The First Long-Term Successful Kidney Transplant, 1954

Priority depends on the outcome being measured. In 1933, Yurii Voronoy in Soviet Ukraine performed the first documented human-to-human kidney allograft; his account appeared in the mid-1930s, which explains why some older histories date the event to 1936. The deceased-donor kidney had been without circulation for hours, crossed an incompatible ABO blood group, did not function, and the recipient died after two days. It was a first attempt, not a therapeutic success (Barker and Markmann).

In Chicago on 17 June 1950, Richard Lawler's team placed a deceased donor's kidney in Ruth Tucker, who retained another diseased kidney. The graft may have produced urine for a time and was later removed after it had become small. Tucker survived for years, but historical reviews caution that her own kidney sustained her and that the graft's benefit cannot be established. Calling this simply the first “successful” transplant confuses recipient survival with durable graft function (Barker and Markmann).

French work supplied another essential precedent. René Küss, Charles Dubost, Marceau Servelle, and their colleagues developed pelvic implantation using the iliac vessels. In December 1952 at Hôpital Necker in Paris, Louis Michon, Jean Hamburger, and colleagues transplanted a kidney from Gilberte Renard to her son Marius after an accident left him without renal function. The graft worked for about three weeks before rejection. This was the first kidney removed from a healthy volunteer for another person's benefit; Ronald Herrick was therefore not the first living kidney donor (Legendre and Kreis).

The defensible Boston priority is consequently specific: the Herrick graft was the first human kidney transplant to restore function for years. It was also the first long-term successful solid-organ transplant. Stating that achievement precisely preserves the earlier work and the patients whose short-lived grafts supplied evidence about technique, rejection, and risk.

A transplanted kidney needed an arterial inflow, venous drainage, and a path for urine to reach the bladder. Fine vascular suturing developed around the turn of the twentieth century made those connections possible. French surgeons then helped establish an extraperitoneal pelvic site close to the iliac blood vessels and bladder. The 1954 operation belonged to this international circulation of technique, as well as to the longer history of safer operative practice (Barker and Markmann).

Dialysis made experimentation clinically possible without making chronic kidney failure routinely survivable. Willem Kolff brought his artificial kidney design to the Brigham after the Second World War; George Thorn, John Merrill, Carl Walter, and colleagues adapted it into the Kolff-Brigham machine. It could support selected patients with acute, potentially reversible kidney failure and could stabilise Richard before surgery, but maintenance haemodialysis was not yet an established long-term alternative (Murray).

The Brigham programme had already tested nine human grafts under David Hume, Merrill, Benjamin Miller, and Thorn. Most kidneys were placed in the thigh, with the ureter draining through the skin so that output could be observed. One functioned for nearly six months, but every recipient ultimately died. Their 1955 report explicitly described the work as investigation rather than established treatment—important evidence of both what the team learned and how experimental surgery was justified in terminal illness (Hume et al.).

Wartime skin-graft research by Thomas Gibson and Peter Medawar had shown that a second graft from the same genetically different donor was rejected more rapidly, evidence of an acquired immune response. By contrast, earlier skin grafts between identical twins could persist. The Herrick case applied that distinction to a whole organ. Contemporary authors used homograft or homotransplant for transfer within the human species; allograft is now usual for genetically different members of one species, while an identical-twin graft is more exactly an isograft or syngeneic graft (Barker and Markmann).

1. 1933: Voronoy performs the first documented human-to-human kidney graft in Soviet Ukraine. The kidney does not function and the recipient dies after two days; the case is published later in the decade (Barker and Markmann).
2. 1940s: Kolff's dialysis work and Medawar's skin-graft experiments create two different resources for transplantation: temporary renal support and an immunological explanation of rejection (Murray; Barker and Markmann).
3. 17 June 1950: Lawler's Chicago team transplants a deceased-donor kidney into Tucker. The graft does not provide durable renal replacement, although publicity encourages further clinical attempts (Barker and Markmann).
4. 1951-1953: Paris teams establish pelvic implantation; the Brigham group reports transient function in experimental human grafts; and the Renard mother-to-son operation in Paris demonstrates both the promise and rejection of a living-donor kidney (Hume et al.; Legendre and Kreis).
5. Autumn 1954: Richard Herrick arrives at the Brigham with uraemia and severe hypertension. The team compares the brothers' blood groups and physical characteristics and exchanges skin grafts to build the strongest evidence then available that they were monozygotic twins (Merrill et al.).
6. 23 December 1954: Harrison removes Ronald's kidney and Murray's team implants it in Richard's pelvis. Merrill directs renal management and Leroy Vandam oversees anaesthesia. The graft begins to function during the operation (Merrill et al.; Leeson and Desai).
7. 28 January 1956: Merrill, Murray, Harrison, and Warren Guild publish their detailed report in JAMA. At eleven months the graft remained functional; the article's cautious conclusion limited dependable graft survival to identical twins (Merrill et al.).
8. 1958: the Boston group reports seven identical-twin pairs. A series, rather than one celebrated operation alone, shows that sustained renal grafting in this special setting is reproducible (Murray, Merrill, and Harrison).
9. 24 January 1959: the Brigham team obtains long survival between fraternal twins after total-body irradiation. This crosses a genetic barrier, but radiation proves hazardous and unreliable (Starzl and Barker).
10. 1962-1963: azathioprine-based regimens in Boston and azathioprine with prednisone in Denver produce longer survival in genetically different recipients. Rejection, infection, and drug toxicity remain frequent, but kidney transplantation begins to become a clinical service rather than an identical-twin exception (Starzl and Barker).
11. 1990: Murray shares the Nobel Prize in Physiology or Medicine with E. Donnall Thomas for discoveries concerning organ and cell transplantation. The award recognises a larger research trajectory, not the work of every participant in the 1954 operation (Nobel Assembly).

Richard had advanced chronic renal disease then often described with the broad historical term Bright's disease; the clinical report used evidence of severely atrophied kidneys, uraemia, oedema, anaemia, and malignant hypertension. “Bright's disease” should not be read as one modern diagnosis. Later follow-up identified his disease as glomerulonephritis (Merrill et al.; Desai et al.).

Confirmation of twin identity was crucial because no effective, acceptably safe immunosuppressive regimen existed. The team compared fingerprints and other inherited characteristics, tested blood groups, and observed that exchanged skin grafts were not rejected. These methods preceded modern HLA typing; they were used to establish monozygosity, not to discover a close enough match between ordinary siblings (Merrill et al.).

In adjoining operating rooms, Harrison's team removed a kidney from Ronald while Murray's team prepared vessels in Richard's lower abdomen. The donor kidney was placed outside the peritoneal cavity in the pelvis, its vessels joined to the iliac circulation and its ureter connected to the bladder. The primary report records an eighty-two-minute period without blood flow and functional activity after circulation was restored. This pelvic graft was initially an additional, third kidney; it did not occupy the anatomical site of either native kidney (Merrill et al.).

Richard's high blood pressure persisted after the graft began filtering his blood. Only after surgeons removed both of his severely diseased kidneys did the hypertension resolve. That sequence mattered scientifically: the graft corrected renal failure, while the native organs continued to drive another dangerous part of his illness. Success required serial operations, fluid and electrolyte management, dialysis, laboratory measurement, and nursing after the headline procedure (Merrill et al.; Leeson and Desai).

Accounts that reduce the event to “Murray performed the first transplant” obscure divided responsibility. Harrison accepted and carried out the operation on the healthy donor; Merrill and the renal service selected and prepared the recipient; Vandam managed anaesthesia; Gustave Dammin and the pathology service studied the renal disease; and the hospital's staff sustained two patients. Murray himself later presented the institutional programme, rather than a lone surgeon, as the necessary unit of achievement (Murray; Desai et al.).

Ronald's nephrectomy could not improve his own health. The justification rested on his willingness to accept anaesthetic, haemorrhagic, infectious, and uncertain long-term risks for a possible benefit to Richard. Clinicians had evidence that a person could live with one kidney, but the long-term evidence available in 1954 was limited. The moral problem was therefore not erased by the twin match; the match made a benefit plausible enough for the problem to be confronted (Leeson and Desai).

Later accounts by Murray and other participants say that the team consulted physicians, clergy, and legal advisers and held repeated discussions with the twins and their family. Those recollections are valuable, and Leeson and Desai compared them with hospital records and personal notes. They do not document a modern research ethics committee, a standardised consent form, or an independent donor advocate—institutions and expectations that developed later. It would be presentist either to claim that no ethical scrutiny occurred or to say that present-day consent protections were already in place (Leeson and Desai; Murray).

Kinship could support an extraordinary act of care while also making refusal emotionally difficult. The surviving literature is dominated by clinicians' reports and later institutional memory; it cannot fully reconstruct private family pressure or what each brother understood at every stage. Ronald's later recollections describe initial conflict as well as determination to help Richard. They are testimony remembered decades afterward, not a verbatim record of consent in 1954 (Murray).

The Paris operation of 1952 prevents another heroic simplification. Gilberte Renard had already undergone nephrectomy for her son, whose graft failed after three weeks. The Herrick case made successful living donation visible, but the ethical history includes an earlier donor and recipient whose outcome did not become the field's triumphant origin story (Legendre and Kreis).

Richard recovered sufficiently to marry Clara, a nurse he had met during his illness, and they had two children. He died on 14 March 1963, more than eight years after transplantation. Later summaries disagree about the cause, with some attributing his death to cardiac disease. A 2007 peer-reviewed follow-up based on participants and surviving family reports that glomerulonephritis recurred in the donated kidney and that Richard died of renal failure. The recurrence is also recorded in Francis Moore's participant memoir; that is the better-supported account, although neither source is a newly produced autopsy report (Desai et al.).

Ronald's long survival showed that donation had not produced an evident catastrophic late outcome in this individual, but one donor could not settle the lifetime safety of nephrectomy for everyone. His experience became a powerful symbol of altruistic donation; it should not be used as if it were a controlled study of donor risk (Desai et al.).

Biologically, the 1954 success was a limiting case. It demonstrated surgical feasibility and renal recovery under nearly ideal genetic compatibility. The decisive generalisation came later, through hazardous irradiation, azathioprine and corticosteroids, tissue-antigen research, improved matching, pathology, infection control, organ preservation, and organised follow-up. None was a single solution: suppressing rejection could expose recipients to lethal infection and drug toxicity (Starzl and Barker; Barker and Markmann).

The strongest historical claim is therefore not that one operation created modern transplantation. The Herrick case supplied durable proof of what a functioning graft could do, clarified the biological question that had to be solved for genetically different people, and joined organ replacement to a continuing ethics of donor risk. Later programmes made that exceptional proof into an imperfect but repeatable treatment.