Rejection, shortages hamper progress Series: 50 YEARS OF ORGAN TRANSPLANTS

Hours before he was to receive a history-making kidney transplantfrom his twin brother, Richard Herrick developed serious doubts.

He knew he'd die without a transplant. Still, he agonized overputting his brother, Ronald, through the ordeal of donating a kidney.

The night before the Dec. 23, 1954, operation at Brigham andWomen's Hospital in Boston, Richard wrote a note to Ronald, tellinghim, "Get out of here and go home."

But Ronald was determined to save his brother's life. He wroteback: "I am here and I am going to stay."

The transplant went on as scheduled, Dr. Joseph Murray, thesurgeon, recalled in a memoir. "With that, we entered unchartedterritory," he wrote.

The Herrick operation was the world's first successful organtransplant, but it was followed by many setbacks.

Perhaps the biggest hurdle was preventing the recipient's immunesystem from rejecting a foreign organ. Richard Herrick didn't havethat problem, because his organ came from his identical twin. Butearlier experimental transplants, involving genetically differentdonors, were rejected.

Four years before the Herrick transplant, doctors at LittleCompany of Mary Hospital in Evergreen Park did the first kidneytransplant in the nation. Surgeons there removed a kidney from awoman who had just died, transplanting the organ into Ruth Tucker, a44-year-old patient with failing kidneys.

Doctors knew there was a good chance Tucker would reject thekidney. But she had no other option because, in those days, there wasno kidney dialysis.

"She was a very strong and stalwart women, with a lot of hope,"recalled one of her surgeons, Dr. James West.

The transplanted kidney worked for about three months before itwas rejected. During that time, the organ took the load off Tucker'sother kidney, allowing that kidney to begin working again. Though hertransplanted kidney died, Tucker lived another five years.

The transplant was controversial, West recalled.

"It sounded bizarre to take an organ from a dead person and expectit to work," he said.

As is the case today, doctors had to suppress the immune systemenough so the body wouldn't reject the organ, but not so much thatthe patient would be vulnerable to infections. The first immune-suppressing drugs were introduced in the 1960s, but they had seriousside effects.

The first lung and liver transplants were done in 1963, and thefirst heart was transplanted in 1967. But transplantation didn't takeoff until the 1980s with the approval of the much-improved anti-rejection drug, cyclosporin. Today's drugs are even better.

Since 1988, the number of transplants performed each year in theUnited States has more than doubled. This success has lead to avexing new problem: Now, there aren't enough organs.

More than 86,000 people in the United States are waiting fortransplants, and the number keeps growing. Each day, on average,about 17 people on the transplant list die while waiting for anorgan.