The history and development of organ transplantation: biology and rejection

In this chapter I have tried to survey organ transplantation from the point of view of a researcher who has been involved in the field since 1959. I have traced the two different lines of research--one, immunological and the other, surgical. To a large extent the surgical problems of transplantation have now been solved but rejection remains the main stumbling block to long-term survival of organ allografts. Immunological tolerance and defining rejection as an immune mechanism provided a background which was considered by immunologists to be hopeless from the point of view of clinical application. Surgeons, however, demonstrated the successful grafting of kidneys in identical twins. Then surgical observations clarified the different susceptibility of individual tissues to rejection, the liver being less likely to be rejected of the vital vascularized organs. An analysis of this phenomenon has been presented together with data on new powerful immunosuppressive drugs. Work in progress world wide is directed to the eventual establishment of tolerance in the clinic so that recipients of organ grafts will not have to submit to a lifetime of potentially toxic drug dosage. A shortage of organs for transplantation and the ethical dilemmas make organ transplantation an unusual and worrying field of medicine. Perhaps we will find salvation in transplanting organs from animals, although this achievement would seem to be some way off.