First Successful Kidney Transplant

Kidney transplantation had been attempted in humans since the 1930s. In 1933 Yurii Voronoy and his team in Kherson, Ukraine, transplanted a kidney from a deceased donor; the 26-year-old recipient died two days later. Groups in Boston, Paris, and Chicago tried again in the early 1950s, using both living donors and cadavers. Every graft eventually failed; the longest, placed by Richard Lawler's team in Illinois, worked for about nine months. The limiting problem was immunological, not surgical.

Joseph Murray, a plastic surgeon at Peter Bent Brigham Hospital in Boston, recognized that the immune barrier could be sidestepped entirely if the donor and recipient were genetically identical. Twin brothers Richard and Ronald Herrick offered that chance. Richard had chronic glomerulonephritis and was gravely ill, with malignant hypertension and heart failure; the nephrologist John Merrill stabilized him with dialysis before surgery. On December 23, 1954, J. Hartwell Harrison removed a kidney from Ronald, and Murray transplanted it into Richard. The graft began producing urine immediately. Richard Herrick lived another eight years and died of his original disease; the graft was not rejected.

In the following years the Boston team performed seven more kidney transplants between identical twins, and six of the seven achieved normal kidney function. By 1958 they had reported the series, showing that a transplanted kidney could sustain life long-term when there was no immune mismatch.

The transplant community understood clearly that identical twin donors would be rare. The productive question became how to suppress rejection in non-identical pairs. The Brigham group tried total-body irradiation between 1958 and 1962, with grim early results that led them to smaller doses. Robert Schwartz identified 6-mercaptopurine as an immune suppressant around 1959; George Hitchings and Gertrude Elion at Burroughs Wellcome developed the less toxic derivative azathioprine, and in 1962 the Brigham team performed the first successful kidney transplant between unrelated people using it.

In 1979 Roy Calne reported the first successful human trials of cyclosporine in kidney transplantation, and the drug became the mainstay of immunosuppression for transplanted organs. Murray received the Nobel Prize in Physiology or Medicine in 1990, sharing it with E. Donnall Thomas, for discoveries concerning organ and cell transplantation in the treatment of human disease.