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'Louis Washkansky' (1913 – 21 December 1967) was the recipient of the world's first human heart transplant.
Washkansky was a Lithuanian Jew, who migrated with his friends to South Africa in 1922, aged nine, and became a grocer in Cape Town. Washkansky saw active service in World War II in East and North Africa and Italy. After the war, he married his wife Ann.
Washkansky was an avid sportsman. He took part in soccer, swimming, and weightlifting. However, late in his life his health declined substantially: he was diabetic, and had an incurable heart disease, causing him to suffer three heart attacks. The last of these heart attacks led to congestive heart failure.
He received his heart transplant on 3 December 1967, at the Groote Schuur Hospital in Cape Town, South Africa. The donor was Denise Darvall, who had recently been critically injured in a car accident, and the procedure was performed by Professor Christiaan Barnard. It was a success, but Washkansky had a weakened immune system and died of double pneumonia eighteen days after the transplant.
His grandson, Dale Washkansky, is a South African artist.
December 2nd 1967 was a hot summer day in Cape Town. In his hospital bed, Louis Washkansky was dying. He had suffered a series of coronary thromboses, and now his heart was beyond repair.
Washkansky had been born in the Tsarist Empire in 1903. As a teenager during World War One, he had been sent to a Jew's exile in the Crimea: at the war's end, the Washkansky family would spend several months returning to their home on the Baltic coast, by cattle-truck.
With the Bolshevik victory in the civil war, Washkansky decided to leave Russia for good, making his way to the very tip of the African continent. At one time earning his living as a prize-fighter, Louis eventually established his own grocery business: during World War Two, he served with distinction in the North Africa Campaign.
Now, it seemed that Louis Washkansky's life would end quietly on a ward in Cape Town's Groote Schuur Hospital. Nevertheless, Louis was demonstrating a formidable will to live.
Fluid pooled in Washkansky's legs, and doctors inserted tubes for drainage: for five agonising days and nights, he sat with his feet in a bowl, whilst his bloated limbs drained.
Each week when the coronary care specialists met, someone would say: "We must do something for Washkansky." But, of course, there was nothing that could be done.
When Louis told his wife Ann that he had met a Professor Christiaan Barnard, who wanted to give him a new heart, she did not at first believe him. Surely he meant a new valve?
When she realised the truth, Ann Washkansky was perturbed. To give Louis a new heart, first they would have to take out his old one: didn't that mean that they would have to kill him, before trying to stitch back new life?
South Africa was the first nation to develop a theory of "brain death". Dutch Roman Law required that an individual who had died violently (and this included road accident victims) must undergo a post mortem examination. Crucially, tissues could then be retained for 'study'.
Once neurosurgeon Dr. Peter Rose Innes had declared Denise to be brain dead, the way was open for Professor Barnard to remove her heart and transplant it into Louis Washkansky.
Edward Darvall took only four minutes to decide to allow his daughter's heart to be used in the operation. Later he would say that he could not have refused: "If I hadn't said "yes," I think that I would have forever been hearing Denny's voice asking me why I hadn't wanted to save that man."
The first human heart transplant took place in the early hours of the morning of December 3rd, 1967. Having connected the Great Vessels, Barnard allowed Louis Washkansky's blood to flow into Denise Darvall's heart.
Immediately the little heart turned pink, and began to fibrillate: a jolt of electricity from a defibrillator machine, quickly put Washkansky's new heart into sinus rhythm.
The first time Professor Barnard attempted to switch off the heart-lung machine which was keeping Washkansky alive, Denise Darvall's hart began to struggle. Ten minutes later, Barnard tried again, with the same result. Again he waited, and tried a third time. At first, Washkansky's heart rate began to fall once more: then, suddenly recovering its composure, Denise Darvall's heart ploughed on. "Jesus! Dit gant werk," Christian Barnard exclaimed in Afrikaans, as the tension of the past hours broke at last.
Indeed it did work, and continued to do so for the next eighteen days. Washkansky was given huge doses of Imuran and Hydrocortisone, to prevent his body rejecting the transplanted heart.
In addition to this, he was wheeled down to the hospital's "cobalt bomb" (a giant ex-ray machine), so that the graft could be irradiated, killing the cells that cause rejection before they could do much damage.
In order that Louis Washkansky might live, his immune system had to be suppressed: otherwise, it would destroy his new heart as surely as invading bacteria. Imuran, pioneered by Professor Roy Calne in England, was a very powerful immuno-suppressant. In 1967 however, no body of clinical experience existed to guide the Groote Schuur doctors on how best to treat a heart transplant patient. They themselves were inventing the procedures as they went along.
When Washkansky became ill, fearing rejection of the donor heart, Barnard suppressed his patient's immune system further. Washkansky died eighteen days after his operation - pneumonia had claimed his lungs, whilst his defences were undermined.
As the autopsy was to prove, there had been no rejection: Denise Darvall's heart was still in perfect condition. Louis Washkansky died of infection, and not rejection. For the future of heart transplantation was concerned, this was a vital finding.
The first human heart transplant had been a success: it was the aftercare that had failed. Barnard would work to improve this.

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★ South African history: Louis Washkansky