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A history of transplantation

The idea of transplanting organs

Traditions from antiquity

Since ancient times, mankind has cherished the idea of using transplants to replace lost body parts or damaged organs. Since as early as 500 BC, myths, sagas and legends have revolved around the transfer of tissues and organs. One particularly famous tale tells of Cosmas and Damian, the patron saints of healing, who successfully transplanted the leg of a coloured man to a white missionary in the 3rd century AD. This legend reflects the long history and enduring fascination that the subject of transplantation holds for humanity.

Age of Enlightenment

Transplantation of skin, tendons or teeth

During the 17th and 18th centuries, several attempts were made to replace destroyed human skin by using animal tissue. Similarly, transplants of teeth, tendons and other organs were attempted, with the tissue used coming mainly from dogs, chickens and cattle. In the 18th and late 19th centuries, reports of transplants of glandular tissue were published, including the transplantation of thyroid tissue or ovaries after surgical procedures.

The problem of organ rejection

In 1863, the French surgeon Paul Bert described that transplants are often rejected. At the beginning of the 20th century, the Austrian surgeon H. Ullmann from Vienna performed the first technically successful kidney transplant on a dog. He implanted the kidney in the dog's neck and led the ureter through the skin to the outside in order to be able to document urine production. Urine production worked for five days. 
The Frenchman Alexis Carrel developed the basic vascular surgery techniques. Among other things, he showed that a severed vessel could be re-adapted by means of a vascular suture and thus created the prerequisites for transplanting organs. At the same time, he was one of the first to notice that, in contrast to the body's own tissue, tissue foreign to the body is rejected during a transplant. The problem of rejection, which was unsolved at that time, led to the fact that the realisation of organ transplantation was initially abandoned in the early 20th century. 
However, it is important to emphasise that these pioneers of surgery laid the foundations for today's organ transplantation.

The Modern Age

The beginnings of kidney transplantation

The origins of successful kidney transplantation date back to 1936, when Dr Y. Voronoy was able to transplant the kidney of a deceased donor for the first time in Kiev, Ukraine. Unfortunately, the recipient survived only four days because the donor kidney never functioned properly. In the 1950s, human kidneys were again transplanted in the USA, but with moderate success. It was realised at this time that the rejection reaction was the result of the recipient's immune defence.
The first successful kidney transplant was finally performed in Boston (USA) in 1954. The organ was taken from an identical twin of the patient, which meant that there was a genetic identity between the donor and the recipient and thus no rejection reaction occurred.
However, in order to be able to transplant patients without a genetic identity, the suppression of the rejection reaction had to be realised through medication. Initially, whole-body radioactive irradiation was sought, but in the USA specific drugs to prevent organ rejection by inhibiting the immune response were already being used in the early 1960s. In 1960, pharmacological inhibition of kidney transplant rejection was achieved experimentally with the drug azathioprine.

The beginnings of liver transplantation

Inspired by the groundbreaking advances in kidney transplantation that have since become known, the outstanding surgeon Thomas Starzl and his team in the USA accelerated the implementation of a liver transplant. After numerous animal experiments, he performed the first three liver transplants on humans in 1963, which, however, only had a survival time of up to 22 days. 
Nevertheless, this was a significant step in medical research and opened the doors to further innovations in this field. The first liver transplant in Germany was performed by Gütemann at the University Hospital in Bonn in 1969.

Beginnings of lung transplantation

In 1963, US surgeon James D. Hardy made a major medical breakthrough in Jackson, Mississippi, by performing a groundbreaking operation - the first successful transplantation of a human lung into a patient with an inoperable lung tumour. This milestone in the history of medicine is a remarkable example of the relentless search for new ways to improve people's lives. Hardy's groundbreaking achievement paved the way for further medical achievements and inspired others to develop their own innovative ideas and technologies.

First successful organ transplants

Groundbreaking achievements

In 1964, Borsig and Nagel in Berlin achieved a groundbreaking feat when they performed the first successful kidney trans plant from a mother to her daughter.
Also in that year, the US Americans N. Shumway and R. Lower began to do important research on heart transplantation. But it was not until 1967 that Christian Barnard was able to perform the first successful human-to-human heart transplant in Cape Town, South Africa - albeit with a tragic outcome, as the patient died 18 days later from an infection. At that time, the USA was still hesitant to approve such interventions.
It was not until W.D. Kelly and R. Lillehei in Minnesota (USA) performed the first successful pancreas transplant in the same year. The first medically successful lung transplant was performed by F. Derom in Ghent (Belgium) in 1968, in which the patient regained 80% of his lung capacity and survived for 10 months. After several unsuccessful attempts, Thomas Starzl finally achieved the first liver transplantation in humans to be described as "successful" in Pittsburgh in 1967.

Defence response and tissue compatibility

In the late 1970s, a significant achievement was made by discovering and developing the immunosuppressive agent ciclosporin. This groundbreaking discovery led to a significant improvement in transplant survival rates. Ciclosporin works effectively against rejection without suppressing the entire immune system. Thus, the body's defence reaction is controlled and a successful transplantation is made possible. Among other factors, tissue compatibility between donor and recipient is a crucial factor that reduces the body's defence reaction. Tissue compatibility is therefore an important aspect of transplantation that contributes to a successful outcome.

Organ transplantation in Heidelberg

As far as kidney transplantation is concerned, almost 4000 kidneys have been transplanted in Heidelberg since its beginnings in 1967; an average of 150 kidney transplants per year, many of which are the result of a living kidney donation, are performed at the Heidelberg site.

The first liver transplant was performed on 16 June 1987 by Prof. Herfarth and Prof. Otto. In 2002, Prof. M.W. Büchler and Prof. J. Schmidt performed the first living liver transplant in Heidelberg. Since then, more than 1380 liver transplants have been performed in Heidelberg.

Although there have been decisive advances in the development of new immunosuppression techniques and surgical techniques, recipients still have to take immunosuppressive drugs for life.