Forty years ago today, South African surgeon Christiaan Barnard performed the first human-to-human heart transpant. To say that it was a very big deal is an understatement. Although the patient only lived 12 days after the operation, it began a new era in medicine.

Until then, if your heart degenerated past a certain point, well, that’s life. People accepted their fate because they had no choice.

But not now. Knowing that a heart transplant is possible has come to mean that such a procedure is every human’s due. Thus health care costs rise.

In 2002, the state of California spent $1 million to give a prison inmate a new heart.

A California prison inmate serving 14 years for robbery received a heart transplant earlier this month, renewing a debate about who deserves to get desperately needed organs.

The taxpayer-supported transplant, expected to cost $1 million with follow-up care, occurred as 500 Californians waited for hearts. The operation saved the 31-year-old inmate from dying of a viral heart condition, said Russ Heimerich, spokesman for the California Department of Corrections.

Citing two court rulings in favor of inmate care, Heimerich said, “Our hands are pretty much tied. It’s not a question for this department to decide.”

He pointed to a 1976 U.S. Supreme Court ruling declaring it “cruel and unusual punishment” to withhold necessary medical care from inmates.