17 - Disillusionment: The Clinical Failure of Organ Transplantation

Summary

Organ Replacement and Surgery

The development and establishment of the organ replacement concept had been completed by about 1900. Determining whether organ replacement made sense had by now become less and less of a concern. Its validity had been established as a scientific fact, particularly in connection with internal secretions, and no longer needed proving. Organ transplantation was now considered an ideal therapy. The only remaining hitch was in its practical application, but even this problem did not affect the validity of the underlying rationale, as Heinrich Bircher emphasized in 1890. Replacing a deficient organ was, as Kocher wrote in 1908, the “obvious” thing to do.

The general acceptance of the organ replacement concept also marked the end of the conjunction of endocrinology and transplant surgery. While the early inventors of organ transplantation were also the pioneers of (the future field of) endocrinology, in the twentieth century the two fields followed their own separate trajectories. In the second decade of the new century endocrinology established itself as a new scientific endeavor. Textbooks were published; a professional association and a specialized journal were founded. This new field specified the explanation of organ function in a new way. The organs themselves became secondary; instead, scientists focused on specific substances that they examined in terms of their coordinative function within the body. Ernest Henry Starling coined the term “hormone” for them. Hormones were defined as messenger substances produced by the endocrine organs. Like nerves, they were able to control physiological processes. Thus the endocrine system joined the nervous system as a coordinating mechanism of the body. Researchers could isolate these hormones and examine them in the laboratory with established experimental physiological methods. Endocrinologists were therefore not that interested in transplantation any more; their preferred method of treatment was hormone therapy—a pharmaceutical mode of therapy. To hormone researchers, experimental transplantation was nothing but a preliminary stage followed, if possible, by the administration of hormones. For them, gland transplants were thus a stopgap measure as long as science was unable to get hold of the hormone itself.