The period of the 1950s and 1960s was clearly the golden age of transplantation attempts, successes and failures. From liver to kidney to hearts, from procedures on animals to humans, many trials based on technologies of the time allowed for the unthinkable. Due to the obvious importance of the lungs, as physician William Harvey stated in a mid-17th century publication, “there is nothing living that does not breathe nor anything which breathing which does not live”, it was only a matter of time before a method was developed to transfer lungs from one person to another. This first successfully occurred in humans during the 1960s.
The former Soviet Union was the genesis of experimental lung transplantation in the mid-1940s, beginning with animal experimentation. Among those studying this phenomenon was Vladimir Demikhov, noted to be one of the pioneers of organ transplantation (https://www.ncbi.nlm.nih.gov/pubmed/21620094). Lung transplantation experiments were first begun as combined heart-lung transplantation procedures performed by Demikhov from 1946 to 1955, when he accomplished 4 and 6-day survival periods with dogs being his subjects (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC325641/).
Dr. James Hardy was another pioneer in the lung transplantation field. In preparation for conducting human lung transplants, Dr. Hardy, too, utilized dogs, as he attempted approximately 400 transplant experiments on those subjects. Recognizing the inherent risks of a lung transplants in the 1950s and 1960s, Dr. Hardy would only conduct this procedure on someone in failing health. He found such a patient when the doctor performed the first human lung transplant in 1963 in Jackson, Mississippi on a man suffering from lung cancer. This recipient passed away 18 days after the transplant as a result of kidney failure (https://secondwindstl.org/who-we-are/articles-by-dr-hacheem/the-history-of-lung-transplantation/).
This attempt illustrated that lung transplantation held many barriers in the 1960s which had yet to be conquered, although it spurred subsequent attempts. Over the following ten-year period, there were 36 transplants performed worldwide. However, of those recipients, most died within a few days, with just two surviving more than a month.
Almost twenty years after that first transplant attempt, two episodes brought about the first long term successes in this field. It was in 1981 that Dr. Norman Shumway conducted three heart-lung transplants at Stanford University. Two of those recipients survived for more than a year. Two years later, in 1983, the Toronto Lung Transplant Group performed the first successful lung transplant, which took place on a 58-year-old man with pulmonary fibrosis.
Since then, the occurrences of lung transplants have increased exponentially. In 1987, approximately 45 transplants were performed, and by 1990, over 400 were performed worldwide. Commensurate with the increased frequency of the transplants were improved outcomes. To note, the median survival rate of patients transplanted between 2000 and 2006 was 5.5 years compared to 4 years for those transplanted between 1998 and 1994.
Finally, since the early 1990s, more than 25,000 lung transplants have been performed worldwide (https://emedicine.medscape.com/article/429499-overview#a7).
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Topic for Saturday, March 3rd posting – Organ Preservation Practices