Au Revoir to a Pioneer

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While we were all sitting down to our Thanksgiving dinner, a pioneer passed away from the complications of an hemorrhagic stroke. Dr. Joseph E. Murray of Peter Bent Brigham (now Brigham and Women’s Hospital), who won the Nobel Prize in 1990 for developing the first living transplant, sharing the honor with Dr. E. Donnal Thomas, who pioneered bone marrow transplants (who died just one month earlier).

 

As was true for the pioneers of dialysis (who came after him, during the Korean War), his experiences as an Army physician proved most useful. Murray tested using the skin of cadavers to treat burned soldiers. Unfortunately, his early experiments barely provided success for a fortnight- but he did learn that tissues from one person could survive, at least for a while, in another individual.

When he returned from the war, his specialty was plastic and reconstructive surgery. But, he realized that his successes with the skin grafts means that transplanting organs had to be possible. He began this research by removing and reimplanting kidneys in dogs, among other animals. Two years of research. Which led Murray to believe that he had perfected the technique to transplant the organs.

But, in 1954, a special circumstance arose. One identical twin (Richard Herrick, 23) was succumbing to chronic nephritis. His identical twin, Ronald, was willing to donate one of his (healthy) kidneys to save his brother.

But, the Hippocratic Oath had not progressed that far yet. Given the cardinal rule of ‘first, do no harm’, how could Murray conceive of removing a kidney from a perfectly normal individual- would that not create harm? There was no guarantee the kidney would take, either… Immunosuppresive drugs were a decade away from being discovered.

After much soul searching, praying, and discussions with various clergy of different denominations, Murray felt he was not violating any ethical proscriptions. Further, he obtained a writ allowing him to proceed from the Massachusetts Supreme Judicial Court. And, he had spent much time insuring the the Herricks were clearly identical, and not fraternal, twins. (There was no DNA analysis then; a total of 17 different tests were effected to insure the twins were identical.) Murray, and his team did a dry run (so to speak) on a cadaver.

And, then, they were ready. On 23 December, 1954, Dr. Murray, Dr. John H. Harrison, and their team performed the historic operation, which required some 5.5 hours, in OR 2. But, the public outcry lasted much longer.

Murray was vilified. He was accused of playing G0d. This vilification and ostracization obtains for many pioneering scientists. It makes one wonder if one’s convictions are correct. (I recall being accused of just such an act and tampering with nature decades later, when we developed a new strain of microbes, by a world-famous scientist. And, again a few years later, by a lesser scientist, for my efforts in nephrology.)

But, that rush- in an absolutely quiet operating room- when blood began perfusing the transplanted kidney and Richard began producing urine…. It cannot be described by words. And, much of his work was done with young patients, whose families understood the need to experiment; that it may not help them, but would create success for someone in the future. (This is the concept behind all medical research protocols.)

Murray persevered. His kidney transplants provided relief for more than 24 identical twins. In 1959, he performed the first living transplant between non-identical twins. Three years later (1962), the first cadaveric kidney transplant (23 y old Mel Doucette) was under his belt. And, then he went on to train other doctors who pioneered the transplantation of kidneys, lungs, hearts, livers for patients whose organs had failed.
And, by that time, radiation was no longer being used to suppress the body’s immune system. Because researchers (such as Calne, Elion, and Hitchings) working with Murray had developed viable suppression drugs. Burroughs Wellcome (the employer of those other researchers) had produced the drug Imuran, which meant that survival rates now were approaching 65%.

In the late 60’s, Murray served on that (in)famous Harvard board (as discussed here) that developed the protocols to determine brain death.

In 1971, Murray decided he wanted to return to plastic surgery (not cosmetic, as we currently consider the field) and resigned as the Brigham’s Chief of Transplant Surgery. Murray went on to treat hundreds of adults and children with congenital facial deformities, cancer survivors (of the neck and head), and those with horrendous facial injuries.

He also managed to inspire two people to effect another pioneering transplant. Dr. Jean-Michel Dubernard of France credits Murray with the inspiration to effect the first facial transplant in 2005. And, Murray convinced Dr. Elof Eriksson (Director, Plastic Surgery, Brigham and Women’s Hospital) to do the same in 2012.

That’s scientific progress.

May Dr. Murray inspire many others, even after his death.

Roy A. Ackerman, Ph.D., E.A.

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10 thoughts on “Au Revoir to a Pioneer”

    1. I think he was, as well. But, I can tell you that this entire field- just as was true for the pioneering genetic engineering folks and for the neuro devices- involved many folks who, contrary to public perception, were trepidatious of their efforts. They knew the world would change the day after they succeeded. Those were heady, scary, life-altering moments of decision, Ann.

  1. What inspires me is the courage of the man: bravery to deal with the unknown and the fears of the society in favor of helping people. Thank you for introducing this inspiring man to me.

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