The Boundary
The heart had to come from someone who was dead, yet it also had to be alive enough to use.
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In December 1967, in Cape Town, Christiaan Barnard transplanted the heart of Denise Darvall, a 25-year-old woman fatally injured in a car accident, into Louis Washkansky, a 54-year-old man dying of heart disease. Washkansky survived for 18 days before dying of pneumonia, and the transplanted heart was still functioning. The operation had succeeded, but it brought an old question into sharper focus: when, exactly, does life end?
The following year, in 1968, a Harvard committee proposed new criteria for determining death based on irreversible coma and neurological function. Medicine was confronting circumstances its traditional definitions had not fully anticipated, and the boundary had moved.
What interests me is the order: the operation came first, and the definition came after.
As a high-school student in Lagos, Oluyinka Olutoye read a biography of Barnard. What stayed with him was not the famous heart transplant, but Barnard’s earlier experiments involving surgery on fetal animals. He would eventually become a pediatric and fetal surgeon in the United States, and in 2016 he and surgeon Darrell Cass faced a problem that could not wait for birth.
A tumour growing from a 23-week-old fetus’s lower spine was placing enormous strain on her heart. Delivering her so early carried grave risks, and waiting carried risks of its own. The team opened the mother’s uterus and partially brought the baby out. They removed most of the tumour in about 20 minutes of operating directly on the fetus, then returned her to the womb and closed the uterus. The pregnancy continued for another 12 weeks, and Lynlee was delivered by Caesarean section at around 36 weeks.
Medicine had treated a patient who had not yet been born.
