Richard Carlton Lillehei: transplant and shock surgical pioneer

Solid organ transplantation in the 21st century

Solid organ transplantation (SOT) has emerged from an experimental approach in the 20th century to now being an established and practical definitive treatment option for patients with end-organ dysfunction. The evolution of SOT has seen the field progress rapidly over the past few decades with incorporation of a variety of solid organs-liver, kidney, pancreas, heart, and lung-into the donor pool. New advancements in surgical technique have allowed for more efficient and refined multi-organ procurements with minimal complications and decreased ischemic injury events. Additionally, immunosuppression therapy has also seen advancements with the expansion of immunosuppressive protocols to dampen the host immune response and improve short and long-term graft survival. However, the field of SOT faces new barriers, most importantly the expanding demand for SOT that is outpacing the current supply. Allocation protocols have been developed in an attempt to address these concerns. Other avenues for SOT are also being explored to increase the donor pool, including split-liver donor transplants, islet cell implantation for pancreas transplants, and xenotransplantation. The future of SOT is bright with exciting new research being explored to overcome current obstacles.

An orthopaedic conquest: the first inter-human tissue transplantation

Nineteenth century Scottish surgeon William Macewen performed, in 1879, the first inter-human living donor transplantation in medical history. It was a bone allograft performed on a 3-year-old boy affected by a huge humeral bone loss. This paper analyses the historical context around Macewen, briefly introducing his life and the discoveries made by Lister and by the pioneers of anaesthesia. It focuses on the details of the bone allograft procedure invented by Macewen. He was both a basic researcher and a skilled surgeon, a combination that is rare nowadays. The paper includes a description of the surgical procedure and is also enriched by the reproduction of the original image used by Macewen in his 1881 article to explain the clinical evolution. William Macewen was one of the greatest pioneers in musculoskeletal medicine whose brilliant intuition led to the origin and development of bone grafting, one of the most common orthopaedic procedures in the world today.

LEVEL OF EVIDENCE

V.