Organ transplantation could be described as a unique biological experiment for all recipients. The replacement of a failed organ or tissue provided by another person, either dead or alive, presents medical challenges which do not readily conform to textbook guidelines. Each donor-transplant process may follow similar, broad patterns but emotional and physical responses to this life saving or enhancing procedure varies from one patient to another.

This very grainy image of Christiaan Barnard was taken at the Groote Schuur Hospital near Capetown at some point after he had completed the first successful heart transplant on December 3rd 1967. Transplant technology has made monumental strides forward since this historic event took place.

Christiaan Barnard just happened to be in the right place at the right time. There were American surgeons that were very close to completing the first heart transplant before circumstances came together to put the Groote Schuur Hospital near Cape Town firmly on the medical map. On December 2nd 1967 the Darvall family were involved in a car accident on Main Road, Salt River in the Observatory district of Cape Town. Edward Darvall witnessed his wife’s death. Myrtle had been hit by a vehicle driven by Frederick Prins. (Source: Donald McRae – The Guardian). His daughter Denise was critically injured in the accident. The twenty five year old was rushed to the local hospital but medical support was withdrawn from Denise at 9pm that night.

A diabetic patient with heart failure had been admitted to the Groote Schuur Hospital on 14th September. His name was Louis Washkansky. Washkansky had endured three heart attacks leading to congestive cardiac failure. The effects of this were huge cardiac swelling, irregular heartbeat, extreme shortness of breath, a heart incapable of maintaining normal output so that his body slowly starved of food and oxygen. He knew he was dying and that realisation was discussed with his medical team. The photo to the right shows Louis after his operation. Evidently Barnard had offered him an 80% chance of success which would seem very good odds when confronted with the prospect of imminent death. How Barnard was able to give Louis an 8 out 10 chance of survival is difficult to assess. Barnard had completed some kidney transplants by this time and numerous heart exchanges experimentally between dogs. No surgeon anywhere in the world had successfully completed a heart transplant.

According to the Heart of Cape Town museum Denise Darvall's heart was withdrawn (explanted) at 3am and by 6.13am her heart was beating strongly in Washkansky's chest. Barnard took the international acclaim for this surgical break through. But it is all too apparent that a transplant procedure of this type is a collaborative effort. Barnard had a team of 30 doctors and nurses to assist in this operation.

But what of the role played by Denise Darvall and her family? It very unlikely that Denise had discussed the possibility of being an organ donor at the point of her death. Most transplants up to this time had been kidney transplants between twins. The end of life choice to be a donor was made for her. This is still the case today because many families prefer not to discuss their plans for when they die so the decision in relation to tissue or organ donation is left with the bereaved family. If Edward Darvall had not consented to the process the transplant would not have taken pace. Denise (shown her to the left) made history without her knowledge.

I often ponder on how I would have reacted in Louis’ position. Would I have volunteered to be the first human guinea pig? I suspect that given the option of certain death because of heart failure I would have agreed. Eighteen days later the heart of Denise Darvall stopped beating in Washkansky’s chest. He died of pneumonia. Without immunosuppressants at this time this was the fate of most heart transplant recipients. The procedure was virtually halted around the world until a more effective solution could be found to deal with organ rejection.

The transplant programme took off in the 1980’s. This acceleration happened because of the development of medication called immunosuppressants. Although kidney transplants can be traced back to the mid 1950’s in the USA these tended to be isografts rather than allograft transplant procedures. Isografts involve kidney swaps from one living identical twin to another whose kidney function has failed. An allograft is a transplant between the same species – one human to another, or from a pig to another pig.

The first kidney transplant procedure took place in Chicago in June 1950. This involved a 44 year old woman called Ruth Tucker who had polycystic kidney disorder. This is a cystic genetic disorder in which the kidneys develop cysts that cause them to get bigger reducing their kidney function. The transplanted kidney was rejected but Ruth lived for a further 5 years on the reduced function of her remaining kidney.

To be historically accurate the first officially recorded and recognised transplant was a cornea procedure in 1905 – though no doubt this is open to interpretation. Earlier transplants did take place but were not deemed to be ‘successful’. But what is the measure of success in these situations? Graft survival after one minute, one day, a month or what?

The main problem with allografts is that unless the tissue match is very close the recipient’s immune system will attempt to reject the foreign or alien tissue. We all possess white cells in our bodies that are created by our bone marrow. The white cells are programmed to destroy viruses, bacteria, germs or pathogens that would otherwise harm our bodies. White cells do not attack our own body cells, just those that are seen as intruders or ‘non-self’. The problem with most transplanted organs and tissues is that your own body’s white cells will want to destroy the transplanted cells because they are seen as ‘foreign’ bodies. Not until the 1980’s did medical bioscience get to grips with this challenge enabling transplant programmes around the world to expand at a rapid rate.

Current developments

The development of new surgical techniques, life support systems, drug therapies, perfusion techniques, ex vivo methods and stem cell research has led to pioneering changes to the way transplant procedures are carried out in the twenty-first century. These will be examined and explained by leading health professionals in this section of the website. The recent innovations that led to Claudio Castillo’s trachea transplant in November 2008 open up new horizons for transplant procedures. Claudio shown her has received a trachea from a deceased donor to replace her windpipe that was damaged by tuberculosis. The donor’s stem cells were stripped from the trachea and then coated with Claudio’s own stem cells. This is a remarkable collaborative development which will be examined in more detail on this website. Claudio is able to lead an active life but without the need for anti-rejection medication which can have difficult side effects. Claudio had been faced with either the removal of her left lung or a lung transplant.

In addition to the scientific innovations that are breaking new ground social attitudes are changing in relation to transplant and donor issues. There is more widespread public discussion of the political, moral, legal, ethical and economic aspects of transplantation. These will be examined here too.

We all share a responsibility to shape the future of transplantation as a life saving medical outcome. This website needs your input to help us make informed decisions that will benefit society as a whole. Nobody can safeguard themselves from the impact of a transplant; not for themselves or for someone they love.

Prime Minister Gordon Brown pushed the transplant programme firmly into the political domain when he called for a national debate on the issue of presumed consent. See Gordon Brown’s interview with the Sunday Telegraph and the blog responses to the Daily Telegraph on January 14th 2008. [Daily Telegraph Web Link]Clearly no politician or newspaper or TV/radio pundit has a monopoly of wisdom on this crucial issue. So don’t stand aside – get involved.

I hope this website will give you sufficient ideas from various perspectives to help you make an informed input to this debate.

To be continued

TRANSPLANTS SAVE LIVES, MONEY and MISERY.