Kidney transplantation replaces a failing kidney with a healthy one from a donor. This procedure offers individuals with end-stage kidney disease a chance for healthier, more active lives. Achieving widespread, successful kidney transplants required overcoming significant scientific and medical challenges.
Early Attempts at Organ Transplantation
The idea of replacing diseased organs has ancient roots, but practical organ transplantation attempts began in the 19th and early 20th centuries. Early experiments, mainly in animals, explored transferring tissues and organs, including xenografts. These efforts often resulted in immediate immune rejection, as the recipient’s body recognized the transplanted tissue as foreign and attacked it.
Despite surgical progress, a major obstacle was the lack of understanding of the immune system’s role in rejection. Early 20th-century attempts to transplant kidneys into humans, like those by Yurii Voronoy in the 1930s, were unsuccessful. These failures underscored the biological barrier of immune incompatibility and guided future research.
The First Successful Kidney Transplant
On December 23, 1954, Dr. Joseph Murray and his team performed the world’s first successful human kidney transplant at Peter Bent Brigham Hospital in Boston. The recipient, 23-year-old Richard Herrick, was dying from chronic nephritis. His identical twin brother, Ronald Herrick, donated a healthy kidney.
The identical twins’ genetic match was a crucial factor in the procedure’s success, minimizing immune rejection. Richard lived for eight more years, eventually succumbing to heart failure related to his original kidney disease, but not from rejection of the transplanted organ. This operation demonstrated that human organ transplantation was surgically feasible. Dr. Murray received a Nobel Prize in Physiology or Medicine in 1990 for his pioneering work.
Overcoming Organ Rejection
While the 1954 transplant proved surgical viability, immune rejection in non-identical individuals persisted. The body’s immune system naturally identifies and attacks foreign cells, including transplanted organs. This led to efforts to suppress the immune response without compromising patient health. Early immunosuppression attempts, like total body irradiation, proved too harmful, making patients vulnerable to fatal infections.
A breakthrough came in the early 1960s with the introduction of immunosuppressive drugs. Medications like azathioprine, often combined with corticosteroids such as prednisone, became available. These drugs helped dampen the immune system’s activity, allowing for successful transplants between non-identical relatives and deceased donors. The discovery of cyclosporine in 1972 further advanced immunosuppression. Approved for clinical use in 1983, cyclosporine specifically targeted T-cells, which are key players in rejection, while leaving other parts of the immune system largely intact. This selective action improved transplant success rates and patient survival.
The Era of Widespread Kidney Transplants
With effective immunosuppressive drugs, particularly cyclosporine, kidney transplantation transitioned from an experimental procedure to a viable and increasingly common treatment. The ability to control rejection allowed for a broader range of donor-recipient matches, expanding the pool of available organs. Transplant centers began to emerge globally, establishing specialized teams and protocols for the complex care required before and after transplantation.
Further advancements in tissue matching techniques also contributed to improved outcomes, although immunosuppression remained the primary defense against rejection. In the United States, Medicare coverage was extended in 1972 to all individuals with end-stage kidney disease, regardless of age or income. This policy change, combined with medical progress, led to a substantial increase in kidney transplants, making the procedure available to a much larger population.