Surgery: The Best Hope of All

• Share

(8 of 11)

Insight. Surgeons are virtually unanimous in believing that the most exciting and promising new area now being opened to them is the field of transplantation. After this momentary agreement, they promptly offer a thousand differing opinions on how soon transplantation of an organ from one human being to another will become a daily routine instead of the headline-heralded event that it is today. They are equally diverse in their views as to how surgery will eventually overcome the fact that all animals, and especially man, are designed to resist any invasion of foreign protein from any creature except an identical twin. (The major exception is the cornea, which has no blood supply. Paradoxically, blood transfusion itself is a transplant, but it tides the patient over, despite eventual rejection of white cells.)

The surgeons of old had some success in using part of a man's own arm to rebuild a nose or ear, but as early as 1597, Gasparo Tagliacozzi of Bologna wrote with great insight that "the singular character of the individual entirely dissuades us from attempting this work in another person, for such is the force and power of individuality." Three centuries later, Charles Claude Guthrie and Alexis Carrel learned the wisdom of this judgment. With great virtuosity, they proved that organ grafts between animals were surgically possible. Guthrie even succeeded in grafting a second head onto a dog; more constructively, he and Carrel learned how to stitch together the ends of small, slippery blood vessels so that they would neither leak nor become clogged by clots. But for all their dexterity, the scientists did not solve the problem of getting organ grafts between two individuals to take.

Then, in 1953, Britain's Peter Brian Medawar pinpointed the "rejection phenomenon." It is, he proved, a display of the same immune mechanism that enables a healthy body to beat down a virus infection by developing antibody against the foreign protein. Against a second invasion, the body reacts faster. It is the same with grafts: the first may be rejected slowly, but a second one from the same donor is turned down more quickly.

"By the Way. . . ." When Dr. Willem J. Kolff visited Boston in 1947 with the design for an artificial kidney to filter waste products from the blood, he had no idea that he was laying the foundation for today's flurry of kidney transplants.

Dr. George W. Thorn, the Brigham's physician in chief, and Surgeon Carl W. Walter modified Kolff's early model, which he had built in secret during the Nazi occupation of The Netherlands; and for patients whose kidney failure was only temporary, the contraption was a lifesaver. But it could not keep alive those whose kidneys had failed permanently. In 1951, in a desperate effort to save these patients, Brigham surgeons decided to go ahead and transplant kidneys without waiting for the mysteries of immunity to be dispelled. But all those "unprotected"' transplants eventually failed.

One day in 1954 a doctor phoned the Brigham from Northboro, Mass., and begged Dr. John P. Merrill to put Richard Herrick, 24, back on the artificial kidney because both of his own kidneys were failing catastrophically. As he was about to hang up, the Northboro doctor added: "By the way, this patient has an identical twin." Physician Merrill immediately