Surgery: art or science? Birth of organ transplantation.

The revolution in organ transplantation that occurred between 1950 and 1963 can be used to illustrate the way that surgery has influenced science, all the while preserving a niche as an art form. This modern era of transplantation immunology had begun several years earlier when Peter Brian Medawar, a 24-year-old zoologist fresh from graduate studies at Oxford University, was assigned to the service of the British plastic surgeon Dr Thomas Gibson to determine if skin allografts could be used to treat casualties from the Battle of Britain. First in human studies [1] and then with simple and logical rabbit experiments [2], it was shown that rejection of the skin was an immunologic phenomenon analogous to the cell mediated delayed hypersensitivity that confers immunity to diseases such as tuberculosis [3-5]. The principal evidence was that repetitive grafts from the same donor were rejected more rapidly with each successive attempt [1,2]. The donor specific sensitisation caused by repetitive grafting confirmed previous clinical observations by the surgeon Emil Holman of Stanford University in skin grafted burn victims [6].