A History of Organ Transplantation

Title Page, Copyright

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Contents

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Foreword

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pp. vii-x

David Hamilton has been a senior transplant surgeon at the Western Infi rmary, Glasgow, Scotland, and also the first director of the Wellcome Unit for the History of Medicine at Glasgow University. In addition, he is steeped in the lore and the basic science of the fi eld because of his early...

Acknowledgments

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pp. xi-xii

Introduction

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pp. xiii-xx

It is usually thought that within the general advance of medicine, tissue and organ transplantation has a short history. Certainly the modern successful era started only in the 1950s, but there was earlier, much earlier, interest. Even the surgical records from 600 BCE contain accounts...

1 Early Transplantation

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pp. 1-30

To early humans, as to all their descendants, the possibility of restoration of lost or mutilated parts of the body was a lively issue. To make good such losses incurred by war, disease or punishment, ancient humans had recourse to local help and healers. But they also looked for supernatural help, because legends told them that such...

2 The Eighteenth Century

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pp. 31-48

The subject of human tissue grafting disappeared from surgical and literary texts in the early 1700s, but some experimentation continued. Two individuals in particular, Abraham Trembley and John Hunter, took an interest in grafting in order to gain insight into the fundamental mechanisms of animal life. Their work focused on tissue...

3 The Reawakening

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pp. 49-64

The ancient craft of plastic surgery was revived in Europe in the early nineteenth century. With the discovery of early Indian surgical methods, which were still in use there, and the realization that Tagliacozzi’s works, when read in the original language, had merit,...

4 Clinical and Academic Transplantation in Paris

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pp. 65-87

Germany was the first nation to nourish and broaden the revival of the old techniques of plastic surgery, but it was midnineteenth- century French surgeons who can be credited with fi nding the simple solution to the problem of grafting detached skin. The solution was for the graft to be very thin, and although this simple discovery...

5 The Beginning of Organ Transplantation

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pp. 88-104

At the start of the twentieth century, the new methods of blood vessel surgery allowed experimental and human organ transplantation to commence, and some order returned to the understanding of tissue transplantation. Increasingly, the famous European surgical centers took up tissue grafting studies and did so care...

6 The “Lost Era” of Transplantation Immunology

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pp. 105-125

Awareness of the phenomenon later called “immunity” existed in ancient times.¹ After epidemics, those who recovered from the disaster seemed naturally protected from future outbreaks of the illness. Possibly in India or China, early peoples learned to induce a state of immunity to smallpox by inoculation—placing a small amount of material...

7 Anarchy in the 1920s

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pp. 126-153

The impressive gains in transplantation immunology research and the technical expertise developed in experimental and human transplantation were largely forgotten in the wake of World War I. War, which often gives birth to medical advances, was in this instance the assassin. Although academic studies in mainstream humoral immunology...

8 Progress in the 1930s

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pp. 154-172

By the early 1930s, after the muddles of the previous decade, the prewar European experimental transplant work was revived in small ways. There was some activity in Lyon.¹ In Germany, there was a modest restoration of studies on immunosuppression. In the Soviet Union, there was impressive innovation in blood transfusion, corneal...

9 Understanding the Mechanism

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pp. 173-194

The emergence of a new and lasting interest in tissue transplantation is usually dated to 1943, the year of publication of a reinvestigation by the surgeon Tom Gibson and biologist Peter Medawar. Entitled “The Fate of Skin Homografts in Man,” this...

10 Experimental Organ Transplantation

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pp. 195-220

At this time in the late 1940s, some surgeons renewed their interest in experimental organ transplantation, attempting to transplant not only kidneys but also the heart. As described earlier, these eff orts had started in Europe before World War I and largely ceased when the war began, but the growing interest in transplantation...

11 Transplantation Tolerance and Beyond

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pp. 221-253

During the early 1950s, while human and experimental organ transplant attempts were under way, in the laboratory steady progress was being made toward understanding graft rejection, and the advance of great significance resulted. In 1949, Peter Medawar...

12 Hopes for Radiation Tolerance

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pp. 254-268

The first hesitant steps that marked the start of the modern, continuous period of human organ transplantation were taken in 1958, when attempts were made to thwart organ graft rejection in humans. The strategy used came from radiobiology—the study of the effects of lethal radiation and its treatment using bone marrow infusion....

13 The Emergence of Chemical Immunosuppression

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pp. 269-295

In the early 1960s, the approach to organ transplantation changed, allowing attempts with radiation to be put aside in favor of progress by other means. Immunosuppressive drugs appeared, and they proved to be more controllable and more eff ective than irradiation, and the surgeon’s assumptions changed from hoping for “one-shot” tolerance to accepting...

14 Support from Hemodialysis and Immunology in the 1960s

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pp. 296-313

In 1960, the medical community made signifi cant progress toward a full understanding of cell-mediated immunity. Most notably, researchers uncovered the central role of the thymus and defi ned the two types of lymphocyte and their links with cell-mediated immunity. Also in 1960, Peter Medawar was awarded a Nobel Prize for his work on tolerance,...

15 Progress in the Mid-1960s

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pp. 314-339

The technical side of kidney transplantation was now well established, and there was growing confi dence with the surgical management. Policy shifted to encourage the use of cadaveric organs, thus removing the concerns associated with living-related donation....

16 Brain Death and the “Year of the Heart”

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pp. 340-358

A major change in hospital practice occurred in the mid-1960s when gravely ill or injured patients could receive respiratory support on a ventilator. This shift transformed resuscitation into a focused, successful strategy. Intubation and ventilation of patients, followed by care in the orderly calm of the new intensive care units, constituted...

17 The Plateau of the Early 1970s

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pp. 359-379

In the early 1970s, there was a hesitation in the development of organ transplantation. The results of kidney transplantation had been encouraging in the late 1960s, but thereafter the pace of improvement stalled.¹The numbers of kidney transplants also leveled off after 1972, and the results then got mysteriously worse. After the major promise of antilymphocyte...

18 The Arrival of Cyclosporine

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pp. 380-412

After the uncertain and at times discouraging events of the middle 1970s, the mood in the transplant world changed. In 1976, a possibly useful immunosuppressive agent made its fi rst appearance in a pharmaceutical company laboratory and then slowly made its way into transplant management....

19 Waiting for the Xenografts

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pp. 413-422

The 1990s were a time of continued, steady improvement in the results of organ transplantation. In the United States in middecade, 250 hospitals carried out kidney transplants, 160 reported heart grafting, and there were 70 liver transplant units. Cyclosporine was still important, but a number of new agents began to rival its dominant...

Conclusion

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pp. 423-430

The many l andmark events in the development of tissue transplantation off er data useful not only for their own sake but also for analyzing the more general mechanisms of clinical and scientifi c innovation. Looking at what happened and how it happened, rather than how it ought to have happened according to theory, is illuminating....

Notes

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pp. 431-526

Bibliographic Essay

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pp. 527-538

Index

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pp. 539-556