The first experimental heart transplantation was performed by Demikhov in Moscow in the very early 1940s. His experiments were discontinued during World War II but, when they resumed in 1946, he produced a large volume of work devising 24 different methods of heterotopic heart transplantation within the chest. During the 1950s, many research workers transplanted the heart in the orthotopic position and also transplanted the heart and lungs en bloc. They used various methods, including cardiopulmonary bypass (heart- lung machine). During the 1960s, Lower and Shumway established beyond doubt that heart transplantation was a possibility. Christiaan Barnard, using their surgical techniques, performed the first human- to-human heart transplant, in December 1967 in Cape Town. Early transplantation attempts 1,2 He noted the behaviour of autografts, allografts and xenografts, and believed allografts could have a successful outcome. Corneal transplants were carried out as far back as 1872 using xenografts, but were unsuccessful. Allograft corneal grafts, however, were the first successful tissues to be transplanted, the earliest being around 1930. Organ transplantation was first attempted in the early 20th century. Previously, Murphy and Beck had devised vascular suturing methods, and these were used by Carrel in transplanting organs. Carrel observed that kidneys transplanted from one site to another in the same animal had a better survival rate than those from other animals. He believed, however, that the functioning of the transplanted organ depends on the success of the vascular anastomosis. This thinking persisted until the 1940s, with many researchers spending all their time and effort devising better and faster techniques for the anastomoses of vessels. Some human application of these techniques was attempted. Ullman, in 1902, having experimented with kidney allograft transplantation in dogs, transplanted a pig's kidney into the elbow of a uraemic woman. The kidney did not function and he thought this was due to technical problems. At that time, many other research workers reported experimental kidney transplantation, some of whom also attempted transplantation from animals to man. The overall experience was reviewed by Guthrie in 1912, who summed up the situation as follows: 'No one, though many experiments have been reported, has yet succeeded in keeping an animal alive for any great length of time which carried the kidney or kidneys of another animal, after its own kidneys were removed … the outlook is by no means hopeless and the principle of immunity which yields such brilliant results in many other fields would be worthy of being tested in this case'. 1