A medical marvel How one Scots surgeon saved countless lives with revolutionary op
It is now 60 years since a groundbreaking surgical technique at Leith Hospital made the sci-fi idea of organ transplants a reality, finds Sandra Dick
MID-SEPTEMBER 1960, a young band called The Beatles had just played their first gig in Hamburg, fresh-faced footballer Denis Law had signed for Manchester City, and in Leith, a 49-yearold man who had suddenly fallen ill was about to make history.
Doctors at Leith Hospital were not sure whether Lewis Abbot’s kidneys were being destroyed by a bacterial infection or whether an autoimmune condition was to blame. But they did know the outlook was poor.
Desperately unlucky to have been struck down by a potentially fatal condition that caused his kidneys to fail, Abbot, a steel worker, was also incredibly lucky.
For not only was he living a stone’s throw from the Edinburgh hospital where one of the country’s leading surgeons was based, he was also an identical twin.
And his brother Martin, who was healthy and willing to give up one of his kidneys in a last effort to save his twin’s life, was the perfect match.
Within weeks, lead surgeon Sir Michael Woodruff and his dedicated team were celebrating a remarkable medical first that changed the face of modern medicine: the UK’s first successful kidney transplant.
The surgery, which took place 60 years ago next month, was a pivotal moment for the relatively new NHS and opened the door for a new area of surgery that would capture patients on the very edge of death and, with the gift of a healthy, new organ, give them back their lives.
While transplant surgery had been attempted in the UK before the Abbot twins went under the knife, they agreed to the surgery knowing that the chances of success weren’t just slim, but were exceedingly unlikely.
Yet incredibly, within a few hours of surgery, both were enjoying a cigarette. And within weeks of surgery, the “inseparable” twins who lived together in Leith’s Sandport Street were both back at work.
According to Edinburgh consultant renal transplant surgeon, Professor Lorna Marson, the success of the twins’ surgery broke the stalemate which had seen pioneering transplants attempted on courageous patients at various UK hospitals, only to end in failure.
“Prior to this first successful transplant there had been unsuccessful transplants, as efforts were made to try to understand the interaction between donor and recipient,” she said.
“They didn’t understand why the (transplanted) kidney didn’t work.
“But patients would have had no alternative but to undergo transplant surgery. They would have had nothing to lose, because dialysis was probably only just being developed around the same time.
“There was no anti-rejection treatment and the only possibility for a kidney transplant would be if you had someone genetically identical to the patient.
“It was their only option.” London-born but raised in Australia, Woodruff had been captured by the Japanese during the Second World War and imprisoned at notorious Changi prison camp.
Having watched his fellow prisoners starve, he devised a way of extracting nutrients from grass, soya beans and agricultural waste using old machinery found at the camp. Later, as chair of surgical science at Edinburgh University, he proved his expertise specialising in immunotherapy in cancer treatment, transplant research, and vascular surgery.
On October 30, 1960, with the Abbot twins in separate rooms, Woodruff’s colleague James A Ross removed Martin’s healthy kidney while he worked on his twin, removing the diseased organ and replacing it with the other.
The aftermath of the surgery would have been tense – particularly as each day passed, news of its apparent success leaked out and onto the nation’s front pages, putting the eyes of the UK on the surgeons and their patients.
Perhaps no-one was more surprised that Martin Abbot when, just three weeks later, he was back at work. As for his twin, recovery took slightly longer – a whole 15 weeks before he was able to resume his job.
Both lived for a further six years before dying from completely unrelated conditions.
Within months of the Abbot brothers’ surgery, a second transplant was carried out in Edinburgh between a brother and sister.
But while total body radiation carried out on the recipient prior to the surgery – the only known method at the time to help prevent organ rejection for non-identical twin patients – seemed effective, the success was brief, and the patient died 30 days later as the result of septicaemia.
A third transplant the following year, however, had astonishing results. A new and safer method of immunosuppression, azathioprine, had been developed in the United States.
Its use in Edinburgh was only the second time it had ever been used. Remarkably, the transplanted kidney this time lasted for more than 20 years. Woodruff went on to steer the Edinburgh surgical research laboratory towards specialising in the study of immunological aspects of transplant surgery, and he also developed a drug that helped prevent rejection of transplanted organs.
In his wake, surgeons across the UK perfected their knowledge of transplant surgery. Eventually legislation surrounding the use of deceased human organs for transplant purposes caught up and what was once groundbreaking surgery became almost routine.
After laws surrounding wearing seatbelts in cars helped push down the number of people dying on the roads – and therefore, the number of deceased organs – new living donor programmes brought a fresh and less traumatic source of potential organs to offer desperately ill patients.
Now around 40% of kidney transplants in the UK are performed thanks to living donors, with an increasing number offered through the kidney sharing scheme and some as a result of altruistic gifts.
“There has been significant change in the way we run live donor kidney
transplants,” said Marson. “The highly successful kidney sharing scheme has had a massive impact on patients, with the ability to transplant patients that we could not transplant before or didn’t have a living donor for.”
The kidney sharing scheme uses an algorithm designed at Glasgow University, and searches everyone who has volunteered to donate an organ in an effort to find better matches with patients other than their own loved ones.
But while some technology surrounding the actual process of transplant has developed since the days of the Abbot twins, the basics have mostly remained the same.
“It’s fine tuning now,” added Professor Marson.
Meanwhile, for those families who find themselves confronted with sudden tragedy, huge steps have been made to help ensure the decision to donate loved ones’ organs is as smooth and seamless as possible.
Transplant teams now work hand in hand with intensive care unit staff.
“We hope in some small way there is some solace from knowing that from the death of their loved one, some good has come,” she added.
Steel worker Lewis Abbot was the recipient of the UK’s first successful kidney transplant, performed at Leith Hospital, above