Every second Counts: The race to transplant the first human heart

by Donald McRae

The dramatic race to transplant the first human heart spanned two years, three continents and five cities against a backdrop of searing tension, scientific brilliance, ethical controversy, racial strife and emotional turmoil. It culminated in a terrifying moment in the early hours of 3 December 1967 when, in a cramped operating theatre in a Cape Town hospital, Professor Chris Barnard stared into an empty cavity from which he had just removed a heart. He knew that he had only minutes left to make history and save the life of a 55-year-old man by filling the gaping hole in his chest with a heart which had just been beating inside a 25-year-old woman. Every Second Counts is the story of Chris Barnard and his gripping race against four extraordinary men to conquer the greatest of medical challenges. It is also a deeply personal biography of a Casanova surgeon with film-starlooks, whose tortured private life was played out on the most public of stages.

Genres: Nonfiction, Medicine, Science, Medical, History, Historical, Book Club

368 pages, Hardcover

First published January 1, 2006

About the author

Donald McRae was born near Johannesburg in South Africa in 1961 and has been based in London since 1984.

He is the award-winning author of six non-fiction books which have featured legendary trial lawyers, heart surgeons and sporting icons. He is the only two-time winner of the UK’s prestigious William Hill Sports Book of the Year – an award won in the past by Nick Hornby’s Fever Pitch and Laura Hillenbrand’s Sea Biscuit. As a journalist he has won the UK’s Sports Feature Writer of The Year – and was runner up in the 2008 UK Sports Writer of the Year – for his work in the Guardian.

Donald lived under apartheid for the first twenty-three years of his life. The impact of that experience has shaped much of his non-fiction writing. At the age of twenty-one he took up a full-time post as a teacher of English literature in Soweto. He worked in the black township for eighteen months until, in August 1984, he was forced to leave the country. He is currently writing a memoir based on these experiences.

Reviews

[Basil B · Rating 5 out of 5]

moving straight to "favorites" shelf. Unexpectedly emotional and extremely powerful. I can't imagine how much work McRae did to unravel this whole story

[Maya Caroline · Rating 5 out of 5]

Very well-written and well-researched book about the first human heart transplant and all the research leading up to it. Particularly neat to read about events that happened in Richmond, since I work at that same hospital now.
Also, can I just point out that some of these surgeons are the antithesis to the argument “women are too emotional to lead”? These boys are a mess. Incredible contributions to medicine. But also, damn, the DRAMA.

[Nicholas Bestbier · Rating 4 out of 5]

Compulsory reading for any South African. An incredible story told in fabulous detail.

[Jim Gleason · Rating 5 out of 5]

Written in the styles of historic biography and gripping suspense driven novels, award winning author and fellow African countryman, Donald McRae, recounts the real-life “race to the death” between four amazing cardiac surgeons’ to become the first to accomplish what was then seen as “impossible” – the “miracle” of transplanting a human heart into another human being. While each were poised and ready to be the first, it was the risk taking Christiaan Barnard, working in Cape Town, South Africa where less restrictive laws allowed him to take the beating heart of a brain dead donor to save a dying Louis Washkansky’s life with the world’s first human heart transplant on December 3rd, 1967. Amidst passionate rivalry, left in the shadow of worldwide news coverage frenzy were Norman Shumway (California), Richard Lower (Virginia) and New York's Adrian Kantrowitz, each long time researchers of organ transplant and rejection who were dependent on the right recipient/donor combination, some only days away from performing the same life saving historical milestone. Barnard, some would say, appropriated their work in his own successful surgery, but in the United States, brain death had yet to be legally recognized, and, as it turns out, Barnard is often credited with helping overturn that disparity of outdated medical fact vs. legal definition of death in that successful operation. Barnard’s life story is both technically remarkable and yet a sad personal one in its final years, while the others, overcoming the initial disappointment in missing out on that milestone themselves, continue to perfect the surgery and later mechanical discoveries that we see today in common use.

McRae’s narrative, describing in graphical medical detail amazing surgeries of research in animal subjects and later on dying patients who had no other options, along with his carefully researched personality descriptions of the main characters, makes for fascinating reading for medical professional and patient alike. This was especially true for this reviewer who, with a 1994 heart transplant, owes his life to these pioneering efforts that too often resulted in death for the early patients who gave their lives in sacrifice of medical progress. Today, with over 2500 heart transplants done each year in the US alone and survival rates of 89% over their first year, heart transplants may seem almost routine. For each heart recipient, however, they certainly are NOT routine, but arguably remain the “outstanding medical achievement of the 20th Century.”

A word of advice, don’t miss reading the personal and detailed closing 38 pages of Notes and Sources in which the author recounts his personal interviews and researching for each chapter.

see this and more than a hundred other organ donation/transplant related books - many with my personal reviews - at http://www.trioweb.org/resources/book...

[Leaburn · Rating 2 out of 5]

I’ve read most of McRae’s books and enjoyed all of them to date before picking this one up. Famed mostly for his books on boxing, he clearly can write about other subjects because his Clarence Darrow biography is gripping. This seemed likely to be in a similar vein until you actually start it.

Immediately bogged down in dull medical terminology and a drawn out history of surgical challenges in dog heart transplants, it proved almost impossible to wade through. Things do pick up as the seminal transplant is covered and subsequent attempts are covered. The story of the post op downfall of Barnard is almost like a parable but I was utterly relieved when I eventually finished the book after an insane two months of painfully trudging through.

I’ll return for McRae’s goodbye to the world of boxing that has just been released and hope he’s on better form on more familiar territory. I’ll put this one down to a strange aberration from a writer I usually enjoy.

[Siby · Rating 4 out of 5]

Heart transplant surgeries still rank up there in the list of scary and incredibly complicated surgical procedures conducted today. However, very few of us (including me) pause to consider the road that led to this day when the procedure is considered routine and has a 89% survival rate over 1 yr.

The pioneers in this space, especially Norman Shumway and Richard Lower, had to battle hard and long to develop and perfect the surgical procedures, post operative care and most difficult of all, finding a way to combat the body's natural reaction to reject a foreign body. Their story of painstaking experiments and studies of the procedures on dogs, the simultaneous development of the heart lung machine, the ethical and moral hurdles that had to be crossed, the very real human tragedies that made a transplant possible and inevitably the competitive streak in cardiac surgeons racing to be the first is very well captured in this book.

Some things really stood out for me:
1. Winning matters (unpopular opinion). They only remember the name of the person who got their first, be it the moon or the human heart transplant.
2. Success is built on the shoulders of giants...
3. Ethics and morals are fluid and innovators and pioneers have always had to fight the existing ethical and moral standards, right from the time of Galileo to the 1960s when the idea of brain death was not accepted. We just have to be open to the thought that our morals and ethical standards will inevitably be questioned in the future and should be willing to have an open mind when they are.

[Angie · Rating 5 out of 5]

This was a really great book about the processes and stories that built up to the first ever successful human heart transplant. It was not only extremely informational, it was also quite thrilling and packed with tension and action. I totally recommend this if you're researching the first human heart transplant.

[Jacqueline Kuntz · Rating 4 out of 5]

The book was slow to start and technically, very heavy, even as someone involved in this work. However, the portrayals of each surgeon were thoughtful and unbiased, and descriptions procedures seemed logical for the times and places.

[Pulkit · Rating 4 out of 5]

3.5

[Chris Lovejoy · Rating 4 out of 5]

Read this for medical school interviews

[George Mallett · Rating 5 out of 5]

MCrae's access to all the key characters in the story is clear. At times a difficult book to put down.

[David Highton · Rating 5 out of 5]

Excellent book, very absorbing

[Kristin · Rating 5 out of 5]

I work in the transplant field, so naturally, I have an interest in the history of the surgical techniques used to restore life to patients through the gifts of others. Because we don't transplant hearts at our center, most of the information in this book was new to me, although Paul Terasaki, the man behind much of our knowledge on rejection and histocompatibility, essentially the basis of the job I do, does get a mention in the author's notes at the end of the book, which was neat. Like many students of medicine, I was very familiar with the name Christiaan Barnard going into this book, as he was the South African doctor who was the first to successfully transplant a human heart. Learning there were 3 other doctors days away from being in Barnard's shoes was news, especially in that he was a longshot to earn the honor compared to the work the others put into research and development.
Much of the book deals with the years leading up to the transplant, when Drs. Shumway, Lower, Kantrowitz, and Barnard, among others, worked to determine whether operating on the heart was even possible, much less transplanting the entire organ. It was fascinating to realize that all of the heart-related surgical procedures, not just the transplant, that are common today were developed within the last 50-60 years, and makes me glad to live in an era where, should something go wrong with my heart, I have a good chance of surviving. Shumway and Lower were the ones who led the race towards transplant, devoting extensive laboratory time and energy at Stanford for the purpose, while Kantrowitz was across the country in New York securing grant money to do his own research. Barnard, in South Africa during the height of apartheid, was somewhat of an afterthought, though all 4 knew each other from getting their educations from the same pioneers of cardiac surgery in the U.S.
The hardest part of the book for me was the research on dogs. I was glad for the lack of pictures, as I don't think I could have taken the sight of the dogs whose lives were sacrificed to give the surgeons the experience needed to figure out what they were doing before taking on human patients. That said, I understand why the dogs were used, and my feelings on the whole thing vacillate from thinking its cruel to the dogs and other lab animals (baboons and chimps were also used to a lesser extent) to realizing that without the dogs, we might not be transplanting hearts in humans at all.
Overall, a very educating book, and much of the things discussed still apply today, from trying to combat rejection and infection to losing patients due to the lack of a compatible donor. Thankfully, my work is primarily with patients in need of kidneys, who have the option of dialysis to keep them alive until an organ can be found, but for those in needs of other organs face a narrow window of being sick enough to move to the top of the waiting list but not too sick that the transplant won't save them or they die waiting. In the epilogue, McRae expands on what happened to the 4 principal surgeons once the transplant race was over, and Kantrowitz, the doctor in New York, became one of the developers of the left-ventricular assist device, which buys patients in need of new hearts a little more time by supporting their failing organ until a donor can be found, so I thought it was a fitting way for his career to come full-circle.

[Trawets · Rating 4 out of 5]

I'm old enough to remember the excitement of the first heart transplants, and Donald McRae's very readable book brought it all back Donald McRae gives us the history of the race to transplant the first human heart, and race it was. Surgeons have never had the reputation of being quiet unassuming people, and some super-sized egos were involved in cardiac surgery in the 1950's and 60's.
Christian Barnard was a minor figure in the world of cardiac surgery, he had done very little original research, but he had watched and learnt from some of the greats such as Norman Shumway and Dick Lower. Helped by South African law which allowed death to be certified by brain death rather than absence of heart beat as in America, he was able to against all expectations succesfully carry out the first heart transplant in December 1967.
Christian Barnard was never a nice person and fame did nothing to improve his character, he was however a competent surgeon who cared very much for his patients and had the courage to take cardiac surgery into a new realm.
This story set against a background of apartheid, the space race, medical and legal conservatism was a real page turner.

[Ahmed Elhamshary]

"Go ahead", Barnard said quietly, "shock it."
Ozinsky sent a 20-joule charge into the heart . "For a moment," Barnard wrote,"the heart lay paralyzed , without any sign of life . We waited - it seemed like hours --until it slowly began to relax . Then it came , like a bolt of light .
There was a sudden contractions of the atria , followed quickly by the ventricles in obedient response -then the atria and again the ventricle , little by little it began to roll with the lovely rhythm of life."
Barnard had won the race , He had become the first man to transplant a heart from one human being to another .The surgeon watched it beat for another minute and then , smiling behind his mask, he removed the last catheter and tied the purse-string suture . The heart pulsed steadily and determinedly . A solid echo of its beat resounded from the EKG . The machine lit up with a perfect green pattern on the black screen.
Barnard stretched his right hand across the opened chest of Louis Washkansky . Rodney Hewitson did the same . His glove was also red with blood .
"We made it!" Barnard said as their hands locked across the pumping heart. "Jesus,we did it!"

[Ian Bull · Rating 5 out of 5]

Maybe it's because I come from a medical family, but I found this book fascinating, and the plot feels like a movie. There is a great race, and a flawed protagonist who won the face to be the first, but his flaws limited him in his personal life and make you question whether it was worth it for him. The book tracks four great surgeons and medical researchers in the race to be the first person to do a heart transplant -- something that was as radical at the time as landing a man on the moon. There were the Americans Shumway, Lower, Kantrowitz and then there was the South African Barnard, who of course, eventually won the race. The personalities were all so different, which gave them, it seems, different approaches which allowed for different breakthroughs. But Barnard wanted it more, and "borrowed" a bit from the other doctors so he could be the first. The others may have been first if they had been as driven or as daring as Barnard, however. The science is wonderful, the personalities are fascinating.

[King Haddock · Rating 5 out of 5]

I love this book! I may not be an extreme medical-lover at heart, but I find life sciences and stuff still very interesting, and this book was very captivating. While a heavy research project, McRae really does make it feel like a fast-paced fiction novel. The in-depth descriptions of everything from the current scene to the medical procedures themselves made it very exciting to read. This has to be one of my favorites. And how I picked it up in the first place? For a report. I planned on reading only a few sections off the successful transplantation of the human heart, but then I became captivated and had to read through the entire novel.

[Allison · Rating 3 out of 5]

Interesting account of the "other" big race during the 1960s. Four heart surgeons were poised to be the first to transplant a heart from one person to another at exactly the same time; it simply came down to luck, timing, and law. Got a little bogged down during accounts of surgeries and other medical talk.

[Ellen · Rating 5 out of 5]

UNOS encouraged me to read this. I am so grateful for the 4 surgeons who made medical history. Without there determination, my 16 year old son would not be alive today. Medicine has come so far, so quickly. I can only hope that by the time he will need another transplant, medical geniuses will continue to make historic improvements.

[Alexis Morra · Rating 5 out of 5]

I loved hearing about all the surgeons and their race to transplant. All the preparation the other surgeons did was amazing and then they didn't even win, but they succeeded in the lasting transplants. I liked learning about their lives and their personality quirks. They did not make the doctors seem like amazing gods, they made them crazy annoying imperfect people who have a drive and skill.

[Edson Brambate]

Um dos melhor livros que já li dentro da área médica. Não digo que tenha influenciado a tomada decisão acerca da minha especialidade, mas o registro daquilo que estes homens conseguiram realizar certamente serviu como inspiração para seguir em frente.
Esta deveria ser leitura obrigatória para todos os estudantes de Medicina e pessoas interessadas nesta área.
Recomendadíssimo !

[Julie · Rating 3 out of 5]

Fascinating to read the behind the scenes story of the race to transplant the first human heart. Barnard only got there first because of American politics and the fact that the same restrictions didn't apply in South Africa. Well worth a read if you are interested in medical history.

[Margaret · Rating 4 out of 5]

This was an exciting account of the science leading up to first heart transplant. I remember this event from my childhood, but had no idea the real researchers behind heart transplantation were sort of cheated out of their glory. Really gripping.

[Amy · Rating 5 out of 5]

I absolutely loved this book. A truly fascinating story about 4 brilliant surgeons, each poised to make medical history by performing the first human heart transplant. Creatively written thus allowing readers an up front view into the world transplant surgery.

[Christina · Rating 5 out of 5]

This was an excellent read. I found the entire book quite fascinating, with very strong story-telling and an intriguing set of people portrayed.

[Claire · Rating 3 out of 5]

I didn't want the guy that won to win! I felt bad for him!

[Paige · Rating 3 out of 5]

slightly interesting,

[Vesta Hurlbutt · Rating 4 out of 5]

I work in cardiology and this book gave a great recap to the past of heart transplants

[Stephanie · Rating 4 out of 5]

Was interesting for me as my mother knew Barnard and she was included in the book.

[Hilary · Rating 1 out of 5]

everymans rules of scientific living