Africa to recommit to the best aspects of Barnard's legacy and ensure that chronic heart disease is effectively treated.
• Hartle talks today on Chris Barnard's contested legacy at the National Arts Festival's Think!Fest in Grahamstown. He had a heart transplant in October

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