A History of Organ Transplantation: Ancient Legends to Modern Practice

Introduction

xiii Introduction Toward the Impossible 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 of plastic surgery, and the question of the use of tissue from donors appears in surgical works of medieval times. And many outside of surgery were interested from the first in the replacement of lost tissue. In medieval times, numerous shrines to the saints Cosmas and Damian and images of those twin physicians showed them transplanting a human leg. In Bologna, word of Gaspare Tagliacozzi’s plastic surgery spread, and people widely (and wrongly) believed that he had obtained grafts from living donors and that when the donor died, the donated graft also died. Philosophers pondered deeply on the matter, and this urban myth, too good to be false, spread rapidly throughout Europe and was sustained by the satirists and coffeehouse gossips of London in the early 1700s. In the 1800s, the public noticed the activities of tooth transplanters, and antivivisectionists protested experimental transplant work in France. In the 1920s, skin and “monkey gland” transplantation gained a new and dubious public fame. By the 1960s, surgeons rode high in public esteem, not least for the new success with organ grafting. The public were amused rather than shocked by the prospect of humanized pig organs in the 1900s, then intrigued by intricate arm, leg, and face transplants, and entranced by the hopes for organs grown from stem cells. The default view of the public, disturbed briefly from time to time, seems to be that transplantation attempts are admirable. Public opinion has a unique day-to-day input in clinical transplantation since transplantation requires organ donors and, hence, the support of the public. When public opinion is alienated , all donations decrease. Among the interested public observers of transplant history were writers , fascinated by the possibilities and keen on exploiting each new effort. xiv Introduction London satirists in the 1700s found a convenient literary motif in John Hunter’s transfer of teeth from the poor to the rich. The London revival of plastic surgery in the early 1800s provided inspiration for the monster in the novel Frankenstein, and by the end of the century, the grafting of skin and glands provided a mother lode of opportunities for what was soon to be called science fiction. An early practitioner, H.G.Wells, introduced fanciful transplantation possibilities into his work and thence into popular culture. This genre blossomed as a result of the anarchy in the transplant world of the 1920s. Adding to the gland-graft rejuvenation possibilities, there were tales of head, brain, face, and limb transplants. The inventive authors had license to transfer much else with the tissue—hands donated from dead murderers could prove murderous, brain grafts might be malevolent, and simian characteristics could appear after monkey testis transplants. With good science restored in mid-twentieth century, transplant themes were temporarily absent from the fiction of the day, but the controversies of the heart transplants and brain death in the 1970s encouraged publishers and writers to return to these genres. These novels fed on the new fears of the times, featuring sleazy doctors and organ-snatching gangs, but in the more settled periods that followed, popular nonfiction accounts found success, and positive personal stories of successful organ grafts sold well. But it was not until the early 1950s that surgeons embarked with growing success on what was widely considered to be an unreachable mission, namely to successfully graft an organ from one person to another. Such grafting was considered to be impossible because the human body almost invariably rejected grafts from either humans or animals, other than in a few special situations. This reaction against foreign tissue, found at all levels of the animal kingdom, seemed so fundamental that no strategy, surgical or pharmacological, could hope to triumph over the problem. Moreover , many members of the medical community respected this relentless, ubiquitous power of the body to reject what was foreign to it, and many medical professionals, even surgeons, believed that to try to stave off rejection was not only futile but also “against nature.” The pioneers in organ transplantation thus faced not only a huge biological challenge but also peer opposition and even hostility at times. Although the early transplants of the 1950s and 1960s are now...