Word: starzl
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...Starzl's epiphany--which he calls a "paradigm shift" in transplant thinking--in no way diminishes the work already accomplished. The surgical techniques used by him and his colleagues have added years--decades in some cases--to the lives of hundreds of thousands of men, women and children. From the 1950s through today, physicians like Starzl, Barnard, Toronto's Joel Cooper and Stanford's Norman Shumway have moved mountains' worth of kidneys, pancreases, livers, hearts and lungs from one human body to another...
...large it worked. More and more patients were surviving beyond a year, an established milestone of transplant success. But in 1992 Starzl and his colleagues discovered that there was something different about those recipients who had lived much longer--10, 20, as many as 30 years. By testing these patients, they discovered that white blood cells from the recipient's immune system had migrated into the donated organs--and vice versa. What is more, with the encouragement of the antirejection drugs, body and organ had learned to coexist in peace. If scientists could somehow find a way to facilitate that...
...Starzl acknowledges that this insight had also occurred to other researchers. Scientists, going back as far as 1960 Nobel prizewinner Peter Medawar, had come to recognize that tolerance was possible. If bone marrow, for instance, would only accept an interloping cell, the larger system would follow suit. The trouble was, the only way to achieve that was to kill off the body's entire current bone-marrow supply and replace it with another--a technique oncologists use as a last-ditch weapon to try to cleanse patients of such systemic cancers as leukemia and breast cancer...
...bone-marrow work and solid-organ transplant work have traditionally been two separate fields of medicine. "The big misconception," says Starzl, "was not realizing that the acceptance and tolerance of solid-organ grafts are due to the same mechanisms described by Medawar. There is a seamless work of transplantation immunology. It's so damn simple, it's crushing...
...Center at the University of Alabama. They have found that by first transplanting some donor bone marrow into the recipient animal, it is possible to trick the animal's immune system into accepting a solid-organ transplant almost as if it were native to its own body--just as Starzl suggests will be the case in humans. That in turn allows them to use lower doses of immunosuppressive drugs--and then phase out the use of those drugs entirely. "For a short time, drugs are used to keep the body's leukocytes from attacking the bone marrow, until...