Part Of Chris Barnard’s Contested legacy

I would never have been a fan of Professor Chris Barnard, growing up in the 1960s and ’70s. He was, after all, an Afrikaner male in a country ruled by Afrikaner men who made it their life’s mission to legally subjugate black South Africans, like my family, although we were defined by the apartheid laws as coloured.

News of Barnard’s achievement in performing the first successful transplant of a human heart on December 3, 1967, raced around the world and was the subject also of discussion around our family’s supper table, in classrooms at the local school and among friends when we took breaks from playing soccer in the street.

Clearly, Barnard deserved acknowledgment for his scientific achievement, even as young minds could not completely comprehend the medical, ethical or even political significance of the transplant. His success was on a par with the later first moon walk by astronaut Neil Armstrong or the ring exploits of Mohammed Ali.

Barnard has been variously described as ambitious, confident, charismatic, temperamental, abrasive, impatient, having a photographic memory and excellent intellectual ability, outspoken, unconventional, a perfectionist.

But it was the other big story of our viciously divided country at the time, apartheid, which was foremost in our minds, even in relation to the superstar surgeon. How were we to know that, despite being part of the ruling group in our country, enjoying the support of the National Party government and the close family friendships of NP politicians, Barnard’s association with apartheid was more nuanced, conflicted even.

As a student, he was open to communist influences, supporting the Students’ Socialist Party while at university on issues like the discrimination faced by coloured medical students who, for example, were excluded from post-mortems on white patients.

Certainly, he used the interests and machinery of the NP to achieve his personal and professional ambitions, even if he did not associate himself entirely with the machinations of the party faithful. He enjoyed the support of the apartheid state both during his tenure at Groote Schuur and during research and promotional sorties abroad.

Among the first people to get the news of Barnard’s successful transplant of Denise Darval’s heart into Louis Washkansky, was then prime minister John Vorster who later hosted a private dinner for the transplant team. The momentous transplant, establishing SA’s eminence in the medical world, was an essential antidote to the negative publicity the country was attracting because of legalised apartheid, the general injustices faced by the black majority and the crackdown on the leadership of the resistance movements. Barnard’s achievement was recorded in a special edition of the SA Medical Journal, with the government buying up 10 000 copies to use in its propaganda war globally and at home.

Journalist Chris Logan wrote that, in Cape Town, “the white Afrikaner elite who ran the hospitals, the police, the courts and the provincial administration departments were sympathetic to one another”. Barnard’s “cosy relationship” with the attorney-general of the Cape was useful when a blind eye needed to be turned after removal of a donor heart without the permission of the patient’s relatives.

During the fallout from the Information Scandal, when it was revealed that a multi-million rand National Party slush fund had been used to promote apartheid interests around the world, Barnard admitted that the government had paid some of his travel expenses.

Race was never far removed from Barnard’s medical achievements, black and white donor organs were transplanted variously into black and white recipients, although with Washkansky, Barnard was cautioned to ensure that only a white donor heart was sourced, with many potential donors rejected because of their colour.

It could be argued that Barnard was constrained to play by the rules of the era. But his approach in the academic and medical arenas did not accord with this respect for the engagement rules with apartheid. In one anecdote, he is said to have stormed out of a lengthy oral examination for his master of medicine degree, telling examiners that they knew “enough about me to either plug me or pass me”.

Barnard, in his two autobiographies and numerous media interviews, presented himself as opposed to grand apartheid and the overt racism of radical Afrikaners. But there are hints – most notably in his utterances on his female conquests and in explanations given of how the final decisions to confirm donor Denise Darval’s dead status came about – that he was capable of revising his own role in events to suit his personal and professional ambitions.

The Darval issue must have been especially disconcerting at the time, as the two-doctor protocol for certifying a dead patient only came into effect after the first transplant. Barnard had been accused of simply wanting to remove Darval’s heart without waiting for it to stop beating.

In a three-month research stint in Virginia, USA, Barnard convinced his mentors that he was planning to set up a renal unit at Groote Schuur, when he was in fact researching how to successfully transplant a kidney as a precursor to eventually transplanting a heart.

Barnard’s usefulness to the NP did not go unnoticed by the anti-apartheid movement internationally, with exiled poet Breyten Breytenbach comparing the fight to save the life of one “white” man with the high infant mortality rate in the country.

Port Elizabeth-born anti-apartheid activist Bill Hoffenberg, who went on to become an acclaimed endocrinologist in Cape Town and London, was on duty when Barnard and hospital authorities pressured him to authorise the brain dead status of the second donor to be identified as part of the Groote Schuur heart transplant programme. Forced into exile in Britain, Hoffenberg later said: “The SA government seized on the transplants with great alacrity and joy. They were getting a lot of flak internally and overseas, and this provided welcome relief.”

Today, I still remain slightly at odds with Barnard’s place in our country’s history. But, his visionary and relentless research efforts to place human heart transplants at the forefront of medical science in the way he did, alongside his commitment to advancing the health of all patients regardless of the colour of their skin mean that, whether I like it or not, I am now part of Barnard’s legacy.
• See Barnard’s autobiographical accounts One Life and The Second Life and Chris Logan’s Celebrity Surgeon: Chris Barnard