Surgery: The Best Hope of All

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grasped the significance of the opportunity. Dr. J. Hartwell Harrison removed Twin Ronald's healthy left kidney. Dr. David Hume implanted it in Richard's flank, and it took, though Richard died this year of heart disease. Of 19 other identical-twin transplants, 17 made a good start. But over the years, three patients have died of recurrent kidney disease. "So now we know," says Dr. Moore, "that the critical factor is glomerulonephritis [a form of kidney inflammation involving the small capillary loops or glomeruli], and that these people have a tendency to get the same disease again, and it attacks the transplanted kidney."

In an effort to stave off the immune reaction, Brigham surgeons have done ten transplants after irradiating the recipients' whole body. But only one nonidentical twin survives. Now Surgeon Joseph E. Murray and his colleagues are relying on drugs alone to suppress the immune reaction, and all of their last four patients who received transplants are still living. So is one of an earlier group whose operation is now a year old. His kidney came from a cadaver.

X-ray the Transplant. Now at the Medical College of Virginia, Dr. Hume has begun kidney transplants with modified techniques. First, Dr. Hume removes both of the patient's diseased kidneys, to lower blood pressure and to guard against infection and especially against glomerulonephritis. After the operation, Dr. Hume doses the transplant itself with X rays, on the theory that if antibody-loaded cells are moving in to attack the kidney, they will be concentrated around the target. One important thing, says Dr. Hume, is to get the replacement kidneys fresh. Most cadaver kidneys are. in effect, "in shock" for several hours before they can be transplanted.

A University of Colorado team headed by Dr. William R. Waddell also takes out both diseased kidneys first. But the Denver surgeons go farther: they remove the recipient's thymus and spleen as well, on the theory that these glands are headquarters for rejection mechanisms. The Denver group has made seven non-twin transplants in five months, and guardedly reports that so far, all the recipients but one are doing well.

Block the Rejection. Medical men who hate eager chatter about "breakthroughs" because it raises false hopes in patients are willing to make one exception. They concede that it will indeed be a major breakthrough when a way is found to tune down the immune mechanism just enough so that a transplant will take and the patient will still have a defense against infectious diseases.

The moment a method is found to control the immune mechanism in man, there will be a flood of transplants of many organs. The kidney has been favored up to now, because one kidney is enough for anyone, and everyone with a healthy pair is a potential donor. Even so, the kidney may not prove to be the easiest or the most wanted transplant. The pancreas, source of insulin, would be a boon to a diabetic. Dr. Moore is already making experimental transplants of whole livers between dogs. In Denver, two months ago. Colorado General Hospital and Veterans Administration Hospital surgeons attempted the first human liver transplant, from a girl of ten. who died of a brain tumor, to a boy of three. The boy died of profuse bleeding.

A lung or a heart would be technically more difficult