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Who was mainly involved in the early developments of organ transplantations?

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2013-03-27 15:54:21

"color: #000;" id="Answer">Answer

Successful inter-human allotransplants have a relatively long

history; the operative skills were present long before the

necessities for post-operative survival were discovered. Rejection

and the side effects of preventing rejection (especially infection

and nephropathy) were, are, and may always be the key problem.

Several apocryphal accounts of transplants exist well prior to

the scientific understanding and advancements that would be

necessary for them to have actually occurred. The Chinese physician

Pien Ch-iao reportedly exchanged hearts between a man of strong

spirit but weak will with one of a man of weak spirit but strong

will in an attempt to achieve balance in each man. Roman Catholic

mythology reports the third-century saints Damian and Cosmas as

replacing the gangrenous leg of the Roman deacon Justinian with the

leg of a recently deceased Ethiopian. Most accounts have the saints

performing the transplant in the fourth century A.D., decades after

their death; some accounts have them only instructing living

surgeons who performed the procedure.

More likely accounts exist in the area of skin transplantation.

The first reasonable account is of the Indian surgeon Sushruta in

the second century B.C., who used autografted skin transplantation

in nose reconstruction rhinoplasty. Success or failure of these

procedures is not well documented. Centuries later, the Italian

surgeon Gaspare Tagliacozzi performed successful skin autografts;

he also failed consistently with allografts, offering the first

suggestion of rejection centuries before that mechanism could

possibly be understood. He attributed it to the "force and power of

individuality" in his 1596 work De Curtorum Chirurgia per

Insitionem.

The first successful corneal allograft transplant was performed

in 1837 in a gazelle model; the first successful human corneal

transplant, a keratoplastic operation, was performed by Eduard Zirm

in Austria in 1905. Pioneering work in the surgical technique of

transplantation was made in the early 1900s by the French surgeon

Alexis Carrel, with Charles Guthrie, with the transplantation of

arteries or veins. Their skillful anastomosis operations, the new

suturing techniques, laid the groundwork for later transplant

surgery and won Carrel the 1912 Nobel Prize for Medicine or

Physiology. From 1902 Carrel performed transplant experiments on

dogs. Surgically successful in moving kidneys, hearts and spleens,

he was one of the first to identify the problem of rejection, which

remained insurmountable for decades.

Major steps in skin transplantation occurred during WW I,

notably in the work of Harold Gillies at Aldershot. Among his

advances was the tubed pedicle graft, maintaining a flesh

connection from the donor site until the graft established its own

blood flow. Gillies' assistant, Archibald McIndoe, carried on the

work into WW II as reconstructive surgery. In 1962 the first

successful replantation surgery was performed - re-attaching a

severed limb and restoring (limited) functioning and feeling.

The first attempted human deceased-donor transplant was

performed by the Ukrainian surgeon Yu Yu Voronoy in the 1930s;

rejection resulted in failure. Joseph Murray performed the first

successful transplant, a kidney transplant between identical twins,

in 1954, successful because no immunosuppression was necessary in

genetically identical twins.

In the late 1940s Peter Medawar, working for the National

Institute for Medical Research, improved the understanding of

rejection. Identifying the immune reactions in 1951 Medawar

suggested that immunosuppressive drugs could be used. Cortisone had

been recently discovered and the more effective azathioprine was

identified in 1959, but it was not until the discovery of

cyclosporine in 1970 that transplant surgery found a sufficiently

powerful immunosuppressive.

Dr. Murray's success with the kidney led to attempts with other

organs. There was a successful deceased-donor lung transplant into

a lung cancer sufferer in June 1963 by James Hardy in Jackson,

Mississippi. The patient survived for eighteen days before dying of

kidney failure. Thomas Starzl of Denver attempted a liver

transplant in the same year, but was not successful until 1967.

The heart was a major prize for transplant surgeons. But, as

well as rejection issues the heart deteriorates within minutes of

death so any operation would have to be performed at great speed.

The development of the heart-lung machine was also needed. Lung

pioneer James Hardy attempted a human heart transplant in 1964, but

a premature failure of the recipient's heart caught Hardy with no

human donor, he used a chimpanzee heart which failed very quickly.

The first success was achieved December 3rd 1967 by Christiaan

Barnard in Cape Town, South

"http://africa.answers.com" title="Africa">Africa. Louis

Washkansky, the recipient, survived for eighteen days amid what

many saw as a distasteful publicity circus. The media interest

prompted a spate of heart transplants. Over a hundred were

performed in 1968-69, but almost all the patients died within sixty

days. Barnard's second patient, Philip Blaiberg, lived for 19

months.

As mentioned, it was the advent of cyclosporine that altered

transplants from research surgery to life-saving treatment. In 1968

surgical pioneer Denton Cooley performed seventeen transplants

including the first heart-lung transplant. Fourteen of his patients

were dead within six months. By 1984 two-thirds of all heart

transplant patients survived for five years or more. With organ

transplants becoming commonplace, limited only by donors, surgeons

moved onto more risky fields, multiple organ transplants on humans

and whole-body transplant research on animals. On March 9th 1981

the first successful heart-lung transplant took place at Stanford

University Hospital. The head surgeon, Bruce Reitz, credited the

patient's recovery to cyclosporine-A.

History of successful transplants:

* 1954: First successful kidney transplant by Joseph Murray

(Boston)

* 1966: First successful pancreas transplant by Richard Lillehei

and William Kelly (Minnesota)

* 1967: First successful liver transplant by Thomas Starzl

(Pittsburgh)

* 1967: First successful heart transplant by Christiaan Barnard

(South Africa)

* 1970: First successful monkey head transplant by Robert White

(Cleveland, U.S.A.)

* 1981: First successful heart/lung transplant by Bruce Reitz

(Stanford)

* 1983: First successful lung lobe transplant by Joel Cooper

(Toronto)

* 1986: First successful double-lung transplant (Ann Harrison)

by Joel Cooper (Toronto)

* 1987: First successful whole lung transplant by Joel Cooper

(St. Louis)

* 1995: First successful laparoscopic live-donor nephrectomy by

Lloyd Ratner and Louis Kavoussi (Baltimore)

* 1998: First successful live-donor partial pancreas transplant

by David Sutherland (Minnesota)

* 1998: First successful hand transplant (France)

* 2005: First successful partial face transplant (France)

As successful transplants and modern immunosuppression make

transplants more common, the need for more organs has become

critical. Advances in living-related donor transplants have made

that increasingly common. Additionally, there is substantive

research into xenotransplantation or transgenic organs; although

these forms of transplant are not yet being used in humans,

clinical trials involving the use of specific cell types have been

conducted with promising results, such as using porcine islets of

Langerhans to treat type one diabetes.


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