In the past few years the transplantation of organs in man has received publicity unprecedented in medical history. The first heart grafts were covered by press, radio, and television on a scal equiva lent to the news of the outbreak of a major war. Unwarranted and extravagant optimism has been followed by bitter criticism. This has undermined public confidence in the medical profession and seriously impeded progress in an important endeavour aimed at reducing human suffering. This unfortunate situation has arisen from widespread ignorance amongst the public and the medical profession of the background, present achievements, and future potential of organ grafting. Short statements by experts, frequently misquoted or cut short by television interviewers, and misinformed derogatory pronouncements by prejudiced medically qualified men, with no knowledge of the field, have produced a sorry state of confusion. It is the purpose of this book to attempt to clarify organ transplantation. The principles of organ transplantation are common to all organs but I will confine most of the discussion to transplantation of four vital organs, namely the kidney, liver, heart, and lung. ROY CALNE Cambridge January 1970 CONTENTS Preface IX List of Illustrations Xlll Acknowledgements XVll I. THE IDEA I II. THE SURGERY 7 III. REJECTION 15 IV. PREVENTION OF REJECTION 23 v. TISSUEMATCHING 39 VI. ORGAN PRESERVATION 47 VII. SUITABLE DONORS 53 VIII. ORGAN TRANSPLANTS 57 IX. ETHICS AND THE LAW 81 X."

R. Y.Calne Surgeons are transplanting kidneys in ever increasing numbers-more than 10000 renal allografts have now been reported to the Transplant Registry. With related donors 75% of grafted kidneys continued to function after 2 years, compared with 50% when the donors were unrelated. The therapeutic value is obvious, but the management is largely empirical and results have improved little in the past 5 years. The basic sciences related to tissue transplantation have advanced rapidly. New serological and tissue culture techniques and chemical analysis of antigens and anti bodies have produced complicated data that is almost incomprehensible to the non specialist. Mathematical treatment of genetic probabilities and of immunological kinetics are similarly difficult to follow for those not especially trained. There has always been a gulf between the practical clinician whose patients do not behave like inbred rodents and the biologist who likes carefully controlled experiments with easily observed results. Both realize, however, that predictable and safe control of rejection must involve close collaboration and co-operation between the laboratory and the clinic. Unfortwlately, the different nature of the work and the workers has widened the gap between them. The clinicians tend to improve their techniques and patient care, whilst the biologists seek clearer and more precisely deflned experi ments which lead them to use increasingly artiflcial experimental models."