Before the 1950s, organ transplantation belonged more to the realm of science fiction than to medical science. Although references to tissue and organ transplantation date back as far as 2000 B.C. in Egyptian manuscripts, it was not until revolutionary progress in the world of medicine during the later half of the 20th Century that organ transplantation became a reliable treatment for the thousands of people suffering from organ failure.
Transplantation Then . . .
And Now... 
Despite the success of early skin grafting, organ transplantation could not become a reality until a reliable mechanism of connecting blood vessels was developed. In 1912, Alexis Carrel received the Nobel Prize for his work on vascular suture and transplantation techniques. He used extremely fine needles and thread to unite the delicate blood vessels. Following his development, there was a vast amount of experimentation with animal transplant surgery techniques, which, in the end, proved only marginally successful.
Then, in 1954, the first successful human-to-human organ transplant was performed at Peter Brent Brigham Hospital in Boston, when a young man was transplanted with a kidney donated by his twin brother. Prior to this, a small number of renal transplants had been attempted under the assumption that transplants between persons with the same blood type would prove successful in preventing rejection. While the surgical procedures appeared to be successful, within months the recipients died. Autopsies revealed that despite correct blood-type matching, the transplanted kidneys were rejected. Based on these findings, it was apparent that blood-type matching alone would not ensure graft viability.
By the early 1960s, it seemed that physicians had assembled the primary tools necessary for organ transplantation: antibiotics, improved vascular surgery techniques, as well as crucial blood-match and tissue-typing compatibility testing. Early attempts to prevent organ rejection included the use of whole body radiation and strong medications that compromised the recipient’s immune response to disease. Due to the high rate of rejection, the use of transplantation as a treatment for organ failure proceeded slowly.
Inspired by scientific breakthroughs in the world of medicine, physician pioneers at Saint Barnabas and Newark Beth Israel Medical Centers (SBMC and NBIMC) offered renewed hope for patients and families. People with chronic renal failure in New Jersey were among the first in the nation to benefit from transplantation. The first living donor kidney transplant in New Jersey was performed in 1968 at NBIMC.
Stephen Fletcher, M.D., an attending surgeon at SBMC has been performing renal transplants for more than 25 years. “The surgical techniques for renal transplant have remained basically the same,” he notes, “however surgeons are now able to use laparoscopic techniques for donor surgery, and they perform more transplants on patients whose age or other medical conditions may have prevented surgery years ago.”
The most significant breakthrough in the field of transplantation came in 1976 with the development of cyclosporine, an immunosuppressive drug still used today that has more than doubled the one-year graft survival rate. Approved by the FDA in 1984, cyclosporine does not suppress the entire immune system. Instead, it attacks the T-lymphocytes that are responsible for organ rejection. With the advent of this and other drugs for the treatment and prevention of organ rejection, multiple advancements in the field of organ and tissue transplantation were made and resulted in the opening of many transplant programs. Currently there are 240 Renal and Pancreas Transplant Centers throughout the United States, of which the SBHCS Centers are the fifth most active.
In the year 2000, the field of transplantation is experiencing unprecedented patient and graft survival rates; however, there are many obstacles yet to overcome. As the secrets of the immune system continue to unfold, current organ transplant techniques and protocols may become outdated within the next 25 years.
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