Surgical Transplant

The idea of transplanting animal or human parts dates back for many centuries. The mythical Chimera, animals made up of different animal parts, was believed to be the work of the gods. Perhaps the most famous chimera is the Sphinx in Egypt, which has the head of a man and the body of a lion.

The first viable transplantation occurred in the sixteenth century when a technique was developed for replacing noses lost during battle or due to syphilis. The technique involved using skin from the upper inner arm and then grafting and shaping it onto the nose area. In the eighteenth century, Scottish surgeon John Hunter successfully transplanted a cock's claw to the animal's comb. Corneal transplants between two gazelles were also successfully performed in the latter part of the century.

During the nineteenth century, advances in surgery (like the development of antiseptic surgery to prevent infection and anesthetics to the lessen the pain) increased the success rates of most surgical procedures. However, transplantation of organs languished as surgeons had no knowledge of how to "reconnect" the organ to the new body. It was not until techniques for vascular anastomosis, or the ability to reconnect blood vessels, was developed near the twentieth century that transplant surgery began to move ahead. The first long-lasting renal transplant was performed in Germany in 1902, when a dog kidney was transplanted into another dog by using tube stents (a slender tube used to support the structural integrity of the artery during an operation) and ligatures (wires used to tie off the blood vessels) to make the vascular connections.

The next major advance in transplantation would not occur for more than 40 years. Although renal and kidney transplants were attempted, the transplant recipient's body always rejected the organ. In 1944, Peter Medawar A comparison of the old and new hearts of Dylan Stork, the smallest heart transplant recipient in the world. Dylan weighed 5.5 lb (2.5 kg) at the time of the operation. Photograph by Alexander Tsiaras. National Audubon Society Collection/Photo Researchers, Inc. Reproduced by permission.

showed that the rejection was due to the immune system, which attacked the foreign tissues or organs as foreign invaders, much the same way it works to ward of viruses and other disease. Although short-term successful renal transplants from donor to recipient were achieved in the early 1950s, these transplants usually were rejected by the patient's immune system. As a result, scientists began to focus on manipulating the immune system so it would accept the transplant.

By the early 1960s radiation and drugs were being used to suppress the immune system, in effect, shutting it down to prevent rejection. As a result, that decade saw the first bone marrow transplant, kidney transplant, and kidney/pancreas transplant. In 1967, Christiaan Barnard, a South African surgeon, received world wide notoriety for achieving the first successful heart transplant.

The next major advance came in 1978 with the development of the extremely effective antirejection (also called immunosuppressant) drug cyclosporin. Continued research on how to selectively control the immune system has grown to the point that transplantation is now a relatively common operation with more than 35,000 surgical transplants performed in medical centers throughout the world each year.