The Emotion of Transplant Surgery

I watched this episode of Horizon recently on BBC iplayer - it featured 40 years of coverage of progress in transplant science and surgery on the BBC. The programme brought back so many memories and emotions about transplant surgery related events that have occurred during my training as well as the great people who I have had the privilege to work with and/or meet on the way - people like the late great Norman Shumway, Michael Debakey, Joel Cooper, Roy Calne, Terence English, John Wallwork, Randy Morris and David White. It also made me think a great deal of how so much has changed in medicine - not only the medical and surgical progress that has occurred over the past 30 to 40 years but also the bigger changes that have influenced HOW we practice medicine i.e the advent of MDTs, guidelines and evidenced based medicine and our relationship with patients and the effect of the world's fiscal situation which whether we like it or not will be a major determinant of progress over the next 30 years.
There is no doubt that doctors (surgeons usually) did things that would today lead them to be struck off and imprisoned (in the UK at least ). Will this mean in the future progress will be slower or just different?
The scene featuring the girl with cystic fibrosis brought a lump to my throat - it reminded me of a patient who I looked after and who featured on one of the programmes in this special called Knife to the Heart.
A final point I would like to make is that this work is a Clinical Ethical minefield e.g. shortening the lifespan of a patient with immunosuppressive drugs (including steroids) for cosmetic reasons (hand/face transplant) or performing surgery (living related lung or liver transplant) that has a potential 300% mortality are issues I would have difficulty dealing with today.

Death of a Pioneer and the British Connection

Today, the death of Joseph Murray was announced. He was 93 years of age. He was hugely influential in the evolution of solid organ transplantation and during my years in transplantation and transplantation research, his name and work cropped up frequently. The fact that he won the Nobel Prize reflected his contribution.
There is a strong British connection with this man. Sir Roy Calne, British surgeon, transplant pioneer, academic, artist etc worked with Joe Murray in Boston in the early 1950s. His work in Murray's lab  was the first to establish the fact that organ (kidney) rejection in dogs could be controlled by drugs - the birth of the immunosuppressive drug. The first drug was  6 Mercaptopurine, later changed to Azothioprine - still used today as an immunosuppressant.  In Cambridge, Roy Calne went on to be involved in the evolution of cyclosporine and with Randall Morris and Norman Shumway at Stanford, rapamycin or sirolimus. I was a cardiopulmonary transplant fellow in Cambridge in the early 1990s & I worked with Randy Morris and Norm Shumway in the lab at Stanford in the mid 1990s - hence the connection and interest! 

Gertrude Elion at Harvard Medical School with Dr. Roy Calne, Dr. George Hitchings, Dr. Donald Searle, Dr. Hager, and Dr. Joseph, Murray, and the dogs Tweedledum, Tweedledee, Titus, and Lollipop (recipient of the first successful foreign kidney transplant)

(courtesy of Jewish Women's Archive)

FRANKENSTEIN RAT HEART

Amazing Video.
Imagine, whole organ farms, no waiting, no immunosuppression, no pig viruses etc etc.
Bring it on I say!

TRANSPLANTATION IN SPAIN

 
http://www.bmj.com/content/341/bmj.c4973.extract
Very good piece explaining why donation rates in Spain are higher than those in the UK.