Organ replacement by man-made devices

Abstract

EPLACING R a defective component of the body or substituting for a deteriorated organ function by a natural or man-made counterpart is one of the major contributions of modern science to clinical medicine. My objective in this essay is to draw some lessons from the experience with organ replacement in the last 40 years, and to project where substitutive and reparative medicine may lead us in the decades ahead. If the generalized practice of organ replacement is a recent phenomenon, the idea of substituting in some manner for body parts lost by accident or worn out by disease is apparently as old as mankind. Witness for man-made implants the use of gold plates to cover traumatic skull defects in several ancient civilizations. Witness for external support systems the technology for grinding rock crystal into the vision-correcting lenses allegedly used by the emperor Nero, and quite widespread in the western world since the 13th century. Witness, in the case of transplantation, the geographic transfer of knowledge regarding pediculated skin flaps to reconstruct the nose from ancient origins in India seven centuries before Christ, to Alexandria in the Ptolemaic period, and then through Arabic conquest of the Mediterranean coast, to a lineage of barber-surgeons in Southern Italy in the late Middle Ages, and finally to Tagliacozzi who, in the 16th century, codified in Bologna an operation that is still practiced today. What is new to our times is not so much the impact of modern science and technology on organ replacement procedures. as the epic scale on which substitutive and reparative medicine are now, rather suddenly, being practiced.