In the late 40s, during the ward rounds at this Boston hospital, the residents were very concerned at the young comatose patient who had been wheeled in. The consultant looked at the patient at her and said "the only thing that can save her is a new kidney. Else she will not last more than a day or two"
During the evening after the consultant had gone, another patient in the ward died and the young residents took his words seriously. They felt that they could try to give her a new kidney. They went to the mortuary and removed the kidney, brought it back to the ward and using a wick lamp worked till late at night stitching the renal artery and vein to the most easily approachable vessels - Brachial artery and cephalic vein in the ante-cubital fossa.
At the end of the anastomosis they realized that the ureter was hanging free. Too tired they just placed it in a kidney tray and covered the donor kidney with a wet gauze and headed back to sleep.
Next morning when they came back the patient was awake, sitting up. The kidney tray was full of urine and had dripped all over the floor.
Obviously there is no mention about long term survival and the kidney must have been rejected later but the ball was set rolling. Joseph Murray, a Plastic Surgeon did the first proper kidney transplant. It needs a Plastic Surgeon to think out of the box!
During the evening after the consultant had gone, another patient in the ward died and the young residents took his words seriously. They felt that they could try to give her a new kidney. They went to the mortuary and removed the kidney, brought it back to the ward and using a wick lamp worked till late at night stitching the renal artery and vein to the most easily approachable vessels - Brachial artery and cephalic vein in the ante-cubital fossa.
At the end of the anastomosis they realized that the ureter was hanging free. Too tired they just placed it in a kidney tray and covered the donor kidney with a wet gauze and headed back to sleep.
Next morning when they came back the patient was awake, sitting up. The kidney tray was full of urine and had dripped all over the floor.
Obviously there is no mention about long term survival and the kidney must have been rejected later but the ball was set rolling. Joseph Murray, a Plastic Surgeon did the first proper kidney transplant. It needs a Plastic Surgeon to think out of the box!
Experimental studies to transplant a kidney in animals started in 1902 in Vienna Medical School in Austria. In 1909 the first kidney transplant experiments were performed in humans in France using animal kidneys – a brave surgeon inserted slices of rabbit kidney into a child suffering from kidney failure. Although “the immediate results were excellent” the child died about 2 weeks later. Scientists blamed such failures to unknown ‘biochemical barriers’. The first human to human kidney transplant was attempted in 1933 by Yuri Voroniy from Kherson in the Soviet Union but the donor kidney never produced urine and they blamed it to the fact that the donor had a different blood group!
On June 17, 1950 a successful transplant could be performed on Ruth Tucker, a 44-year-old woman with polycystic kidney disease, at Little Company of Mary Hospital in Evergreen Park, Illinois. Although her transplanted kidney was rejected eventually as there were no immuno-suppressants available then, before rejection it gave sufficient time for her own remaining kidney to recover and she lived for another five years!
The first kidney transplants between living patients were undertaken in 1952 at the Necker hospital in Paris by Jean Hamburger although the kidney failed after 3 weeks of good function. However, by now people knew that new approaches were needed to prevent the body from fighting off a “foreign” donor kidney. Sir Peter Medawar at the University of London was experimenting with the immunologic basis of organ rejection in the late 40s and in early 50s Cortisone like medications were used to protect the donor kidney from the recipient’s immune system!
Two days before Christmas in 1954 Joseph E. Murray and his colleagues J. Hartwell Harrison, John P. Merrill performed the famous Boston Transplantation, which changed the course of history. The procedure was done between identical twins Ronald and Richard Herrick to eliminate any problems of an immune reaction and so was done without any immunosuppressive medication. For this and later work, Dr. Murray received the Nobel Prize for Medicine in 1990. The recipient, Richard Herrick, died eight years after the transplantation. More importantly, this opened the door to many more kidney transplant between identical twins, both in Europe and in America.
After scientists more accurately understood why our bodies fight off foreign organs, they experimented with ways to combat these defenses. Surgeons used X-ray, bone marrow infusion, immunoparalysis, donor-recipient matching, and drugs to stop rejection. The 60s came with rapid advances and better techniques for matching donor and recipient blood and tissue types. Improvements in preserving cadaveric (from recently deceased donors) kidneys, were developed and today’s solutions and cooling methods can be safely preserve kidneys for up to 48 hours, there were times when surgeons rush organs from decapitated prisoners!
A procedure, which today is practiced with effortless ease in almost every country, has developed because of the determination and dedication of countless men and women of medicine who were not happy with status quo, and challenged the prevalent norms.
No comments:
Post a Comment