Dr. Joseph E. Murray at the announcement of the 1990 Nobel Prize in Medicine.
Joseph E. Murray is the only Plastic Surgeon to ever win a Nobel Prize. He and E. Donnall Thomas shared the 1990 Nobel Prize in Physiology or Medicine for their discoveries concerning organ and cell transplantation in the treatment of human disease. Dr. Murray was the first surgeon to successfully transplant a kidney, while Dr. Thomas performed the first successful bone marrow transplantation.
Kidney Transplantation
Our immune systems are tasked with protecting our bodies, or more specifically, our cells. It recognizes our cells and rejects all foreign cells. For this reason, transferring organs from one individual to another was long thought impossible. However, in 1954 Joseph Murray avoided rejection using radiotherapy and immunosuppressants, successfully transplanting a kidney between identical twins. Eventually, this led to our ability to transplant other organs, too.
Immune Rejection
Dr. Murray was first introduced to immune rejection at Valley Forge General Hospital in Pennsylvania, while caring for burn patients. World War II was raging on and the plastic surgery wards were overflowing with casualties. Some were so extensively burned that donor sites were not available. As a life-saving measure for these patients, skin grafts were taken from other persons and used as a temporary surface cover. He described his experience with Colonel James Barrett Brown, the Chief of Plastic Surgery in his Noble acceptance speech:
- “The slow rejection of the foreign skin grafts fascinated me. How could the host distinguish another person’s skin from his own? Colonel Brown and I often discussed this while scrubbing. In civilian life Brown had treated many severely burned patients with temporary skin allografts and observed and written about the differential dissolution of skin allografts from various donors. He tentatively postulated that the closer the genetic relationship between the skin donor and the recipient, the slower the dissolution of the graft. In 1937, he had experimentally cross skin grafted a pair of identical twins and documented permanent graft survival in both twins. This was the impetus to my study of organ transplantation, which is the subject of my Nobel Lecture.”
Transplant Surgery
As a result of his work, Dr. Murray became the First Transplant Surgeon. The first operation was summarized by Siang Yong Tan, MD, JD and Jason Merchant, MD in the Singapore Medical Journal.
- In 1954, Richard Herrick, a patient with a healthy twin brother named Ronald, presented with renal failure to Peter Bent Brigham Hospital. It did not take long for Murray to raise the idea of a successful renal transplant between the genetically identical brothers.
Drs. Murray, Merrill and Harrison with the Herrick Twins, Ronald and Richard.
- After establishing successful cross-skin grafting, his team began preparations for the transplantation, even as Murray realized that they were confronting a major ethical dilemma. Performing a major live donor operation, in effect removing a healthy kidney for no personal benefit and possibly causing harm, was something that had never been done before.
- The team consulted various medical and religious leaders on whether this broke Hippocrates’ oath “First, do no harm”. After due discussion, all parties involved agreed that surgery should proceed because of its life-saving potential.
This photograph was taken during the first successful kidney transplantation by Dr. Joseph E. Murray in 1954.
- Surgery took place on 23 December 1954, with Murray leading the recipient’s surgical team and Dr J Hartwell Harrison leading the donor’s surgical team. Both operations proved uneventful; postoperatively, the transplanted kidney functioned immediately. Richard would survive long enough to get married and have two children before succumbing to cardiac failure eight years later. Ronald had no major complications and lived over 50 years after the surgery.
- While this sentinel event showed that kidney transplantation surgery was technically possible, it nonetheless did not address or solve the underlying issue of immunologic incompatibility.
The 1990 Nobel Prize in Medicine
Nobel Prizes are awarded in the fields of Physics, Chemistry, Physiology or Medicine, Literature, and Peace to those who, during the preceding year, have conferred the greatest benefit to humankind.
Dr. Joseph E. Murray receiving the 1990 Nobel Prize in Medicine.
Dr. Joseph E. Murray’s contribution has saved many lives. In the US alone, more than 42,800 organ transplants were performed in 2022, and total kidney transplants exceeded 25,000. Dr. Murray would be proud. Despite this trend, the number of organ donors has decreased for the twelfth year in a row. If you want to be a donor in California it is as simple as checking a box on your driver’s license renewal.
Previous Post Next Post