16 - Methods of Monitoring the Success of Transplants

Summary

Organ transplantation was eventually abandoned because doctors and scientists gradually became convinced that allogenic and xenogenic transplantations usually do not work. From today’s perspective, the question arises how it was even possible, at a time when immunosuppression did not exist, that so many organ transplantations were carried out in the first place. One wonders whether doctors noticed that their transplantations were not working, which leads to the more general question of how surgeons could tell whether a transplantation was successful or not. The criteria used for answering this question shifted in the course of the several decades during which surgeons pursued it. Initially they focused primarily on whether organ replacement could actually relieve or cure specific disorders at all. Subsequently, they mostly discussed whether it was really possible for transplanted tissue to resume its original function in the host’s body and, finally, whether it could maintain its function there in the long run.

At all times, discussions centered on the question of whether postoperative improvements in the patient’s condition were owed specifically to the presence and function of the transplanted tissue or not. If they were, this would mean doctors had gained control over organ function, the necessary cause and “obligatory passage point” of specific diseases, and consequently control over those diseases themselves. Many of the discussions in scientific publications revolved around this aspiration. In the following, I will examine the methods used to verify success and the arguments presented for and against the effectiveness of organ transplantations.

Morphological Examination

Basically surgeons had two kinds of criteria to evaluate a transplant’s outcome: morphological and functional. Palpation and appearance easily allowed assessing the transplant morphologically while the surgical cut was still open. A kidney, for instance, changes its appearance when the blood supply sets in after the vascular linkup. Thus the surgeon N. Floresco observed grafted kidneys for another half hour before he closed the incisions. Doctors would also verify whether testicle transplants seemed to have a good blood supply right after the vessels were linked up. After the incision had been closed up and healed, they often tried to obtain an impression of the transplants’ fate by palpating the organ’s size.