The Short Answer: By using identical twins — whose immune systems are genetically indistinguishable — Murray bypassed the rejection problem that had defeated every previous transplant attempt. Richard Herrick survived eight years with his brother's kidney. The operation proved organ transplantation was possible.

Every previous attempt at organ transplantation had failed because the recipient's immune system attacked the foreign tissue. Surgeons knew how to connect blood vessels and physically transplant organs — the technical surgery was not the problem. The immune system was. Joseph Murray's insight was to remove that variable entirely.

The Herrick Twins

Richard Herrick was dying of chronic nephritis at Peter Bent Brigham Hospital in Boston. His identical twin brother Ronald was healthy and willing to donate a kidney. Because they were identical twins, their tissues were immunologically identical — Ronald's kidney would not be recognised as foreign by Richard's body.

The operation took place on 23 December 1954. Murray transplanted Ronald's left kidney into Richard's pelvis, connecting the renal artery, renal vein, and ureter. The kidney began producing urine almost immediately. Richard recovered, married his nurse, and lived until 1963.

From Twins to Everyone

The twin transplant proved the surgery worked. The next challenge was making it work between non-identical donors and recipients. The development of immunosuppressive drugs — first azathioprine in the 1960s, then cyclosporine in the 1980s — gradually made this possible.

Today, over 100,000 organ transplants are performed worldwide each year. Kidney transplants remain the most common, with over 25,000 performed annually in the US alone.

Sources

• Murray JE, The First Successful Organ Transplants in Man, Nobel Lecture, 1990.
• NHS Blood and Transplant, Organ Transplantation in the UK.