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On 3 December 1967, Christiaan Barnard performed the first heart transplantation in the world at Groote Schuur Hospital in Cape Town, South Africa. In the succeeding months, heart transplantations in the USA, Asia and Europe followed. On 14 April 1969, Åke Senning successfully accomplished the first heart transplantation in Switzerland at the former Cantonal Hospital in Zurich. In the summer of 1969, he undertook a second heart transplantation. Although the surgical procedure went well technically, both patients died within weeks to months after transplantation. Causes of death were infection in the first and rejection in the second patient. Senning’s colleagues around the world had similar experiences. Survival after heart transplantation was unacceptably low. The heart transplant community recognised the lack of knowledge about immunological processes and appropriate immunosuppressive regimens as underlying reason for the early deaths. Most transplant centres decided to refrain from heart transplantation until sufficient immunological insight became available. After the introduction of the new immunosuppressive drug ciclosporin into the clinic and the availability of tools to monitor rejection in the early 1980s, heart transplant programmes were restarted all over the world. The legal recognition of brain death allowed procurement of donor hearts without exposure to warm ischaemia, and the principle of cold storage enabled prolongation of ischaemia time and acceptance of donors in distant hospitals, resulting in enlargement of the donor pool. In Switzerland, Marko Turina resumed heart transplantation in 1985 at Senning’s former workplace in Zurich. The number of heart transplants in Switzerland and in the world grew rapidly because the outcome markedly improved. Particularly over the long-term, survival in Zurich surpassed the outcome worldwide. Zurich created internationally recognised milestones such as transplantation of patients with grown-up congenital heart disease, the implementation of the bicaval instead of the right atrial anastomosis during the transplant procedure and the dual transplantation of one heart. Since the middle of the 1990s, however, the number of heart transplants has plateaued, mainly because of donor shortage. The current era is characterised by efforts to increase the number of donors. The utilisation of marginal donors, the change from informed to presumed consent for organ donation and donation after cardiocirculatory-determined death have been proposed to augment the donor pool.

The first human-to-human heart transplantation in Czechoslovakia, and the 25th transplantation in the world, was performed in Bratislava, the second largest city in Czechoslovakia on July 9, 1968. The operation was carried out by a team led by Professors Karol Siska and Ladislav Kuzela at the second Surgical Clinic at the Comenius University of the Medical Faculty in Bratislava, Partizanska Street-only seven months after the first heart transplantation performed by Dr. Christiaan Barnard in Cape Town. Other members of the team in Bratislava included surgery recipients Siska, Kuzela, Pivkova, Holoman; surgery donors Schnorrer, Kuzela, Holoman; an extracorporeal circulation team of Treger, Carsky, Podolay; anesthesiologists Sobesky and Neumanova; operating room nurses Machkova, Homerova, Kralova, and operating room laboratory technician Malinova. The donor was P.V., a 46-year-old man, who suffered from a deadly brain trauma. The recipient was S.H., a 54-year-old woman with a failing heart, heavily affected diseased lungs, kidneys and liver. Her heart began to work, but lasted only for five hours. (Additional members of the team, Prof. Simkovic and Drs. Silvay and Sujansky were in the USA at the moment of transplantation, in Houston and New York, subsequently) (Tab. 1, Fig. 2, Ref. 62). Keywords: first heart transplantation in Bratislava, 2nd Surgical Clinic at the Comenius University.

Heart failure or congestive heart failure remains a major public health concern on the global scale. End-stage heart failure is a severe disease where the heart is unable to pump enough oxygen and nutrients to other tissues and organs of the body. When the lines of treatment of heart failure such as lifestyle adjustments, medical management, and device therapy fail, a patient may be deemed a candidate for heart transplantation. This article reviews the history of heart transplantation, complications post-heart transplantation, and nursing management considerations for the immediate period after heart transplant surgery.

50 years have passed since the first human to human heart transplantation, performed by Christiaan Barnard in Cape Town December 3rd 1967. Over the years there has been a dramatic improvement in postoperative survival, mainly due to numerous diagnostic and therapeutic advances. Today, heart transplantation constitutes the treatment of choice among suitable patients with severe heart failure who worsen despite medical and surgical optimization. The world average 10-year survival has now reached more than 58 %. This text summarizes the past, present and future.

Heart transplantation has become a standard therapy option for advanced heart failure. The translation of heart transplantation from innovative experiments to long-term clinical success has married prescient insights with discipline and organization in the domains of surgical techniques, organ preservation, immunosuppression, organ donation and transplantation logistics, infection control, and long-term graft surveillance. This review explores the key milestones of the past 50 years of heart transplantation and discusses current challenges and promising innovations on the clinical horizon., (© 2018 American Heart Association, Inc.)

Article on the first heart transplant, performed at Groote Schuur Hospital, Cape Town, on 3 December 1967. Reprinted from the SAMJ of 30 December 1967 to commemorate the 50th anniversary of the transplant.

Article on the first heart transplant, performed at Groote Schuur Hospital, Cape Town, on 3 December 1967. Reprinted from the SAMJ of 30 December 1967 to commemorate the 50th anniversary of the transplant.

Health research, as a social good, needs to be conducted in the interests of the common good. Because of the unfortunate exploitation of research participants globally, safeguards for protections are necessary. Most international codes and guidelines originated as responses to the abuse and mistreatment of research subjects. By the 1890s, antivivisectionists were already calling for laws to protect children, as a result of the increasing numbers of institutionalised children being subjected to vaccine experiments in Europe and the USA. Just after the turn of the century, the first attempt to test a polio vaccine was thwarted after the American Public Health Association condemned the programme. In South Africa, medical scientists were busy with discoveries and innovations as far back as the 1800s. In December 1967, the historic first human heart transplant was undertaken in Cape Town. Although it is unclear how much research preceded this procedure, there is no doubt that the operation was done in a research setting, and it had a far-reaching impact.

How death should be measured was a subject of intense debate during the late 1960s, and one in which transplant surgeons had a particular interest. Legislation required a doctor to first pronounce 'extinct' the patients from whom 'spare parts' were sought for grafting. But transplant surgeons increasingly argued the moment of death was less important than was the moment of establishing that a patient was beyond the point of no return in dying, at which time she or he should be passed to the transplant team. This raised concerns that people identified as being a potential source of organs might not be adequately cared for in their own right. In 1968 the World Medical Association issued an international statement on death at its meeting in Sydney, Australia following a debate between delegates about how and by whom death should be assessed prior to organ removal. Soon afterwards Australian surgeons performed two of the one hundred and five heart transplants carried out around the world that year, dubbed by the New York Times to be one during which an 'international epidemic' of such grafts were carried out. This essay examines debates about death and transplanting, then analyses the pioneering Australian heart transplants, in the context of the Declaration of Sydney and continuing international discussions about whether these operations were moral and legal.

On December 2, 1967, when Denise Darvall was hit by a car, a surgery that made medical history was unfold: Hamilton Naki, a black man, expertly removed her heart and gave it to Christian Barnard, who was preparing the receptor, Louis Washkansky, in an adjacent operating room. Naki's contribution was an outlaw act, a criminal offense under the laws of apartheid due to the difference of races; the law forbade him to cut white meat or touch white blood. Naki was perhaps the second most important man in the team that day. There were few photographs where he and Barnard appeared together, but because of the nature of society was Barnard who won the world's attention.

Mechanical circulatory support of the failing heart has become an important means of treating end-stage heart disease. This rapidly growing therapeutic field has produced impressive clinical outcomes and has great potential to help thousands of otherwise terminal patients worldwide. In this review, we examine the state of the art of mechanical circulatory support: current practice, totally implantable systems of the future, evolving biventricular support mechanisms, the potential for myocardial recovery and adjunctive treatment methods, and miniaturized devices with expanded indications for therapy.

This article features 1999-2008 trends in heart transplantation, as seen in data from the Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR). Despite a 32% decline in actively listed candidates over the decade, there was a 20% increase from 2007 to 2008. There continues to be an increase in listed candidates diagnosed with congenital heart disease or retransplantation. The proportion of patients listed as Status 1A and 1B continues to increase, with a decrease in Status 2 listings. Waiting list mortality decreased from 2000 through 2007, but increased 18% from 2007 to 2008; despite the increase in waiting list death rates in 2008, waiting list mortality for Status 1A and Status 1B continues to decrease. Recipient numbers have varied by 10% over the past decade, with an increased proportion of transplants performed in infants and patients above 65 years of age. Despite the increase in Status 1A and Status 1B recipients at transplant, posttransplant survival has continued to improve. With the rise in infant candidates for transplantation and their high waiting list mortality, better means of supporting infants in need of transplant and allocation of organs to infant candidates is clearly needed.

In recent years scientists have created genetically modified pigs for the purpose of xenotransplantations. These are transplants of animal organs into human patients. But xenotransplantation has a long history. Since the early twentieth century, many surgeons tried to insert animal organs into human and non-human bodies. This paper examines the controversies that these innovations have caused in the United States and France, including the notion of the objectification of animals. Three phases are described. The historical review shows that far from the choice of pigs being "natural" it turns out to be recent and to follow controversies surrounding the possible use of primates. During the last phase, the scientists have internalized the "animal issue" in their practice: the official donor is now the pig, and the animals are treated respectfully during all the lab manipulations. Since pigs are different from humans they can be objectified and thus absorbed. This objective distance is, however, threatened by new discourses on animal rights, by genetic manipulations that "humanise" pigs, and by scientific practice itself that recognizes a moral proximity between pigs and men.

Vladimir P. Demikhov (1916-1998) performed the world's first experimental intrathoracic transplantations and coronary artery bypass operation. His successes heralded the era of modern heart and lung transplantation and the surgical treatment of coronary artery disease. Even though he was one of the greatest experimental surgeons of the 20th century, his international isolation fueled speculation, suppositions, and myths. Ironically, his transplantation of a dog's head drew more publicity than did his pioneering thoracic surgical accomplishments, and he became an easy target for criticism. An account of Demikhov's life and work is presented herein.

Christiaan (Chris) Barnard was born in 1922 and qualified in medicine at the University of Cape Town in 1946. Following surgical training in South Africa and the USA, Barnard established a successful open-heart surgery programme at Groote Schuur Hospital and the University of Cape Town in 1958. In 1967, he led the team that performed the world's first human-to-human heart transplant. The article describing this remarkable achievement was published in the South African Medical Journal just three weeks after the event and is one of the most cited articles in the cardiovascular field. In the lay media as well, this first transplant remains the most publicised event in world medical history. Although the first heart transplant patient survived only 18 days, four of Groote Schuur Hospital's first 10 patients survived for more than one year, two living for 13 and 23 years, respectively. This relative success amid many failures worldwide did much to generate guarded optimism that heart transplantation would eventually become a viable therapeutic option. This first heart transplant and subsequent ongoing research in cardiac transplantation at the University of Cape Town and in a few other dedicated centres over the subsequent 15 years laid the foundation for heart transplantation to become a well-established form of therapy for end-stage cardiac disease. During this period from 1968 to 1983, Chris Barnard and his team continued to make major contributions to organ transplantation, notably the development of the heterotopic ( 'piggy-back') heart transplants; advancing the concept of brain death, organ donation and other related ethical issues; better preservation and protection of the donor heart (including hypothermic perfusion storage of the heart; studies on the haemodynamic and metabolic effects of brain death; and even early attempts at xenotransplantation.

The article analyzes academic production about the debate surrounding the definition of brain death, based on bibliographic and documental research of international medical periodicals in the 1960s. The development and adoption of life support technologies during the twentieth century sparked a heated debate that sought to legitimize new procedures like organ transplants. As its practices changed, medical science set about inventing new knowledge about these practices. Discussions as to the definition of brain death turned it into a 'black box', dismantled by anthropological studies into the topic starting in 1980s. The present article explores the deconstruction of brain death as a black box.

Between 1987 and 2008, 45 patients have undergone cardiac transplantation in Hawai'i. This article summarizes the authors' experiences with cardiac transplantation over this 21-year period. The cumulative 1-, 3- and 5-year survival rates after transplantation have been 73.8%, 70.0%, and 63.2%, respectively. The corresponding survival rates have improved over the last eight years and are now 90.0%, 87.5%, and 83.3%, respectively. Despite clinical improvements, low patient volumes make the maintenance of a state-based program in Hawai'i difficult. Problems with financing and referral biases will need to be addressed if a local program is to continue.

Although it is commonly believed that the concept of brain death (BD) was developed to benefit organ transplants, it evolved independently. Transplantation owed its development to advances in surgery and immunosuppressive treatment; BD owed its origin to the development of intensive care. The first autotransplant was achieved in the early 1900s, when studies of increased intracranial pressure causing respiratory arrest with preserved heartbeat were reported. Between 1902 and 1950, the BD concept was supported by the discovery of EEG, Crile's definition of death, the use of EEG to demonstrate abolition of brain potentials after ischaemia, and Crafoord's statement that death was due to cessation of blood flow. Transplantation saw the first xenotransplant in humans and the first unsuccessful kidney transplant from a cadaver. In the 1950s, circulatory arrest in coma was identified by angiography, and the death of the nervous system and coma dépassé were described. Murray performed the first successful kidney transplant. In the 1960s, the BD concept and organ transplants were instantly linked when the first kidney transplant using a brain-dead donor was performed; Schwab proposed to use EEG in BD; the Harvard Committee report and the Sydney Declaration appeared; the first successful kidney, lung and pancreas transplants using cadaveric (not brain-dead) donors were achieved; Barnard performed the first human heart transplant. This historical review demonstrates that the BD concept and organ transplantation arose separately and advanced in parallel, and only began to progress together in the late 1960s. Therefore, the BD concept did not evolve to benefit transplantation.