The Development of Clinical Renal Transplantation

Abstract

Any two people can travel the same road and see different things. Thus, others discussing the history of renal transplantation might have noted different landmarks. Valuable personal reminiscences have been written by R.Y Calne of England1 and J.E. Murray of Boston,2 whose initially separate careers came together in a remarkable joint venture at Harvard in 1960. In addition, original articles, which are usually cited in historical reviews, but rarely read because of their inaccessibility, were republished recently in a volume of the Clio Chirurgica series.3 Perusal of this material gives unusual insight into the process of discovery and development. Another prime source of historical information was published in 1972 by Professor Carl Groth, the Swedish transplantation surgeon who examined the medical literature from the crucial period of 1950 to 1970 and interviewed or corresponded with almost all of the physicians and surgeons who were working during this time.4 Kidney transplantation as a practical therapeutic option came from a series of steps that began to appear in the literature at the turn of this century. At first, the steps were small, widely spread in time, and often quixotic enough to be overlooked or condemned. As late as 1961, the Nobel Laureate Macfarland Burnet wrote in the New England Journal of Medicine that “… much thought has been given to ways by which tissues or organs not genetically and antigenically identical with the patient might be made to survive and function in the alien environment. On the whole, the present outlook is highly unfavorable to success . . . .”5 This opinion was published on the eve of the successful clinical renal transplantations in 1962 and 1963 that extended such procedures beyond the occasional identical and fraternal twin cases of the mid and late 1950s. These clinical trials in 1962 and 1963 provoked editorials questioning the inherent feasibility of such efforts, as well as their ethical basis.6 Yet, these trials were already late in a long, but at first slowly unfolding, story of whole organ transplantation, which was dominated by but not confined to the kidney.