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Review article: Biomedical intelligence

Vol. 150 No. 0506 (2020)

Fiftieth anniversary of the first heart transplantation in Switzerland in the context of the worldwide history of heart transplantation

  • Markus J. Wilhelm
  • Frank Ruschitzka
  • Andreas J. Flammer
  • Dominique Bettex
  • Marko I. Turina
  • Francesco Maisano
Cite this as:
Swiss Med Wkly. 2020;150:w20192


On 3 December 1967, Christiaan Barnard performed the first heart transplantation in the world at Groote Schuur Hospital in Cape Town, South Africa. In the succeeding months, heart transplantations in the USA, Asia and Europe followed. On 14 April 1969, Åke Senning successfully accomplished the first heart transplantation in Switzerland at the former Cantonal Hospital in Zurich. In the summer of 1969, he undertook a second heart transplantation. Although the surgical procedure went well technically, both patients died within weeks to months after transplantation. Causes of death were infection in the first and rejection in the second patient. Senning’s colleagues around the world had similar experiences. Survival after heart transplantation was unacceptably low. The heart transplant community recognised the lack of knowledge about immunological processes and appropriate immunosuppressive regimens as underlying reason for the early deaths. Most transplant centres decided to refrain from heart transplantation until sufficient immunological insight became available. After the introduction of the new immunosuppressive drug ciclosporin into the clinic and the availability of tools to monitor rejection in the early 1980s, heart transplant programmes were restarted all over the world. The legal recognition of brain death allowed procurement of donor hearts without exposure to warm ischaemia, and the principle of cold storage enabled prolongation of ischaemia time and acceptance of donors in distant hospitals, resulting in enlargement of the donor pool. In Switzerland, Marko Turina resumed heart transplantation in 1985 at Senning’s former workplace in Zurich. The number of heart transplants in Switzerland and in the world grew rapidly because the outcome markedly improved. Particularly over the long-term, survival in Zurich surpassed the outcome worldwide. Zurich created internationally recognised milestones such as transplantation of patients with grown-up congenital heart disease, the implementation of the bicaval instead of the right atrial anastomosis during the transplant procedure and the dual transplantation of one heart. Since the middle of the 1990s, however, the number of heart transplants has plateaued, mainly because of donor shortage. The current era is characterised by efforts to increase the number of donors. The utilisation of marginal donors, the change from informed to presumed consent for organ donation and donation after cardiocirculatory-determined death have been proposed to augment the donor pool.


  1. Cooper DKC. Life’s defining moment: Christiaan Barnard and the first human heart transplant. J Heart Lung Transplant. 2017;36(12):1273–5. doi:.
  2. Barnard CN. The operation. A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town. S Afr Med J. 1967;41(48):1271–4.
  3. Turina M. Fifty years of heart transplantation. Cardiovasc Med. 2018;21:209–11.
  4. Messer S, Page A, Axell R, Berman M, Hernández-Sánchez J, Colah S, et al. Outcome after heart transplantation from donation after circulatory-determined death donors. J Heart Lung Transplant. 2017;36(12):1311–8. doi:.
  5. Lower RR, Shumway NE. Studies on orthotopic homotransplantation of the canine heart. Surg Forum. 1960;11:18–9.
  6. Kantrowitz A, Haller JD, Joos H, Cerruti MM, Carstensen HE. Transplantation of the heart in an infant and an adult. Am J Cardiol. 1968;22(6):782–90. doi:.
  7. White T. Magical moment: The enormity of the first U.S. adult heart transplant. Stanford Medicine,
  8. Thomson JG. Production of severe atheroma in a transplanted human heart. Lancet. 1969;294(7630):1088–92. doi:.
  9. Hosain N. Dr PK Sen - The Bengali Surgeon of the Century. Cardiovasc J. 2011;3(2):254–7. doi:.
  10. Cabrol C, Associates. Human heart transplantation. Am J Cardiol. 1968;22(6):833–7. doi:.
  11. Hosain N, Amin F, Leprince P. Christian Cabrol MD: A Tribute to pioneer cardiac surgeon Christian Cabrol 1 year after his death, on the 50th Anniversary of the First European Human Heart Transplantation that he performed in 1968. Eur Heart J. 2018;39(19):1661–71. doi:.
  12. English ST. The dark early years of heart transplantation: Some lessons learned. J Heart Lung Transplant. 2017;36(12):1279–82. doi:.
  13. Swiss Television. Press Conference on April 14, 1969
  14. Hess ML, Hunt S. Conquering the first hurdles in cardiac transplantation: In the footprints of giants. J Heart Lung Transplant. 2017;36(12):1276–8. doi:.
  15. Caves PK, Billingham ME, Schulz WP, Dong E, Jr, Shumway NE. Transvenous biopsy from canine orthotopic heart allografts. Am Heart J. 1973;85(4):525–30. doi:.
  16. Caves PK, Stinson EB, Billingham M, Shumway NE. Percutaneous transvenous endomyocardial biopsy in human heart recipients. Experience with a new technique. Ann Thorac Surg. 1973;16(4):325–36. doi:.
  17. Billingham ME, Caves PK, Dong E, Jr, Shumway NE. The diagnosis of canine orthotopic cardiac allograft rejection by transvenous endomyocardial biopsy. Transplant Proc. 1973;5(1):741–3.
  18. Billingham M, Warnke R, Weissman IL. The cellular infiltrate in cardiac allograft rejection in mice. Transplantation. 1977;23(2):171–5. doi:.
  19. Caves PK, Stinson EB, Billingham ME, Rider AK, Shumway NE. Diagnosis of human cardiac allograft rejection by serial cardiac biopsy. J Thorac Cardiovasc Surg. 1973;66(3):461–6. doi:.
  20. Billingham ME, Cary NR, Hammond ME, Kemnitz J, Marboe C, McCallister HA, et al.; The International Society for Heart Transplantation. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Heart Rejection Study Group. J Heart Transplant. 1990;9(6):587–93.
  21. Robbins RC, Barlow CW, Oyer PE, Hunt SA, Miller JL, Reitz BA, et al. Thirty years of cardiac transplantation at Stanford university. J Thorac Cardiovasc Surg. 1999;117(5):939–51. doi:.
  22. Borel JF, Feurer C, Gubler HU, Stähelin H. Biological effects of cyclosporin A: a new antilymphocytic agent. Agents Actions. 1976;6(4):468–75. doi:.
  23. Heusler K, Pletscher A. The controversial early history of cyclosporin. Swiss Med Wkly. 2001;131(21-22):299–302.
  24. Oyer PE, Stinson EB, Jamieson SW, et al. One year experience with cyclosporin A in clinical heart transplantation. J Heart Transplant. 1982;1:285–90.
  25. Grattan MT, Moreno-Cabral CE, Starnes VA, Oyer PE, Stinson EB, Shumway NE. Eight-year results of cyclosporine-treated patients with cardiac transplants. J Thorac Cardiovasc Surg. 1990;99(3):500–9. doi:.
  26. Kolata G. FDA speeds approval of cyclosporin. Science. 1983;221(4617):1273. doi:.
  27. A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death. JAMA. 1968;205(6):337–40. doi:.
  28. Nikas NT, Bordlee DC, Moreira M. Determination of death and the dead donor rule: A survey of the current law on brain death. J Med Philos. 2016;41(3):237–56. doi:.
  29. Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA. 1981;246(19):2184–6. doi:.
  30. Marasco SF, Kras A, Schulberg E, Vale M, Lee GA. Impact of warm ischemia time on survival after heart transplantation. Transplant Proc. 2012;44(5):1385–9. doi:.
  31. Stoica SC, Satchithananda DK, Dunning J, Large SR. Two-decade analysis of cardiac storage for transplantation. Eur J Cardiothorac Surg. 2001;20(4):792–8. doi:.
  32. Ou R, Gavin JB, Esmore DS, Rosenfeldt FL. Increased temperature reduces the protective effect of University of Wisconsin solution in the heart. Ann Thorac Surg. 1999;68(5):1628–34, discussion 1634–5. doi:.
  33. Lower RR, Stofer RC, Hurley EJ, Dong E, Jr, Cohn RB, Shumway NE. Successful homotransplantation of the canine heart after anoxic preservation for seven hours. Am J Surg. 1962;104(2):302–6. doi:.
  34. Thomas FT, Szentpetery SS, Mammana RE, Wolfgang TC, Lower RR. Long-distance transportation of human hearts for transplantation. Ann Thorac Surg. 1978;26(4):344–50. doi:.
  35. Watson DC, Reitz BA, Baumgartner WA, Raney AA, Oyer PE, Stinson EB, et al. Distant heart procurement for transplantation. Surgery. 1979;86(1):56–9.
  36. Khush KK, Cherikh WS, Chambers DC, Goldfarb S, Hayes D, Jr, Kucheryavaya AY, et al.; International Society for Heart and Lung Transplantation. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-fifth Adult Heart Transplantation Report-2018; Focus Theme: Multiorgan Transplantation. J Heart Lung Transplant. 2018;37(10):1155–68. doi:.
  37. Carrel T, Neth J, Pasic M, Laske A, Jenni R, Maggiorini M, et al. Should cardiac transplantation for congenital heart disease be delayed until adult age? Eur J Cardiothorac Surg. 1994;8(9):462–8, discussion 469. doi:.
  38. Laske A, Carrel T, Niederhäuser U, Pasic M, von Segesser LK, Jenni R, et al. Modified operation technique for orthotopic heart transplantation. Eur J Cardiothorac Surg. 1995;9(3):120–6. doi:.
  39. Pasic M, Gallino A, Carrel T, Maggiorini M, Laske A, von Segesser L, et al. Reuse of a transplanted heart. N Engl J Med. 1993;328(5):319–20. doi:.
  40. Rodriguez Cetina Biefer H, Sündermann SH, Emmert MY, Enseleit F, Seifert B, Ruschitzka F, et al. Surviving 20 years after heart transplantation: a success story. Ann Thorac Surg. 2014;97(2):499–504. doi:.
  41. Schaub S, Immer F, Steiger J. Organ Transplantation in Switzerland. Transplantation. 2019;103(5):853–6. doi:.
  42. Swisstransplant. Annual Report 2018, p 32. Available at:
  43. Wever Pinzon O, Stoddard G, Drakos SG, Gilbert EM, Nativi JN, Budge D, et al. Impact of donor left ventricular hypertrophy on survival after heart transplant. Am J Transplant. 2011;11(12):2755–61. doi:.
  44. Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, et al., International Society of Heart and Lung Transplantation Guidelines. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010;29(8):914–56. doi:.
  45. Wittwer T, Wahlers T. Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience. Transpl Int. 2008;21(2):113–25. doi:.
  46. Wheeldon DR, Potter CD, Oduro A, Wallwork J, Large SR. Transforming the “unacceptable” donor: outcomes from the adoption of a standardized donor management technique. J Heart Lung Transplant. 1995;14(4):734–42.
  47. Swisstransplant. Annual report 2018, pp 12–14. Available at:
  48. Nacional de Trasplantes O. Memoria de Actividad 2017: Actividad de donación, p 1. Available at:
  49. Eurotransplant. Statistical report 2017: Donation, waiting lists and transplants, p 2. Available at:
  50. Pitarch Martínez M, Sánchez Pérez B, León Díaz FJ, Fernández Aguilar JL, Pérez Daga JA, Montiel Casado MC, et al. Donation After Cardiac Death in Liver Transplantation: An Additional Source of Organs With Similar Results to Donation After Brain Death. Transplant Proc. 2019;51(1):4–8. doi:.
  51. Schlegel A, Muller X, Kalisvaart M, Muellhaupt B, Perera MTPR, Isaac JR, et al. Outcomes of DCD liver transplantation using organs treated by hypothermic oxygenated perfusion before implantation. J Hepatol. 2019;70(1):50–7. doi:.
  52. Summers DM, Watson CJ, Pettigrew GJ, Johnson RJ, Collett D, Neuberger JM, et al. Kidney donation after circulatory death (DCD): state of the art. Kidney Int. 2015;88(2):241–9. doi:.
  53. Ceulemans LJ, Inci I, Van Raemdonck D. Lung donation after circulatory death. Curr Opin Organ Transplant. 2019;24(3):288–96. doi:.
  54. Chew HC, Iyer A, Connellan M, Scheuer S, Villanueva J, Gao L, et al. Outcomes of Donation After Circulatory Death Heart Transplantation in Australia. J Am Coll Cardiol. 2019;73(12):1447–59. doi:.

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