Dr. Christiaan Barnard's—and the world's—first patient to receive a transplanted human heart, Louis Washkansky, lived for only 18 days after his historic operation. But Barnard's second transplant recipient, Dentist Philip Blaiberg, recovered fully, wrote a book about his experiences and displayed such a zest for life that he went swimming on the first anniversary of his operation. Last week, after surviving for an incredible 594 days with another man's heart in his chest—longer by far than any other heart transplant patient—Blaiberg died peacefully in the same Cape Town hospital at which he had received his new lease on life.
The challenge that confronted heart-transplant teams in Blaiberg's case, as it has in all others, was more medical than surgical. The South African dentist was 58 when his own heart reached such an advanced stage of slow, progressive failure that it could no longer pump enough oxygenated blood to support any physical activity. After having been obliged to give up his dental practice, Blaiberg was bedfast. It was problematical whether he would hold out for another month or even a week. In these circumstances, Barnard felt fully justified in removing Blaiberg's heart and replacing it with that of a young "Cape Colored" (half-caste) man, Clive Haupt, who had died of a stroke. The surgical technique, worked out by Stanford University's Dr. Norman E. Shumway Jr., was clear-cut and immediately successful. It was only after the operation that the real struggle began.
Small White Cells. Blaiberg's doctors were at once faced with the problem of controlling the immune mechanism by which the body seeks to reject any invading foreign substance, especially protein. Nature devised this complex reaction largely to protect the higher animals against parasitism and infection by such lowly microbes as bacteria and viruses. But the defense works equally well against tissues from higher animals, including those from any other man (except an identical twin).
The detailed workings of the immune mechanism are still imperfectly understood, but the main outlines are clear. The principal components of immunity are a type of white blood cell, the lymphoid cells. They have the genetically built-in ability to identify other cells as "self" (part of the same body) or "not self" (invaders to be destroyed). In the presence of "self" cells the lymphoid cells remain passive, but if they detect foreign material, they manufacture antibodies to contain or attack the invader. These antibodies are in the form of gamma globulin particles. Some remain on the surface of the lymphoid cells and circulate with them; others, free-floating, circulate in the blood stream. Both kinds adhere to cells in the foreign tissues of such organs as the transplanted heart. Which type is more important in graft rejection is still debated. What is certain is that, together, the two types can be devastatingly effective in destroying a graft.