In September 1999, 11 of the pioneers from them early days of transplantation were invited to meet together in California to share their recollection. At this meeting, the development of transplantation was described as “one of the two or three most important advances in medicine to have been made in the twentieth century. A miracle of modern medicine is another phrase that is frequently heard and read. This afternoon I would like to explore just what it is that makes transplant surgery “a miracle of modern medicine” I’m not, in these venerable surrounding, going to try to establish precisely what is meant by the word miracle - that’s for philosophers or theologians or cathedral Deans – but I am going to identify how something that was an impossible dream to those brought up in the first 60 years of the twentieth century has become. Only a generation later, an – almost literally – every day event –that is, now it has become possible to save the lives of patients dying of heart failure or liver failure or kidneys. To demonstrate the degree of scepticism and doubt about the possible eventual success of organ transplants, I can do no better than recount two stories about two of the great pioneers of transplantation in the UK.  In 1950, when Roy Calne –now Professor Sir Roy – was a medical student at Guy’s Hospital in London, he asked his very eminent consultant whether a young man dying kidney failure could be saved by giving him a new kidney. He was told “NO”.  Being Roy he persisted –“Why not” he asked. “Because it can’t be done” was the very final end to the discussion. 

A few years later, Sir Peter Medawar, who was without doubt the greatest scientist in the early days of transplant immunology, gave a lecture in Oxford about his extensive laboratory work. Afterwards a student asked Medawar whether it was possible to apply his experimental work to the treatment of human patients. The reply was blunt –“Absolutely not.” Even 15 years later when, like Roy Calne, I was a student at Guy’s and had developed fascination for transplantation, I asked one of the surgeons, who by then had started a programme of kidney transplants, whether it would ever “catch on’’ – whether it could become successful enough. He thought for a long time before saying that yes, perhaps, it might, one day, become part of routine surgical practice.

So what happened, and who made it happen?

            Transplantation is almost unique in that it involves two apparently separate disciplines, science and surgery, each of which could only succeed with the help of other –so much so that the boundaries are almost completely blurred. It is now not all clear whether science has unravelled the hugely complex problems of rejection and tissue matching and so on, allowing surgeons – in their typically cavalier way – have preserved with their prime object of trying to explain where they went wrong – or, occasionally, where they got it right. The truth is probably somewhere in the middle.

Undeniably, though our understanding of the basic science of the immune system has been a fundamental part of the path towards success. The rate of progress has increased dramatically in the past 20 years stimulated, at least in part, by the work Jean Boreal in Switzerland who first of all discovered that cyclosporine is a highly potent anti –rejection drug and then spent the next 20 years trying to find out how it worked we owe a huge debt of gratitude to the thousands of research scientists all round the world for their contributions. But let’s go back to the surgeons because they after all, deal with real people. They make real sometimes, very immediate decisions and the consequences of their decisions and their actions are very apparent.

What sort of person does it take to start the first programme of liver transplants, to see the first six patients all die during immediately after the operation – and to carry on, as Tom Starzl in Denver did? I couldn’t and nor could most of us. And what sort of a person was Chris Barnard – who sadly did just over a month ago, who felt able, for the first time in history, to remove the heart of a living person, knowing that unless he could make the new heart work immediately, his his patient was dead? It takes quiet a remarkable degree of determination and confidence to do these things and to carry on doing them despite so many failures and so few successes and I take my hat off to all the early transplant surgeons for their courage and their persistence.

And what of their patients? I find it difficult, now, to think how I would respond if I were told that my life depended on heart or liver transplant, even though the odds are now so heavily in favour of success. What must it have felt like to be told – like Louis Washkansky, the first heart transplant recipient was that your survival depended on an operation that had never been done before. Or Philip Blaiberg, the second heart recipient, who knew that Washkanshy had died after only 18 days. Or Starzl’s seventh patient, knowing the fate of the first six transplants. Not only did it  take a very special sort of these early operation, it took a pretty special sort of patient to agree to them –something, perhaps, that is still true today.              

To describe transplantation as unique because it involves brilliant scientist, courageous surgeons (and physicians) and brave patients, is, how heaver, to miss the most remarkable part of the story. What really makes transplants surgery so extraordinary is that involves not only the recipient of the transplant but also the donor. Kidney Transplants may involve a living donor and that itself is pretty special deal – to undergo major surgery and give up a Kidney for someone else represents an act courage and generosity way beyond the call of duty and I have never, ever, lost my respect and admiration for those who do this.

But of course that majority of transplants in country use organs from people who have died – almost invariably suddenly and tragically –and organ donation occurs because that is what they wanted or because their family and friends have felt that , that is what they wanted. It is here that transplantation moves beyond a mere medical miracle and represents  all that is good about human nature. All the work of all scientists in all their laboratories, all the courage and skill of surgeons and physicians and their patients would count for nothing if organ donation didn’t happen. This is the real miracle.