Television: Future of Transplants

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For countless viewers, TV's man of the holiday week proved to be no beer-bellied, chortling Santa Claus, but a lean, rather stern-faced man in a dark business suit who spoke through thin lips with a noticeable Afrikaans accent. He offered no tinseled presents, but the hope that his kind of surgical pioneering may eventually bring the vastly more valuable gift of renewed and prolonged life to many victims of heart disease. He was Dr. Christiaan Neethling Barnard (TIME cover, Dec. 15), who flew to the U.S. from Cape Town to Face the Nation on CBS, appeared on Today, filmed a future episode for The 21st Century, and began this week with a second full hour for NBC. Sandwiched in was a respects-paying call on President Johnson at the LBJ Ranch. For his CBS debut, Barnard was flanked by the two surgeons most prominently identified with artificial hearts and transplantation: Houston's Dr. Michael E. DeBakey and Brooklyn's Dr. Adrian Kantrowitz. He also faced two expert interrogators: Newsman Martin Agronsky and Science Editor Earl Ubell. If anyone showed strain it was Dr. Kantrowitz — understandably, because his transplantation of a heart into a 19-day-old infant had failed after 61 hours. Dr. Barnard was lit up by the glow of a far greater success — the 18-day survival of Louis Washkansky's transplant.

Short Supply. That operation raised many questions. Was it, asked Agronsky, just a surgical spectacular? On the contrary, said Barnard, medicine today is developing methods that offer curative treatment instead of palliation for hundreds of thousands of patients suffering a lingering death. What, asked Ubell, persuaded Barnard that no treatment short of a transplant would be effective in Washkansky's case? For answer, Barnard showed a screen-filling photograph of Washkansky's original heart, so damaged by the growth of fibrous tissue that only about one-tenth of the muscle in its main pumping chamber was working properly.

What's more, Barnard disclosed, this heart had been working so poorly that for weeks Washkansky's other organs —notably the liver and even the brain —had shown signs of deterioration from shortage of blood and oxygen. After Washkansky received Denise Darvall's heart, these organs improved enormously. One thing that his 30-man team learned from Washkansky's case, said Barnard, is that the recipient's body is less prone to reject a heart transplant than a kidney, so future patients will not be so heavily dosed with drugs to suppress the immune reaction. That means less danger of infection and more hope of lasting success.

What bothered all the panelists was the problem of supply. Though there are 500,000 adults in the U.S. dying each year of coronary disease and 6,000 to 7,000 children dying of incurable inborn heart defects, there is no prospect of more than a few thousand hearts becoming available. The pressing question, therefore, is how will these be allocated? Dr. Barnard was not worried by the chance of having two or more patients at one time with equal need. He was confident that one would have the more urgent need for a new heart, and he would get it. If forced to choose between a psychotic who could never be a really useful citizen and one who is mentally normal, he admitted, he would operate on the normal man first.