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Thursday 19 January 2017

Joe: the first transplant doctor . . . who was then accused of playing God

Published 02/12/2012 | 06:00

Joseph Murray, who has died aged 93, carried out the world's first successful organ transplant, revolutionising the treatment of acute illness. His first success in the field came in 1954, when he transplanted a kidney between identical twins. Eight years later he performed the same feat between two unrelated individuals – achievements for which he shared the Nobel Prize in Physiology or Medicine with the bone marrow transplant pioneer Donnall Thomas in 1990.

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Until 1954, attempts to transplant living tissue from one human being to another had failed due to the rejection of the transplanted tissue by the recipients' immune systems. Transplant operations generally ended up killing the transplanted tissue, and often the patient.

Murray's interest in transplants developed during World War Two, when he was assigned to Valley Forge General Hospital in Pennsylvania, which specialised in performing reconstructive surgery.

One patient in particular intrigued him. Charles Woods was a 22-year-old pilot who had been badly burnt in a crash, and needed 18 months of reconstructive surgery and skin grafts.

To do this doctors had to relocate small patches of skin from Woods's own body in each operation and use skin taken from dead bodies as temporary protection on his open wounds.

Murray noticed that, instead of destroying these foreign grafts within the usual eight to 10 days, Woods's immune system took a month. Studying his medical records, he realised that Woods's weakened state had slowed his body's rejection of the transplanted skin.

He found another clue when a surgeon who had performed skin grafts on civilians before the war told him that he had noticed that the closer the donor and recipient were related, the slower the tissue was rejected.

In 1937 a skin graft between identical twins had taken permanently. As Murray later put it in his autobiography, 2001's Surgery of the Soul, "perhaps there were tricks we could learn that would one day allow us to prevent the rejection of transplanted organs" such as kidneys.

Yet most surgeons thought that organ transplants were a pipe dream.

After the war, Murray moved to Peter Bent Brigham Hospital in Boston; he pioneered new techniques involving the reconnection of nerves, tissues and blood vessels and carried out successful kidney transplants on animals.

In December 1954 the opportunity to operate on a human patient presented itself in Richard Herrick, a 23-year old dying of chronic nephritis, who had an identical twin brother willing to donate a kidney.

Murray prepared thoroughly, even (in an age before DNA testing) having the brothers fingerprinted by the Boston Police Department to ensure that they were identical, not fraternal, twins.

He held meetings with doctors, religious leaders and lawyers to explore the ethical issues involved in subjecting a healthy human being to potentially risky surgery, and carried out a test transplant using dead bodies.

The operation, carried out on December 23, went without a hitch. Less than 90 minutes after one surgical team removed the donated kidney, Murray had connected it to Richard Herrick's blood vessels.

As the new kidney turned a healthy pink, "there were grins all around" in the operating room, Murray recalled. Richard Herrick lived for eight more years until the kidney disease recurred.

Despite the success, Murray faced enormous problems. People accused him of "playing God" and his breakthrough did not solve the problem of rejection in patients without an identical twin.

It was the development of immunosuppressant drugs that made real progress possible. In 1959 Murray heard about an experiment in which scientists had injected an anti-cancer drug, Imuran, into dogs to trick their immune systems into accepting a foreign protein while not preventing them from attacking other germs, and he determined to try the drug.

By 1962, Murray had worked out the correct dosage and the fourth patient, a 23-year old accountant, survived after being given a kidney from an unrelated donor with the same blood type, ushering in a new era in transplant surgery.

In 1971 Murray resigned as head of transplant surgery at Peter Bent Brigham Hospital to concentrate on plastic surgery.

A devout Roman Catholic, Murray was a member of the Pontifical Academy of Sciences, which advises the Vatican on scientific issues. In 1945 he married Virginia Link, who survives him with their six children.

Joseph Murray, born April 1, 1919, died November 29, 2012.

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