“It can't be done”

In 1950, medical students in the UK were allocated patients for whom we had a special, personal responsibility and acted as advocate. I presented the case of a patient about my age dying of kidney failure. The senior consultant told me to make my patient as comfortable as possible, but, sadly, he would be dead in two weeks. I was appalled by this stark prognosis and, thinking in terms of gardening, I asked whether the patient could receive a kidney graft. The consultant said no, and, when I asked why not, I was told “it can’t be done.” I was perplexed because it seemed that there were only three plumbing junctions required—an artery, a vein and the ureter—and surgical techniques were available to accomplish these tasks. I had no idea of the phenomenon of graft rejection. I returned to the subject in 1959 after hearing Peter Medawar give a lecture in Oxford explaining the immunological nature of graft rejection and the exciting experiments that he and his colleagues had done, showing “specific immunological tolerance”1. The concept of the developing immune system in the fetus, which would accept as a ‘self-product’ any potential antigen with which it came in contact, raised an important question not yet answered: could an adult immune system be temporarily returned to the fetal state while the organ graft was inserted, and could the immune system then regain its protective role, having accepted the foreign graft?