A Cape Town father and his son, both respected cardiac surgeons, operate together at a hospital built on the legacy of the man who pioneered heart transplantation – Chris Barnard.
For the pair, each day is alive with hope and possibilities, reports YOU.
In the morning when the screen of Dr Willie Koen’s phone lights up in the darkness of his bedroom, the message reads: “We have a heart for your patient. Do you accept?”
Koen’s patient has been waiting for this moment for a year. He quickly types a message to his team and hits send. Within seconds his phone starts flashing again as his teammates respond one by one with a thumbs up. They all know exactly what needs to happen next.
His son, Dr Johan Koen (36), must get on a plane and fly to Bloemfontein to retrieve the heart. The rest of the team is already at Netcare Christiaan Barnard Memorial Hospital in Cape Town, waiting for Johan’s signal so they can prepare the patient.
Hours later, Willie’s phone pings again. “The heart is out. It’s in the cooler. We’re boarding the plane now.” Willie presses his stopwatch. Four hours – that’s all they have. If they take longer, the heart can’t be used.
The Koens’ patients have included some remarkable cases – among them Rhys Thomas (43), a former Welsh rugby player who received a life-saving heart transplant at the hospital this year.
Willie (62) waits for his son to bring the heart to the operating theatre. Just more than an hour later, the plane lands. An ambulance is waiting, and eight minutes later, the siren wails as it pulls into the hospital.
“The heart is here” echoes through the theatre.
After an hour of precise work, the entire team holds their breath and looks at the new heart in the patient’s chest.
“After every transplant, I still feel like Chris Barnard must have done when (that first) heart started beating,” Johan says.
On the 16th floor of Christiaan Barnard Memorial Hospital, the Cape southeaster whips against the windows of the consulting room father and son share.
Willie gets up and fetches a small glass box from the bookshelf. There isn’t a single book on this shelf – it’s his souvenir collection from patients.
Inside the triangular box is a tiny model of a hospital, doctors operating on someone and a Christmas tree. A newspaper headline pasted on top reads ‘A Heart for Christmas’.
“One of my patients received a new heart on Christmas Day,” Willie says. “He gave me this box. All the little things on my bookshelf are there to remind me of my patients.”
He says when he was younger, he wanted to do physics and computers, “but my brother convinced me to study medicine”.
He initially worked in internal medicine, a speciality focusing on prevention, diagnosis and treatment of diseases, until one day he came across a young patient in hospital with heart failure.
“I saw this 18-year-old guy in the hospital corridors and we referred him to the larger academic hospital. When I went to that hospital for a lecture two weeks later, I saw him again – and he looked a lot better.”
The teenager had had a heart valve replacement. When Willie heard about it, he went to see what heart surgeons do and knew immediately that this was his calling.
“There’s a pull to this field,” Johan says. “It happened to me too.”
But perhaps that pull started earlier than Willie realised. As a boy, he regularly went to the hospital with his father and attended functions for donors and recipients.
At one event he was playing while the adults chatted when a man came to stand in front of him. Everyone shook this man’s hand and wanted to talk to him. “Are you little Koen?” the man asked. “Yes, sir,” Johan replied. “Are you also going to become a great heart surgeon like your father?”
Johan nodded. “Yes, sir.”
Little did he know he’d promised Professor Chris Barnard that he’d one day work in his field.
Willie was trained by Barnard himself, the man who performed the world’s first human-to-human heart transplant in 1967 at Groote Schuur Hospital. Johan trained in Toronto, Canada, before returning to Cape Town to work alongside his dad.
For him, every transplant carries the weight of history. “When Neil Armstrong walked on the moon, he said, ‘One small step for man, one giant leap for mankind’. Then Martin Luther King came along and said, ‘I have a dream’. And then came Chris Barnard, who, after his first heart transplant, told his team, ‘It looks like it’s going to work’.”
For Willie and Johan, the moment when the heart starts beating is just the beginning.
“It has to keep beating until tomorrow morning. If it’s still beating tomorrow morning, it has to keep beating until the end of the week. And if it’s still beating at the end of the week, it has to keep beating for a month,” Willie says.
When a transplant is done, the team feel like the Springboks who’ve just won the Rugby World Cup. But the celebration is brief because they know not every case has a happy ending.
Their patients become like family, and when a new heart doesn’t keep beating, it’s something both Koens carry forever. Over the decades, Willie missed countless Christmases because he was needed in the operating theatre, watched his son grow up between surgeries and delivered news to families no one would want to give. Johan has followed the same path, knowing the cost.
There aren’t always hearts available for transplants, but they can sometimes use an artificial mechanical heart. For every heart they transplant, they now implant about 10 artificial hearts.
Willie implanted Africa’s first mechanical heart in Cape Town in 2000. At the time medical experts in South Africa – including Chris Barnard – didn’t have much hope for it. Now it’s at the forefront of the field – hearts smaller and more refined than they were then and working with batteries that sit outside the body.
“There’s a study in Germany where they hope to implant the batteries with the heart. Then you can just go to Starbucks and charge your heart there,” Johan says with a laugh.
“When I implant a mechanical heart, I tell the older people they’re now Steve Austin [from The Bionic Man] and I tell the younger people they’re Tony Stark from Iron Man.”
See more from MedicalBrief archives:
How a historic heart transplant created SA’s first celebrity scientist 50 years ago
Lifesaving mechanical heart pump makes it a birthday to remember
New SA-produced heart valve may revolutionise cardiac surgery