Learn about the technical and scientific advancements achieved over the past 70 years that are saving the lives of thousands of patients a year.
Introduction
Organ transplantation is “the process of surgically transferring a donated organ to someone diagnosed with organ failure,” a complex multidisciplinary endeavor, requiring the collaboration of various specialties across the medical field including teams of scientists, immunologists, and surgeons.
The technical and scientific advancements that have been achieved in the field over the past 70 years are today saving the lives of thousands of patients a year, providing them with outstanding long-term quality of life. Continuous innovations and relentless research have transformed what was once impossible into reality, with procedures today ranging from kidney transplants to full facial transplants and everything in between.
While this success has required unyielding efforts from scientists and doctors across the board, it has also required pivotal adjustments in the legal framework to accommodate these procedures in a suitable timeframe, as well as vital changes in social attitudes.
Ancient Times
There are fascinating myths and legends originating from ancient civilizations around the world that refer to body parts being transferred from person to person. Ancient tales in the Greek, Roman, Chinese, Indian and Egyptian cultures describe gods and healers performing organ transplants using animal cadavers.
However, the first written reference on skin grafting as a treatment for burns can be found in the *Ebers Papyrus*, which is considered one of the oldest and most extensive records of Egyptian medical history, created around 1500 BCE.
Around 800 BCE, an Indian physician named Sushruta recorded in detail his advanced technique for full-thickness skin grafts in a text called *Sushruta Samhita*, the first of its kind in ancient history, establishing Sushruta as the father of plastic surgery.
Notable Early Observations & Attempts
In the 1500s, Italian surgery and anatomy professor Gasparo Tagliacozzi who wrote *The Surgery of Defects by Implantations*, reconstructed noses and ears using skin from patients’ arms. He observed that using skin from a different donor caused the procedure to fail, thus observing what we now recognize as transplant rejection.
In the early 1900s, there are records of doctors transplanting kidneys from animals such as monkeys and pigs to patients dying from renal failure. None of these attempts were successful, and patients died within days of the procedures. In 1936, the first human-to-human kidney transplant was attempted unsuccessfully.
In the 1940s, research in immunosuppression as a method to overcome transplant rejection got under way. British zoologist Peter Medawar carried out transplant research and advanced the theory of acquired immunological tolerance. In 1960, Medawar received the Nobel Prize for Physiology or Medicine for developing the foundation for successful tissue transplantation.
Kidney Transplants
While there had been ongoing research on the viability of transplanting organs, by the 1950s the only successful transplants to have been performed were skin grafts. At the time, the only potential donors were live donors, and so most of the research had been focused on kidney transplants as donors could survive with just one of their own.
Earlier attempts of kidney transplantation had failed because of the incompatibility between donor and host, and the subsequent immune rejection of the transplanted organ by the recipient. However, pioneering research of Sir Peter Medawar on acquired immunological tolerance in the 1940s propelled the concept into reality.
In 1954, the first successful organ transplant in a human was performed by American physician Joseph Murray who used a kidney from his patient’s identical twin brother. As the brothers were genetically identical, there was no immune rejection from the recipient brother, and both men survived the operation and recovered well.
Donor & Recipient: From Twins to Strangers
By the 1950s, intensive and extensive research had highlighted the immune system’s crucial role in organ rejection, and scientists were gaining a better understanding around the concept of donor/recipient compatibility. As a result, in 1954, Dr Joseph Murray performed a kidney transplant between twin brothers which was the first ever successful kidney transplant in human history.
In 1959, the first kidney transplant between individuals not genetically identical was successfully performed in Louisiana. In this case, the donor and recipient were fraternal twin brothers. A year later, a successful kidney transplant between non-twin siblings took place, and, in 1961, the first successful kidney transplant between non-siblings was performed, marking the beginning of a new era.
1960s – Kidneys and Beyond
By the 1960s, it was evident that transplants were feasible between unrelated individuals, so scientists and doctors turned their attention to immunosuppression as a means to prevent rejection. Drugs including azathioprine and prednisone were showing promising results in suppressing the immune system and, in 1962, American doctor Joseph Murray performed the first renal transplant between nonrelated patients using azathioprine. This was also the first successful transplant from a deceased donor.
By the late 1960s, successful heart, liver, and pancreas transplants from deceased donors had been performed. In 1963, American surgeon James Hardy transplanted the first human lung from a deceased donor. In 1967, Dr. Thomas Starzl performed the first liver transplant in a human, using azathioprine and steroid to suppress the recipient’s immune system and prevent organ rejection.
Another major development took place in 1968 when the first U.S. organ donor program was established, allowing anyone over 18 to legally donate their organs upon death.
The First Artificial Heart
In the early 80s, Dr. Robert Jarvik made a groundbreaking invention in the organ transplant field by designing a totally artificial heart at the University of Utah, known as the Jarvik-7. In 1982, Dr. William DeVries and his team successfully implanted the first ever artificial heart in a human during a 7-hour surgery.
The Jarvik-7 contained two plastic pumps powered by compressed air, which required the patient to be attached to a 350-pound air compressor for the rest of their life. This artificial heart pumped blood through the body at 40-120 pulses per minute and made a soft clicking sound instead of the usual heartbeat sound.
In the 1990s, the Jarvik-7 was implanted in more than 150 patients whose hearts were too damaged for other interventions while waiting for appropriate donors.
Vascularized Composite Grafting
By the late 1990s, advanced immunosuppressant drugs further improved transplant tolerance in recipients, allowing for even more complex procedures such as vascularized composite grafts composed of multiple tissues. Vascularized composite grafting is “the transplantation of multiple tissues as a functional unit from a deceased donor to a recipient with a severe injury.”
Noteworthy examples of vascularized composite grafting include the first successful hand transplant in 1998 by Dr. Jean-Michel Dubernard and the first ever full-face transplant successfully performed by Spanish surgeon Juan Barret and his team in 2010.
Vascularized composite grafting hailed a new era in the treatment of patients with deformities due to accidents, burns, and other trauma. Prior to that, the only surgical option was facial reconstruction, which had cosmetic and motor function limitations especially for patients with particularly complex deformities.
