Barnard's Bullet

There had been two previous transplants of a human heart with both lungs attached, all in the U.S., and none of the recipients lived more than a few days. But last week, in Cape Town's Groote Schuur Hospital, Dr. Christiaan Barnard performed this feat of surgical bravura. The man who first transplanted a human heart has lost none of his daring or his ability to provoke controversy.

The patient was Adrian Herbert, 49, a dental technician. Emphysema had so ravaged his lungs that they scarcely functioned. This condition had overloaded the heart, and it, too, was badly damaged. Herbert could not have lived more than a day or two away from intensive hospital care. Even with that care, says Barnard, Herbert was a "semivegetable." Radical surgery, therefore, seemed justified. Relatives gave their consent; Barnard alerted his team of 14 and awaited the arrival of a donor.

New Technique. A fatal mugging provided one. Jackson Gunya, 28, died after neurosurgeons found his brain injury irreparable. Barnard was ready for the six-hour operation that centered on a new technique. First, Herbert's chest was opened, he was put on the heart-lung machine, and his heart was removed --all but part of the left auricle (upper chamber). Next, Barnard removed each lung, leaving most of the patient's bronchi (the two main branches from the windpipe). These were clamped. Then the surgeon closed off the stumps of the pulmonary veins attached to the left auricle and sewed up the auricle. He could have taken these out, but, Barnard explained later, "this way, we don't have to do all of that dissection. They're not functioning, but there's no harm in leaving them there."

At last he was ready to install the transplant. It had been tailored to fit, with the bronchi cut short. These were stitched to Herbert's bronchi. The venae cavae, the great veins that return blood to the heart's upper right chamber, were connected, as in an ordinary heart transplant. In like fashion, the aorta was hooked up. It all went "without a hitch," said Barnard.

Soon after Herbert emerged from the anaesthesia, his secondhand heart and lungs were described as functioning adequately. In three days he was sitting up to eat breakfast. Then he suffered a setback and needed mechanical assistance in breathing. But at week's end Herbert was progressing satisfactorily.

Evading the Noose. While his patient fought for life, Barnard was fighting critics. Heart transplants, with their low level of survival, arouse skepticism among many specialists. To try both heart and lungs seems foolish to much of the medical profession. In Britain and France last week, Barnard was attacked for taking undue risks.

In an interview with TIME, he replied: "Barnard never takes the risk. The patient always takes the risk. Of course I'm taking a risk in that if I fail, it may hurt my reputation, but that has never ruled my judgment."

The surgeon also vented his resentment of South African physicians who will not refer patients for transplants because the chance of success is so slender. He acknowledged that organ rejection by the body was still an obstacle, but argued that "because a problem is not completely solved" is no reason to abandon a procedure. Barnard compared a patient doomed to die of heart disease with a man on the scaffold, the noose already around his neck: "Now you say to him, we won't hang you. You can stand 200 yards away and we'll get a man to fire one bullet at you. It's not much of a chance, but it's better than definitely hanging."

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