Lessons learned from early organ recipients continue to hearten the future of transplant medicine.
When Thomas Starzl, MD, PhD, stitched a donor kidney into 37-year-old truck driver Bob Phillips in January 1963, he never dreamed that his patient would live to see the next millennium. Hoping for even a five-year survival rate was tempting fate in the early 1960s, an era when it was cause for jubilation when kidney transplantees made it to a year post-operation. Yet in 2012, the men met again to smile and pose for photos. By then, Dr. Starzl was 20 years retired from clinical practice and Phillips had outlived his donor, his younger sister Ruth. The kidney had thrived despite the fact that Ruth’s blood type did not match Bob’s. More remarkable still, Phillips had lived the last 18 of those nearly 50 years without needing immunosuppressive, or antirejection, drugs.
The knowledge gleaned from Phillips and a handful of other long-lived organ recipients has continued to shape the course of transplant medicine, a field that has evolved rapidly. Once considered the purview of fiction—along the lines of Mary Shelley’s Frankenstein—organ or limb transplantation was considered unnatural and akin to interfering in the realm of gods. Just 65 years ago, successful organ transplants were essentially impossible; by 1999, doctors had mastered the transplantation of kidneys, hearts, livers, and other organs and were starting to attempt even more complex transplant surgeries. Last year, New Jersey’s Matt Scott celebrated 15 years with his donated left hand, a world record for a limb recipient. The first partial face transplant took place in France in 2005 and the recipient remains stable; in 2012, Isabelle Dinoire gave a rare interview to the BBC in which she thanked the donor, saying, “She saved my life.” And in September 2014, an anonymous Swedish woman gave birth to the first child gestated successfully in a donor uterus. The mother, who lacked a womb but had healthy ovaries, accepted a uterus from a postmenopausal friend who had given birth twice. Conceived via IVF and delivered by C-section at 32 weeks, the 3-pound, 14-ounce boy was named Vincent, which means “to conquer” in Latin. The organ donor is Vincent’s godmother.
Within the last half-century, the science of organ transplantation has gone from resembling the Apollo lunar program—experimental, expensive, and high-profile—to the Space Shuttle: still extraordinary, still requiring the efforts of platoons of highly trained people, and still expensive, but understood to the point where it is now considered almost routine. Although faces, hands, and wombs continue to edge closer to the Apollo side of the equation, all transplant recipients confront astronomical obstacles, not only in managing their postoperative lives but first finding a suitable donor organ in time to save them.
Several medical breakthroughs were needed to make organ transplantation viable, but the biggest was the creation of effective immunosuppressant drugs, the earliest of which emerged in 1957. It is no coincidence that the first successful human kidney transplant, performed by Joseph Murray, MD, in Boston in 1954, involved identical twins, who do not have to worry about organ rejection. On the cellular level, the body is xenophobic, attacking anything that is not native. Immunosuppressant drugs tamp down the aggressive reaction to non-native cells by weakening the immune system, yet at the risk of admitting infective agents that can devastate or kill.
Also required for transplants to work were new tools and techniques for stitching tiny blood vessels, the development of heart-lung and dialysis machines, and the forging of formal donor-recipient networks like the United Network for Organ Sharing (UNOS). Equally important was a revision of the medical definition of death to include the complete and irreversible loss of cerebral function, aka brain death, which improves the viability of donor organs. The now widespread acceptance of the concept of brain death by doctors, lawyers, ethicists, and the general public was by no means a given.
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