The First Successful Kidney Transplantation. Oil on canvas. (Image source: Anesthesia & Analgesia [figure 3] from manuscript)

The first successful kidney transplantation took place in Boston almost 60 years ago. The donor and recipient were identical twins, and this success led the way to research and development in human organ transplantation. The physicians who attempted the pioneering procedure risked their careers, while the brave patients put their lives on the line. Dr. Stanley Leeson and Dr. Sukumar P. Desai, Department of Anaesthesia, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, explore the development of renal transplantation and the medical and ethical challenges that were overcome to undertake the lifesaving operation in their article published in this month’s issue of Anesthesia & Analgesia titled “Medical and Ethical Challenges During the First Successful Human Kidney Transplantation in 1954 at Peter Bent Brigham Hospital Boston.â€

In the mid 20th century, before dialysis and kidney transplantation, chronic renal failure was fatal. During World War II in Holland, Dr. Willem Johan Kolff developed a hemodialysis machine after witnessing a young man die of renal failure and being unable to help. In 1945, after the war, Dr. Kolff used this machine to treat an imprisoned 67-year-old Nazi sympathizer who had gone into a coma due to kidney failure. After placing her on experimental hemodialysis, she woke up.

The authors then go on to describe the first kidney transplant that was performed on December 23, 1954. This was a team effort. Richard Herrick, 23 years of age, had severe hypertension and developed signs of malignant hypertensive syndrome: retinal hemorrhages and exudates, marked cardiomegaly, and peripheral as well as pulmonary edema. He had an identical twin brother named Ronald, a fact established based on eye examination, fingerprints, skin grafting, and blood group matching. Drs. J. Hartwell Harrison, surgeon, and Thomas K. Burnap, anesthesiologist, managed the donor, the recipient’s twin. After the donor kidney was removed, the vascular clamp on the arterial stump slipped off: though 1 L blood was lost, the patient did not need a transfusion. The surgeon for the recipient was Dr. Joseph E. Murray. The anesthesiologist, Dr. Leroy Vandam, felt that continuous spinal anesthesia with tetracaine using a catheter would be the best option for the recipient: vasodilation would be a desirable side effect in a patient with uncontrolled hypertension. Both donor and recipient procedures began at 8:15 am and by 11:15, blood flow to the new kidney (now transplanted into the recipient) was restored. Both brothers were discharged from the hospital without complication. The following year, however, Richard, the recipient, needed two nephrectomy operations to control severe renovascular hypertension resistant to medical treatment. He died from a myocardial infarction in 1963 after developing pneumonia; his death was not related to the kidney transplant.

The article goes into much more detail about everything that led up to the procedure, including informed consent, ethical issues, anesthesia concerns, and the operative management: it is an interesting and informative read.