Joseph Edward Murray

1919-

American Surgeon

Joseph Murray began his career as a plastic surgeon, but soon became interested in transplantation—surgically moving tissue from one part of the body to another or from one person to another. Murray eventually performed the first successful transplant of an entire human organ.

Murray was born in 1919 in Milford, Massachusetts. He did not take premedical courses in college, but instead earned a liberal arts degree from the College of the Holy Cross. His studies focused on philosophy, English, Latin, and Greek. After graduating, however, he attended Harvard Medical School and completed a medical degree in 1943.

Soon afterward, Murray entered the army and was assigned to Valley Forge Army Hospital in Pennsylvania. This hospital specialized in plastic surgery, and Murray worked there to treat burn victims. One treatment for burn victims is the use of skin grafts—the removal of healthy skin from one part of a patient's body to cover a burned or otherwise injured area. Sometimes, however, the patients at Valley Forge were so severely burned that they had no undamaged skin available for grafting. As a temporary measure, skin was transplanted to the patients from other people. These "foreign" grafts could not be left in place permanently, however, because the patient's body eventually rejected them. Murray became interested in why this rejection occurred. (It is now known that the immune system can recognize a unique set of marker proteins on the foreign cells.) At Valley Forge, Murray was taught that the more closely related two people are, the less likelihood of rejection. (Closely related people are more likely to have similar marker proteins.)

After three years, Murray left the army and returned to Boston to finish his surgical training. He became a plastic surgeon, specializing in the treatment of facial cancer and birth defects. In 1951, he joined a group of doctors who were attempting to develop procedures for transplanting kidneys. Kidneys remove waste from the bloodstream and help to maintain water balance. Although humans have a pair of these organs, they can survive with only one. The doctors reasoned that a healthy person could theoretically donate one of his or her kidneys to someone whose kidneys were damaged or diseased.

Before attempting the surgery on humans, Murray experimented with transplanting kidneys in dogs. Then, in 1954, the case of Richard Herrick was brought to his attention. Herrick was near death due to kidney disease. He had an identical twin brother, and a kidney transplant was proposed. Murray believed that Herrick's immune system would not recognize his twin's kidney as foreign and so would not reject it. First, Murray performed a skin graft from one twin to the other as a test. When the graft proved successful, Murray led a team of doctors in the kidney transplant operation. The operation worked, and Herrick lived for an additional eight years.

Murray then began to examine ways in which kidneys could be transplanted between people who were not identical twins. Other scientists had developed ways of suppressing a patient's immune system so that it would not attack foreign tissue. One of these methods was with the use of x rays. In 1959, Murray transplanted a kidney between fraternal, or nonidentical, twins. The kidney recipient was irradiated with x rays and went on to live for an additional 26 years. Other such operations, however, were not as successful. The x rays often so reduced the ability of the patients' immune systems to function that their bodies were susceptible to lethal infections.

As transplanting technology improved, Murray began testing a drug that suppressed the immune system called azathioprine. He became the first doctor to transplant kidneys from both unrelated and recently deceased donors, and he treated the recipients with this drug. About half of the first group of patients who received azathioprine survived. (It was thought that only 20% would do so.) Today, azathioprine is still given to the recipients of kidney transplants, and thousands of these operations are performed each year. Seventy percent of patients survive for at least a decade.

In addition to his work in the operating room, Murray helped to establish a worldwide registry of patients who had received kidney transplants so that their progress could be tracked and monitored. In 1990, he won the Nobel Prize in medicine for his work in kidney transplantation. His successes helped to initiate the advances in other transplant surgery such as liver, heart, and pancreas transplant operations.

STACEY R. MURRAY