Donate a healthy organ to mend another’s failed one

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A desire, that we could replace a failed organ, is age-old. Hindu God Ganesha, had his head replaced by one of an elephant. So are numerous chimeric Greek gods, that have fused body parts from more than one animal. Cosmas and Damian patron saints in medieval Rome, transplanted a diseased leg with a healthy one. While, this was just a sufferer’s dream, the duo were adopted by many surgical societies as their patron saints. However, this dream of donating one’s healthy organ to replace another one’s diseased part, became a reality only in the 1950s.

Corneal transplants

Cornea is an outermost tissue in the eye, and does not have a blood supply. First organ to be transplanted was a cornea in the year 1905. Eduard Zirm, performed this feat in Prague. The technique, to transplant another person’s cornea to repair one’s damaged one is called keratoplasty. Like all other transplants to follow, the success in 1905 was preceded by numerous trials, of using animal corneas. Corneal transplant is now the most frequent one. The source of these corneas are from recently deceased persons. Eye donations are promoted as a virtue, as one can actually help two others.

First Renal Transplant

Kidney was first complete organ to be transplanted from one human to another. In December of 1954, doctors in Boston – Joseph Murray, J. Hartwell Harrison and John P. Merill, transplanted a kidney from one identical twin to another. This feat was a result of years of hard-work. Surgeons had perfected techniques of vascular suturing in early 1900s, and Landsteiner had discovered blood groups. Scientists tried many animal to animal transplants, and knew that often donated organs get rejected. Hence, first transplant in 1954 was between two twins, minimising chances of a rejection.

Most concerning issue was rejection of a donor kidney by recipients immune system. A few years later in 1959, we discovered 6-mercaptopurine, and in 1960, another drug – Azathioprine. These drugs suppress body’s immune system, allowing it to accept a donor kidney.

By 1966, we had a method to match donor and a recipient to know if the tissues from two will react. More better drugs that could suppress immune system such as Cyclosporine (1978) and Tacrolimus (1987), improved the success rates of transplanted kidneys.

Today, more than 80,000 Kidney transplants take place every year, across the globe. Demand outstrips the supply, paving way for organ trafficking. Various countries have framed laws, to regulate organ donation as well as transplant. It is a constant struggle between need and ethics.

Heart Transplant

After initial technical success of a transplanted Kidney, Liver and Heart were not far behind. In 1961, we had our first successful Heart transplant in South Africa. Dr. Christiaan Barnard, a South African cardiothoracic surgeon pioneered this feat.

Christiaan Barnard was a surgeon, who received his medical training in South Africa. In 1955 he went to Minnesota to train under Walt Lillehei, a renowned cardiac surgeon. He retuned back in 1958, and was appointed as head of Cardiothoracic surgery in Cape-town.

In 1964, first heart transplant was done in Mississippi, United States was unsuccessful. In this surgery a Chimpanzee heart, was transplanted to a human. Many animal to animal heart-transplant experiments were done in animal laboratories till then. The technique worked, but was never tried in a human.

Barnard performed the world’s first human-to-human heart transplant operation in the early morning hours of Sunday 3 December 1967. A young woman Denis Darvall was the donor. Doctors had declared her as brain dead a day earlier. Louis Washkansky, a 54 year old grocer was the recipient. Overnight Christiaan was a celebrity. There are no actual photographs of the surgery, as none were clicked.

After initial success, The transplanted heart lasted 18 days. Mr Washkansky developed lung infection, which doctors initially mistook as inflammation. Baarnard’s second transplant in 1968 lasted 19 months, third lasted 20 months and the fifth one in 1971, for 23 years. (Read his incredible story here)

Liver transplants

In 1967, Dr. Thomas Starzl performed the first liver transplant in a human at the University of Colorado, US. While the first recipients survived for only a few days, improvement in techniques and medicines that could suppress immunity, have improved the survival to years.

Organ transplants in India

First corneal transplant in India was done by Dr. RES Muthayya in Chennai (then Madras) in 1948. First Kidney transplants are attributed to KEM hospital Mumbai (then Bombay) in 1965, and another one in CMC Vellore in 1971. About 30 years after the global first, India’s Liver transplant happened on November 6, 1998. This was done at Apollo hospital Delhi by Dr. A.S. Soin and Dr. Rajashekar.

Dr. P. Venugopal and team performed India’s first heart transplant at AIIMS, Delhi on August 3, 1994. First Lung transplant came in 2012 from Hinduja hospital, and first Pancreas from PGIMER in 2014. World organ donation day is observed on 13th August. India currently has its organ donation day on 3rd August every year. Before 2023, the date was 27th November.

Altruism and Ethics or Organ donation

Donating ones organs for another is altruism. However this is often marked by need and greed. In order to prevent rich harnessing the poor, laws are in place in India that allow live organ donation only amongst close relations. However, different countries have their own laws on who can be eligible to donate.

Countries have set up registries and waiting lists to make this process transparent. Cadaveric transplantation is promoted, as one person can help many. Since many in need are not in the close vicinity of others who are giving, elaborate transportation mechanisms are in place to transport organs.

Despite the ethics debate, the evolution of organ transplantation in the last half century is one of Medicine’s great stories. In support of this contention are the five Nobel Prizes given for transplantation and another 19 for its related immunology.