One deceased organ donor can save as many as eight lives between organ and tissue transplants possible. On Wednesday 10/10/18, LiveOnNY.org asks New Yorkers to “Unleash Your Inner Hero” and sign up for organ donation. This is especially urgent in the Empire State, since it is 50th out of 50 states in percentage of registered organ donors at a paltry thirty-three percent. Here’s a list of ten Pioneering Medical Transplants – the genesis of real life heroism.
1665 The First Recorded Successful Blood Transfusion
It was in the 17th century the earliest known blood transfusion is attempted. In 1628 English physician William Harvey discovered blood circulation. Not long after, the earliest known blood transfusion is attempted. In England in 1665, the first recorded successful blood transfusion was performed, but not on humans. Man’s best friend really earned its name by being the test subject for this life saving procedure. Physician Richard Lower kept dogs alive by transfusing blood from other dogs.
More than fifty years later,the first successful blood transfusion of human blood was performed in 1818 by Dr. James Blundell to treat postpartum hemorrhage. Blood types were not discovered for another 82 years, but once they were, doctors began developing blood typing and cross matching between donors and patients to improve the safety of transfusions. The universality of the O blood group was identified in 1907. Later discoveries, including sodium citrate for use as an anticoagulant, the Rh blood group, and plastic implements for collection and storage of blood greatly improved the thirty day survival rate of patients post transfusion.
1838 First Corneal Transplant
This was actually the first successful human organ transplant. Corneal transplantation, also known as keratoplasty, is the only therapeutic procedure for many disorders of the cornea that can lead to blindness. It can also benefit patients with infection, pain or perforation of the cornea. In fact, in 1838 the first corneal transplant in a human was performed using a cornea from a pig was grafted into a human recipient. It remained transparent for a couple of weeks. Richard Kissam reported this years before the invention of anaesthesia!
In successive years, more partial thickness transplants were performed. The first “full-thickness” corneal transplant in a human being happened in 1906. This is the transplant that paved the way for the growth of the procedure and the opening of eye banks in different countries to perform them. As immunosuppression medications improved, failure rate for corneal transplantation has lowered, with approximately twenty-five percent of corneas being lost by four to five years post transplant.
1954 First Successful Human Kidney Transplant
The first documented successful kidney transplants were experiments performed on animals in 1902 at the Vienna Medical School in Austria. Then, in 1933 the first human-to-human kidney transplant was performed, but the donor kidney never functioned because doctors were unaware that mismatches in donor and recipient blood groups were problematic in the procedure. Indeed, what made the 1954 transplant successful was that it the donor and recipient were identical twins. It was performed by a team headed by Joseph E. Murray at Peter Bent Brigham Hospital in Boston, Massachusetts. Because their organs were indistinguishable to each other’s immune systems, no immunosuppressive medication was necessary.
While advances in kidney transplantation were happening, there were other developments being perfected that helped keep renal failure patients alive. Kidney dialysis was keeping patients alive by using an artificial kidney to purify human blood, which is what normal functioning kidneys do every day. Nonetheless, surgeons charged ahead, developing a surgical procedure that would not only place a new kidney in the patient, but connect all the necessary tubes and blood vessels, and improving immunosuppression upon accurately understanding why our bodies fight off foreign organs.
1956 The First Successful Bone Marrow Transplant
In the early nineteen hundreds, doctors made the first ever attempt to treat patients with a donor’s bone marrow. However, this treatment was unsuccessful, as the bone marrow was given by mouth. The first successful transplant was again between identical twins. It was performed by Dr E Donnall Thomas in New York. The patient, who had leukaemia, first had radiotherapy and then was given the healthy bone marrow.
Two years later, in November 1958, French oncologist and immunologist Dr. Georges Mathé performs a human bone marrow transplant using bone marrow from donors who were not related to their recipients. The six patients were Yugoslav engineers who were irradiated at different levels after a nuclear reactor incident. Later, researchers discover bone marrow contains at least two kinds of stem cells – blood or haematopoietic stem cells ( these form all the types of blood cells in the body) and stromal stem cells(these form bone, cartilage, fat and connective tissue).
1963 First Lung Transplant
Up until Dr. James Hardy performed the first human lung transplant in 1963, Dr. Hardy and his team had performed about four hundred transplant experiments on dogs at their Jackson, Mississippi. Repeatedly, although the transplanted lungs seemed to function reasonably well early after transplantation, the dogs ultimately rejected the lungs within a month despite various immunosuppressants available at the time.
The transplant recipient was a 58-year old man who had lung cancer involving the left main airway and obstructing distal airways resulting in lung collapse and recurrent pneumonia. He was a prison inmate, serving a life sentence. Nonetheless, Dr. Hardy treated his patient with dignity, carefully outlining the potential complications and risks with him in detail. He agreed to proceed. The donor had been brought to the emergency department because of a massive heart attack resulting in heart failure and shock, and once he passed away, the family consented to the donation. Over the next ten years only 36 lung transplants were performed worldwide and the majority of recipients died within a few days. In 1983, the Toronto Lung Transplant Group performed the first successful lung transplant. The recipient was another 58-year old man, this one suffering from pulmonary fibrosis. When the group reported their experience in 1986, he was alive and leading a normal lifestyle. This success was remarkably encouraging for pulmonary physicians and patients with lung disease.
1966 First Successful Pancreas Transplant
In December 1966, more than 50 years ago, doctors at the University of Minnesota pioneered the first-ever pancreas transplant. The procedure was performed by surgeons Richard Lillehei and William Kelly. Since then, more than 50,000 pancreas transplants have been performed worldwide, and roughly 30,000 in the United States alone. University of Minnesota holds the worldwide record, with an impressive 2,300 and counting.
As late as the nineteen nineties, one out of every six type 1 diabetics would not live to see their fortieth birthday. That mortality rate increased if a patient suffered kidney failure, a common complication of type 1 diabetes. Pancreas and kidney transplantation offered a solution. With improved surgical techniques, new immunosuppressive medications that decreased the chance transplant rejection and more effective antibiotics, success rates greatly improved. One University of Minnesota physician is quoted as saying “Transplantation of a kidney and a pancreas not only improves a patient’s quality of life—making that person insulin and dialysis free—it also has been shown to extend life”. Modern medicine: one, Premature death: nil!
1967 First Successful Liver Transplant
It was Thomas E. Starzl, M.D., Ph.D., FAAP (Hon.) who performed this groundbreaking surgery. He lived to be 90 years old and passed away in 2017. He conducted the procedure at University of Colorado in Denver, where he was serving as professor and chair of surgery. He is also credited with performing the first successful pediatric liver transplant. Starzl attempted the first human liver transplant in 1963, but a successful liver transplant was not achieved until 1967. In 1970 survival rates were dismal—approximately fifteen percent at the one-year follow-up. The discovery of the immunosuppressive drug cyclosporine in the early 1980s led to improvements in rejection rates, and soon liver transplantation became a more viable treatment.
Living liver donation is possible because of the liver’s remarkable capacity to regenerate. It only takes about one week to regenerate back to it’s full size after a portion of it has been removed. Also, when transplanted, the liver can regenerate to suit the size of its new host. In the few cases where baboon livers have been transplanted into people, they quickly grow to the size of a human liver.
1988 First Successful Intestinal Transplant
Although experiments were being conducted in the early 20th century, intestinal transplantation has only recently become a viable clinical procedure. As the largest lymphoid organ in the body and host to a multitude of foreign antigens, the small bowel has presented a challenge throughout the history of organ transplants. In 1902, French Nobel laureate Alexis Carrel performs experiments in which intestinal segments are implanted in the necks of dogs. Man’s best friend comes through yet again!
In the 1960s Initial attempts at intestinal transplantation are suspended due to poor graft and patient survival. Of eight human intestinal recipients recorded during this period, none survived; this was due to ineffective immunosuppressive drugs. Patients transplanted in Kiel, Germany in 1988 and in Paris, France in 1989 became the first long-term survivors with sufficient graft function. Also in 1988, in London, Ontario the first successful combined liver-intestinal graft was performed. The recipient lived several years after.
1999 First Successful Hand Transplant Performed in the United States
Surgeons in Louisville, Kentucky, performed the first successful hand transplant in the United States. The surgery replaced the left hand of a New Jersey man with one taken from an unidentified donor who had died a few hours earlier. The 15-hour operation was performed at Louisville Jewish Hospital. The first hand transplant was carried out in Ecuador in 1964. It failed after two weeks when the recipient’s body rejected the donor hand. At the time only crude anti-rejection therapy was available.
As of 2017, there have been approximately 100 hands transplanted on more than 60 patients around the world. A hand transplant, unlike a solid organ transplant, involves multiple tissues (skin, muscle, tendon, bone, cartilage, fat, nerves and blood vessels) and is called vascularized composite allotransplantation, or VCA..
2010 First Successful Full Face Transplant
At Barcelona’s Vall d’Hebron hospital, a 31-year-old man received the world’s first successful full face transplant in March 2010. During the 24-hour surgery, a team of 30 surgeons lifted an entire face, including jaw, nose, cheekbones, muscles, teeth and eyelids, and placed it mask-like on to the man. The transplant was necessary after the man accidentally shot himself in the face in 2005. Four months after the surgery, the patient spoke at a press conference. Beforehand, he had been unable to breathe or eat on his own. By the time of the press conference, he was able to drink liquids and eat soft foods
The first partial face transplant, was carried out in France in 2005.
Liver Transplant: http://www.aappublications.org/news/2017/04/20/Obits042017, https://emedicine.medscape.com/article/431783-overview, http://www.vivo.colostate.edu/hbooks/pathphys/digestion/liver/regen.html
Full Face Transplant: https://www.theguardian.com/world/2010/jul/26/full-face-transplant-patient