Surgery: Transplant Progress: More Bold Advances

In the dawning age of the surgical transplant, there seems to be no end to the variety of daring and delicate feats that surgeons are willing to try in the hope of saving patients who would otherwise be doomed by the failure of a vital organ.

A young Colorado mother was getting along well last week although her liver had been replaced by one taken from a dead man. A boy of twelve was living a normal life in his Pueblo, Colo., home with his mother’s spleen inside him, while his mother went about her chores with no spleen at all. A couple of lung transplants have been tried, and though the patients died, there will soon be others.

Two from a Monkey. Today, at least twoscore Americans are going about their business kept alive and active by kidneys transplanted from other people. Some of the donors were living at the time of the operation, some were dead; some were close kin, some unrelated. In Denver, Royal Jones, 12, went blind for a while because of kidney disease but is now well enough to play ball, thanks to a transplant last November from his mother. Another Denver patient, Jerry Will Ruth, 24, got a kidney from Brother Billy, 22; he pumps gas and greases cars, declares, “I feel as good as I ever felt in my life.”

The youngest patient ever to receive a kidney transplant was operated on recently in a Manhattan hospital: not yet two years old, the little white boy had a kidney transplanted from a Negro boy of 13, who died of a brain tumor. A man in Virginia whose body sloughed off one kidney transplant was making medical history by apparently accepting a second. These were all “homotransplants” (between two humans). But in New Orleans, a woman for whom no donor could be found in time, had a pair of monkey kidneys implanted in her groin. This was the first significant “heterotransplant” (between different species), important even though it finally failed and the patient went back on the artificial kidney.

No less ingenious are “autotrans-plants” of a patient’s organs to a different part of his own body. Kidneys have been thus transplanted at the University of Mississippi Medical Center so that they might continue working although the tube that connected them to the bladder had been damaged by disease or injury. Parts of the adrenal glands that bestride the kidneys have been moved to the thigh to facilitate continued treatment without repeated major operations.

Precise Timing. The latest liver surgery in Denver involved the deathwatch and precise timing that are a common feature of homotransplants. Housewife Jeanine Goodfellow, 29, of Arvada, arrived at the University of Colorado Medical Center in September with cancer of the liver so advanced that her only real hope of life lay in taking the long chance of becoming the first human being to survive with a transplanted liver.

Across the street at Denver’s VA Hospital, a man was admitted for accidental gunshot wounds, and when it became clear that he could not survive, relatives gave permission for the use of his liver in a transplant. As the prospective donor’s life ebbed, Surgeon Thomas E. Starzl opened Mrs. Goodfellow’s abdomen to get her ready for a quick transplant. This operation took ten hours. Her liver was so enlarged by disease that instead of a normal 4 Ibs. it weighed closer to 20 Ibs. Dr. Starzl left his patient anesthetized, with her liver “just sitting there” until it was time for the final cuts to remove it.

Within minutes after the donor died, Ralph Huntley, a mechanical engineer who has switched to biophysics, began cooling the body “from the inside out” by perfusing it with chilled saline solution. He kept this up while Surgeon Thomas Marchioro cut out the liver. Dr. Starzl cut out Mrs. Goodfellow’s diseased liver at almost the same moment as its replacement arrived in a chilled, sterile container. Then Dr. Starzl stitched the newly arrived liver in, connecting its blood vessels to their counterparts in Mrs. Goodfellow’s body. This part of the operation took 164 minutes.

For days, Mrs. Goodfellow was kept in sterile isolation: the danger of infection had increased enormously because Mrs. Goodfellow’s defenses against it had been weakened by the immunosuppressive drugs, Imuran and prednisone, that the doctors had given her to increase the likelihood that the liver graft would “take” instead of being rejected. Last week she was well enough to take a ride outside the hospital, but the crucial time, determining whether her system will accept or reject her grafted liver, is not likely to come until early in November.

Dr. Starzl’s Denver team also performed the spleen transplant between mother and son. The boy, Richard Hill, suffered from a shortage of gamma globulin in his blood, leaving him virtually defenseless against infectious diseases. This shortage arose largely from the failure of his spleen to produce enough of the antibodies that make up an important fraction of gamma globulin. The boy’s mother, Mrs. Jacqueline Carver, had a good supply of gamma globulin, and her lymphatic system would maintain it. She could get along without her spleen far better than her son. The operations were performed in June, and the boy has been getting doses of Imuran in hopes of subduing his body’s reactions against “foreign” tissue, from even so close a relative as his mother. “It will be six months or so before we know whether the transplant is working,” says Dr. Starzl.

Second Chance. So alert and powerful are the body’s defenses against invasion by proteins from any other body, human or animal (except an identical twin), that some transplant researchers believe donor and recipient should be “look-alikes.” An eloquent exception to that argument is a long-surviving kidney transplant, now more than a year old, from a fatally injured Negro to a white man.

Usually even more abrupt than the body’s rejection of a first graft is its rejection of a second, even from a different donor. Surgeon David Hume of the Medical College of Virginia has just reported a notable exception to that rule. James Connor, 37, got a kidney transplant from his brother-in-law. It worked well for two months, then was rejected and had to be removed. For 40 days, Connor was kept alive on an artificial kidney. Then a cadaver kidney became available, and Dr. Hume tried a second transplant. Surprisingly, it has worked for three months and shows no signs of being rejected.

The New Orleans housewife whose own kidneys were not working because of long-standing infection was unlucky in that the eleven-doctor team at Tulane University could find no suitable human donor to help her. Despite generous use of an artificial kidney, her condition was getting worse. The patient was fortunate, though, in that Tulane has a special interest in the subhuman primates—apes and monkeys—and has its own collection of them. When there seemed to be no other alternative, the doctors decided to put a pair of monkey kidneys in the woman’s right groin.

Dr. Keith Reemtsma and his col leagues picked a 25-lb. rhesus monkey. The doctors knew that a monkey’s kidneys work in almost exactly the same way as a man’s, filtering out virtually the same poisonous wastes from the blood.

When Dr. Reemtsma had his patient nearly ready, other doctors across the street in the Tulane University School of Medicine anesthetized the monkey, removed its kidneys, and flushed all the blood out of them with salt solution. (An overdose of anesthetic then killed the monkey humanely.) Dr. Reemtsma implanted the two kidneys in the woman’s groin. He joined the arteries and veins of both kidneys to major branches of the woman’s aorta and inferior vena cava. The ureters were attached to her bladder. After the monkey kidneys failed, the surgeons still hoped to replace them with a single human kidney installed at the same site if a suitable donor could be found.