 Over the last century, science has made incredible advances that border on the miraculous. We have cured polio, put a man on the moon, and mapped the human genome. But among the greatest advances science has made in the last 100 years is a discovery that is so dramatic and so profound that it has literally saved hundreds of thousands of lives. It is the extraordinary act of taking a healthy organ from one person and transplanting it into another to give them new life. Transplantation probably is the greatest triumph of medicine of the 20th century. It is more than a miracle of science, it's a science of miracles. Ashley Brooks has had a life-threatening heart condition since birth and now at age 20 is awaiting the miracle of transplantation. She'd be lagging behind and we always thought it was just an excuse but she'd say her heart hurt or she was tired or she was out of breath and so we didn't really understand that it was, you know, she wasn't putting us on, it really was her heart. She was born with a heart problem but when she was first born they misdiagnosed her and told us that she would die at any time and we should join a support group and it was pretty scary and then in first grade when she was old enough they diagnosed her with that. Ashley has a restrictive cardiomyopathy and with that condition the heart doesn't feel well with blood. The way Dr. Belfort explains that it's like a turkey baster, you know how you can close it and then it opens and it sucks it in, well her heart closes okay but it doesn't open all the way, the wall is getting thicker and it's getting harder as she gets older so it doesn't work like this. This is a heart here in 91 and if you compare it, it's enlarged here and the lungs are not as clear. She has fluid collecting in her lungs as a result of a worsening of the condition. You feel like crud all the time, you know, you don't get to do anything. Rest your body is not getting enough oxygen and it's just basically there's no care for it except for at end stage illness you get a heart transplant. During her senior year in high school Ashley suffered several small strokes which caused her doctor to put her on the transplant list. It was kind of a shock right then, you know, this is my senior year, I was getting ready to go to college and I've been on the waiting list, it will be two years this month. She's receiving home inotropic drugs to stimulate her heart muscle cells to function in a more efficient manner and she's on a continuous infusion of those drugs at home. And in addition she has a device implanted which is called a AICD which is a device that's used to prevent any abnormal lethal heart rhythm from occurring. Because the medicine she's on it can cause her to have arrhythmias which are irregular heartbeats and if she does that then the pacemaker will fire. People that need a transplant, they're looking death in the face, it's slow death and they get up every morning and look in the mirror and brush their teeth and know that they may not live to see the end of the day because they're waiting for a transplant. They're taking my child's heart out, that's a pretty scary thing, you know, and putting a new one in and you want it to start beating right away and then the other scary part is afterwards that it doesn't reject, you know, and that your body's going to say, okay I'll keep you, you know, you can work inside me. The heart transplant that Ashley Brooks is counting on to save her life is a paragon of medical science that has been meticulously developed over the past 50 years. But the real story of transplantation actually begins in the fourth century when Cosmos and Damien, the patron saints of transplantation were said to have removed the gangrenous leg of a church custodian and replaced it with one from a dead Ethiopian gladiator. It wasn't until the turn of the 20th century that a French surgeon named Alex Carell devised a method for connecting blood vessels using silk thread and techniques that he learned from a seamstress. Along with the control of infection and the invention of anesthesia, the stage was set for the development of transplantation in fact rather than legend. Carell's first attempts were on animals such as these dogs whose legs were swapped in 1908 prompting him to claim that transplantation had become a reality. He was far from correct. For the next five decades there were few transplantation attempts and fewer successes because the recipient's bodies mysteriously but inevitably rejected the transplants. By 1950 prominent biologist Leo Loeb declared transplantation a waste of time. The goal was impossible to obtain. What he didn't know was that within four short years he would be proven wrong. In Stockton, California, Alex and Grace Lopez are facing the challenge of transplantation. After the birth of their second child, Grace Lopez developed an autoimmune disease that attacked her liver. And the doctor, we talked to him and he says, well, you know, this is what you got and eventually you're going to need a liver transplant or if not, you know, die. We're not here at a point where she needs a liver. Yeah, my little boy, he's seven, he's like, well, when are you going to get your new liver? When are you going to go to the hospital to go get it? I don't think he quite understands. I prayed last night that God's going to give you a good liver more real soon. So I tell him, keep praying. Keep praying God has a good plan for us. In the early 1950s there would have been no hope for Grace Lopez. But it was the suffering of patients like her that prompted a team of visionary doctors led by George Thorne at Peter Bent Brigham Hospital in Boston to set about solving the mysteries of transplantation step by step. Like so many things that takes a lot of courage to go beyond step one and have to have real confidence that what you're after is worth the effort and that there's a chance that you will be successful. With the approval of Dr. Thorne, a young surgical resident named David Hume performed nine experimental kidney transplants between 1951 and 53. He implanted kidneys into the thighs of nine patients, but none of the patients survived because their bodies rejected the new kidneys. And no one understood why. Then a young surgeon on the experimental transplant team in Boston named Joe Murray made history by acting on a brilliant insight. The big problem, of course, is the rejection of the foreign organ. And we knew, using skin as a model, that if you had transplantation between identical twins of skin, the skin would survive. However, we didn't have any twins to operate upon until the Herak twins happened to be referred to us in 1954. My brother had kidney disease. He was in the Marine Hospital in Brighton. The doctor there said they couldn't do anything about it. My older brother said the doctor too bad I couldn't give him one of my kidneys. And the doctor said that it'd be nice, but that just wouldn't work. But then the doctor's name was Dr. Miller. And Dr. Miller said, but they're twins. And he said that might be a possibility. When the time came to do the operation on the 23rd of December, I felt very comfortable driving in on that early winter morning. And the radio was blaring. Brigham surgeons are doing a daring operation today. But it didn't bother me. I figured I'd do the best I could. If the operation had not proven successful, it would have set back transplantation at least a decade. Because of their identical genetics, Richard Herak's body did not reject the kidney from his twin brother. How does it feel to have three kidneys? Any difference? No, it feels no different at all. He did well. Three months after he had the transplant, he was probably just as well off as I was. He had two daughters. He worked in the clothing store for a while and then he decided he was going to go back to school and he started to get sick and didn't finish. The kidney was transplanted, became infected with the same disease again. Richard had survived for eight years after his transplant. This singular success was a critical event that made transplantation acceptable medical practice. But the insurmountable barrier of organ rejection made transplants between anyone but identical twins impossible. For everyone else, the human body's powerful immune response attacked and destroyed foreign tissue almost immediately. Dr. James Wolfe, a transplant surgeon who trained under Dr. Hume in the 1960s, is himself a heart transplant recipient and remembers the early days. There were big articles in the New York Times by all of the classic immunologists in the country who said, you know, these foolhardy surgeons are doing this and it's way too premature and we shouldn't even think about it yet, we don't know enough science. So the mood was pretty much just let the dumb surgeons do what they want. Surgeons have hard heads anyway and the mood in the surgeons was, first of all you're dealing with patients who have 100% fatal disease so that anything is better than 100% death and it was worth the try. And it was so obvious when you could see some success that it wasn't that it's not going to work. We aren't doing it right. A member of the transplant team at Harvard, John Merrill had had a particularly horrific experience in Japan at the end of World War II. While attending atomic bomb survivors in Nagasaki, he noticed that their immune systems had shut down as a result of the exposure to radiation. Using reports of successful immunological suppression from radiation in German experiments early in the century, the Harvard team decided to try whole body radiation to inhibit the immune response in transplant recipients. The method that was suggested and was used in patients in both sides of the Atlantic was to do total body exeradiation to irradiate the patient, very high doses, and then do the kidney graft. This was really just about useless treatment. They rejected the kidney or they died, with one exception. In the case of the Reteris brothers who were 26-year-old fraternal twins, John was given radiation treatment and increments to alter his immune system. His brother Andrew donated one kidney, which when transplanted, functioned well with the help of cortisone. But with the irradiation, somehow it helped enough so the kidneys survived. The patient survived for 25 years. By the end of the 1950s, it was clear that the genetic barrier was still an overwhelming obstacle, but the success of the Reteris brothers offered hope that there was a way around it. That hope has become a reality for Grace Lopez. Desperate to relieve her suffering, her husband Alex submits to extensive testing to see if he can donate half his own liver. In a live liver transplant, half of the donor's liver is removed and implanted into the recipient, replacing the disease liver. This complex procedure is among the most sophisticated transplants available today and requires tremendous courage on the part of the donor. I'm going to give Grace half of my liver just so I can see her back to normal so she can stop suffering. You know, I mean, lately she's been so much. As soon as he found out that he can qualify for one, a live donor, he jumped on it. Three days before the surgery, Alex and the two children, seven-year-old Jacob and 11-year-old Alexis, packed for a three-week stay with relatives while their parents are in the hospital. You know, God willing, you know, we're going to pull through this together and you know, we'll go with our lives, you know, later on. Grace's hope lies in her doctor's ability to convince her body to accept a portion of Alex's liver, a procedure that seemed impossible to the transplant research team at Harvard in 1960 who were still mystified by the inevitability of tissue rejection that destroyed the organ in virtually every transplant they attempted. But then a breakthrough at Tufts University, where Robert Schwartz and William Damichek discovered that a drug originally created to fight leukemia could be used to inhibit the body's immune response. What we found was that treatment with this anti-leukemic drug suppressed almost completely the response to a foreign antigen. This opened the door to chemical immunosuppression as had been predicted by Sir Peter Meadowar in 1945 in England. He had demonstrated that tissue rejection was an immune response that could be altered. A young surgical student of his, Roy Count, became intrigued with this research. The first thing I did was listen to a lecture from Peter Meadowar, who was the most brilliant charismatic lecturer. So, paradoxical though it may seem, the rejection of an organ graft, something which is certainly most fears, is essentially the body curing itself. And his lecture made it seem that maybe transplantation would one time work. With Meadowar's encouragement, I managed to get a scholarship to come to Boston to work at Harvard Medical School. On his way to Boston, Dr. Count picked up some experimental drugs from Gertrude Ileon and George Hitchens at the Burroughs Welcome Lab in New York. So I took some of these new drugs and then we were able to get animals living, not all of them, but some of them living really a long time, years even. And one of them was a very famous dog called Lollipop, who was the kind of star of our dog colony. And the grand rounds would bring a very prestigious occasion once a week that the chief resident would present the dog as if it was a patient. So this young adult lady lost her kidney function, had a kidney graft and was treated with this new drug treatment and is now doing well, the kidney's working and would you like to bring the patient in? The chief resident opened the door and we whistled Lollipop and she ran in, licked everybody in the front row and that had a big, big impression, you couldn't do that now, you wouldn't be allowed to do that. The new drug that had defeated Lollipop's immune reaction after her transplant was renamed M-neurad and immediately tried in humans, but only a few of them survived as long as a year. The secrets of the body's immune system had yet to be unlocked. In St. Louis, Missouri, a female patient with head trauma is brought into the hospital in the early morning. Her injury makes her a potential organ donor. The donor was brought in at like one in the morning and was pronounced brain dead at one in the afternoon. We got the call about, I got it about 12.30 and called Dr. Balfour and he spoke with Dr. Fiori and they decided to accept it then. At about 1.20 in the morning, Erin called and she said, Patty, this is Erin Happy Father's Day and I was like, oh my gosh and so then she said, go get Ashley. So I woke her up and I ran in and I went, Ashley, you got a heart. And she was like, you know, she was asleep and she didn't know what was going on. I actually haven't been feeling my best lately. I've been really tired and dragging and just I've been getting a lot of fluid on my lungs. That's really hard for me to breathe. So I'm kind of glad that it's coming when it is. 25 months after being listed for a heart transplant, Ashley's long wait is over. This is the UNO's list that shows Ashley. A crucial first step in any transplant is making sure the immune reaction to the donated organ can be controlled. The breakthrough in this process was discovered by a brilliant young surgeon named Thomas Darzel working at the University of Colorado. We turned our attention to studies of kidney transplantation almost exclusively starting in the spring of 1962. And the observations were that you could reverse rejections that developed under Imuran with steroids. This simple yet amazing discovery permitted Dr. Darzel and his team to transplant kidneys into several people who are still alive more than 40 years later. Transplantation of human organs had finally become clinically viable as a long-term cure for disease. And suddenly we had this huge burst of successful kidneys and it was totally unexpected. Caught everybody with their pants down probably even including ourselves. The curious thing was that no one knew why things had succeeded. I mean for at least the next 30 years. It was apparent why organ transplantation should work at all. It was that's a great mystery. Having overcome the major obstacles to successful kidney transplants, Dr. Darzel returned to his original goal. Transplantation of the human liver. The first five attempts at liver replacement occurred over a period of eight months but all ended in death. Looking back on it in retrospect those patients were well on their way to recovery as far as defeating rejection. The problem lay in transferring the complex procedures from the laboratory to the operating room and it took Dr. Darzel four more years to perfect the operation. One breakthrough that made it possible was improved immunosuppression with the use of anti-lymphocyte globulin that had been developed by Anthony Monaco in Boston and John Najarian in San Francisco. And it turned out that RALG the anti-lymphocyte globulin was able to increase the survivalship of grafts by some 10, 15 percent or more and so it really turned out to be quite an effective agent. ALG when combined with immune and steroids became the standard immunosuppressive therapy over the next decade. These drugs along with improved surgical techniques made it possible for Dr. Darzel to resume liver transplantation. He said we're going to do another series of dogs using this drug you know how to handle it? I said sure. Paul Taylor a research assistant and highly regarded lab technician working side by side with Dr. Darzel and other transplant surgeons was a key player in helping to develop successful liver transplants in humans using the new drug therapy in canine patients. So we did a series of liver transplants and at about 15 days with a house full of dogs he said we've got to do a human we've got to be first in the world. In 1967 Dr. Darzel's new transplant trial succeeded making these young girls the first liver transplant survivors in history. It was a fruitful period maybe the most fruitful period of my life because all the fundamental issues were addressed and for the most part solved at least in principle. One insight that seems obvious now but was a revelation to doctors in 1964 was the importance of matching blood and tissue types between donor and recipient. This discovery occurred at the medical college of Virginia where David Hume had set up a new transplant program. They did two transplants from the same donor and one of the kidneys worked spectacularly and the other kidney got blown out in a couple hours and so Dr. Hume studied it. He found out that you could have hypercute rejection if you have antibodies against that particular donor and out of that came the whole concept of that you have to do a cross match with the cells of the donor and the serum of the recipient to see if there's a reaction. At UCLA cross matching of donor and recipient will become the research focus of Dr. Paul Terasaki considered the Dean of Tissue Typing. In 1964 we developed a method for tissue typing and this method allowed us to look at many, many antisera, many, many people. For kidney transplants the best results are obtained with the HLA matched transplant. But while tissue typing was important in improving transplantation success during the 1970s it did not completely solve the complex problem of tissue rejection which still took the lives of far too many patients. In San Francisco Grace Lopez's condition is deteriorating so dramatically that the day before she is to receive half her husband's liver her doctors have to change their plans. And because of my kidneys have gotten worse in a weekend we cannot do the live donor at this time. Because of Grace's failing kidneys she will need a kidney transplant in addition to the liver. So a live transplant from her husband is out of the question. She is placed on the waiting list for a combined liver and kidney from a deceased donor. But as of right now my score is so high and amounts for a whole liver. It's gotten high too where I can qualify for one. So the way our system works in the United States patients are given points for being ill. And the most gravely ill patients get the most points on the meld score and they have first access to organs. As Grace's meld score climbs both of her kidneys fail and she is put on 24 hour dialysis. Finally as she faces death itself a liver and kidney are donated by the family of a nine-year-old who died in a tragic accident. They say it's a perfect match. It's not too big, not too small, it will fit me just right. Lily you're gonna go to sleep in about 15 minutes. I'll let you know what it's about to be. You're a man, it's true, okay? Okay baby, you're late. While the blood vessels of the donor liver are prepared for their new connection the disease liver is removed. After the new liver is connected and perfused with blood the new kidney is placed in the lower abdomen leaving the disease kidneys in place. It soon produces urine. All together the double transplant surgery takes 10 hours. Everything went fine. Yeah no problems. You know the operation went very very well. I think the liver is already working and the kidney looks like it's probably going to perk up too. Excellent organs but right now she's very stable and everything's going well. The double transplant of a liver and a kidney that saved Grace's life followed essentially the same procedures developed by Dr. Starzl and others almost 40 years ago. With those breakthroughs the demand for organs increased dramatically making it essential to develop ways to preserve organs outside of the human body so they could be transported from donors to recipients who were often many hours away. In 1966 Folkert Belzer a Dutch immigrant who became a transplant surgeon at the University of California San Francisco developed a preservation technique that allowed donated kidneys to be kept in a viable condition for 72 hours. It came to be known as the Belzer machine. This huge 400 pound preservation machine rolled it on the lift gate and put it inside of the van and tie it down and we would transport organs within a 300 mile radius of Richmond. Take it into hospitals. That worked very well. Later at the University of Wisconsin Belzer developed a new preservation solution that kept organs viable for three times longer than had been possible before. The reason we're able to transplant as many organs today in good part goes to him because he developed a solution by which we can preserve the kidneys, hearts, livers, and can afford to keep those organs outside the body for some period of time before they're transplanted. Ironically new successes in surgery and immunosuppression and the ability to preserve and transport organs created a new problem and ever-increasing demand for healthy organs. In the late 1960s some relieved to this short as resulted from a new definition of death created at Harvard in order to relieve the suffering of terminally ill patients. So I went to the Dean of the Medical School and said we should define death in terms of brain function rather than heart or lung function. And so Dean Ebert set up a committee and there are about 15 of us on it and tried to define death in terms of cessation of brain function. And they consider just what should be the ingredients of the diagnosis of brain death that would be utterly reliable so that when you found these changes in a patient you could say that patient will never live again. That you can sustain the body for a period of time but that the patient would never wake up and would never have a life after that. It had to be utterly certain that that was true. The Harvard Committee's criteria for brain death was published in the Journal of the American Medical Association in 1968. And when that occurred that opened the field because then we could take a patient whose heart was still beating, lungs were still working, kidneys were working, liver was working and yet he's brain dead and be able to remove those organs while they were still vital and be able to use them for transplantation. It's important to emphasize that this diagnosis of brain death was not made for transplantation. It was made for those patients who were dying and one needed to have that to stop treatment when it wasn't going to do anything further. It did turn out to be very helpful for transplantation and sometimes people have been confused and thought well transplantation made it happen but it didn't. It was there anyway. And when there's brain death there is nothing that can be done and families often respond to the suggestion that others will benefit from this and others will live and they find that very comforting. The idea of brain death opened the door for the most dramatic of all transplants the human heart. This remarkable procedure was developed by Norman Shumway at Stanford University beginning in 1951. Working with Dr. Richard Lauer he spent 10 years in the research clinic and laboratory. So we knew that it would work. So we had if you will a confidence that it would work and from that confidence we had better results coming with every successive transplant. But in spite of a decade of painstaking research it was not Shumway who performed the first human heart transplant. In 1966 a young man named Christian Barnard came and spent three months with us in Richmond. I shared an office with him for three months and then he went back to South Africa and the thoughts were here both with Shumway and with Lauer that you couldn't really lay somebody on the table and then take their heart out. That it had to be somebody who had been on the pump and couldn't get off which happens in heart surgery and they never had a patient like that at the time they had a donor. And so Chris Barnard said well that's crazy what we need to do is to take a patient to the operating room when we have a donor and take out his heart. On December 2nd 1967 in Cape Town South Africa Dr. Christian Barnard a surgeon who had studied with Dr. Shumway performed the first successful heart transplant in a human. So I connected the heart exactly as I had practiced in the laboratory. I was not under stress or tension during that period because I knew that I could do. The next point was where I was worried would the heart start beating again once I supplied now with warm blood from the Heartland machine. There was absolute silence and nervousness I think that was almost tangible at that moment and then he took the clamp off and the next thing the heart started beating and it was absolutely wonderful. The jubilation everybody was smiling and it was really superb. And I then stretched my hand across to my first assistant I said to him it's going to work. I was lucky enough to get a second chance. It's very few people do. By 11 days the patient was out of bed but then fatal pneumonia supervene on day 18. They did have an infection and I'd made the biggest mistake there because what I did it I increased the drugs that that stop rejection and actually therefore made it much worse for him to fight the infection that they had in his lungs. But even though the success was fleeting, Kristen Barnard's daring operation was hailed around the world and made him an instant celebrity. Within a couple of months Norm Shumway did one in Stanford and we did one in Richmond. There's that old saying you know the early bird gets the worm but the second mouse gets the cheese which I always thought was kind of interesting to say. These dramatic surgeries stimulated an explosive growth in heart transplantation around the world. In 1969 places were doing heart transplants where you wouldn't want a regular open heart operation done. Of course as those patients all began to die in very short order there were very few institutions that kept a program active in the 1970s. The death of so many heart transplant patients in the 1970s pointed once again to the relentless ravages of tissue rejection. It was clear that more research into immunosuppression was essential. At Cardinal Glennon Children's Hospital in St. Louis the time for Ashley Brooks heart transplant has arrived and Dr. Fiore prepares for surgery. The technique has been around since the 60s and it was developed by predominantly Richard Lauer and Norm Shumway. Together worked out the details and the technique is pretty much not precisely but pretty much unchanged. The actual surgery takes several hours once you receive the heart it doesn't take really very long to implant it especially in this case where the anatomy is normal. The anesthesiologists prepare Ashley for surgery. Meanwhile across town the organ recovery team working on the donor discover a nodule in the abdomen which could halt the transplant if it is found to be cancerous. Cancer makes any transplant impossible because it complicates the administration of immunosuppressive drugs. The most important of these drugs were discovered by accident in a clump of soil from the coast of Norway. A compound named cyclosporine was isolated from a fungus in the soil and it would have a far-reaching impact on transplantation. In 1972 at Sando's laboratories in Basel, Switzerland a team of researchers including immunologist Jean Morel identified immunosuppressive properties of cyclosporine. The first example of a drug that bound inside a cell and prevented it from producing its program of response. And this was finally approved by the FDA 1983, January 83, and then transplantation just boomed because it moved the results from 40 to 50 percent to 75 to 85 percent. And then everybody wanted it and became respectable. Sometimes there was a perception if a little kid went on TV a little yellow baby who had liver failure and that person got a transplant people thought oh you have to go on TV to get an organ. I want Jamie to live. I'm willing to go anywhere do anything at any time day or night to have that take place. And it began to get very unseemly and it was clear that we needed a national system. The United States Congress recognized the need for standards and regulations on a national scale. I was at that time president of the American side of transplant surgeons and I took this on as my cause. So began approaching members of Congress both representatives and senators. This took two years to do. Finally in 1984 Congress passed the National Organ Transplant Act. The National Organ Transplant Act created several things it created the system we have in this country of organ procurement organizations that work in their local areas to encourage organ donation and to recover the organs and to distribute them for transplantation. It also created the National Organ Procurement and Transplantation Network which UNOS has operated since its inception. Since 1986 UNOS the United Network for Organ Sharing in Richmond, Virginia has been the national center through which all organs from deceased donors are procured for transplantation. Their large database is kept current with medical information on each potential recipient waiting for an organ. Then the organs are allocated locally first to those patients who have the highest urgency. If there's not a good match locally then it would go out to a region of the country. If there's not a good match there then ultimately out to the rest of the country. Hi this is Rob. This is coming to you guys out of Virginia VATB. This is a right kidney. It was through UNOS that Grace Lopez received her new liver and kidney. Finally made it. Three weeks after her surgery she makes a follow-up visit to her doctor. Your kidney is working great. Your creatinine is 0.9 so your kidney transplant is working great and the billarubin is usually the last thing to come down back to normal but everything else looks like it's doing great. So from the liver and kidney transplant standpoint everything's a-okay. The miraculous science of transplantation has saved the lives of tens of thousands like Grace Lopez but the organ transplantation procedure that took the longest to develop was the lung. The first lung transplant was performed by Dr Thomas Hardy at the University of Mississippi in 1963 but it was unsuccessful. Over the next 20 years 38 transplants fail not just because of the tissue rejection but also because the airway connection would not heal properly. Then in the early 80s Dr Cooper developed a unique solution to this problem and performed the first successful lung transplant at Toronto General Hospital in 1983. We used an old surgical trick. There's a long fatty appendage off of the stomach. It looks like chicken fat. It has a lot of rich blood vessels. It's very mobile and it can be taken still attached to its blood supply to various parts of the body to bring in new blood supply. Again it was a trick that I learned when doing airway surgery. So we then did experiments and we brought that fatty appendage up wrapped it around the airway connection just like a plumber would wrap a pipe and demonstrated that within hours new blood vessels could grow into the airway that had been reattached. Dr Cooper's innovation and the powerful new immunosuppressive drug cyclosporine finally made lung transplants successful. In St. Louis as Ashley's chest is prepared pathology reports show the donor does not have cancer and her heart transplant can proceed. All right, ready? Here we go. It's tying up. Pepper's in. At this moment called the cross clamp the donor's heart is stopped and removed. Within four hours the heart must be packed in ice transported across the city and sutured in Ashley's chest. If all goes well the transplanted heart will start beating on its own when it fills with warm blood. Meanwhile Ashley's circulation is diverted to the heart lung machine before her defective heart is removed. The blood vessels are tailored to fit and then sutured in place. Using electrical panels the heart is stimulated to start beating after it is perfused with blood and soon a normal rhythm is achieved. By 8.15 in the evening the surgery is completed and Dr Fiori meets with Ashley's family. Everything looks really good so far the rhythm's normal there's no bleeding the heart function is good and the valves are working normally. There's a lot of people keeping a close eye on her back there. The complex surgery replacing Ashley's heart appears to be successful but another challenge lies ahead for the transplant team preventing her body from rejecting the new organ. It's a fine line they do really well but it's an incredible effort by a lot of other doctors and nurses after the surgeon implants this. This had been true from the very beginning of transplantation when doctors learned that medical care after the transplant was as important as the transplant itself in keeping patients alive. The surgery itself was easy enough it's taking care of the patients and running this line between too much immunosuppression and not enough and taking care of the complications. As the outcomes got better it was clear that the long-term issues were largely medical issues not surgical issues I mean the surgeons had were successful in doing what they were had set out to do they got the organ in it was functioning nicely but then people got infections they got heart problems they got diabetes and so it became a field for both surgeons and physicians. If something gets out of whack if you know drugs don't get given or appropriate tests don't get drawn and you when you examine these patients if you see something or note something which isn't quite right and you pursue it and you uncover a problem and you treat it that can be the difference between life or death for these patients. Five days after the heart transplant Ashley's progress is evaluated. It's a miracle that they know how to put it in it's a miracle that it's still being nice and strong and this morning she called me and said mom I had a heart transplant I have a new heart in me and she was really I think that's the first time it really dawned on her that she was you know gonna be okay I've been so lucky you know I just was like it's just a miracle I can hardly believe it. While the surgery appears to be successful the next few weeks and months will determine the outcome of Ashley's transplant. As her doctors maintain the precurious balance of medication that will prevent rejection of her new heart Ashley looks forward to a new life as an adult. I just love getting Christmas tree. Yes! That's a pretty one. It will be. It feels like a second chance at life because I've never felt like this before so it's just amazing it really is. We're gonna get these little branches. I have so much energy now and I just I get to do all these things that I haven't gotten to do. It is a miracle. It's like a new kid. Just got this life to look forward to. A paradox of the many miracles in the science of transplantation is that its successes have caused an overwhelming shortage of organs but new breakthroughs are helping to alleviate this problem. New surgery techniques for example have made donating much less traumatic for live kidney donors. In 1990 the first removal of a diseased kidney using the minimally invasive technique of laparoscopic surgery was achieved by Dr. Ralph Claiming in St. Louis. We looked at the kidney and said well why why can't we take the kidney out and lo and behold we could dissect it out. It does result in less blood loss. It does result in less pain. It does result in shorter hospital stay. It does result in less disfigurement. It does result in quicker convalescence. A modification of this laparoscopic technique will later be used at John's Hopkins to remove donor kidneys for transplant by Dr. Lord Ratner. It's worked out terrifically. In fact the first case that we did, the first case was performed by myself and Dr. Lewis Kavusi in February of 1995 and at that time it was extremely controversial. We would present our data at national meetings and people would stand up and yell at us and say we were going to kill patients and that it was you know that couldn't be done and now in the United States more than 70 percent of all kidney donor operations are performed laparoscopically. And the patients get out of the hospital and get back to work in half the time. So essentially that operation has made it easier in a way to donate a kidney. We thought we understood everything about kidney transplant in terms of the technical advances. Well we didn't. We made this little advance and look what has happened in the same way. The whole technical advance of splitting the liver, of doing the live donor liver transplant has opened the door again. The fascinating thing about the liver that permits us to do this surgery is that it's the only solid organ in the body that's able to regenerate. The cells receive a stimulus that tells them now it's time to grow so they will replicate and they will and the liver will regenerate to the size that it was before within about 95 percent of the size but functionally it will be identical. In a complex and carefully timed procedure that takes seven hours in two separate operating rooms the live liver transplant is helping to overcome the severe shortage of available livers from deceased donors. The enormous amount of work and effort and extra risk that we have to take in doing living donation is justified because that's better than watching you know patients die in the waiting list waiting for a cadaver liver. Our big question is concerned how do you increase the supply of organs for transplantation and given the fact that supply is now and will probably be limited in the future how do you distribute available organs in an efficacious and fair or just way and those two questions remain the central ones in the ethics of organ transplantation. An organ donation now is our most important project for the next decade finding organs there's so many more people who need organs than who are receiving them. The statement has been made that we just aren't getting enough donor kidneys in this country. You've been doing this now for what 15 years as long as kidney transplant. This shortage of available transplant organs is what motivated Dr. Samuel L. Coons one of the early transplant surgeons working out of San Francisco's General Hospital to bring the need for donors to mass public awareness and into their living rooms. His son remembers. He was becoming quite an advocate for organ donation and he arranged to do a live transplant on the today's show. Now in this case you you've already hooked up the kidney. The kidney has been hooked up the renalottery it's hooked up here I think you can see it. He really wanted to demystify it and make it something that wasn't so distant and scary. To help address the growing need for donation of healthy organs efforts to raise public awareness has been undertaken by public and private organizations across the country. Organizations like Donate Life America. It's not about dying. It's about living. Donor families, transplant recipients, local and national donation and transplant organizations and state and federal governments all have implemented efforts to encourage donation. In fact the U.S. Department of Health and Human Services recently implemented three breakthrough collaborations involving hundreds of healthcare facilities in the donation community to focus intensively on increasing donation within the nation's hospitals. This effort led to an unprecedented increase in donation in 2004 through 2006. But sadly, despite all these efforts, the donation of healthy organs still lags far behind the nation's growing need. And minority donation is an even greater challenge. That's why we're out here. We're out here trying to alleviate some of the fears and misconceptions surrounding this issue. Many African Americans there have missed some misperceptions about why they don't want to donate. And Dr. Kellander was able to quantify those misperceptions and say these are the things we need to change through education. MoTAP is the National Minority Organ Tissue Transplant Education Program and because of that effort now, more than 50% of the donors that for the kidneys that our patients receive at Howard are from African Americans. Although the efforts of MoTAP have increased minority donations significantly at Howard University, in most other areas of the United States, there are still disproportionately low numbers of minority donors compared to minorities who are waiting for transplants. On the waiting list here in Alabama, nearly 80% of those waiting for our kidney transplant are African American. Yet still less than 15% of all donor organs come from African Americans. And so I appeal to you that we need more African Americans to be organ donors. But even with all these efforts to encourage donation, within the next few years a hundred thousand people will be waiting for life-saving organs. And more than 16 people die every day because no organ is available for them. And even with the remarkable advances over the past 50 years, the ultimate goal of tissue tolerance has yet to be achieved. The research today is looking for tolerance, which is the ideal. It's something that we refer to as a holy grail of transplantation. In other words, is it possible that we can make individuals tolerant to the point that they will not require immunosuppressive drugs? Looking at the past 50 years, I look at it as a climb towards the top of the mountain to achieve a perfect transplant. So if a blind mountain climber could scale Mount Everest, I'm sure we can reach the top of the mountain and achieve that perfect transplant. I've often said that everything we've done up to this point is just a drop in the bucket. This is a prelude to the real era of transplantation. But there are still major problems. The biggest obstacle to long-term success is rejection or the complications of immunosuppressive drugs. The biggest obstacle to getting a transplant is the insufficient number of donor organs. That problem's going to be a little more difficult. The future looks bright for Grace Lopez. Six months after her double transplant, her family and friends join her to celebrate her 37th birthday in the beginning of a new life. Nothing hurts anymore. I feel good and it feels good just to feel good. The bottom of my heart. I don't think there's a day that I don't think about my donor's family. Every day, every day I think about them because of them, because of their decision. I'm here today. I've now done transplants, kidney transplants, and over 900 children. And it's the most rewarding of all the transplants I do to take a little child and give them an organ and have that child grow up and send you an invitation to his graduation from high school. You can't find a better paymaster than that. There's a gentleman from Denver, Colorado who came here and was on a ventilator from severe emphysema. And I think it's been about 10 or 11 years now since he had his successful bilateral transplant. Every year he goes to Switzerland. He sends me a picture from the top of the mountains surrounded by snow capped peaks. That's a miracle. It is a miracle. It's a miracle in the broadest sense. It's not magic. It's a wonderful thing. For Science of Miracles, I'm Alonzo Morning and I got my new kidney on December the 19th, 2003.