Joshua Mezrich is an associate professor in the Department of Multi-Organ Transplantation at the University of Wisconsin-Madison School of Medicine and Public Health.
When Joshua Mezrich was a medical student, he was called into the operating room during the first day of rotational surgery and witnessed a kidney transplant.
Everything he saw that day changed him.
He describes the experience this way: "I took the kidney out of the freezer and saw it gradually regain its color, and then a stream of urine spurted out. It scared me! ”
Mezrich was stunned and exclaimed, "This is amazing, what an incredible gift." Can I do it?
He later became a transplant surgeon and performed hundreds of kidney, liver and pancreas transplants. He also assists in actions involving other agencies.
He found that each organ had a different response after transplantation. The liver will flow out of the liver bile, the lungs will start to breathe, and the most wonderful thing is the heart, slowly putting the heart into the patient's body, touching it gently, like a keyboard, it will start to beat. It's amazing!
However, the development of transplantation is not a single puzzle, but multiple puzzles involving different organs and different scientific probes – as if the cast of several of Agatha Christie's novels met on the same page. Mezrich weaves every strand of this history into a fascinating organic whole.
Huge potential threat
French President Marie François P. Sadie M Kano was assassinated and the cause of death was determined to be a portal vein injury.
The assassination of Kano had a huge impact on a young student, Alexis Carrel. Karel, who was a surgical intern (equivalent to a medical student) in Lyon at the time, decided to become a surgeon when he decided to become a surgeon if he could somehow improve the treatment of such injuries. He was a natural surgeon, ambitious, driven, and eager to be famous. He reportedly told people that doctors could have saved Kano and that there should have been a way to stitch the ruptured blood vessel back. Surgeons at the time thought the idea was crazy.
Alexis Karel
In 1901, after completing his initial training in surgery, Karel was granted access to a laboratory with access to surgical equipment and experimental dogs. His research focuses on devising a technique that connects two blood vessels together.
Karel is also actively working on organ transplantation, a method of suturing blood vessels to supply new organs.
There, Karel met physiologist Charles Claude Guthrie, whose lab was operating on dogs.
Karel invented vascular suture
In just a few months, Karel and Guthrie pondered and described a number of different vascular anastomosis procedures, including: linking the femoral vein and femoral artery on the dog's leg (with the aim of improving blood flow in the leg); improving Karel's original vascular anastomosis by suturing the entire arterial wall, not just the outer layer of the vessel; performing a vascular thyroid transplant, including grafting between all-species animals and between different species of animals; and multiple attempts at kidney transplantation. Encouraged by the successful results, they also transplanted one dog's heart into the neck of another dog (the heart beat for two hours) and tried heart and lung transplants (but always failed). In 1906, they published an article about the "Carrel patch," a technique for cutting through blood vessels and aortic walls to increase the length of sutures. Today, we still use this technology in organ transplants.
1945 Colf successfully administers dialysis to patients
The kidneys are delicate organs.
"Even the most clumsy kidneys are smarter than the most knowledgeable doctors in the world." In a healthy person whose organs function properly, blood flows into the kidneys and through an elaborate glomerular filtration system. This is the ring of capillaries that surround the tubules, where toxins, waste products, and electrolytes in the blood pass through the membrane structure of the kidneys, are filtered into the tubules, and are excreted in the form of urine. The kidneys are also involved in the regulation of blood pressure and stimulate the production of red blood cells. It's surprising that healthy kidneys seem to know exactly what to do with bodily fluids and reabsorption; no matter how many laboratory tests we do and how many vital signs we look at, doctors still have a lot of difficulty regulating a patient's bodily fluids.
William Colf was born in Leiden, the Netherlands, in 1911. His father was a family doctor who later ran a tuberculosis nursing home. His father's medical experience had a great influence on Colf, and he became obsessed with medicine. At the same time, he also specializes in carpentry and mechanical restoration. What he liked most about the medical outlook was the possibility of solving problems, especially through the use of things he had made with his own hands.
William Colf, pioneer of kidney dialysis and artificial heart
In Nazi-occupied Netherlands, William Korff secretly built his dialysis machine with sausage jackets and sewing machine motors. Inspired by sausages, the first dialysis machine was successfully built under the eyes of the Nazis. Korff's dialysis machine was a prerequisite for a successful kidney transplant, while the invention of cardiopulmonary bypass was an absolute requirement for achieving a heart transplant.
Early dialysis instruments made by Colf
In 1955, the great "Holy Hand of Invention" Colf participated in the development and innovation of the heart bypass membrane oxygenator, and eventually participated in the invention of the most famous artificial heart at the University of Utah, which is now known as ECMO, to make open heart surgery a reality.
1953 Medavo discovers acquired immune tolerance
Sir Peter Medawa is known as the father of transplantation. Medawa's most famous discovery was the concept of "acquired immunological tolerance."
In 1960, Medawa was awarded the Nobel Prize in Physiology or Medicine for his outstanding contributions to immunology
He found that if the embryos of pregnant female mice were injected with cells from non-immune matching donors (i.e., mice with different genotypes), the recipient mice (i.e., embryos that received cell injections) could receive skin transfers from mice of the same genotype as the donor after they were born and raised without rejection, without any medications blocking the immune response. In other words, the recipient mouse "tolerated" the donor. In 1944, Medavo presented his initial findings on the concept at a conference; in 1953, he published a more complete report. This idea of gaining tolerance is called the "holy grail" of immunity by many, but it is not the state that we modern immunity has reached or tried to achieve, and only some animal studies or very small experimental protocols will be used. Instead, we intervene with patients in a chronic immunosuppressive way that prevents their bodies from rejecting transplanted organs.
If Alexis Karel's contribution demonstrated the perseverance and physical genius required to master the technique of organ transplantation between animals, Peter Medawa went one step further and proved that overcoming this "biological power" and making transplanted organs work for a long time is possible. Medawa brings certainty to transplantation, provides researchers with a legitimate research mechanism, and opens up a new world for latecomers who aspire to make transplantation a reality.
The real implication of finding immune tolerance is that it shows that the problems encountered when performing tissue transplantation between two different individuals can be solved, although the experimental methods we invented in the laboratory cannot be applied to humans. Its pioneeringness lies in the possibility of breaking down the natural barriers of allogeneic genetic tissue for transplantation: some people insist that this is not possible in principle ... Therefore, the most important meaning of finding tolerance is not practical application, but spiritual support. It reassures many biologists and surgeons who are working to make transplants possible, such as transplanting one person's kidney to another.
人体肾脏 | Wikimedia Commons, Henry Vandyke Carter - Henry Gray, Anatomy of the Human Body / Public Domain
If Alexis Karel's contribution demonstrated the perseverance and physical genius required to master the technique of organ transplantation between animals, Peter Medawa went one step further and proved that overcoming this "biological power" and making transplanted organs work for a long time is possible.
Medawa brings certainty to transplantation, provides researchers with a legitimate research mechanism, and opens up a new world for latecomers who aspire to make transplantation a reality.
In other words, Medawa discovered a technique that could overcome the insurmountable barrier of transplant immune rejection, a phenomenon they named "acquired immune tolerance."
By 1983, cyclosporine had been approved by the FDA (United States Food and Drug Administration) for kidney, liver and heart transplantation. The discovery of this drug has taken a big step forward in the field of organ transplantation, and its significance may be no less important than the first success of various transplants in the 1960s, when the era of organ transplantation officially arrived.
When Death Turns into Life
Most doctors fight death, but doctors in the field of transplantation rekindle hope in life from death. In his book When Death Comes to Life, Dr. Joshua Mezrich takes us on a closer look at the modern transplant world, how generations of healers have carried the weight forward and explored ways to overcome disease. It also takes the reader into the operating room and reveals the magical process of organ transplant surgery. The high-precision transplant surgery is no longer far away, and the thrilling plot makes people hold their breath.
By Joshua Mezrich
Editor: Hakuna
Typography: Lei Yu'er
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