Joseph Murray, 1919-2012

On 26th November Joseph Murray, plastic surgeon and transplant pioneer, passed away in Boston in the same hospital in which he had performed the first human kidney transplant in 1954. Nearly four decades later Dr Murray was to win a Nobel prize for his role in transforming transplant surgery into a routine operation which has been performed on over half a million patients worldwide.  

Inspired as Sir Archibald McIndoe was by the revolutionary treatment of burned soldiers during World War II, Dr Murray was the archetypal plastic surgeon: unrestricted by an anatomical area or set of operations, his surgical skills were overlaid with a creativity which enabled him to tackle a range of challenging pathologies in a relentless effort to improve patient health.  His ability to see past what to others appeared to be insurmountable barriers and to operate on previously untreatable conditions made him a truly great surgeon.

Francis Moore, Chief of Staff at Brigham Hospital in Boston and a supporter of Murray’s work, wrote that innovations in transplantation should not be performed for the purposes of institutional prestige or professional recognition.  Indeed, Dr Murray was a pioneer not a maverick, his ground-breaking work part of the chain which links Alexis Carrel and Peter Medawar to Thomas Starzl and Jean-Michel “Max” Dubernard.

There have been few break-throughs in the history of surgery that have resulted in the birth of a new specialty. Murray himself once remarked: “kidney transplants seem so routine now, but the first one was like Lindbergh’s flight across the ocean”. Coming full circle back to the challenge of skin transplantation that originally inspired Dr Murray in the 1940s, Max Dubernard, one of his former research fellows, has over the last 15 years led the transformation of vascularised composite allograft (VCA) transplantation from an experimental technique into a viable treatment.  During the few times I have attended meetings on VCA transplantation there has been a palpable sense of excitement in the air, described by those who have been in the field long enough as identical to that during the early years of organ transplantation.  Will hand and face transplantation become a standard procedure in the future?  Certainly some medical journalists I have spoken to in the USA have expressed the view that they are unlikely to report any further VCA transplants on the front pages, perhaps signalling the beginning of the ‘routine’ era of VCA transplantation.  

Dr Murray’s surgical contributions were not restricted to transplantation but extended to the treatment of head and neck cancer, trauma and craniofacial disorders – the impact of his work on later generations of surgeons cannot be overestimated. Indeed, my personal inspiration comes in part from his ability to bridge the gap between science and surgery.  As Francis Moore once wrote, “a surgical investigator is a bridge tender, channelling knowledge from biological science to the patient’s bed-side and back again”.  

The late Robert Goldwyn who worked closely with Dr Murray once wrote of his “indestructible optimism” and quoted him as saying “we as plastic surgeons are here to right the balance”.  This seems to embody Dr Murray’s entire philosophy. His optimism and tenacity allowed him to transform the lives of patients that other surgeons had considered hopeless.  I have met a number of surgeons during my short career who also embody this principle and I am convinced that the values they espouse have been passed down from surgeons such as Joseph Murray.

Fadi Issa