Medicine: Progress in Transplants

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Then John went to the Brigham with his twin brother Andrew, who hoped to give him one of his healthy kidneys. One look at the twins raised doubts in Dr. Merrill's mind. John is 2 in. taller than Andrew, and less heavily built; tests proved that they were not identical but fraternal, and therefore different persons chemically. John was likely to have the usual rejection reaction. But a graft from Andrew's arm to John's had lasted long enough to be encouraging. Because of this, and hoping that John's uremia would be an advantage, the team decided to go ahead. To help the graft take, they had to knock out John's entire factory (mainly in the bone marrow) for making antibodies and blood cells. The knockout, they hoped, would be temporary.

Within a week, Radiologist James B. Dealy Jr. beamed a total of 450 roentgen into John in two doses; given in one shot it probably would have killed him. Then the team was ready to operate. Surgeon Joseph E. Murray opened John's abdomen and prepared a "bed" on the right side for insertion of a kidney. In an adjacent operating theater, Surgeon-Urologist J. Hartwell Harrison removed Donor Andrew's left kidney. A nurse carried it in a sterile basin to Dr. Murray, who stitched it into John's pelvis, carefully hooking up the ureter, main artery and vein.

How well Andrew's kidney had been grafted was soon evident: John, voided 33 quarts within 36 hours. In another major operation, the doctors removed both his own diseased kidneys. In ten weeks he was discharged and stayed fairly well. But after nine months, John's system started to react against his new kidney, and Dr. Dealy ordered an additional 200 r. of X rays. John's survival in good health since then, the Brigham team suggests, gives reason to hope that nature's primeval reaction against invasion has been sidetracked in this case.

Since the Riteris transplant, Paris surgeons using radiation have successfully duplicated the operation with another set of nonidentical twins, and a second Paris team has transplanted a kidney from a woman of 47 to her 40-year-old brother. The transplant appeared to take, but the patient died of cancer of the liver.

Search for the Ideal. Despite these achievements, Dr. Merrill and his colleagues consider radiation far from the ideal solution. Massive radiation exposes the patient to a higher-than-average risk of death from infection or hemorrhage; there is danger of cataracts or cancer, especially leukemia. What they want is a drug or chemical that will switch off the rejection reaction selectively, enabling the body to accept the transplant but leaving other antibody mechanisms unimpaired.

Some potent chemicals, like nitrogen mustard, suppress the blood-forming and antibody mechanisms, but at the same high price as radiation. Other anti-cancer drugs, which interfere with the metabolism of cells, may be more selective but are less effective. So the search goes on.