With a sweep of one of his famous hands and a few staccato bursts of Afrikaans-accented English, Dr. Christiaan N. Barnard, who performed the world's first human heart transplant, condemned Virginia's health planning system today.
In the process, the renowned surgeon also plugged Fairfax Hospital's application to become the first heart transplant facility in the Washington metropolitan area.
In a hearing before the state health commissioner that had the air of Hank Aaron dropping by a neighborhood baseball sandlot, the 63-year-old Barnard offered a soliloquy on the evolution of cardiac surgery, the serendipity of his own success and the immorality, in his view, of denying some hospitals permission to perform heart transplants.
"I don't think that any hospital that has an established program of open heart surgery ought to be denied" permission to perform transplantations, the doctor declared. "I think it's immoral to deny that."
Barnard was Fairfax Hospital's star witness at the hearing today, and hospital officials hope his testimony will help them overcome the objections of a regional state agency that has opposed their request to perform heart transplants. State Health Commissioner James B. Kenley is expected to announce a final decision on the hospital's application by the end of March.
The 656-bed hospital, which paid Barnard an honorarium and expenses, has a highly regarded open heart surgery program. After more than two years of study and preparation, it applied in December for permission to begin transplants. More than 100 hospitals in the nation perform heart transplants, a number that has grown rapidly in two years.
The hospital argues that residents of the Washington area should not have to travel to the Medical College of Virginia in Richmond or Johns Hopkins Hospital in Baltimore -- the two closest facilities that perform transplants -- to have the operation.
"We feel like it's our duty to provide the service for patients in our area who wish to stay there," said Dr. Edward A. Lefrak, the hospital's chief heart surgeon.
State health planners in Northern Virginia have opposed the application, saying Washington is well served by the centers in Richmond and Baltimore, and saying that new programs -- the Washington Hospital Center is also seeking to perform heart transplants -- would be inefficient and a strain on the limited supply of donor hearts.
The Health System Agency of Northern Virginia, which has challenged Fairfax Hospital's application, also contends that the heart transplant programs at Johns Hopkins and Medical College of Virginia would be harmed by a transplant facility in Fairfax.
Agency officials say that area residents would suffer if heart transplant facilities were forced to compete for organ donors. They said that the hospital might be forced to accept patients who have less chance of surviving a transplant operation.
Lefrak, the Fairfax Hospital surgeon, countered that a new tranplant program in the metropolitan area would actually generate a greater supply of hearts because area doctors would be more conscious of the nearby facility, and forward suitable organs.
In his 40-minute testimony today, Barnard did not dwell long on the nice details of health planning. Rather, his view is that heart transplants, with the assistance of new drugs to control rejection of the organs, have become a workaday, routine procedure in the last several years, and that all hospitals with the necessary expertise -- particularly those in metropolitan areas -- should have heart transplant programs.
His message was that the state essentially had no business telling a hospital what operations it can or cannot perform.
"There has been too much fuss about cardiac transplantion," said the man who touched off the fuss. "All you should consider is whether a hospital is competent to do the operation."
On the subject of his own fame, which stems from the successful heart tranplantation he performed Dec. 3, 1967, he said: "I was lucky to have backed the right horse."