|The History of Organ Transplantation|
|Friday, 08 March 2013|
David Hamilton, University of Pittsburgh Press, 2012, ISBN 978-0822944133
I confess that it was with a lack of enthusiasm that I took up the offer to review David Hamilton’s History of Organ Transplantation. As someone who finds it challenging to find time to keep up to date with the relevant surgical and transplant literature, the luxury of reading such a historical tome seemed beyond my reach. I have been pleasantly surprised.
David Hamilton is well-placed to write such a book in a manner that is accessible to the busy clinical surgeon as well as to individuals with a more specific interest in medical history. As a clinical transplant surgeon, and someone who trained in transplant science under the doyen of the field, Sir Peter Medawar, Mr Hamilton has written a book that is eminently readable, and masterly in its detail.
The history of transplantation begins much earlier than many of us would have believed, and in this book the author outlines the history from times well before the fourteenth century. Throughout the book, several histories run in parallel; that of surgical successes and failures, scientific challenges, and accompanying ethical dilemmas, all of which ring true in the modern era of transplantation.
It is clear that, throughout the history of transplantation, surgeons have been at the forefront of developments. The early examples described by the author are of attempts at nose reconstructions, using skin from the patient or from a donor, not infrequently, a slave. During the 1500s, important work undertaken by Taglicozzi in Italy, described the notion of biological individuality, preventing uptake of donor skin. It was with the advent of vascular surgery in the early 1900s that the possibility of organ transplantation became real, with well-known names such as Jaboulay and Carrel at the forefront of such developments. Familiar themes stand out as I read of these times: the old-fashioned surgical trainee, who, whilst on a ‘ward round’ with Professor Lister, offered his own leg for skin grafting onto a patient. His offer was taken up, and he was taken directly to the operating theatre!
The ethical challenges facing surgeons and scientists in the field of transplantation are another common theme throughout the book, with fascinating and amusing examples. As early as the 1400s, consideration was given as to whether skin grafting between dogs was considered moral behaviour, and the challenge of paid donation was considered following the work of John Hunter in developing tooth transplantation, in 1803, with the following comment: “I might indeed have observed that this operation involved in it a defect of the moral principle, as one person is injured and disfigured, in order to contribute to the luxury and convenience of another…an injury is done to the moral sense by such an operation”. An ethical dilemma that particularly appealed to me accompanied the development of ovarian grafts, which, it was hoped, might become a treatment for infertility. The issue about ultimate maternal rights was followed by a discussion about who was eligible to consent to donate: ‘He took a stern view and opined that the donor’s ovaries properly belonged to the husband and that consent thus lay with him’!
I have learnt a huge amount from this book, and it is humbling to realise once again how privileged I am as a transplant surgeon to be part of this legacy spanning several hundred years, giving new meaning to the phrase ‘standing on the shoulders of giants’.