Borrowing Life: How Scientists, Surgeons, and a War Hero Made the First Successful Organ Transplant a Reality

A Note to Readers THIS STORY BEGINS during World War II, six months after D-Day, when the worst fighting was still ahead. The Battle of the Bulge had just started; the crossing of the Rhine River was three months away. To tell it well, I must begin at an unexpected place. I say unexpected because when two young men came together that January of 1945—one a burned pilot, the other a surgeon determined to save him—they had no idea they were about to take the first step in making one of the most valuable contributions to mankind in the twentieth century. While this story is mostly about what scientists and surgeons can achieve—given curiosity, a passion for science, a large dollop of compassion, and a little luck—it’s a whole lot about how a science fiction–like dream pushed two American surgeons and a British scientist to scale the wall of what was deemed to be impossible. Over a decade they pioneered the giving and taking of organs that one of the surgeons called “spare-parts surgery,” or borrowing life, which in no way belittled the ultimate gift of retrieving life for one so close to losing it.  In the late 1960s I knew two of the three. The American ones. I was too young and dumb to know I was walking among giants. The British one I know now by the energy of his words. And those of his wife, whose touching memoir gives us an idea of what it was like to love Peter Medawar, a scientist so important to the understanding of the universe of the immune system that his colleagues compared him to Galileo. Yes, Jean Medawar, like the wives of all these men, is unequivocally part of this narrative. As is Miriam Woods, who gives clear meaning to the words “in sickness and in health” as she devotedly rushed to be with her husband after a horrendous World War II plane crash. So here are four gripping love stories. In fact, before anyone answers that all-powerful question, Will you marry me?, they should ask: Will you love me like Miriam loved Charles, like Joe loved Bobby, like Franny loved Laurie, like Jean loved Peter?  Surgeon Joe Murray performed the first successful kidney transplant in December 1954 in a five-and-a-half-hour surgery—so monumental that it is immortalized in an oil painting hanging in the Countway Library in Boston next to the painting of the first surgery performed with ether. It is that important. Joe himself is a study in star stuff. At birth he was given gifts—those of both heredity and tradition. His family practiced irrepressible cheer as a matter of habit. His questing intelligence, unwavering buoyancy, uncommon dexterity, and an extraordinary compassion for those who suffered—especially for those who had to walk out into the world with a horrendous facial deformity, particularly children—seem almost superhuman. He said in his Nobel Prize lecture in 1990 that his life as a surgeon-scientist gave him the rewarding experience of witnessing “human nature in the raw: fear, despair, courage, understanding, hope, resignation, heroism.” Indeed, his part in this story allows us to get our minds around the slippery concept of hope—and how not to lose it. Joe was not just one among many in the greatest generation, he was the kind of man who evokes prayers of please God, make more like him.  Francis (“Franny”) Moore had the mettle of old New England running in his veins, the kind of grit that could make a man want to found a nation. Extraordinarily gifted as a surgeon-scientist, he was also extraordinarily gifted as a leader. And he had vision. He could foresee the promise of organ transplantation as a viable treatment for devastating injury and disease, thus opening the gates for the monumental first organ transplant in 1954. But that was not all. His understanding of how the body reacts to surgery still affects every patient who comes through a hospital door. It was said that when Franny entered a room, it was like being in the midst of a full-scale orchestra performing a roof-raising symphony. He was that commanding. Paternal, wanting to take over and fix everything for everyone, he was loath to waste a minute, as if time and suffering were his enemies on the battlefield of sickness. Even his secretary said of him that “Dr. Moore lives life on a different plane.” In short, he was like many esteemed people in history: he didn’t have to do what he did. Born wealthy and privileged, he was driven by that elusive trait that we all wish for ourselves and for our children, and yet can’t quite name. Simply put: Get off your duff and pursue excellence for its own sake. He would become the youngest surgeon to ever be named the Moseley Professor of Surgery at Harvard.  Peter Brian Medawar—how can we even grasp the whole of who he was? After witnessing a Spitfire crash near his home in Oxford, England, during the Battle of Britain, he became so haunted by the suffering of the burned pilot that he focused his brilliant mind on unveiling the secrets of the body’s immune system to supply long-lasting skin grafts. His learning to bamboozle the body’s system of defense to manipulate rejection established the new field of science, immunogenetics. In fact, Peter would make such a monumental contribution to the understanding of human biology that he was awarded the Nobel Prize in Medicine when he was only forty-five. So here is this story: blending the horrors of war with the boldness of youth and the clenched-teeth defiance to not relinquish hope, it begins in December 1944 and will continue to be told well beyond today. Because borrowing life to extend the lives of those suffering from organ failure has enabled scientists of the present and future to apply the immune system’s exquisite power to treating cancer and other ravaging diseases. War—what is it good for? Beyond the absolute answer, nothing, there is that other little nudge: to find ways to preserve life. When historian Edward Gibbon wrote in the l700s that “hope [is] the best comfort of our imperfect world,” he knew what we humans were facing.  No, this is not quite a fairy tale, but it is close. The main difference is that the villain is not human. It’s death.  —Shelley Fraser Mickle   Spring, 2020 Part 1, Chapter 1: Joe THE WOUNDED CAME EVERY DAY. They came straight from the front lines—from Europe, Africa, Italy, China, the Pacific. They came by trainloads in railroad cars, stacked in bunks, one over the other. Brought into the wards on gurneys, they soon swelled the Valley Forge Military Hospital in Phoenixville, Pennsylvania, into the largest in the United States: three thousand patients. A hundred buildings. Tunnels connected the buildings to outfox the weather. Day and night, the staff never stopped moving.  That fall of 1944, a young man briskly walked through the halls. Like all medical students in America, he had been drafted after Japan’s attack on Pearl Harbor. Slim, athletic, a few inches under six feet, Joe Murray was swallowed up by the official uniform of all medical personnel. At a distance, you might even mistake his heavily starched white coat and pants to be walking on their own.  At twenty-five, after only nine months of surgical training, he had been assigned to Valley Forge to await overseas duty. When first called up, he’d tried to join the navy. But because of his myopia, he was turned away, and the army became his only option. He was still laughing at the irony that for all his childhood photographs, his mother had dressed him in sailor suits.  With his rimless glasses reflecting the glare of the overhead hospital lights, he did not seem anything other than the prized student of his fifth-grade class in Milford, Massachusetts, or the salutatorian at his high school graduation. He was simply too understated to catch much attention. His presence was akin to the subtle movement of the earth’s seasons. He was that constant, that reliable, that fueled by a hidden power. Over the more than ninety years that he would live, he would keep many of the traits he showed as a callow young lieutenant at the beginning of the war—humming songs as he worked, upbeat, quick to connect with others by asking, “And where are you from?” Of course, the songs would change, and in the 1960s he would begin singing his favorite Louis Armstrong song, “What a Wonderful World,” his tenor voice delivering words that expressed exactly his view on life: “I hear babies crying…I watch them grow…And I think to myself what a wonderful world.” Eventually he would have six children over seventeen years, so those words would take on richer meaning. And after his first grandchildren discovered his gentle nature and grand achievements, they poked fun at him by nicknaming him “Holy Joe.” Yes, throughout the years of his long life, he would stay much as he was that winter of 1944: wiry, thin, athletic, and fearless. His questing intelligence could be daunting. As his brown hair disappeared, friends would say that his head was simply too occupied to grow hair—grass doesn’t grow on a busy street! His reverence for all life never waned. He would continue to pry an insect from a window screen and flick it outside rather than squash it. To eat burned toast for breakfast. To drink chocolate syrup straight from the can. And to give no reasons. The delight in such childlike whimsy was its own excuse for being. Indeed, he was so unassuming and cheerful, few would guess that he was fueled by a secret sweet stubbornness. Not the bull-headed sort that could stop action, but the unrelenting kind that could calmly spend hours picking a rusty lock to release whatever was captive. From his Irish grandparents and Italian mother he learned a cheerfulness that perhaps only immigrants fully understand. To them, getting into America was a lucky charm that pessimism should never tarnish, so Joe grew up in a household with the Pollyannaish outlook that every glass was not just half full but a fountain, overflowing. Already, in his twenties, he had a spray of smile lines at the edges of his glasses and parentheses of smile tracks around his mouth.  That winter of 1944, as he went from room to room at the Valley Forge Hospital checking on patients, he probably hummed tunes from that year’s hit parade, “Sentimental Journey” and “Don’t Fence Me In.” Music was his passion—as well as a lingering desire. While in medical school, he had walked to the Boston Conservatory to take piano lessons until his unrelenting honesty demanded that he quit. Explaining away his small talent with characteristic humor, he said he was going to marry musical talent instead. Indeed, his fiancée, Bobby Link, was studying piano and voice. The following June they were to be married in a church in upstate New York, and Joe’s greatest worry was being sent overseas. Being separated from Bobby would be agony. Thankfully, work at Valley Forge kept his mind distracted from that. The sheer number of patients was daunting. With only nine months of surgical training, he was barely prepared for a normal hospital, much less one like this. Five days a week, from eight in the morning to three in the afternoon, three operating rooms were running with two surgeries performed in each. By the end of the day, Joe often had completed twenty to twenty-five operations. After each, the used instruments were taken away, sterilized, and quickly brought back, so that in five to ten minutes he could begin the next.  And the wounded never stopped coming. Since outstanding surgeons were brought to Valley Forge from across the country, the military hospital provided a great education. By a quirk of nature, Joe was garnering notice in the operating room, for he was left-handed, and since his elementary school teachers had insisted he conform to a right-handed world, he was now ambidextrous. He could conquer puzzles of anatomy by getting into tight spots in ways that other surgeons couldn’t. He could use both right- and left-handed surgical instruments, which meant he never had to change his angle of attack. To get at a patient from the other side, he didn’t have to walk around the operating table, which saved that patient from more time under anesthesia. Most of all, his thoughts centered on Bobby. Starting off their married life in this countryside of rolling hills, surrounded by Amish and Mennonite communities, would be idyllic. Because of gas rationing, he carpooled the twenty miles from his rented cottage to the hospital with a technician who also worked there, and they often passed horse-drawn buggies. Hardships of war would not be hardships but problems to solve. Housekeeping would be a puzzle. Tires, gasoline, meat, butter, canned vegetables, sugar, shoes—all were rationed. Ration cards had been issued to over a hundred million Americans. Corn syrup was a substitute for sugar. Most civilians grew their own vegetables in victory gardens because food was needed for the troops. By 1943, there were some twenty million victory gardens throughout the United States. But Joe and Bobby had already agreed to brush wartime difficulties aside. They felt optimistic and hoped for a large family. He could hardly wait to have Bobby in Phoenixville with him.  The previous June, after the invasion of Normandy, the Allied forces were aiming for the Rhine River, hoping to cross it in March. The Battle of the Bulge had started in December 1944. The year before, when General Eisenhower announced the surrender of Italy on September 8, 1943, Hitler had sent his troops swarming into the Italian countryside because the Allies were so close to the German-occupied Balkans. The fighting there turned especially vicious. In the winter of 1943–44, US soldiers faced agonies that few Americans knew about.  GIs battled not just German troops but also frostbite. Trench foot was epidemic. The war was now a war of attrition. Dead bodies were wrapped in bloody bed sacks, waiting for pickup. Scavenging dogs ate the throats of the dead, while at home in America, people were noting how the war had lifted the grip of the Great Depression. War production sent money flowing. As a first lieutenant at Valley Forge, Joe had no control over his future. He had no idea where he would be sent. What he knew above all else was that having to leave Bobby to go overseas would be the most pain he could ever experience. What he did not know was that, during that first winter in Valley Forge, he would meet a young pilot, who, as they worked together to cheat death, would change both their lives and lay the groundwork for  in the give-and-take of human organs.  To achieve that, he would need someone to balance out his gentle nature. He needed a protector, some bold fellow-surgeon to step forward, one who was willing to buck traditional thinking, to clear the way.