Joseph E. Murray, MD, FACS, opened doors for transplant surgeons

Dr. Murray

It is an honor to pay tribute to and to celebrate the life of the 1990 Nobel Laureate, Joseph E. Murray, MD, FACS. Dr. Murray, a former Regent and First Vice-President of the American College of Surgeons (ACS), died November 26, 2012, at Brigham and Women’s Hospital (previously the Peter Bent Brigham Hospital), Boston, MA, after suffering a hemorrhagic stroke at his home on Thanksgiving night. He was 93 years old.

First name in transplantation

Throughout the last half century, the first name to be mentioned in any discussion of organ transplantation has been Dr. Joseph E. Murray. The reason, from a purely historical perspective, is really quite simple. Dr. Murray and his associates at the “Brigham” made three remarkable contributions that have resisted the normal erosions of time and obsolescence.

The first event took place two days before Christmas 1954, with the successful transplantation of a kidney from one identical twin to the other. It was anything but a casual stunt. Research in renal transplantation had been an important activity at the Brigham for several preceding years. There, the fledging specialty of nephrology was being developed by John Merrill, MD. The first artificial kidney in America had been constructed at this hospital. And the medical and surgical departments, under the leadership of George Thorn, MD, and Francis D. Moore, MD, FACS, had committed their resources to what was generally conceived to be a fantasy.

But was it really a fantasy? Years ahead of its time, the Brigham already had equipped itself with all the ingredients of a modern interdisciplinary transplantation unit. The group understood perfectly that success without immunosuppression could be expected only with genetic identity of the donor and recipient. The efforts that were made to be sure of this condition were extraordinary and ultimately included skin grafting. It is no distortion of history to say that the tissue matching of today between non-twin donors and recipients is an attempt to come as close as possible to the ideal conditions of the landmark Brigham case.

The successful operation marked the beginning of a revolution. However, the tabulation of kidney transplant patients surviving today who otherwise would be dead gives a woefully incomplete impression of the ultimate impact of this case. Until 1954, the treatment of organ failure had consisted of palliative measures designed to slow or compensate for the declining function of the organ in question. With the option of transplantation, the philosophy by which the organ-specific medical disciplines were practiced would be changed forever: first in nephrology and ultimately with all of the other specialties. Complete replacement of the failing engine now could be envisioned.

Surgical Forum Volume XXXVI was dedicated to Dr. Murray, pictured here receiving the volume from Thomas J. Krizek, MD, FACS, at the 1985 Clinical Congress. Dr. Murray was one of the first members of the Forum Committee and was often published in the volume.

Before such dreams could be realized, however, it would be necessary to control the immune response that had been scrupulously avoided in the identical twins cases. The attention of the Brigham team already was riveted on this problem. More than four years later, on January 24, 1959, the key step was taken by Dr. Murray and his associates. It consisted of transplanting a kidney allograft from a fraternal (not identical) twin to his dizygotic brother who had been conditioned with total body irradiation. The transplanted kidney functioned for more than 20 years without a need for maintenance immunosuppression.

For the first time (in any species), the genetically determined immune barrier to organ transplantation had been broken down. I have always thought that this second contribution by Dr. Murray and his Brigham associates 53 years ago was the most important one ever made to either the basic or clinical literature of organ transplantation. The validity of the observations in this case reported by Dr. Murray and his friend, Dr. Merrill, were confirmed by further experience in France.

The stage was now set for Dr. Murray’s third epochal contribution—
namely the clinical introduction of drug immunosuppression. On April 6, 1962, Dr. Murray transplanted a kidney from a recently deceased cadaver under azathioprine-based immunosuppression. The graft functioned for 17 months and provided the world with its first example of truly prolonged human organ allograft function using drugs alone.

This was a wonderful story. What could have resulted in institutional and personal ignominy ended in triumph. What might not be so apparent is the fierce determination and faith that sustained Dr. Murray and his colleagues through what they have called their “dark years.” Dr. Murray was the perfect leader because he possessed to an unusual degree those qualities that hold men and women together through tough times: skill, intelligence, genuine kindness, and unfailing integrity. He was the focal point around which others, on his team and around the world, could rally.

Man of many interests

Dr. Murray was born on April 1, 1919, in Milford, MA. His father, William, was a district court judge, and his mother, Mary, was a teacher. A man of many interests, Dr. Murray received a bachelor’s of arts degree in the humanities in 1940 from Holy Cross College in Worcester, MA. While attending Harvard Medical School, he met his future wife, Virginia Link, at a Boston Symphony Orchestra recital. He earned his medical degree from that institution in 1943 and joined the U.S. Army Medical Corps in 1944.

He was a Major at Valley Forge General Hospital in Pennsylvania, working as a plastic surgeon to reconstruct the hands and faces of soldiers burned and maimed on the battlefield during World War II. He then returned to Harvard Medical School in 1947 and was board certified in general surgery in 1952 and in plastic surgery in 1954. He worked his way through the academic ranks and by 1970 was a full professor at Harvard and chair of the plastic and reconstructive surgery department at Brigham and Women’s and Boston Children’s Hospital.

He retired from the active faculty at Harvard Medical School in 1989 but continued to serve as an emeritus professor. The following year, Dr. Murray was awarded the Nobel Prize in Physiology or Medicine. The award was announced during the 1990 ACS Clinical Congress in San Francisco, CA, and was shared with the late E. Donnall Thomas, MD, an oncologist at the Fred Hutchinson Cancer Research Center in Seattle, WA. Dr. Murray was the recipient of numerous other awards including the Frances Amory Prize of the American Academy of Arts and Sciences, Boston (1962); the gold medal of the International Society of Surgeons, Brussels, Belgium (1963); a prize of the American Association of Plastic Surgeons (1969); the ninth Ferdinand C. Valentine medal and award of the New York Academy of Medicine (1970); the National Kidney Foundation Gift of Life award (1979); and the Medawar Prize of The Transplantation Society (2002).

Dr. Murray served as an ACS Regent from 1970 to 1979 and as First Vice-President from 1969 to 1970. He also was a prominent member of other medical and surgical associations, having served as president of the American Association of Plastic Surgeons (1964–1965), chair of the American Board of Plastic Surgery (1969–1970), and president of the Boston Surgical Society (1975).

Dr. Murray at a press conference during the 1990 Clinical Congress, after the announcement of his Nobel Prize.

A builder

If there is a unifying theme in Dr. Murray’s life, it is that of a builder. He began his plastic surgery career by building new faces and body parts for people who had been maimed physically and emotionally by war, accidents, and cancer. It was not so surprising that he next turned to transplantation to rescue patients who could be healthy, were it not for the failure of a vital organ. In the long run, he built a stadium called the specialty of organ transplantation, began to populate it with high-minded people whom he trained, and welcomed with open arms those of us whom he did not even know.

Organ transplantation has become a grand multilayered international superstructure. But it still rests on the three seminal cornerstones placed by Dr. Murray between 50 and 58 years ago: the identical twins, the fraternal twin experience of 1959, and the drug-immunosuppressed kidney cases of the early 1960s. What else is there to say to this plainspoken guy named Joe except “thank you for what you have done.”

Dr. Murray is survived by his wife; three sons, Richard of Scituate, MA, J. Link of Jamestown, RI; and Thomas of Dallas, TX; three daughters, Virginia of Plymouth, MA, Margaret Murray Dupont of Lafayette, CA; and Katherine Murray Leisure, MD, of Plymouth; and 18 grandchildren.

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