Organ donation and transplantation history continues to be made, from the more recent full-face transplant to tissue and eye transplants more than 100 years ago. The following timeline provides insight on significant milestones in organ donation and transplantation history.
- 2007 — Charlie W. Norwood Living Organ Donation Act (PL 110-144) provided the legal basis for kidney-paired donation exchanges.8
- 2005 — First successful partial face transplant performed. 9
- 2004 — Organ Donation and Recovery Improvement Act (PL 108-216) allowed the National Organ Transplant Act to reimburse travel and living expenses for living organ donors and provided for grants to states and public entities.10
- 2000 — Children’s Health Act (PL 106-310)changed the National Organ Transplant Act to require the OPTN to adopt criteria and policies that address children’s unique needs.11
8 PUBLIC LAW 110–144—DEC. 21, 2007 (PDF)
9 First-ever face transplant surgery is completed
10 PUBLIC LAW 108–216—APR. 5, 2004 (PDF)
11 PUBLIC LAW 106–310—OCT. 17, 2000 (PDF)
Modern technology has gifted us with all kinds of resources to help save lives through organ donation, but have you ever wondered how it all began? Below are some key points that highlight some of the most important milestones and achievements in the history of organ & tissue donation.
* Some of the first recorded attempts at bone transplantation actually date back to the Middle Ages, but as you can imagine, this field of medicine was far from sophisticated at the time. Needless to say, those first patients (and doctors) were some brave souls!
* In the late 19th century – 1869 to be exact – the first successful skin transplant was performed by the renowned Swiss surgeon Jacques-Louis Reverdin. His breakthrough work paved the way for the first successful skin graft, which was performed in Denmark in 1870.
* In the middle of the 20th century, real progress in the science of solid organ transplantation really began to emerge. A major milestone occurred in 1954 when the first successful kidney transplant (from one identical twin to another) was performed by Dr. Joseph E. Murray in Boston, Massachusetts. Dr. Murray would go on to receive the Nobel Prize for Medicine in 1990.
* In 1959 and 1960 respectively, the first successful kidney transplants were performed between fraternal twins, and then between siblings who were not twins.
* 1967 was a banner year for organ transplantation, as it saw the first successful liver transplant as well as the first ever human-to-human heart transplant. The liver transplant was performed by Dr. Thomas Starzl, who is widely considered to be a pioneer in the field of kidney and liver transplantation. The heart transplant was performed by Dr. Christiaan Barnard, a renowned South African cardiac surgeon.
* 1968 also saw several important developments take place, including the first successful pancreas transplant, as well as the formation of the Southeast Organ Procurement Foundation (SEOPF), an organization for transplant professionals.
* In 1977, the SEOPF introduced the first computer-assisted organ matching system, which would come to be known as the United Network for Organ Sharing (UNOS).
* One of the biggest breakthroughs in transplantation medicine emerged in 1978 with the introduction of Cyclosporine, an immunosuppressive drug that was designed to help prevent the rejection of new organs in transplant patients. Other drugs have been developed from that time that are even more effective in neutralizing the rejection process, while leaving the critical functions of the immune system intact.
* In 1981, the first ever combination heart-lung transplant was performed under the direction of Dr. Bruce Reitz, a renowned cardiothoracic surgeon.
* In 1983, the first successful single-lung transplant was performed by Dr. Joel Cooper. In that same year, Congress introduced Senate Joint Resolution 78, giving birth to National Organ and Tissue Donor Awareness Week.
* In 1986, the first successful double-lung transplant was performed, again by Dr. Joel Cooper.
* In 1989 alone, 200,000 tissue transplants were performed in the United States.
* The mid-1990s saw quite a bit of progress in terms of establishing standards for organ procurement. In 1998, the first ever successful hand transplant was performed in France, and then in the U.S. in 1999.
* 2001 was the first year ever where the number of living organ donors surpassed the number of deceased donors in the United States.
* In 2002, the Organ Procurement and Transplantation Network (OPTN) introduced an online portal that provides real-time data detailing the number of people in the United States who are waiting for organ transplants.
* In 2005, the first successful partial face transplant was performed in France, followed by the first successful full face transplant in Spain in 2010.
* In 2014, Vascularized Composite Allographs (VCAs) were added to the expanded definition of organs that are covered by federal regulation and legislation.
As you can see, the science of organ transplantation and donation has enjoyed a rich history of innovation and progress that continues to this day. Let’s hear it for many more amazing milestones and achievements in the future!
The dream of curing illness and injury by transplanting organs, bone and other tissue is probably as old as the history of healing with the first recorded attempts to transplant bone dating back to the Middle Ages. Unfortunately the scientific knowledge and surgical techniques that have made modern transplant medicine possible had to wait until the 19th and 20th centuries. Successful transplantation of bone, skin and corneas came first, with advances made between 1900 and 1920. The establishment of the U.S. Navy Tissue Bank in 1949 gave the nation its first bone and tissue processing and storage facility. By 1986 there were more than 300 nonprofit bone banks in operation, although consolidation has since decreased that number by almost half.
Progress in solid organ transplantation began in the 1950s. Dr. Joseph E. Murray (who received the Nobel Prize for Medicine in 1990) achieved the first successful kidney transplant between identical twins in Boston in 1954. In 1967, a young South African heart surgeon named Christian Bernard became an international hero when he performed the first human heart transplant at Groote Schur Hospital in Cape Town.
While most of the technical problems associated with implanting an organ had been overcome early in the century, the long-term outlook for recipients was still far from ideal. The major problem was the tendency of the body’s immune system to become activated against the “foreign” organ and to mount a response designed to kill the invader (rejection). In order to prevent rejection, patients were given strong medications to suppress their entire immune system that in turn left them susceptible to life threatening infections. It was not until 1978, when the immunosuppressive drug Cyclosporin was introduced, that many of the problems of rejection were controlled. Since then, other drugs have been developed which specifically target only those cells involved in the rejection process while leaving the remaining immune system intact. These include drugs such as FK506, Atgam, Orthoclone OKT3 and Prograf. Today, one-year survival rates for most organs are between 70% and 90%.
As transplant medicine accelerated, it produced a wealth of legal and ethical concerns, the most critical of which related to the determination of death. Technology had improved to the point in the 1960s where the body could be maintained with artificial support long after the brain had died. A new definition of death was required; one that included situations where the entire brain and brain stem had irreversibly ceased to function (brain death). This determination is critical to organ donation as it allows recovery before cessation of blood flow to the organs. Prior to brain death, organs could only be recovered after the heart had stopped beating, which limited transplants to kidneys and livers only. Brain death allowed the additional recovery of the heart, pancreas, lungs and intestines. The first standard set of neurologic criteria for determining death were developed at Harvard University in 1968 and 1969. These criteria have since been adopted by all 50 states, as has the Uniform Anatomical Gift Act that addresses the conditions governing donations. The National Transplant Act, passed by Congress in 1984, mandated many of the regulations safeguarding the donation process (outlawing the sale and purchase of human organs and tissue, for example) and set up a national waiting list for patients needing an organ transplant. In 1986 the federal government amended the Social Security Act to require all hospitals receiving Medicare funds to notify the families of potential donors about their option to donate (“Required Request”). After donation rates remained fairly constant the federal government passed additional legislation in 1998 requiring hospitals to notify their local Organ Procurement Agency of all deaths so that trained and experienced staff could screen potential donors and offer the option of organ and tissue donation when appropriate (“Routine Referral”).
In the late 1980s, the Food and Drug Administration announced its intention to regulate tissue banking, beginning this oversight at the end of 1993. Regulation was designed to reduce the possibility of infectious disease transmission by setting standards for donor screening and testing. Additional regulations dealt with record keeping, labeling and tracking. In 1998 legislation required the registration of all tissue processors. Proposed legislation in 1999 included regulation of all human tissue and cellular based products, additional donor screening and reproductive technologies utilizing human sperm and oocytes.
The rapid development of transplant medicine since the 1970s, combined with factors including general population, growth and expansion of the elderly population has caused increasing demand for donated tissues and organs. Today it is estimated that approximately 600,000 Americans benefit from some from of transplant each year. While this is impressive, patients still die daily awaiting a vital organ and many remain debilitated and in pain for lack of a tissue transplant.