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Plastic Surgeons: Pioneers in Transplantation

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The field of plastic surgery recently lost one of our best with the passing of Nobel Prize winner Dr. Joseph Murray. While exceptional in the plastic surgery profession, Dr. Murray's greatest legacy was performing the first living donor kidney transplant in 1954 -- a notable surgical milestone.

Surprisingly, plastic surgeons -- long associated with "pretty faces" -- were among the first interested in transplantation and led its progress. Dating back to 800 B.C., when Indian surgeon Sushruta Samhita first attempted skin grafting, the idea of replacing damaged tissue and organs was a priority for those who would come to be known as plastic surgeons.

Progress on transplantation was slow but consistently connected to plastic surgeons. In the 1920s, Dr. Earl Padgett observed that skin grafts taken from one individual and grafted to another survived longer in individuals if the donated skin came from a close relative. A decade later, fellow plastic surgeon Dr. James Barrett Brown backed up Padgett's observations with a successful skin graft using skin from a patient's identical twin.

In 1944, Dr. Murray, a young surgical intern, was drafted by the U.S. Army Medical Corps and stationed at Valley Forge General Hospital, where he worked with Dr. Barrett Brown and Bradford Cannon, another pioneer in the field of reconstructive surgery. It is there where Murray became interested in transplantation biology, when he was forced to use skin allografts as temporary dressing on severely-burned World War II soldiers.

Much of the early investigational and clinical work in transplantation was inspired by the use of skin allografts for treating burn patients. Plastic surgeons had a considerable role in the early development of the field of transplantation by assisting in the development of periodicals, organizations, and symposia dedicated to this field.

In fact, one of the first periodicals, the quarterly Transplantation Bulletin, was established in 1953 and housed for many years within the journal Plastic and Reconstructive Surgery.

Dr. Murray is best known for the surgical milestone referenced above, during which he successfully transplanted Ronald Herrick's healthy kidney into his ailing 23-year-old identical twin brother. Following Dr. Murray's historic transplant, research on transplantation began in earnest. Milestones followed, including the world's first liver transplant in the late 1960s by British surgeon and organ transplant pioneer Sir Roy Yorke Calne, followed by the world's first liver, heart and lung transplant in 1987.

The transplant surgeries making headlines today tend to be more obviously connected to plastic surgery -- think of facial transplants, which have only been successfully performed since 2005. To date there have been close to 20 facial transplantation surgeries performed worldwide, and research and progress continues. Today, plastic surgeon Dr. Curtis Cetrulo, Jr. and immunologist David Sachs at the Massachusetts General Hospital's Transplant Biology Research Center are investigating methods to transplant organs and faces without immunosuppression.

What's the real lesson here? Plastic surgery is more than skin deep. Reconstructive surgery, which Dr. Murray also excelled in, continues to push the field forward, with implications far beyond cosmetic procedures.

Time will tell how the next innovations in plastic surgery and transplants will have truly life-altering consequences, but those familiar with Dr. Murray's legacy won't be surprised when it happens.

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