December 24, 2004
Celebrating 50 Years of Organ Transplantation
Five decades of progress set the stage for future advances
HealthDayNews -- Fifty years ago today, Dr. Joseph E. Murray led a team of surgeons at Boston's Peter Bent Brigham Hospital -- now Brigham and Women's Hospital -- that gave Richard Herrick a second shot at life.
In the process, the doctors revolutionized modern medicine.
Herrick, who was dying of kidney disease, received a donor kidney from his identical twin, Ronald. The transplant -- the first successful human organ transplant -- let him live another nine years.
In his memoir, Surgery of the Soul, Murray recalls a key moment three hours into surgery: "There was a hush in the operating room as we gently removed the clamps from the vessels newly attached to the donor kidney. As blood flow was restored, the patient's new kidney began to turn pink. There were grins all around."
Since that historic feat, amazing strides have been made in transplantation surgery and the development of immunosuppressive drugs that keep the human body from rejecting donated organs. Surgeons routinely perform heart, lung, kidney, liver and pancreas transplants. Intestines transplants also are being done. And experimental hand transplants continue in the United States and abroad.
"It obviously marks an important, I would say, landmark in medicine," said Dr. Mohamed H. Sayegh, chairman of transplantation medicine at Harvard Medical School and director of the Transplantation Research Center at Brigham and Women's and Children's Hospital in Boston.
"For the first time there [was] a medical procedure that basically can save an individual from dying or, in the case of kidney transplantation, requiring to be on dialysis, and for the most part bring them back almost to a normal life," Sayegh added.
More than 25,000 organ transplants are now performed in the United States each year, and more than 88,000 people are on a waiting list for organs to become available, according to Joel Newman, a spokesman for the United Network for Organ Sharing (UNOS), a Richmond, Va., organization that manages the nation's organ transplant system.
At the end of 2002, there were 150,000 people living with functioning solid organs transplanted from a donor, up from 62,000 in 1993, according to Sayegh and his Brigham and Women's colleague Dr. Charles B. Carpenter. They chronicle the progress made in organ transplantation and the significant challenges that remain in an article in the Dec. 23 issue of the New England Journal of Medicine.
In the early days of organ transplantation, physicians didn't have the means to suppress an organ recipient's immune system to prevent organ rejection. As more transplants were performed between identical twins -- who are born with compatible tissue -- researchers pursued approaches that might make transplantation more widely available.
Initially, patients were subject to sub-lethal total-body irradiation combined with cortisone. In 1962, the first clinical trial of an immunosuppressive drug, azathioprine, was conducted. By the early 1980s, cyclosporine -- one of the most frequently used anti-rejection drugs today -- was introduced. Use of the drug boosted one-year survival among organ recipients from 70 percent to more than 80 percent, the paper notes.
Yet, long-term survival rates among U.S. transplant patients have not achieved similar gains, the authors point out. For example, people who receive a kidney graft from a living donor have a one-year survival rate of more than 94 percent, on average. After a decade, the average survival rate drops to 55 percent.
"A major problem remains that these organs get chronically rejected, which means they lose function over years," Sayegh explained.
In September, the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health (NIH), awarded five-year grants totaling roughly $43 million to Brigham and Women's, the Cleveland Clinic and the University of Pennsylvania to conduct research aimed at improving transplant survival.
A persistent shortage of organs to meet increasing demand for most organ types also remains an obstacle. But there are some encouraging developments, according to Newman. Every year since 2001, the number of living organ donors in the United States has exceeded the number of deceased donors, he said. According to UNOS, more than 40 percent of the kidney transplants performed in the United States each year use organs from a live donor.
Going forward, there is significant interest in finding ways to induce "immunological tolerance," which would allow organ recipients to accept transplanted tissue as their own, Sayegh said. The NIH's Immune Tolerance Network has approved various pilot studies to explore the biology of tolerance in humans, he noted.
Scientists also imagine possibilities in using stem cells to regenerate failed organs. Even xenotransplantation -- the transfer of tissue to humans from other species -- may have a role to play. But that is decades away, if ever.
"For at least 10, maybe 20 to 30 years, the vast majority of people who get to end-stage organ failure will benefit from organ transplantation," Newman said.
To learn more about organ donation and transplantation, visit the Organ Procurement and Transplantation Network.