20 - Chance or Necessity: A Fresh Start for Organ Transplantation

Summary

“University Medicine” and “Techno-Medicine”

As shown in the preceding chapters, the question of organ transplantation had narrowed down to the control of allotransplant rejection since the time of World War I. Ultimately, it was because of this problem that organ transplantation was generally abandoned. By the 1930s, practitioners in all related disciplines and fields of research—surgery, cancer research, biology— had lost interest in further investigating the immunological problems posed by transplants. Each group had its own particular reasons. Basic scientists lacked experimental methods that would make working on such complex problems a promising topic; surgeons saw no means of applying the new research findings to their field; and immunosuppression methods had proved to be either ineffective or, as in the case of x-ray radiation, difficult to control and standardize. None of the disciplines involved with organ transplantation expected tangible benefits from pursuing the topic any further, and the field of immunology, which would have been interested in immunological processes as such, did not yet exist. Even so, it is remarkable how much scientists and doctors already knew about the principles of transplant rejection and how to deal with it at that time. In retrospect, they were clearly on the right track. It is curious, then, why organ transplantation was abandoned, and why most of the facts and approaches known before 1930 came to be forgotten and had to be discovered again after 1945.

One way of explaining the failure of the practical application of organ transplantation is to look at the characteristic features of the types of medicine and science that formed the context in which the concept of organ replacement evolved. Just as resective surgery had come up against the limits of its effectiveness earlier, so the particular approach to medicine that was associated with the invention of organ transplantation seemed to have reached its limits by the time of World War I. As we saw in the first few chapters of this volume, the type of medicine that provided the conditions for the emergence of transplant surgery was organized into competing disciplines, each with its own professional institutes.