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Transplant History

What science achieved relatively recently the imagination accomplished at least 2500 years ago. According to ancient Chinese literature, a doctor
named Pien Chi'ao had two out-of-sorts patients. One had a strong spirit but a weak will; the other had a weak will but a strong spirit. So, to give them "balance" he surgically removed and exchanged two men's hearts. Over the millennia, the idea of replacing a sick organ with a healthy one also shows up in myths and stories of India, Europe, Middle East…but the reality of actually doing it didn't gain much headway until the turn of the 20th century.

Charles Miller, is a liver transplant surgeon at the Cleveland Clinic, says we can thank a French surgeon for that…and the seamstress he studied under.

MILLER: The first preliminary steps in organ transplantation occurred when a surgeon named Alexis Carrel showed the world how to sew together two blood vessels.

The ability to reconnect an organ's blood supply opened up the door to transplanting organs - and a there were a number of attempts in animals. But over and over again, doctors found themselves with the same problem after a while most would simply stop working.

MILLER: it would ultimately turn black and not function. It was realized after a while that there was something about the immune system that was causing rejection.

Let's break down that a bit more. When Doctor Miller says…

MILLER: after a while

….he's covering more than 300 years. An Italian surgeon, Gasparo Tagliacozzi, provided the earliest concept of transplant rejection. He noticed back in 1596 that skin grafts taken from a patient's own skin worked - while grafts from one person to another failed. He didn't know why this happened but Tagliacozzi eloquently described this phenomenon as the "force of individuality." Combining the Italian's observation with the Frenchman's technique for connecting blood vessels and doctors were heading in the right direction…even if they didn't know where they were going.

Over the next 50 years, they searched for the precise answer to the rejection riddle. Gradually, surgeons perfected their abilities, antibiotics were discovered, and anesthesia improved and knowledge increased of how the body defends itself against foreign invaders . And then in the late 1940's a British doctor named Peter Medawar had an "a ha" moment of stupendous proportions. "What if," he said to himself, "what if the body's own immune system was attacking the transplant?"

Answering his own question in the affirmative, Medawar then proposed the solution block the natural immune response with drugs. And voila! From that point forward, transplant medicine began to advance rapidly. Finding immune suppressing drugs and administering in doses that won't kill you is tricky business …but it started to work. Successful transplants! First, with human kidneys in 1954, then livers, lungs - and in 1967 the heart.

The Cleveland Clinic's Charles Miller trained under Dr. Joseph Starzl who pioneered the first liver transplants. He recalls how primitive those immunosuppressive drugs were in the early days.

MILLER: These were very blunt immunological instruments and the survival was not great for about 17 years. It took a LONG time. I think Dr. Starzl did something like 170 liver transplants between 1963 and 1980. He used different types of immunosuppression, but it didn't work well.

Transplants remained experimental and highly risky until the early '80s")says when a new drug, cyclosporin A was approved by the FDA.

MILLER: The use of cyclosporin and prednisone was popularized by Dr. Starzl in what turned out to be a revolutionary moment in transplant history. It changed the survival from maybe 20-30 percent to 70 percent - and liver transplantation went from 10 per year to this rapidly growing major clinical entity that expanded it from one or two centers in the world to hundreds. So that by 1986 I happened to be in Pittsburg with Dr. Starzl. I think we did 450 liver transplants that year

Today, thanks to even more targeted immunosuppresents, better organ preservation, advances in tissue matching and efficient coordination efforts for organ retrieval, transplants are ?? Annually, over 16 hundred lungs, 2 thousand hearts, 6 thousand livers, and 16 thousand kidneys are transplanted every year in the US. And in some cases survival rates are over 90 percent. At the Cleveland Clinic alone, ?? are done each year.

This success has allowed doctors to push the boundaries of transplants beyond simple organs - now bones, muscle, intestines, the larynx of the throat are transplanted successfully…even a pair of hands last year and faces. But the more complicated the transplant, the more sensitive it is to infection and rejection. Cleveland Clinic's Maria Siemionow pioneered one of the world's first face transplants, and received national attention in 2009. Today she is researching ways to trick the immune system into accepting the new grafted organ as its own so that risky and expensive immune suppressing drugs don't have to continue to be used the rest of the patient's life.

SIEMIONOW: They will be blinding the immune system of the recipient, so the recipient and donor will coexist, and will be a more natural way of adopting the graft.

Transplant doctors say this is the last big hurdle. To get to a point where no medicine is needed because the body starts viewing the new, healthier organ as you.

It's A future imagined 2500 hundred years ago. Gretchen Cuda, 90.3