Joseph E. Murray, 93, performed first successful organ transplant
Dr. Joseph E. Murray, the Nobel laureate who conducted the world’s first successful organ transplant, died Monday at the Boston hospital where the pioneering surgery was performed. He was 93.
He had suffered a hemorrhagic stroke at his Wellesley home Thanksgiving night.
On Dec. 23, 1954, in Operating Room 2 of the Peter Bent Brigham Hospital in Boston, Dr. Murray took the healthy kidney of Ronald Herrick and sutured it into the donor’s dying identical twin, Richard.
With that 5½-hour operation, Dr. Murray and his team saved a life, sparked an ethical debate that still echoes today, and opened medicine to a new frontier.
Within a decade, Dr. Murray’s clinical work and his collaboration with scientists on drugs to prevent rejection of donor organs had expanded the pool of transplant candidates beyond identical twins.
Dr. Murray, who was also credited with the first successful transplantation of a kidney from a nonidentical twin and from a cadaver, was awarded the Nobel Prize in Medicine in 1990, an honor he shared with Dr. E. Donnall Thomas, a pioneer in bone marrow transplants who died a month ago.
“Dr. Murray opened the doors for hundreds of thousands of people to receive life-saving transplants,” Dr. Betsy Nabel, president of what’s now known as Brigham and Women’s Hospital, wrote in an e-mail to the staff Monday evening. “To date, more than 600,000 people world-wide have received the gift of life through transplantation.”
Dr. Murray’s specialty was actually plastic surgery and reconstructive surgery, and he was also credited with several advances in those fields. Also, in the late 1960s, he was part of a Harvard team that developed a protocol for determining when a patient is “brain dead.”
In his endeavors, colleagues say, Dr. Murray was an unassuming man who handled each patient, no matter how trivial the malady, with compassion imbued by a quiet sense of confidence.
“I knew the operation was potentially momentous, but in truth I treated it as just part of the week’s work,” Dr. Murray said of the Herrick operation in a 1999 interview with a Harvard University publication. “Two days prior to the Herrick operation I repaired a double cleft lip, resected a recurrent cancer of the mouth, corrected lop ears in a child, and closed a burn of the buttocks.
“To the patient, any operation is momentous.”
Joseph Edward Murray was born on April 1, 1919, in Milford. His father, William, was a district court judge, and his mother, Mary (DePasquale), was a school teacher.
Dr. Murray was a star athlete in high school, particularly in baseball. Science, however, had already captured his imagination. “I still have a vivid memory of my excitement when I first saw a chart of the periodic table of elements,” he wrote in a profile for the Nobel Prize academy. “The order in the universe seemed miraculous.”
His drive to become a surgeon was not a singular pursuit. Possessing an eclectic nature and an inquisitive mind for many realms, Dr. Murray studied philosophy and English at the College of the Holy Cross, getting a degree in humanities in 1940. At Harvard Medical School, he filled any personal time with dances and trips to the university’s museums and the Isabella Stewart Gardner Museum. He met his future wife, Virginia “Bobby” Link, at a Boston Symphony Orchestra recital.
He was a surgical intern at Peter Bent Brigham Hospital before joining the Army Medical Corps in 1944. For three years, he was stationed at the Valley Forge General Hospital outside of Philadelphia, working as a plastic surgeon to reconstruct the hands and faces of soldiers disfigured on the battlefields of World War II.
His pride in his military service was evident two weeks ago, when he donned his uniform again to speak at a Veterans Day ceremony at the Brigham, according to a hospital publication. “I am pleased to see so many of you in uniform, and I am grateful that I can still fit into mine,” he said.
Those years would form the foundation of his career. “We took care of thousands of casualties, many with severe burns,” he told Time magazine. “I was performing skin grafts and became interested in why skin wouldn’t graft permanently.”
Working at the hospital with renowned doctors James Barrett Brown and Bradford Cannon, who as a Massachusetts General surgeon had been on the front line of treating victims of the Cocoanut Grove fire in 1942, Dr. Murray became fascinated with the body’s reaction against transplanted skin. He found that some burn victims, with extremely compromised immune systems, would accept skin transplants from a cadaver for extended periods of time.
In effect, he thought, if a person’s immune system could be manipulated, the chances of a successful transplant would increase. That theory would become the central tenet in his work.
After his discharge, he returned to the Brigham as a plastic surgeon and eventually joined a nascent program investigating the potential for organ transplants. The research was an ethical minefield, with little evidence to show that such operations had any chance to succeed. Several of the most prominent scientists in immunology thought transplants were an impossibility and research a waste of time. Some doctors believed that by extracting a donor organ from a healthy person, a surgeon violated the most basic principle of medicine: First, do no harm.
Early attempts to use a kidney from a cadaver to stabilize a patient were brutal and agonizing failures.
“Some of my closest friends at the medical school faculty advised me not to get involved because they said it would ruin my career,” Dr. Murray told an interviewer for the Nobel Prize nominating committee.
After two years of experiments on animals, particularly dogs, and several failures with potential transplant patients, Dr. Murray perfected a surgical technique for implanting a kidney. The case of Richard Herrick, who was dying from kidney disease and whose twin, Ronald, wished to donate his kidney, provided a chance to put that technique into practice.
A decade earlier, it had been determined that skin grafts from an identical twin could succeed and grow because the recipient’s immune system would not recognize the skin as “foreign” and would not attack it. The Brigham team performed 17 tests to ensure the twins were indeed identical. One of the tests involved fingerprinting the brothers at a Roxbury police station. Unfortunately for Dr. Murray, who had hoped to avoid the glare and pressure of publicity, crime reporters were also at the station.
“Imagine my surprise when, driving home that evening, I heard on the car radio that Brigham doctors were planning a daring operation,” Dr. Murray wrote in his autobiography, “Surgery of the Soul” (2001). “The press began requesting daily bulletins from the hospital.”
The team tackled the ethical questions head on. Dr. Murray discussed Ronald Herrick’s decision with other doctors, along with a wide range of clergy, political, and corporate leaders. He obtained a special decree backing the procedure from the Massachusetts Supreme Judicial Court.
After news of the impending operation leaked, some public reaction was vitriolic.
“They’re saying that God didn’t want this to happen. It’s unnatural. The doctors are on an ego trip. Dr. Frankenstein stuff,” Dr. Murray said in an interview with NPR in 2004.
“We just did our work.”
A deeply religious Catholic, Dr. Murray, his wife, and several of their children knelt in prayer the night before the historic surgery.
Dr. Murray received the kidney at 9:53 a.m. and completed attaching the veins and arteries at 11:15. “There was a collective hush in the operating room as we gently removed the clamps from the vessels newly attached to the donor kidney. As blood flow was restored, Richard’s new kidney began to become engorged and turn pink,” Dr. Murray wrote in his autobiography. “There were grins all around.”
Before the operation, Richard Harrick’s failing kidney had flooded his body with toxins, endangering his heart and sparking psychotic fits in which he had attacked the staff, once biting a nurse. After the operation, he awoke ravenous and clear-headed.
He would live eight years before the disease struck his new kidney. By then, he had married his post-operative nurse, had two children, and toasted his brother for “the extra drink.” Dr. Murray maintained contact with his brother Ronald until his death in 2010.
There would be additional transplant successes with twins, but Dr. Murray’s initial efforts with nephrologist John Merrill to find a way to suppress the immune systems of his patients so they could accept a kidney from another relative or a cadaver largely failed. Attempts at using full-body radiation were particularly devastating. “Mortality was virtually complete,” a surgeon, Nicholas Tilney, was quoted by Dr. Atul Gawande in a 2003 New Yorker article. “As a result, the medical, surgical, and nursing staff became increasingly doubtful about the entire enterprise.”
What kept Dr. Murray searching for a solution, he later said, were the support of the hospital and his wife and the courage of his patients and their families.
“People ask ‘why did we keep on when there was so many failures,’ ” he said in the Nobel interview. “Most of (the patients) were young, in their early 20s. The families knew that we were experimenting. And even though they didn’t expect success, they said ‘it may not help us but it may help someone in the future.’
“It gave me an indication of the wonderful generosity of human nature.”
His son, Richard, said Monday night that his father’s optimism and enthusiasm buoyed him through any dark periods. “The art of the solvable problem, that was his tremendous ability to recognize,’’ Richard Murray said.
In the early 1960s, the top scientists investigating immunosuppressive drugs came to Boston to work with Dr. Murray. With Briton Roy Calne and Burroughs Wellcome scientists Gertrude Elion and George Hitchings, Dr. Murray tailored the new drug Imuran for use in transplants. The biological barrier had been broken: By 1965, the survival rates after receiving a kidney transplant from an unrelated donor topped 65 percent.
Toward the end of his career as a surgeon, Dr. Murray concentrated on plastic surgery, developing ways to repair inborn facial defects in children. In addition to heading the Brigham’s plastic surgery division for almost four decades, he led the division at Children’s Hospital Medical Center from 1972 to 1985.
A few years ago, after retiring, he encouraged the Brigham’s current chief of plastic surgery to embrace another pioneering operation, face transplantation, despite criticism from some about the ethics of the procedure. “I think it’s just great,” he told Dr. Elof Eriksson. “It’s no different than what we went through.’’
Away from the surgeon’s table, Dr. Murray was an intrepid traveler, climbing the famed Matterhorn in the Alps in his 50s and trekking to the Himalayas with his wife.
In addition to his wife, Dr. Murray leaves three sons, J. Link Murray of Jamestown, R.I., Thomas of Dallas, Texas, and Richard of Scituate; three daughters, Ms. Virginia Murray of Plymouth, Ms. Margaret Murray Dupont of Lafayette, Calif., and Dr. Katherine Murray Leisure of Plymouth, and 18 grandchildren.
Richard Murray said his father was supportive, whatever direction his children pursued. The ever-optimistic surgeon displayed the same traits at home. “He loved the word ‘curious.’ ’’ Richard Murray said. “He would always say, ‘Be curious, ask questions. Learn.’ ’’