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Dr. Barnard had already told Washkansky what he had in mind, adding: "You can have two days to think it over." Washkansky decided in two minutes: "Go ahead." Dr. Barnard now called in his team of 30 men and women, scattered for the summer weekend.
When did Denise Darvall die? Explains Dr. Marius Barnard, 40, younger brother of Christiaan and his right-hand assistant during surgery: "I know in some places they consider the patient dead when the electroencephalogram shows no more brain function. We are on the conservative side, and consider a patient dead when the heart is no longer working, the lungs are no longer working, and there are no longer any complexes on the ECG."
Universal Donor. Though Denise Darvall's heart had stopped beating and she was dead, her heart could not be allowed to degenerate. Irreparable cell damage begins at the temperature of a naturally cooling cadaver in 30 minutes. It can be postponed for two to three hours by cooling. The Barnard team took no chances. By this time, Denise's body was in an operating room a few feet from the operating room in which Washkansky lay. A surgeon opened her chest by a midline incision, snipped some ribs and exposed the heart with its attached blood vessels.
Near the arch of the aorta (see diagram) he inserted a plastic catheter tube, which was connected to a heart-lung machine. Another catheter, similarly connected, went into the right auricle. At this point, the whole body was perfused with oxygenated blood. The surgeons then clamped the aorta beyond the catheter and clamped the pulmonary artery and venae cavae, thus isolating the heart from the rest of the body, which thereafter received no circulation.
With the heart-lung machine set at a low flow rate, the heart continued to have oxygenated blood pumped through it. And it was cooled to 73° F.
Meanwhile, Pathologist M. C. Botha was working in his laboratory with a sample of Denise's blood. Washkansky's type was A-positive; Denise's was O-negative. She was the ideal "universal donor." There was no time for Dr. Botha to try matching their white blood cells so that the surgeons could estimate how strong a rejection reaction Washkansky's system would mount against the foreign protein of Denise's heart.
Simultaneously, Washkansky was anesthetized, and at 2:15 a.m. Sunday one of the surgeons opened his chest. Assisting Christiaan Barnard, in addition to his brother Marius, were Drs. Rodney Hewitson and Terry O'Donovan. The main blood vessels were clamped in much the same way as Denise's had been, but in this case the heart-lung machine was to serve a directly opposite purpose: to circulate oxygenated blood through all of Washkansky's body except his about-to-be-discarded heart.