December 23, 1954. 8:15 A.M.
Medical history is being made in Boston with the first successful long-term organ transplant. Richard Herrick, a 23-year-old suffering from chronic nephritis — a devastating kidney disease—was the recipient. On top of nephritis’ effects on his physical health, Herrick suffered from psychological issues due to his disease, often “[struggling] against doctors and nurses.” Ronald Herrick, Richard’s identical twin brother, was the donor.
Prior to this procedure, there had been some other transplants, such as a kidney transplant from a deceased donor performed where the kidney survived for six months. But none would last as long as this transplant performed by the surgeon Dr. Joseph Murray. Richard went on to live for eight years after the operation. Ronald, the donor, lived healthily until he passed away at 79.
One reason transplants were rare and complex at that time was the lack of methods for robust immunosuppression. This is the reason Richard’s donor had to be his identical twin. Since they had identical genetics, there would be no immune rejection. In fact, to ensure Richard and Ronald were definitively identical twins, physicians performed 17 different genetic tests, one of which was getting them fingerprinted at the police station.
The most important test involved taking a piece of Richard’s skin and grafting it onto Ronald’s skin to see if there was rejection. Thankfully for Richard and all subsequent patients who have benefited from the learnings of this operation, there was no rejection.
Ronald’s kidney was removed, the blood vessels no longer attached to the body. Here, time was of the essence. Physicians had to minimize the amount of time the kidney was without a constant supply of blood. By 9:53 A.M., the kidney was brought to Murray for transfer to Richard.
Apart from the medical challenges, there were also ethical considerations to reckon with prior to the surgery. As Murray explains in his memoir Surgery of the Soul, performing a transplant goes against the Hippocratic oath which states physicians must “do no harm.” “For the healthy donor, […] there is no physical benefit,” writes Murray.
When Ronald was told about the possibility of a transplant for his brother, he had a mixed reaction. He wanted to help his brother but this procedure was rare at that time; would he be putting both himself and his brother at risk by doing this? But as we know, he decided to go with the more risky — and luckily, what turned out to be better — option.
The law later agreed with the Herricks’ and physicians’ decision. In another case, the Supreme Court in Massachusetts ruled that a healthy minor could donate an organ as “the donor […] would benefit psychologically and spiritually from the act of charity.”
Ultimately, in the Herricks’ case, through seeking help from religious leaders, ethicists, and other physicians as well as extensive talks with the Herrick family, the physicians and family decided to go ahead with the procedure.
To prepare for the operation, Murray practiced the transplant on a cadaver to find the best positioning and try to anticipate anything that could go wrong. There was only one shot with Ronald’s kidney and no room for error.
The vessels were all reattached. The kidney was full of its new owner’s blood. All that was left to do was to reestablish the flow of urine by attaching the ureter to the kidney and bladder. A medical miracle had been achieved.
Despite the historical importance of this procedure, Murray himself didn’t think transplants would become so widespread, because there just weren’t that many identical twins. As mentioned before, immunosuppression in its modern form did not exist, limiting the future aspirations of surgeons and their views on the viability of transplantation as a mainstay in medicine. Other physicians even told Murray, who went on to win a Nobel prize, not to perform the surgery because it would be career suicide.
These doubts, however, didn’t come to fruition. Murray was not only “the first surgeon to successfully perform [kidney] transplantation” but also went on to perform the “first […] in non-identical twins and […] using a cadaveric donor.”
The next challenge after the first successful long-term transplant was immunosuppression which would allow transplants to help a significantly larger number of people. The first forays into immunosuppression used radiation through X-ray but this was “too blunt, non-specific and unpredictable.” More simply, it didn’t work well.
Then came drug immunosuppression: The first truly course-altering drug was the anticancer medication 6-mercaptopurine (6 MP) which immediately showed greater survival and health in dog kidney transplant recipients.
Sadly, the first two patients who received kidneys from unrelated donors after taking a 6 MP equivalent succumbed to drug toxicity and infection, respectively. Mel Doucette, the third patient, received an unrelated kidney and survived for more than a year. From there, immunosuppression only became more advanced.
In 1976, it was found that 68% of kidney transplant recipients since 1950 were alive. For transplants performed in 1951–1976, the one-year survival of patients who received cadaver or living unrelated kidneys was about 62%. These numbers have continued to improve. Today (for transplants performed in 2010–2014), the number is 97–99%.
About the Author
Parmin Sedigh is an 18-year-old stem cell and science communications enthusiast. She’s also a first-year student at the University of Toronto, studying life sciences. You can usually find her on her computer following her curiosity. Connect with her on LinkedIn.