The Body as System

Richard Herrick was dying. His kidneys had failed, and in 1954, there was no treatment. Dialysis was experimental and barely functional. A kidney transplant had never worked. Surgeons had tried transplanting kidneys from cadavers and live donors, but the recipient's immune system always rejected the foreign organ. The patient would survive a few days, maybe a week, and then die. The body recognized anything foreign as a threat and destroyed it.

But Richard had an advantage. He had an identical twin. Ronald Herrick was genetically identical to his brother, which meant his kidney wouldn't be foreign. It would be self. If the surgery worked, Richard's body wouldn't reject it. On January 14, 1954, at Brigham Hospital in Boston, surgeon Joseph Murray removed a kidney from Ronald and transplanted it into Richard. The surgery took five and a half hours. The transplanted kidney began producing urine almost immediately.

Richard lived for eight more years. He got married, had two children, and died in 1963 from a heart attack, not from kidney failure. Ronald lived to be 79. The transplant was a proof of concept. It showed that organs could be swapped, that the body was modular, that failing parts could be replaced. The human body wasn't a sealed unit. It was a system, and systems could be repaired.

The problem was compatibility. Identical twins were rare. Most transplant recipients didn't have a genetically identical donor. Researchers spent the next decade trying to suppress the immune system enough to prevent rejection without killing the patient from infection. It was a narrow window. Too little immune suppression, and the organ was rejected. Too much, and the patient couldn't fight off bacteria and viruses. The first immunosuppressant drugs were crude and toxic. Many patients died from the treatment instead of the disease.

cross section of a human kidney showing its internal anatomy — the organ at the center of the 1954 transplant breakthrough. source: wikimedia commons

By the 1980s, better drugs like cyclosporine made transplants viable for non-twin donors. Surgeons developed techniques for matching tissue types, reducing the risk of rejection. Organ transplants became routine. Kidneys, hearts, livers, lungs, pancreases, all became swappable parts. The body was no longer a fixed system. It was reconfigurable.

The concept of transplantation raised questions that still haven't been fully answered. Who gets an organ when there aren't enough to go around? How do you value one life against another? Should organs be bought and sold, or only donated? Is the body property, or something else? The waiting list for organs is long. Thousands of people die every year waiting for a transplant. The supply is limited by biology and ethics. Just as Newton's laws governed motion, the laws of supply and demand govern who lives and who dies in the organ transplant system.

The medical profession adapted. Organ procurement became a specialized field. Brain death became the legal definition of death, specifically to allow organs to be harvested from patients on life support. Transplant surgery became a discipline. Patients on immunosuppressants lived with the permanent knowledge that their body was trying to reject a part of itself, held in check only by chemistry.

the peter bent brigham hospital in boston, where joseph murray performed the first successful kidney transplant on january 14, 1954. source: wikimedia commons

Today, researchers are working on growing organs in labs, printing them with 3D printers, and editing genes to make animal organs compatible with human recipients. The goal is to make the body even more designable, to remove the dependency on human donors entirely. Transplantation was the first step. It proved that the body could be treated as an engineered system, that parts could be replaced, that biology was not destiny. It turned medicine into a design problem, and in doing so, it redefined what it means to be human.