watercress words by Dr Aletha

In December 2021 a 57-year-old man was on life support due to heart failure. His only hope for long-term survival was a heart transplant. After being informed of the risks of the procedure, he consented and received a new heart in early 2022.

This might not seem so momentous in these days of routine organ transplantations. But this one was not so routine, because the heart that he received was not human-it was a genetically modified pig heart.

Thousands of years before Western medicine, people began investigating the human body by observing and experimenting on plants and animals, sometimes in ways we consider unethical now. Their motives ranged from curiosity to compassion to commercial.

Spare Parts by Paul Craddock, PhD

Dr. Paul Craddock earned his doctorate by exploring “how transplants have for centuries invited reflection on human identity”.

He begins his narrative in 16th-century Renaissance Italy where surgeons first mastered skin transplants, or grafting techniques, to replace lost noses. And he goes back in time to the ancient Greeks where we encounter the teachings of Galen and Hippocrates.

Transplant surgery and space exploration exploded in the mid-20th century. The first successful heart transplant by Dr. Christian Bernard in Cape Town, South Africa was only two years before astronaut Neil Armstrong stepped onto the moon.

But long before either event could happen, scientists explored and learned the basics of astronomy and of medicine. Before physicians could even begin to think about moving organs from one person to another, they needed to know what organs are in the body, what they do, and how they interact. One crucial step was understanding the circulatory system and the role of blood, which was “still entangled with ancient humoral and religious ideas.”

Even though organs like kidneys are relatively simple to transplant anatomically, the issue of rejection of foreign tissue by the body made successful transplantation impossible. The only successful kidney transplant was between twins; rejection was not an issue due to sharing the same genes.

In 1951 scientists identified why rejection occurred by studying cow twins. It took another 10 years to successfully transplant a kidney to a non-twin using immunosuppressive drugs.

The need to bypass the lungs makes transplanting hearts complicated. By the late 1960s, this was possible but progress was slow due to persistent issues with rejection until an effective drug, cyclosporin, was developed in the late 1970s. With it, in 1981 the first patient received a heart-lung transplant and lived 5 years.

Since then, transplantation medicine has surged, including “vascularized composite allotransplantation”, that is entire body parts such as hands and the face. But with those has come a new problem-psychological rejection.

In Spare Parts you will learn such fascinating facts as

• Early blood transfusions involved animal blood infused into people- and were often successful, at least for a short time.
• The first dental procedure was tooth extraction, and implantation of “donor” teeth became quite lucrative.
• The tooth transplants were the first exchanges of body parts to become heartless financial transactions.
• The differing definitions of death in each country played a role in the first heart transplant occurring in South Africa instead of the United States
• A pharmaceutical company made a breakthrough anti-rejection drug from fungal spores; soil samples containing the fungus had immune-suppressive properties
• The first kidney “transplant” was done by taping a kidney to the patient’s arm after attaching the blood vessels to her existing diseased kidney
• By understanding vaccination, scientists developed the technique for blood typing, making blood transfusion safe.
• In Iran, it is legal to sell one’s kidney. “one kidney is enough.”

History and medicine buffs will recognize many familiar names like Aristotle, Galen, Copernicus, Boyle, Boerhaave, Harvey, Jenner, Lindbergh, Bernard, and Cooley. But most characters are previously unknown, unsung players in the search for the mystery of human life.

“The story of transplantation is not merely technical progress. But a primarily human journey…. about how we understand our bodies, and our relationships with one another and with ourselves.”

One caveat for this book; although Dr Craddock tells his story tastefully it may not be appropriate for those who are squeamish about medical or anatomical descriptions. I found the narrative convoluted at times. It’s not a quick or easy read but well worth the time and effort for those who like to delve deeply into historical narratives.

I received a DRC of Spare Parts from NetGalley and St Martin’s Press in exchange for a review.

Other book reviews at Watercress Words about the way the body works

“Although average survival in lung transplants has slowly improved, the numbers still don’t look as good as for kidney transplants. Further down the line, the science of stem cells and lung regeneration may eliminate the need for any type of foreign transplant. “

A man needed a heart transplant to stay alive- but couldn’t afford the anti-rejection drugs, in

exploring the HEART of health

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