Joseph Murray

Joseph Edward Murray (1 April 1919 - 26 November 2012) was an American plastic and reconstructive surgeon who, on 23 December 1954, led the team that performed the first unequivocally successful human organ transplant: a kidney transplanted between the identical twins Ronald and Richard Herrick at the Peter Bent Brigham Hospital in Boston.[1][2] For this work and for his contributions to understanding and overcoming transplant rejection, Murray shared the 1990 Nobel Prize in Physiology or Medicine with E. Donnall Thomas "for their discoveries concerning organ and cell transplantation in the treatment of human disease."[3] He is widely regarded as a founder of clinical organ transplantation.[2][4]

Early life and training

Murray was born in Milford, Massachusetts, and trained in surgery, with his early career interrupted by service during the Second World War.[2][3] As a young surgeon caring for burned servicemen, he became interested in skin grafting and the question of why grafts from one person were rejected by another, an interest that drew him toward the central immunological problem of transplantation.[2][3] His Nobel biographical materials note that this wartime experience with skin allografts shaped his later transplantation research.[3]

The 1954 Herrick kidney transplant

By the early 1950s it was understood that transplants between genetically different individuals were destroyed by immune rejection, but that genetically identical individuals, identical twins, should not present this barrier.[1][4] When Richard Herrick was dying of chronic kidney failure and was found to have a healthy identical twin, Ronald, the situation offered a unique opportunity to test kidney transplantation without the confounding problem of rejection.[1][2]

On 23 December 1954, Murray's surgical team transplanted one of Ronald Herrick's kidneys into his twin brother.[1][2] The recipient recovered and lived for several years, marking the first time a transplanted human organ had functioned and sustained a recipient long-term.[1][2] The operation established that organ transplantation was surgically and biologically feasible and is conventionally cited as the beginning of successful clinical transplantation.[1][2][4]

Overcoming the rejection barrier

The twin transplant solved the immunological problem only by avoiding it, and Murray and his collaborators next worked to make transplantation possible between non-identical individuals.[1][4] Murray performed transplants using total-body irradiation to suppress the immune system, and then, as chemical immunosuppression emerged, helped pioneer the use of the drug azathioprine to control rejection.[1][4] In 1959 he performed a successful kidney transplant between non-identical (fraternal) twins, and in 1962 he performed one of the first successful kidney transplants from a deceased (cadaveric) donor using immunosuppressive drugs, a critical step because most potential donors are not identical twins.[1][4]

Later career and the Nobel Prize

After his transplantation work, Murray returned to plastic and reconstructive surgery, becoming a leader in the reconstruction of congenital facial deformities, and he chaired plastic surgery at Brigham and Women's Hospital and Children's Hospital in Boston.[2][4] In 1990 he was awarded the Nobel Prize in Physiology or Medicine jointly with E. Donnall Thomas, whose parallel work established bone-marrow (hematopoietic cell) transplantation; the prize recognized that organ and cell transplantation had become established treatments for otherwise fatal disease.[3] Murray published a memoir, Surgery of the Soul, and died in 2012 at the age of 93.[2]

Legacy

Murray is credited with demonstrating, for the first time, that a transplanted human organ could replace the function of a failed one, the foundational proof on which the entire field of transplantation rests.[1][2][4] His progression from the rejection-free twin transplant to irradiation and then drug immunosuppression mirrors the trajectory of the field as a whole, which would be transformed again a generation later by ciclosporin.[4] See history of organ transplantation and kidney transplantation.

See also

• History of organ transplantation
• Kidney transplantation · Transplant immunology
• Thomas Starzl · Christiaan Barnard

References

• Murray JE, Merrill JP, Harrison JH. Renal homotransplantation in identical twins (1954 Herrick twins; orig. Surg Forum 1956). Reprinted, J Am Soc Nephrol. 2001;12(1):201-204. https://journals.lww.com/jasn/fulltext/2001/01000/renal_homotransplantation_in_identical_twins.31.aspx
• Tilney NL / Harvard Medical School. Transplant pioneer, Nobel laureate Joseph E. Murray dies at age 93. HMS News, 2012. https://hms.harvard.edu/news/transplant-pioneer-nobel-laureate-dies-age-93
• Joseph E. Murray - Facts; Biographical. NobelPrize.org, The Nobel Prize in Physiology or Medicine 1990. https://www.nobelprize.org/prizes/medicine/1990/murray/facts/ ; https://www.nobelprize.org/prizes/medicine/1990/murray/biographical/
• Toledo-Pereyra LH. Joseph E. Murray (1919-2012): first transplant surgeon. (biographical review). PMC6482420. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482420/