Heart surgeon Dr. Christiaan Barnard illustrates a point while addressing a group of journalists in Cape Town, South Africa, on Dec. 10, 1967, a week after performing the first successful heart transplant operation in a human. Barnard’s patient, Louis Washkansky, died of pneumonia 18 days after the operation, but within weeks, other doctors began to perform similar surgeries. / AP file photo

Forty years ago this evening, two people who had never met were brought to an operating suite at Groote Schuur Hospital in Cape Town, South Africa. Surgeons led by Dr. Christiaan N. Barnard sought to make history.

The first patient, 24-year-old Denise Darvall, had suffered severe head injuries earlier that day when she was struck by a car as she walked to a bakery to buy a cake. A neurosurgeon declared her brain-dead, and her father gave permission for doctors to harvest her heart. Barnard’s team draped the woman, sterilized her chest, and confirmed that their heart-lung machine, which keeps cells alive, was operational.

Midnight passed, and now it was Dec. 3, 1967.

Barnard’s assistants opened Darvall, connected her heart to the machine, and began to cool her body. When it had reached the proper temperature, they excised Darvall’s heart and placed it in a bowl of ice-cold solution. Unlike the woman’s brain, the heart was perfectly healthy.

Barnard was in an adjacent operating room with the second patient, 55-year-old businessman Louis Washkansky, who had been anesthetized after signing a consent form that essentially rendered him a guinea pig. Washkansky suffered from debilitating coronary disease for which there was no cure. Without a transplant, he would soon die.

Although an American doctor in 1964 had sewn a chimpanzee’s heart into a person who lived but a few hours, no one had ever tried to transplant a human heart — but several surgeons, including Barnard, had experimented with transplanting a heart from one dog to another. By December 1967, Barnard, 45, was ready to leave the lab.

Barnard opened Washkansky, connected him to a separate heart-lung machine, and quickly cut out his damaged organ, replacing it with the young woman’s. Then he tested the sutures. They held strong. Washkansky’s new heart had stopped beating, but the cold had sustained it and one shock of electricity restarted it. Barnard slowly weaned his patient off the heart-lung machine. At 8:30 a.m., Washkansky was wheeled out of the operating room. The beat of his new heart was strong.

Word of the operation had been leaked to reporters, who awaited its outcome at the hospital. One doctor told the Associated Press that jolting Washkansky’s new heart back into action “was like turning the ignition switch of a car.” Barnard told another wire service that Washkansky deserved the credit. “If it had not been for this man’s courage and will to live,” he said, “the operation would never have succeeded.”

Reports of the operation made headlines around the world, including front-page stories Dec. 4 in The New York Times and The Providence Journal. Pneumonia would kill Washkansky 18 days after his transplant, but a new era had arrived.

Forty years later, untold thousands of people who would have been in their graves now are leading normal lives.

Jim Taricani, who received a new heart in 1996 after years of progressive heart failure, is one of them.

This did not seem his future when Taricani, 58, now an investigative reporter for Channel 10, was a young man. He smoked and had high blood pressure, but there were no other clues into what fate held for him. He exercised regularly and had never experienced any of the typical symptoms of heart disease: angina, shortness of breath, weakness, dizziness. To his knowledge, only one relative had a history of cardiac disease: his maternal grandmother, who died at the age of 78 during her fifth heart attack.

At 3:06 a.m. on July 9, 1986, pain that he would later compare to an elephant on his chest awakened Taricani. He thought he’d pulled a muscle the day before while lifting weights at his gym, and he left his bedroom for the kitchen, where he hoped stretching would soothe him. It did not. The pain intensified and spread to his left arm, not a promising sign. He woke his wife, Laurie.

“I think you’d better take me to the hospital,” he said.

I’m going to die, Taricani thought to himself. I’m only 36, and I’m going to die.

“You’re in the middle of a major heart attack,” an emergency room doctor said when Taricani arrived at South County Hospital. A blood clot in an artery to his heart had stopped the flow of blood, killing substantial tissue. But the doctors saved Taricani, and he was transported to Rhode Island Hospital, where he stayed for 16 days. A few weeks later, he returned to work — and, he hoped, an ordinary life.

In February 1987, he suffered a second heart attack.

Cardiologists at Providence’s Miriam Hospital took charge of his care, prescribing drugs and admitting him when his heart lost normal rhythm, as it did repeatedly. As the 1980s ended, Taricani was becoming short of breath. His energy flagged and his abdomen bloated as his kidneys deteriorated. He’d entered an early stage of dying.

In November 1993, Laurie returned home to find her husband collapsed on the floor. When an ambulance delivered him to Miriam Hospital, his cardiologist, Dr. Richard Shulman, said: “You need a defibrillator and you’re going to need a heart transplant someday.” Heart transplants are not performed in Rhode Island and Shulman referred Taricani to Boston’s Massachusetts General Hospital, where doctors implanted a defibrillator, a device that would automatically shock his heart back into normal beating with a jolt of electricity when it lost rhythm. A transplant was inevitable now.

Taricani was 44 years old, and scared.

Oh my God, he thought, a heart transplant. Somebody’s going to cut my heart out — they’ve got to get a donor. Why me?

BARNARD INTENDED to be a general surgeon when he enrolled in a training program at the University of Minnesota in the mid-1950s. But working with the university’s open-heart pioneer, Dr. C. Walton Lillehei, headed him in another direction. He returned to his native South Africa, where he specialized in heart surgery — and briefly attracted attention, in 1960, when he transplanted a second head onto a dog. Barnard was a technically flawless surgeon, though no prominent innovator. But he had an ego.

On a visit to the United States early in 1967, Barnard became familiar with the experimental work of Dr. Norman Shumway, another surgeon trained in Minnesota who was a professor at California’s Stanford University School of Medicine. Shumway had devised an ingenious heart transplant operation — with dogs. He planned eventually to move to humans.

Using Shumway’s methods, Barnard beat him — unfairly so, many said. Shumway might have accomplished the first human heart transplant if his superiors had not thought he was restricted by California ethics laws — ones that did not apply in South Africa — regarding the definition of death.

Barnard’s transplant operation on Dec. 3, 1967, inspired his colleagues worldwide. Just three days later, a New York City surgeon cut a heart from a baby born without a brain and sewed it into a heart-crippled infant who died hours later. Barnard performed his second transplant on Jan. 2, 1968. Four days later, when Stanford’s administrators lifted their restriction, Shumway performed his first.

By the end of 1968, surgeons in Bombay, Paris, London and elsewhere were transplanting hearts. Barnard had become an international sensation.

WHENEVER HIS implanted defibrillator went off, the shock would kick Taricani halfway across a room. It went off only a few times in 1994 and 1995, but more frequently as 1996 progressed.

He was shaving on the morning of July 19, 1996, when his heart lost rhythm once more, activating the defibrillator and knocking him to the floor. He stood, and the defibrillator fired again. He crawled out of the bathroom, and the machine went off a third time, flipping him onto his back. He was turning blue.

“It’s not working!” he yelled to his wife. “It’s not starting my heart!”

Four more times over the next few minutes, the defibrillator jolted Taricani.

An ambulance took him to Massachusetts General Hospital. When he arrived, cardiologist Dr. G. William Dec said: “You’re not leaving without a transplant.”

In their initial screening, doctors concluded that Taricani was ineligible for a heart transplant alone because of damage to his kidneys; if it was irreversible, his only chance would be a heart and kidney transplant, an operation with a lower rate of survival. But the damage had resulted from one of Taricani’s medications, and adjusting it improved kidney function enough that he qualified for a single-organ transplant. Taricani was listed with regional and national donor registries. He had no control of his destiny.

A week passed, and then two and three. Taricani had time to think. His thoughts were conflicted.

“Here you are wishing and praying that you get a heart, but what you’re really doing is wishing and praying that someone dies,” he recalled recently. “It’s like the most selfish thing — but it was the only way I was going to live.”

As August wore on, Taricani’s condition worsened; he could tell by the monitors, lab reports, and the looks on nurses’ faces. Soon he would be too sick to survive a transplant, and his name would come off the waiting list. He would waste away and be gone.

Laurie visited every evening, and when she arrived on Aug. 21, Taricani said:

“Please go home.”

“Why?”

“Just go home. I’m not feeling well.”

When his wife left, Taricani withdrew into himself.

“I could taste the death,” he said. “I could taste it and my body was rotten and I curled up in a ball and I said, ‘That’s it, it’s over.’ ”

LIKE SOME of the other early heart-surgery pioneers, Barnard craved beautiful women. Except, perhaps, for the thrill of the OR, nothing satisfied him more. And beautiful women found the South African heart surgeon dashingly handsome and charming. He was famous and wealthy, his face known around the world — the original celebrity doctor, a real-life version of Dr. Kildare, one of the first glamorous TV doctors.

Soon after his 1967 breakthrough, Barnard was seen in the company of film stars Sophia Loren and Gina Lollobrigida, among other women. Barnard divorced his wife of 21 years in 1969, and the next year he married socialite and heiress Barbara Zoellner, 19. Barnard was 47.

Dr. Anthony P. Monaco, head of the Kidney Transplant Center at Rhode Island Hospital and a Harvard Medical School professor, recalls attending a scientific meeting in Italy shortly after Barnard wed Zoellner. “He was absolutely the center of attention,” Monaco said. “Everywhere we went, they made an enormous fuss over him.”

“He was a good-looking man and a great personality and charmer. He dressed well and spoke well,” said Dr. Arun K. Singh, Brown professor and cardiac surgeon, who met Barnard when he spoke in the mid-1970s at Rhode Island Hospital. “I never saw so many people in the auditorium,” said Singh.

Barnard lectured around the world and was received by heads of state, including President Lyndon Johnson. He was involved in advancing the science of transplantation, notably the introduction and refinement of immunosuppressive medications that curtail rejection of foreign tissue, which claimed many early patients.

Barnard divorced Zoellner in 1982, and the next year he stopped operating when arthritis begin to cripple his hands. In 1988, when he was 66 years old, Barnard married a model who was 18. He died in September 2001 on a vacation to Cyprus.

“He was one of the giants,” said Singh.

A NURSE woke Taricani early on the morning of Aug. 22, 1996.

A donor had been found, and the heart would arrive at Mass General later that day. At about 1 p.m., a surgical fellow asked Taricani to sign a consent form. He instructed the patient to read carefully the section about risk, the most extreme being death. “We really mean it this time,” the fellow said. If the new heart didn’t work in him, he was done.

Taricani and Laurie discussed grim details, and then offered each other hope and prayer. Dr. David Torchiana, the transplant surgeon, introduced himself. Torchiana is 6 feet 6 inches tall, with hands so big that he must wear size 8 1/2 gloves, the largest available. Taricani stared at those hands.

“I know what you’re thinking,” Torchiana said. “But I’ve done a lot of these operations and these things are really good!”

After saying goodbye to Laurie, Taricani was brought to the operating room. It was 4 p.m.

The operation went smoothly until the end, when internal bleeding took an unusually long time to control. Seven hours after the operation began, Taricani was delivered to the recovery room.

Sometime before dawn on Aug. 23, he woke up.

The thought occurred to him that if he had died and reached heaven, he would see the late John Lennon. He saw machines and plastic tubing.

It must have worked, he thought.

TARICANI STILL marvels at how his new heart transformed him; it was, he said, like being resurrected.

“After being sick for so long, the sickness became my norm,” he said. “I didn’t know what it was like to feel good. And all of a sudden you’ve got this new heart and blood is pumping through my body that hadn’t been, efficiently, for 10 years. The feeling was total amazement.”

Taricani was still in the hospital when Laurie visited with news. Under transplant guidelines, the identities of donors, who can come from anywhere, are kept anonymous unless the family agrees to release details.

In this instance, they did not. But serendipity intervened.

“Your donor came from Providence,” Laurie said.

“How do you know that?” Taricani said.

Laurie explained that a lawyer friend had overheard two women talking in an elevator in a Providence office building. One woman told the other that her sister, a nurse at Rhode Island Hospital, had revealed that Taricani’s heart came from a 22-year-old Guatemalan who had been living in the Ocean State.

“So my donor’s from Rhode Island,” Taricani said to his surgeon.

“Who told you that?” Torchiana said.

“Let’s just say it’s a Rhode Island thing.”

“I’m not saying anything.”

Two weeks after his transplant, Taricani went home, and in early October 1996, he returned to work. He eventually sent two letters to the man’s family through the donor network, but never received a reply. Nor did he try to learn the man’s identity — until two years ago, when he became curious again. He asked a police detective friend to check records for a 22-year-old Guatemalan who had died in August 1996.

The detective found the case of Alvaro Leveron, 22, who had been beaten in a fight outside Providence’s Club International. A kick to his head left him brain-dead.

Tears flow as Taricani, award-winning investigative reporter, tells the story.

“Sorry for getting so emotional,” he says. “There’s guilt in me about this whole thing. As wonderful as it is, the other side is: why did somebody else have to die?”

ACCORDING TO the Virginia-based United Network for Organ Sharing, which matches donors to recipients and provides other services, 42,424 heart transplants have been performed in the United States since 1988, the earliest date in UNOS records — an average of 2,233 per year. As of the middle of last week, 2,690 people were on U.S. waiting lists. With the continuing shortage of organs, many will die before getting their chance.

Even if the shortage were solved, which is unlikely, transplantation has limitations: about 60 percent of people with donated hearts live 10 years or more, which means that 40 percent do not last a decade. Chronic rejection and vulnerability to disease, a result of immunosupression, take a toll. Looking to the future, Torchiana sees possibilities with artificial hearts and heart components, and xenotransplantation: the placing of animal organs, most likely pigs’, into people. Progress on both fronts continues.

Taricani did not know about the 40th anniversary of Barnard’s breakthrough, but he is ever aware, in a way only a person who has traveled his path can be, of its legacy.

“I’m amazed every day,” Taricani said, “every single day! I walk around and I feel good. I feel totally fine. I have no restrictions. … It’s that old, very trite, clichÉd thing: every day’s a good day. But it really is.

“When things get bad, I just laugh it off, because I shouldn’t even be here.”

INTO THE HEART: A Medical Odyssey, G. Wayne Miller’s 1999 Providence Journal series about the invention of open-heart surgery, can be found at: http://www.projo.com/specials/heart/

Information about heart transplantation can be found at several sites, including:

The New England Organ Bank: http://www.neob.org/

The United Network for Organ Sharing: http://www.unos.org/

gwmiller@projo.com