Christiaan Barnard: his first transplants and their impact on concepts of death

Summary points In 1967, when Christiaan Barnard carried out the first human heart transplants, there were no guidelines for the diagnosis of death of beating heart donors The relative success of Barnard's second heart transplant was followed by a period of uncontrolled copycat operations in many countries, with predictably poor results The UK definition of brainstem death, introduced by the Conference of Royal Colleges and their Faculties in 1976, has proved reliable and robust in clinical practice The operations and my minor involvement On 3 December 1967 the heart of a young female accident victim was transplanted into a middle aged man suffering from intractable heart failure caused by coronary artery disease. In 1971 Mohandas and Chou claimed that damage to the brain stem was the crucial component of severe brain damage causing profound irreversible coma. 10 In 1976 the UK Conference of Royal Colleges and their Faculties accepted this and defined brain death as the complete and irreversible loss of function of the brain stem. 11 They discounted the relevance of residual activity in the upper brain; without function of the brain stem, life does not exist.