From the New England Journal of Medicine, November 27, 2003
Nicholas tilney has written an enjoyable book about the history of organ transplantation, suitable for both professionals and laypersons alike. There is limited medical jargon to interfere with reading by a general audience, yet sufficient technical discussion for physicians, surgeons, and other health care providers. Tilney admits up front that his book is less about individual medical pioneers and more about the progression of understanding and the patients who made substantial sacrifices. He sticks to his word in this regard, although it is hard to miss whom he views as the major scientific contributors. Transplant opens with the story of an incident at the Peter Bent Brigham Hospital in Boston when kidney transplantation was still in its infancy. A recently discharged transplant recipient, wearing a mask to prevent opportunistic infection, was arrested by the police as a suspected felon and brought to the station. His physicians were requested to come and post bail. After this interesting vignette, the author presents a thoughtful discussion from a historical perspective about the transfer of body parts, mythology, and ancient religious beliefs, including some of the earliest recorded attempts at surgical repair of bodily injury. He describes how improvements evolved in surgical technique and anesthesia and also reviews the philosophical issues surrounding transplantation in an organized and thoughtful way. Tilney interweaves many accounts of the attempts at and failures of organ transplantation in a logical fashion. The human anecdotes are particularly relevant and poignant. He also incorporates historical descriptions, old photographs, and quotations to assist in setting the stage for the transplantation stories. Some of the most exciting descriptions in the book are of a personal nature, related to Tilney's experience working with Joseph Murray, John Merrill, and David Hume, who are recognized as great names in transplantation. Readers can almost imagine working with them as they devised lifesaving strategies for their patients when no proven options existed. Readers can also imagine the struggles they would have faced had they presented their experimental studies in humans to modern institutional review boards. Interesting discussions of the biology of rejection, the technical issues, and the controversies related to defining brain death and the use of organs from donors with a heartbeat follow the section on kidney transplantation. The pitfalls, frustrations, and detours and the competition for success are plainly reviewed. Cardiac, liver, lung, pancreas, and abdominal-viscera transplantation are also reviewed from the time when they were only experimental possibilities to their status as modern-day realities. Interspersed with descriptions of these advances are illuminating stories about the leaders in the field, their successes and their failures, and even some of their foibles. Less emphasis is placed on the evolution of immunosuppression. Although there is some discussion of the development of calcineurin inhibitors, particularly cyclosporine, many newer drugs and biologicals are only briefly mentioned, not discussed in detail. The book concludes with sobering discussions of problems still to be resolved in the future, including the buying and selling of organs, ethical issues related to donor procurement, organ-donor shortage, and the interplay among pharmaceutical companies and academic investigators. I found Transplant enlightening and enjoyable, with an exciting perspective on the broad field of transplantation and how it has grown in the past 50 years. Tilney is a skillful writer with an engaging style, and he creates an almost "folksy" affinity with his readers so that they are both educated and entertained. Humor mixed with sadness, excitement coupled with disappointment, and hope for the future alongside possible specters provide point and counterpoint throughout. Anyone, layperson or professional, with an interest in transplantation will want to read this book. It is an honest and fair appraisal of the pioneering efforts of many talented investigators and their brave and loyal patients in the development of modern-day transplantation science. Matthew R. Weir, M.D.Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Book Description
One of the most spectacular medical advances of the twentieth century, organ transplantation has become a generally effective and routine treatment for patients with organ failure. In this riveting book, a well-known expert in the fields of clinical transplantation and transplantation research traces the evolution of organ transplantation from its initial stirrings in the imaginations of the ancients to its current status as accepted treatment for nearly 40,000 patients each year. Drawing often on his own firsthand experience, Dr. Nicholas L. Tilney tells the story of the advances in organ transplantation, discusses how societal forces have driven its development, and reveals how its current success is marred by commercialism and exploitation of the less fortunate. Dr. Tilney describes early transplantation attempts, the first successful kidney transplant in 1954 between identical twins, the scientific advances for suppressing the immune system, the introduction of the concept of host tolerance, the new research on donor matching, and the issue of donor brain death. He explores innovations in heart, lung, liver, and other abdominal transplants and reflects on the attempts to make transplants between species. Finally he explains how organ transplantation has become a vast business, creating ethical and logistical conflicts about organ donations.

From the Back Cover
"Dr. Tilney has an eye for the fascinating details, the shocking stories, and the unexpected connection. The result is a lively and enjoyable read."-Atul Gawande, M. D., author of Complications: A Surgeon's Notes on an Imperfect Science; "In this elegantly written book, an international authority on organ transplantation presents his firsthand reflections on the development of this exciting field. The book is a timely, well developed, and unique contribution."-Marc I. Lorber, M.D., Yale University School of Medicine

About the Author
Nicholas L. Tilney, M.D., is the Francis D. Moore Professor of Surgery, director of the Surgical Research Laboratory at Harvard Medical School, and senior surgeon and director of the Center for Transplantation Research at Brigham & Women's Hospital, where he headed the renal transplant service between 1976 and 1992. His research in transplantation biology has been continuously funded since 1974 by the NIH, and he has been the recipient of numerous awards and honors.

FROM THE PUBLISHER

One of the most spectacular medical advances of the twentieth century, organ transplantation has become a generally effective and routine treatment for patients with organ failure. In this riveting book, a well-known expert in the fields of clinical transplantation and transplantation research traces the evolution of organ transplantation from its initial stirrings in the imaginations of the ancients to its current status as accepted treatment for nearly 40,000 patients each year. Drawing often on his own firsthand experience, Dr. Nicholas L. Tilney tells the story of the advances in organ transplantation, discusses how societal forces have driven its development, and reveals how its current success is marred by commercialism and exploitation of the less fortunate.

FROM THE CRITICS

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