Mend me.

Presented by Michael Mosley, this Horizon Guide looks back at the extraordinary odds doctors and patients have had to overcome to achieve radical breakthroughs in transplant surgery, from full face transplants to growing organs in the lab. Key turning points for transplant surgery are revisited using the Horizon archive to explore how far science can go in its bid to prolong life. Mosley begins by visiting Brigham and Women’s Hospital, Boston, to interview Dr Bohdan Pomahac. They discuss the case of Mitch Hunter, one of the first face transplant recipients. Hunter is interviewed four months after his surgery. The history of transplantation is introduced with the story of Alexis Carrel, the first surgeon to experiment with transplantation in the early twentieth century. We are then shown footage from The Man Makers, 1968, in which Oxford biologist Peter Medawar’s skin graft experiments on rabbits are discussed, revealing the science behind rejection. Early experiments in human transplantation led to ethical and moral dilemmas. French surgeon Charles Dubost is shown discussing the harvesting of organs from executed prisoners for transplantation in the 1940s. The first successful organ transplant, of a kidney, was performed in 1954 by American surgeon Joseph Murray between identical twins. Murray recalls the victory, which proved that transplants were possible although rejection remained a barrier. We learn that Murray went on to perform transplants on unrelated patients using a drug developed to treat leukaemia. The increasing viability of transplant surgery necessitated a change in the definition of death from cessation of heart activity to brain death. Footage from Their Life is Your Hands, 1972, briefly explores the ethics of transplanting organs from the recently dead to the living. We then look back on the first heart transplant, performed in South Africa by Christiaan Barnard in 1953. Although the recipient lived for only two weeks, Barnard subsequently became a celebrity. Archive footage from Tomorrow’s World, 1969, features veterinarian Oliver Graham-Jones discussing the first pig-to-human transplant at The National Heart Hospital, which was immediately rejected. Despite the tragic outcome, Graham Jones maintains that ‘if we are to progress in this territory, there have to be brave men’. By the end of the 1960s the poor long-term success rates of heart transplantation resulted in a backlash against Barnard. In an extract from The Transplant Experience, 1976, a heart recipient describes his post-transplant existence as ‘like living on death row’. Mosley introduces the discovery of cyclosporine, a new immunosuppressant which led to a dramatic increase in survival rates. We are shown archival news footage of the first triple organ transplant performed at Papworth. Increased numbers of transplants led to a new problem, that of organ shortage. We revisit the launch of the National Organ Donor Scheme and witness doctors deciding the fate of patients at a weekly meeting of the renal unit at Guys Hospital (Their Life in Your Hands, 1972). The issue of living donors is introduced with a long extract from Breath of Life, 2000, featuring the Loughran family. Two siblings undergo living donor lung transplantation in an attempt to save the life of their sister Sheila who had cystic fibrosis. The elevated risks for donor and recipient become clear when we learn that Sheila died shortly afterwards from complications. Moving on to cosmetic transplants, we revisit the case of the first hand transplant recipient, Cliff Hallam, whose story featured in Superhuman, 2000. Hallam describes the negative psychological impact of the procedure and the severe side effects of immunosuppressant therapy. The section concludes with Newsnight footage from 2001 filmed prior to the removal of the limb. The creation of artificial hearts in the 1960s is explored in footage from Electric Heart, 1999. Michael DeBakey, who developed the technology, and Denton Cooley – the first to implant the device in a dying patient – are interviewed. DeBakey was hesitant to test his invention on humans following unsuccessful animal trials. His views contrast with Cooley’s, who claims he enjoyed doing something for the first time that others did not have the courage to attempt. Mosley then introduces the likely future of transplant surgery – using stem cells to create bespoke organs in the lab. Fix Me, 2009, features Dean, a patient with dilated cardiomyopathy. Dean travels to the University of Minnesota to meet Doris Taylor, a pioneer of stem cell research who shows him a beating, lab-generated, rat heart. Mosley concludes that millions have benefitted from the work of doctors prepared to take risks. Although it is hard to predict where the transplant story will take us next, future advances will no doubt bring their own set of moral dilemmas.