Surgery & Anesthesia · 1954
First Successful Kidney Transplant
Kidney transplantation had been attempted in humans since at least the 1930s. Yuri Voronoy in Kiev transplanted a cadaveric kidney into a patient in 1936; the graft failed within two days. Groups in Boston, Paris, and Chicago tried again in the early 1950s, using both living donors and cadavers. Every graft was rejected within weeks, and the biological mechanism of rejection was poorly understood. 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. In December 1954, twin brothers Richard and Ronald Herrick came to his attention. Richard had chronic glomerulonephritis and renal failure; Ronald was healthy. On December 23, 1954, Murray and nephrologist John Merrill transplanted Ronald's kidney into Richard. The graft began producing urine immediately. Richard Herrick lived another eight years, dying of his original disease rather than rejection.
Murray extended the twin series to nine cases, all successful, establishing that transplanted kidneys could sustain life long-term if immune mismatch was absent. The series also provided precise anatomical and surgical data: arterial anastomosis to the iliac vessels, ureter implanted into the bladder, retroperitoneal placement. The operative technique established then remains the standard approach today.
The transplant community understood clearly that identical twin donors would be rare. The productive question became how to suppress rejection in non-identical pairs. Murray's group explored total-body irradiation as immunosuppression in the late 1950s, with mixed results. 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, which Murray used to perform the first successful non-twin transplant in 1962.
Cyclosporin, introduced clinically in the late 1970s and widely adopted in the 1980s, transformed outcomes further, pushing one-year kidney graft survival above 80 percent. Murray received the Nobel Prize in Physiology or Medicine in 1990, sharing it with E. Donnall Thomas for bone marrow transplantation. The 1954 case is recognized as the moment organ transplantation moved from concept to clinical reality.
Key People
- Joseph Murray — Surgeon who performed the transplant; Nobel Prize 1990.
- Ronald Herrick — Kidney donor; identical twin of the recipient.
- John Merrill — Nephrologist who led the transplant program at Brigham.
- Richard Herrick — Recipient of the first successful kidney transplant; survived eight years.
Surg Forum. 1955;6:432-436
Related landmarks
- 1944 · The Blalock-Taussig Shunt (first "blue baby" operation) (Surgery & Anesthesia)
- 1966 · National Halothane Study (Surgery & Anesthesia)
- 1967 · First Human Heart Transplant (Surgery & Anesthesia)
- 1968 · Coronary Artery Bypass Grafting (CABG) (Surgery & Anesthesia)