Book explores history of organ transplants

Comprehensive saga traces the origins of today's procedures

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Working for years on the ambitious project, David Hamilton found it broader than expected. And that is what eventually sent him searching through the dark and dusty basement shelves of the Royal Society of Medicine's library in London.

With the long-hidden information, he realized that the history of organ transplantation was no 20th century phenomenon -- that the seeds of its history were planted centuries, even millennia, ago, only to blossom in recent decades.

Human persistence, in fits and starts, setbacks and surges, represents one of the amazing characteristics of transplantation history.

Dr. Hamilton's book, "A History of Organ Transplantation: Ancient Legends to Modern Practice," published by the University of Pittsburgh Press, includes a forward written by Pittsburgh transplant pioneer Thomas E. Starzl, director emeritus of the University of Pittsburgh transplantation center that bears his name, along with Clyde F. Barker, distinguished service professor and emeritus professor of surgery at Pitt.

The hardcover 556-page book, the first comprehensive international history of transplantation, is written for the average reader without ignoring scientific detail that drew the interest of Dr. Starzl, the most famous living transplant surgeon and scientist who made Pittsburgh what Dr. Hamilton described as the center of transplantation.

"I think it's a fabulous book that's easy to read. I've read it rather carefully, and I'm more interested in antiquity than the current era," said Dr. Starzl, a central figure in the modern era that he detailed in his own 1992 memoir, "The Puzzle People."

The complicated history might intimidate some readers, he said: "If you take the chapters one by one, they are riveting. It is easy to get overloaded. But each chapter is a story unto itself.

"I'm very happy that Dr. Hamilton was able to get the job done."

Dr. Hamilton, 73, is a retired transplant surgeon living in St. Andrews, Scotland, where he's an honorary professor who teaches medical history at the School of Medicine of the University of St. Andrews. He also wrote "The Monkey Gland Affair" and "The Healers: A History of Medicine in Scotland."

He spent 15 years tracking down transplantation history only to discover how long people have striven to fix medical problems -- damaged or missing skin, lost limbs and fingers and noses, lost teeth and eventually damaged and diseased organs -- by trying to use body parts from others, the dead or animals.

From skin grafts and plastic surgery to heart transplants, the history of organ transplantation is long and complicated with hideous failures followed by incremental successes that served to inspire scientists to proceed, often against steady criticism or claims that transplants were unnatural, unethical or sinful.

Just as science fiction popularizes and inspires scientific inquiry, ancient folklore is filled with tales of "magical replacement of lost tissues," including "restoration of limbs or eyes, and even the replacement of decapitated heads," the book states. Skin grafts long had been the goal of healers. After years of everything from scientific studies to snake-oil claims, serious scientists took up the cause in the 18th century to test skin grafting in animals then humans, always with medical challenges. For example, scientists soon realized that even a tooth transplant could spread syphilis to recipients while skin grafts could infect the recipient with the donor's tuberculosis or smallpox.

World War I put transplantation science on hold for years. But World War II, with the focus on treating soldiers' war wounds, bolstered interest in transplantation science and helped to usher in the modern era with the first successful kidney transplant in 1954.

But the setbacks continued. Even when Christiaan Barnard, the South African cardiologist, had some success with two heart transplants in 1968, it served to halt heart transplantation science.

"He set things back," Dr. Hamilton said. "I'm hard on him. He went too early and then he toured the world as a celebrity and didn't stick with the boys [that is, other research scientists]" to share his knowledge; it turned to "total gloom and doom and set heart transplants back five to 10 years."

The book details the progression of immunosuppressant drugs, which turned transplantation into a common medical practice. It also covers the medical, ethical, policy and political debates that transplant science has stirred.

Dr. Starzl encouraged Dr. Hamilton to complete the book and helped get it published. The two spent several weeks together in Pittsburgh, discussing Dr. Hamilton's project. When it was nearing completion, but still without a publisher, Dr. Starzl recommended its publication to the University of Pittsburgh Press, which had published his memoir.

Peter Kracht, editorial director at the University of Pittsburgh Press, said the history falls in line with a current focus of the press, which received a $750,000 grant from the Mellon Foundation to publish books about the history of science and medicine with an emphasis on international histories.

When he received the book, Mr. Kracht said, he was surprised to find it didn't start in the last century but thousands of years ago. The book not only is the first comprehensive history, but one that is written for the general public. Mr. Kracht said the book will appeal to organ recipients, family members, scientists in the field and general readers with an interest in medical history.

"It's a surprisingly big topic and a challenge for a writer to take a topic so sweeping but also so technical," he said. "Dr. Hamilton doesn't shy away from educating the reader to explain the science. I think he did an excellent job."

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Editor's note: David Templeton underwent a successful kidney-pancreas transplant in October 2011 at UPMC's Thomas E. Starzl Transplantation Institute. David Templeton: or 412-263-1578. First Published June 25, 2012 4:00 AM


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