How a Landmark Operation at Brigham and Women’s Hospital 70 Years Ago Opened the Door for Organ Transplantation

This week marks the 70th anniversary of a medical milestone, when the first-ever organ transplant was performed at Brigham and Women’s Hospital. The organ, a kidney, was transplanted between two twin brothers.

The operation on twins Richard and Ronald Herrick was performed by Joseph Murray, MD, a plastic surgeon, J. Hartwell Harrison, MD, a urologist, and John Merrill, MD, head of the kidney research laboratory at what was then called the Peter Bent Brigham Hospital.

In the carefully timed and closely monitored procedure, Harrison was responsible from removing the kidney from Ronald, who was healthy, and Murray’s role was to attach it to Richard, who was dying of kidney failure. The six-and-a-half-hour procedure ended shortly after noon.

The stakes were high for the patients and physicians alike, as no one had ever successfully transplanted an organ between living patients before, and some in the medical world thought the risks of the procedure outweighed the potential benefits.

Murray and team had been working for years to address these risks, but the outcome of this operation was far from certain. The medical team was hoping that because the two brothers shared identical genes, Richard’s immune system would not recognize Ronald’s kidney as foreign and attack it.

The medical team had consulted with doctors, lawyers and even members of the clergy before they decided to offer the first-ever transplantation procedure to the Merricks, who understood that there were no guarantees it would work.

In a 2011 article for the Harvard Medical School called The Fight for Life, Murray recalled the tense and uncertain moments in the operating room once the transplant was complete.

“We watched—some with fingers crossed, some saying silent prayers—as the transplanted kidney gradually turned pink and plumped up, engorged by Richard’s blood. Then urine began flowing briskly. There were grins all around. Two hours later, Richard and Ronald were in the recovery room, slowly awakening from anesthesia.”

Richard Herrick, who had been ill with anemia prior to the transplant and disoriented and combative due to the buildup of toxins in his system, soon returned to living a healthy and active life, as did his brother Ronald, who suffered no ill effects from donating his kidney.

“Richard’s improvement was stunning,” Murray wrote. “Within a week, his erratic behavior disappeared. His appetite sharpened, his pallor gave way to his normally ruddy complexion, and his energy level returned.”

“Richard left the hospital after two weeks and continued a courtship he had begun with a nurse who had cared for him in the recovery room. They subsequently married and had two children.”

The successful transplant was a big step in the career of Murray, who had been recruited to what is now BWH by the heads of the departments of Surgery and Medicine after World War II to investigate organ transplantation as a cure for kidney failure, which was then a fatal disease.

Inspired by the success of this first-ever transplant, Murray conducted 12 organ transplants between identical twins between 1955 and 1959 while also looking for ways to extend this lifesaving procedure to others.

“We also began to transplant kidneys between people who were not genetically identical, using various techniques to fight tissue rejection,” Murray recalled.  “Although we had several successes, for eight years most of our efforts ended in failure.”

“People who were destined to die young, died young anyway, despite our best efforts,” he wrote. “While our colleagues sometimes judged us harshly, our patients and their families did not. They understood that our treatment might well fail but that they had no other hope.”

The field of organ transplantation reached the modern age in the mid-1960s, with the identification of immune suppressing drugs that allowed for transplantation between genetically mismatched individuals without rejection.

Murray was awarded the Nobel Prize in Physiology or Medicine in 1990 along with E. Donnell Thomas in recognition of their pioneering work in organ transplantation and immunology. It was the pinnacle of a career that included numerous awards and recognitions. He died in 2012.

Richard lived for eight years after the transplant before dying of heart failure and arteriosclerosis that was caused by his pre-transplant kidney disease. Ronald, who lived a normal, healthy life, died in 2010. 

In 2004, Murray, then 85, and Ronald Herrick, then 73, were invited to light the torch at the National Kidney Foundation’s Transplant Games. For Murray, the moment was an opportunity to reflect.

“I thought back to the day when it all began,” he wrote. “Ronald and I were still here, but Richard and the rest of our team were gone. So too were many of the recipients—including all those who died young despite our best efforts.

“They had all understood, perhaps better than we, that life is precious and fragile, and often must be fought for. They went to their graves believing that if they were not going to make it, they might at least help us learn how to save someone else. Their fight, their courage, gave the gift of life to millions.”