The Graft: How a Pioneering Operation Sparked the Modern Age of Organ Transplants

By Edmund O. Lawler

The first human organ transplant in 1950 at a suburban hospital is the focus of The Graft: How a Pioneering Operation Sparked the Modern Age of Organ Transplants. The book examines the controversies the operation generated and the progress medicine has made in organ transplantation.

• Language: English
• Publisher: Union Bridge Books
• Release date: Aug 17, 2021
• ISBN: 9781785278365

Book preview

THE GRAFT

the

GRAFT

HOW A PIONEERING OPERATION SPARKED THE MODERN AGE OF ORGAN TRANSPLANTS

EDMUND O. LAWLER

FIRST HILL BOOKS

An imprint of Wimbledon Publishing Company Limited (WPC)

This edition first published in UK and USA 2021

by FIRST HILL BOOKS

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or PO Box 9779, London SW19 7ZG, UK

and

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Copyright © Edmund O. Lawler 2021

The author asserts the moral right to be identified as the author of this work.

All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book.

British Library Cataloguing-in-Publication Data

A catalogue record for this book is available from the British Library.

Library of Congress Control Number: 2021942293

ISBN-13: 978-1-78527-834-1 (Hbk)

ISBN-10: 1-78527-834-7 (Hbk)

Cover image: OSF HealthCare Little Company of Mary Medical Center

This title is also available as an ebook.

For Rosemary Wong and the late Christine Nagle, who had the good fortune to be the daughters of a warm-hearted father and medical pioneer.

CONTENTS

Acknowledgments

Introduction

PART I

chapter 1The Moment

chapter 2The Road to 1950

chapter 3The First

chapter 4The Pioneers

chapter 5The Transplant

chapter 6The Backlash

PART II

chapter 7The Crisis

chapter 8The Patients

chapter 9The Transplanters

chapter 10The Twenty-First-Century Transplant Centers

Afterword

Index

ACKNOWLEDGMENTS

It was my great privilege to interview the two surviving members of the team responsible for the first kidney transplant. I appreciate Sister Joseph Casey and Nora O’Malley for helping me to see what they saw on June 17, 1950, at Little Company of Mary Hospital. I am also grateful for those who took the time to speak to me about the state of transplantation seven decades later.

Transplant surgeons John Fung, Zoe Stewart Lewis and William Goggins continue to build on the proud legacy of the pioneers with their extraordinary work that has saved so many. Glenn Turner and Eddie Hall shared stories of their respective journeys to a new kidney and an exponentially better life. When I spoke to cancer survivor Christine Bertrand in the summer of 2020, she was awaiting a live kidney donation from a friend that was scheduled for the spring of 2021. Father Christopher Wadelton is one of about seven thousand people in 2020 who selflessly donated one of their kidneys to a family member, a friend, a total stranger or—in Father Chris’s case—a parishioner in desperate need.

Howard Nathan and Kevin Cmunt, the chief executives of two of America’s largest organ procurement organizations, explained the challenges of organ procurement and allocation in a nation in dire need of more transplantable organs. Others who kindly took the time to speak to me are theologian Paul Scherz; urgent care technician and former paramedic Darren Herde; and medical historian Justin Barr, who was doubly helpful because he is also a general surgery resident at Duke University.

I am grateful to the family of James West. Daughter Vicky Dingler and stepdaughter Cheryl Marquis told me wonderful stories, and son Bill West sent along valuable documents and magazine articles. In a similar vein, Richard Lawler’s daughter Rosemary Wong—my cousin—described the personal side of her father and provided photos and clippings. Mary Tucker, grand-niece of first transplant recipient Ruth Tucker, graciously shared information about her history-making relative.

Although they are not quoted in the book, several medical professionals helped educate me. They are nephrologist and former medical director at Little Company Kent Armbruster, vascular surgeon Joe Durham and two of my neighbors in Michiana, Michigan: nephrologist Andrew Aronson and former nurse anesthetist Rick Schillo, who was a member of the liver transplant team at Rush University Medical Center. I am indebted to the librarians at DePaul University, where I teach journalism, for locating materials large and small and to editor extraordinaire Perrin Davis of Three Muses Creative for her invaluable feedback on an early draft of the book.

Kelly Cusack, director of marketing and communications at what’s now OSF Little Company of Mary Medical Center, arranged interviews with Sister Casey and Nora O’Malley and let me to dig through Little Company’s voluminous archive of the historic operation. Thank you. My thanks as well to others at Little Company: Kathleen Kinsella, president; Karen Brodbeck, vice president of brand management; and Lee Batsakis, media relations coordinator.

I am especially grateful to the publisher and managing director of Anthem Press Tej P. S. Sood and acquisitions editor Megan Greiving for recognizing a good story and letting me write this book. And a thousand thanks to Jerry Lawler, a retired airline pilot and my uncle, who piqued my journalistic instincts by sharing the fascinating backstory of the censure and ostracism that confronted the surgeons of the breakthrough 1950 transplant. Astronaut Buzz Aldrin had it right: Pioneers will always pave the way with their sacrifices.

My brother Tim, a genealogical wizard, pointed me to several enlightening documents and articles. Finally, allow me to thank my wife, Priscilla. As she has done with my previous books, she edited the draft, offered feedback, fixed the glitches and listened patiently to whatever it was that was captivating my attention about kidney transplantation on any given day. I subjected the love of my life to my labor of love. I owe her my deepest gratitude.

INTRODUCTION

In the main corridor of the suburban Chicago headquarters of the Gift of Hope Organ & Tissue Donor Network, visitors often pause to explore the striking wall documenting the history of human organ transplantation. The wall, 8 feet tall and 31 feet wide with a slight radius, celebrates significant milestones in transplant history, like the world’s first heart transplant performed by South African surgeon Christiaan Barnard in 1967. But the milestone that visitors—especially those from Chicago—find most intriguing is this: 1950: First successful kidney transplant takes place at Little Company of Mary Hospital, Evergreen Park, Illinois. Kevin Cmunt, then the president and CEO of Gift of Hope, one of the nation’s 58 regional organ procurement organizations, said visitors sometimes remark, That can’t possibly be right. I’ve never heard about that, and I’m from Chicago.

They are amazed the transplant took place at a community hospital like Little Company—better known for delivering babies than for originating medical breakthroughs. The hospital operates in the shadows of Chicago’s powerhouse academic medical centers: the University of Chicago, Northwestern University, Rush University and the University of Illinois. It does seem unlikely that the Sisters of the Little Company of Mary, a Catholic nursing order founded in Nottingham, England in 1877, would play host to such a monumental medical advancement. The world’s first human organ transplant at a community hospital in a Chicago suburb in 1950 sounds as improbable as the world’s first manned airplane flight launched by a pair of Dayton, Ohio, bicycle mechanics from atop a North Carolina sand dune.

The Wright brothers soared to glory that day in 1903. But the surgeons who led the historic transplant of a kidney from a just-deceased woman into the abdominal cavity of a 44-year-old woman named Ruth Tucker flew into controversy. The 1950 transplant led by Richard Lawler—full disclosure, my great-uncle—was dismissed by some doctors as reckless and rogue. Some Catholic clergy declared it immoral. Others would later dispute whether the operation was in fact the world’s first successful kidney transplant, given the ultimate outcome. Despite an initial burst of national attention, the surgical team’s handiwork has been largely lost to history. The operation would come to be overshadowed by more successful kidney and other organ transplants performed at some of the world’s leading medical centers.

The kidney transplant at Little Company of Mary may have seemed like the stuff of science fiction at the midpoint of the twentieth century. James West, a member of the surgical team, acknowledged the operation’s almost macabre nature: It sounded bizarre to remove an organ from a dead person and expect it to work.¹ But it did. And it immediately galvanized the public’s interest in a life-saving medical therapy. More importantly, the pioneering surgery sparked a series of experiments and kidney transplants at more prominent academic-affiliated medical centers. Now, more than seventy years later, kidney transplants—or grafts as surgeons call them—have become relatively routine, extending the lives of hundreds of thousands of patients. Transplants sound miraculous, but they are not miracles. They are not even cures. They are treatments, certainly the best option for people with end-stage kidney failure. The patients must take an array of medications the rest of their lives to prevent their immune system from rejecting the kidney grafted into their abdomen. But they have regained their lives and can expect to live for many more years with diligent management of their health and lifestyle.

This is the story of that surgery and its aftermath told in two parts. Part I examines the 1950 transplant operation, the backlash it created, the long road leading to the groundbreaking transplant and the debate over which kidney transplant is considered the first. It also includes profiles of pioneering surgeons Lawler and West. In Part II, the timeline springs ahead seven decades. Transplantation by the 2020s finds itself the victim of its own success. The life-saving therapy has generated demand that far outstrips the supply of transplantable kidneys. Nearly one hundred thousand people now languish on a waiting list for a new kidney. In other chapters, kidney recipients and a donor share their affecting stories, twenty-first-century transplant surgeons describe the art and science of their craft and a visit to a modern-day university hospital transplant center underscores how different transplantation is today from 70 years earlier. These developments are the legacy of decades of experiments and surgical breakthroughs, including one that took place on June 17, 1950.

1. Valerie J. Nelson, Dr. James West at 98; a Founder of Betty Ford Center, Los Angeles Times , August 5, 2012, https://www.latimes.com/local/obituaries/la-me-james-west-20120805-story.html.

PART I

CHAPTER 1

THE MOMENT

From the window of her room on the seventh floor of Little Company of Mary Hospital, Ruth Tucker watched anxiously on that June day as ambulances with blazing lights and screeching sirens rolled up to the hospital’s emergency room. Watching the ambulances arrive had become a daily ritual for Tucker over the past six weeks as she awaited a risky, unprecedented operation that could save her life. She suffered from polycystic kidney disease, a genetic condition that had claimed three of her family members in the prime of their lives. She feared she was next.

Tucker turned to Sister Joseph Casey, who the hospital had assigned to be her confidante and constant companion: I don’t wish anyone ill will, but if someone was to die, I hope I could get a kidney. Casey, a 22-year-old student nurse and novitiate in the British-based order of nuns that ran the hospital, assured Tucker she would continue to pray for a miracle. Kidney dialysis was in its infancy and not available in Chicago in 1950. The year before, during a visit to the Mayo Clinic, Tucker had been told her condition was likely terminal and that little could be done. She returned in despair to her home in Chicago and to the care of her physician, Edward Clancy, who practiced at Little Company. He referred her to Richard Lawler, a urologist, surgeon and head of Little Company’s recently formed transplant team.

Transplant teams, much less organ transplants themselves, were unheard of in 1950, particularly at a suburban community hospital in the heart of America. Transplant centers, where multidisciplinary teams of surgeons and other specialists operate on and care for transplant recipients, did not emerge until the 1960s—almost always at large university-affiliated medical centers. For example, Duke University Medical Center launched