Horizon (1964) s52e05 Episode Script
Mend Me: A Horizon Guide to Transplants
This programme contains some scenes which some viewers may find upsetting.
Being able to cheat death when our organs fail by having a transplant, is one of the great achievements of modern medicine.
Success, the kidney colours and swells as the patient's blood surges through it.
I feel like I've been blessed with the opportunity to live a longer life.
I've felt, since my transplant, absolutely wonderful.
Yet, it's been a long and bloody fight for surgeons who faced ethical hurdles to revive the living with organs culled from the dead.
I the wonder what the fury of heaven would be at the notion our bodies are collections of spare parts.
And also for the patients, willing to gamble and endure almost anything in their bid for a longer life.
Somebody has to find out how it goes.
If the ship's sinking and this is the last life raft, you know? And the two patients, what happened to them? They died.
For the last 45 years Horizon and the BBC have charted the progress of surgeons whose desire to break new ground drove them to glory and disaster.
Cardiac surgeons who knew absolutely nothing about transplantation, wanted to show that they also could transplant the heart with a 100% mortality.
Despite early failures, surgeons have largely succeeded in their attempts to harvest the body.
Now, the challenge of organ shortage is driving science in ever stranger directions.
How far could and should we go in our bid to prolong life? When I was a medical student, things like kidney transplants were relatively commonplace.
But in the 25 years since then I have seen some truly remarkable, and occasionally disturbing breakthroughs.
Most recently, the transplantation of a whole human face.
I've come to Boston to the Brigham And Women's Hospital to meet one of the world's leading face transplant surgeons, Dr Bohdan Pomahac.
Good morning.
Morning.
Hey, how are you? Hi, Michael Mosley.
Good-looking boy, isn't he? He was.
Yes, until he stepped on the live wire about 10 years ago.
'Mitch Hunter was just 20 years old when his car crashed into a pole 'containing a 10,000 volt electrical cable.
'The injuries to his face were horrendous.
' Ooh.
Ah That's the actual arrival following injury.
Poor soul.
That is there's something about it, I was kind of prepared for it, but that wasthat's a shock.
'Despite 16 previous operations, to correct the injuries, 'Mitch's face was still very disfigured.
'So he agreed to become one of the first 'to have a dead man's face transplanted onto his own.
' First, a team of 14 surgeons has to carefully remove his old face.
Painstaking microvascular surgery is needed to attach Mitch's arteries to the new face.
Blood supply is absolutely critical.
Without blood supply the face is not going to be alive.
Finally, the face is stitched to Mitch's own skin.
After 14 hours the operation is complete.
Four months after surgery I went to see how Mitch was getting used to his new face.
I would say within the first month I started getting sensation and, um, I think I'm going on the fourth and fifth month and it's 10 times better than what it was the first month.
You know, I can feel a lot more, like, I can feel the breeze on my face now.
Which is nice, isn't it? It's just amazing how much sensation that I've gained back in such a short time.
It's not perfect, but something that was once seen as bad science fiction is giving Mitch a much-appreciated chance of a normal life.
Yet, just over 100 years ago the very idea of transplantation was unimaginable.
All that changed with the death of a French president.
It was June, 1894, and President Carnot was on his way to Lyons when he was attacked by a knife-wielding anarchist .
.
severing a vital artery.
Surgeons had no idea how to reconnect the severed blood vessels.
And President Carnot bled to death.
A young doctor, Alexis Carrel watched his president die and was appalled.
Now obsessed, he learnt stitching and then spent years grappling with fragile blood vessels before finally perfecting a technique that drew the ends together in a perfect seal.
Carrel had invented vascular surgery.
But that was not enough for Carrel.
Why not, he thought, uses new surgical technique to take an organ from one body and attach it to another? Dressed in his trademark black, he embarked on a series of grisly and sinister experiments.
He took the kidney out of a puppy and put it in a cat.
And then, the front legs off a white dog and put them on a black one.
Carrel had successfully performed numerous organ transplants.
His surgical techniques were perfect, yet within a short while, the organs stopped working and the animals all died.
Carrel concluded that there was some mysterious biological force that made transplantation impossible and he abandoned this work.
He had inadvertently discovered the nemesis of the transplant surgeon - rejection.
Overcoming this barrier would be a major challenge for decades to come.
It wasn't until World War II that scientists had a breakthrough.
Large numbers of fighter pilots were suffering terrible, often fatal, burns.
An Oxford biologist, Peter Medawar, had the idea of covering burns with skin from corpses.
But the skin simply shrivelled up and flaked off.
Determined to find out why, Medawar started experimenting.
An early Horizon explored his methods.
Well, that was briefly as follows, he took two rabbits .
.
and he transplanted skin from one rabbit onto the other.
That piece of skin, in the form of an organ transplant, sloughed off after 10 days.
Then Sir Peter Medawar, a little later, took another piece of skin of that rabbit and transplanted it again on the same recipient.
And that piece of skin sloughed off after five days.
His recipient rabbit had become immunised by the previous transplantation of the piece of skin.
Medawar had discovered how the patient's bodies were projecting the grafts.
The patients are victims of their body's own defences.
Whenever any foreign material finds its way inside the body, white cells like these will attack it and try to destroy it.
This is what happens to the cells of a grafted organ.
The conclusion was a profoundly depressing one.
Unless scientists could find a way of taming the immune system, rejection would always prevent a successful transplant.
The Second World War did see a medical innovation that offered hope to some patients with organ failure - the first artificial kidney.
But the invention of dialysis meant wards were filled with kidney patients living longer, but with no prospect of a cure.
Despite the continuing problems posed by rejection, ever optimistic surgeons decided they now knew enough to attempt kidney transplants.
In Europe and the US, surgeons quietly began experimenting.
This time, on humans.
But first they needed kidneys from the newly deceased, fresh enough to transplant.
This, in an age when organ donation was unheard of.
A French surgeon settled on a macabre solution.
I said, there is no choice, we have to go to the prison.
So I telephoned the director of the prison, to ask whether or not they had, in the near future, some death penalties.
He said, "Yes".
"Well", I said, "could I take his kidneys?" "Yes, yes.
"He will be dead, no head, you can take the kidneys.
" Even when they could get the organs, surgeons resorted to some bizarre strategies in a bid to overcome rejection.
One tried transplanting kidneys in a plastic bag.
Another tried wiping out the patient's immune system with a massive dose of radiation.
None of the patients survived.
The statement is often made that we couldn't do that work now, it would be outlawed, maybe so, but those patients were suffering badly, they certainly needed a try.
Understandably, pessimism set in.
But American surgeon, Joseph Murray, refused to give up.
'Interestingly, many of my older friends, surgical and medical, 'told me as a young surgeon, don't ever get involved in that project.
'It'll ruin your career.
' But the sceptics' views were about to be challenged when in 1954 Richard Herrick came to Murray's hospital dying of renal disease.
Richard mentioned something about himself which gave Murray hope .
.
he had a perfectly healthy twin, Ronald.
Murray reasoned that if he took one of Ronald's healthy kidneys and give it to his sick brother there would be no rejection because identical twins have identical immune systems.
So he decided to operate.
Within 10 seconds, urine began to pour out the uraduct, coming down onto the floor, we had to get the nurses to mop it up.
But this was a first.
And it was very exciting.
Within, oh, a week, he looked like a new person.
You just couldn't believe the transformation.
Murray had done it.
The world's first successful organ transplant.
Both the twins survived, Richard even married his nurse.
If the operation had failed, transplantation would have been set back years.
Maybe decades.
Because there was an inherent feeling against the whole concept.
It was a total victory for all of us.
Because it meant that the problem was not hopeless.
It just redefined the problem.
Now we had to figure out how to break down a rejection.
It would be eight years before Murray's team did just that.
Cancer researchers noticed that a drug used to treat leukaemia also suppressed the white blood cells which caused rejection of a transplanted organ.
The drug was called is azathioprine.
Murray prepared to try it out on his transplant patients.
Inevitably, it meant taking risks.
The first two patients we transplanted died with functioning kidneys, but they died of toxicity of the drug.
And the third patient we used, um with about a quarter of the expected dose, he survived for over one year.
And that started transplantation on a worldwide basis.
Being able to transplant kidneys between unrelated individuals was a huge achievement.
It offered hope where previously there had been none.
But it also forced people to confront an uncomfortable moral dilemma.
Organs had to come from the newly dead.
But how should doctors define when a person was actually dead? At what point in all of this did your donor actually die? I think that's one of these interminable questions and answers.
The old notion of death occurring when the heart stops had to be modified to mean brain death, so organs could be harvested while blood was still circulating.
And as transplants went mainstream, it forced doctors whose goal is normally to save life, into uncharted territory.
Tell them I'll be there in about an hour and a half.
OK, bye! To find organs to transplant they would have to actively target those on the brink of death.
'I think a transplant surgeon 'has only got to look at the list of patients 'that are waiting for transplants 'and he's driven to go and find kidneys.
'Remember, these people are dying.
'The majority of them have no other form of treatment.
' 'There's a little girl now who is running out of time.
'I've got to find a kidney for her.
' 'It's embarrassing, everybody knows you waiting for somebody to die, 'and you've just got to sit there.
' The relatives are here, you can see them in the office.
OhOK.
Are they really upset? Yes, they're very upset.
Do you think I really ought to ask them? I think you should, I think it may even help them a little.
OK-doke.
Let's go.
The donor kidney having been tested arrives at the theatre inside the perfusion machine.
Success.
The kidney colours and swells as the patient's blood surges through it.
The connections are working.
I've felt, since my transplant, absolutely wonderful.
I didn't know it was possible to feel so well, because it's an experience I've never had through my whole life, even when I didn't even know I was ill.
Surgeons had crossed the frontier.
But now they wanted to go so much further.
And for the truly ambitious, there could be no greater goal than the human heart.
Transplanting a heart would mean taking huge risks.
Unlike the kidney, a beating heart would have to function perfectly, from the off.
In the US, several surgeons were vying to be the first.
And one thought he had the edge.
We had a recipient ready, we had the donor identified, in Philadelphia as a matter of fact, and that morning my daughter came in and said some joker down in Africa has done a heart transplant.
The world's first heart transplant has been performed.
Medical history has been made in South Africa.
Newspapers everywhere carry banner headlines and from medical men as far away as the Soviet Union there is a claim for the dramatic breakthrough.
The surgeon was Dr Christiaan Barnard, an outsider who had taken the world completely by surprise.
That was a new experience.
Because I've never seen a human being that was actually alive without a heart inside his chest.
And I realised at that stage that I was doing something different.
I'd never done THIS before.
And I realised that I had to put a heart back here.
The patient was Louis Washkansky.
For the first time, a transplanted heart beat inside the chest of another human being.
It was amazing to see how he lost all evidence of heart failure, the swelling of his legs disappeared, and he was mentally well.
And I really did not believe that it will not be successful.
So we were very optimistic at the beginning.
The whole world was willing Louis to get well.
But two weeks after transplantation, it all went wrong.
I think he died I think he knew he was going to have a wonderful life because he was fine for about 10 days.
I want to thank the doctors who didn't leave a stone unturned and thank everybody all over the world who wished him well, and they did.
Louis Washkansky didn't die of rejection, but rather a lung infection that he was unable to fight off because of the immunosuppressant drugs.
I was completely destroyed that morning, I went down to our office and I lay on the couch there.
And one of my black laboratory assistants came in and he saw I was crying.
Because he was a very likeable man, Mr Washkansky, he was a very nice man.
There was great sorrow that we let him down.
But the sorrow didn't last long.
Despite the death of his patient, Barnard's life was transformed.
He became the man of the moment.
All of a sudden, I'm a celebrity.
Everyone wants to talk to me, wants to meet me.
I get invitations left, right and centre.
It was exciting.
I think, at one stage, I was probably one of the most popular people in the world.
Naturally, other doctors wanted to share his popularity.
In 1968, transplant fever gripped the world.
102 people were given new hearts in 18 different countries.
And perhaps it was this pioneering spirit that led surgeons in one London hospital to attempt a most improbable experiment.
The phone rang about 5:30 .
.
I had Donald Longmore on the phone.
And he was very succinct, he said, "I'm at the National Heart Hospital, "can you supply immediately two 200 lb pigs?" I had tomake the point that it was 5:30 at night.
It isn't the easiest thing in the world in London to find two 200 lb pigs.
He brushed that to one side and simply said, "Find them, "and have them down here as soon as you can.
" For my part, I made my way to the National Heart Hospital, so I'd be there when they arrived.
As the operating team waited, nine miles away a van was leaving the gates of the Animal Research Centre at the National Orthopaedic Hospital in Stanmore, Middlesex.
The time was just after 6:30 in the evening, the first pig was on its way.
Was it difficult to get the pig upstairs? Not particularly difficult.
But pigs aren't used to lifts, of course.
What happened then, when the first pig's heart was brought in? An attempt was made by the surgeon to attach this to the major vessels of one of the patients and having done this, blood was allowed to flow into it.
Can you describe exactly what happened to the heart as soon as it was attached to the patient? The heart became rocklike almost, and obviously had more and more difficulty maintaining its action.
And finally, it itself died.
And it was obviously the end part of a very swift rejection phenomena.
And the two patients? What happened to them? They died.
But of course if we are to progress in this territory, there have to be brave men.
There have to be first times.
There have to be trials and attempts.
Bravery is one thing, but this form of experimentation without ethical committees or anything like it, these days, seems almost jaw-dropping.
As the '60s drew to a close, the heart transplant dream was beginning to die.
The problem was that patients required much higher doses of immunosuppressant drugs than kidney patients.
And the survival rates made grim reading.
Two thirds of patients who had a heart transplant were dead within three months.
And very few made it much further.
Cardiac surgeons who knew absolutely nothing about transplantation, transplant immunity, the immune transaction of rejection, wanted to show that they also could transplant the heart.
With a 100% mortality.
And that was a disaster.
The man who started it all, Christiaan Barnard, may have become a celebrity, but many other medics were getting anxious.
And when the BBC invited him to face his peers, Barnard got a kicking.
The nauseating publicity, I think, has done harm to the profession, it's done harm to your self.
We're going to get so many failures that the public reaction against it will effectively postpone the day when we can all say that this can be safely done.
And even for those lucky few who did survive beyond the first weeks, life after surgery meant living with devastating uncertainty and a punishing drug regime.
Well, in a sense, I guess you could compare it to a man on death row.
Because he knows sooner or later he's going to go.
He don't know when.
And you're kind of hoping that they'll come up with something that will give you a little bit longer lifespan than that.
Prednisone, taken daily against rejection, can have crippling side effects.
I remember the very first time I was given the shot, I just couldn't move, I wouldn't let anybody touch me, the nurses or anybody.
Not even a bed sheet or my own pyjamas, they were painful.
My legs were very, very huge, swollen.
It wasn't the salvation that patients had been promised.
'My day begins at 5am in the morning, 'with the first batch of medicine I take.
'And it ends at 11 o'clock at night.
'You have to be continuously taking medication.
' Even huge quantities of drugs weren't enough to keep the immune system at bay.
And before long, the new organs would inevitably fail.
It looked like the surgeon's old nemesis, organ rejection, would sink their transplant dream once again.
Many governments started ordering hospitals to down scalpels.
But then help came from a most unexpected source .
.
a Norwegian fjord.
Drug companies routinely screened soil samples from around the world for new drugs.
And this one contained a fungus that appeared to possess exquisite immunosuppressant properties, controlling organ rejection without knocking out resistance to infection.
It was called cyclosporine.
Surgeons crossed their fingers and began using it on patients.
Cyclosporine was the breakthrough that everyone had been hoping for.
Finally, they had a drug which could suppress the immune system without so many lethal side effects.
Heart transplant programs reopened and survival rates soared.
Surgeons were able to make great leaps in the organs they could transplant - livers, lungs, bowls, sometimes all at the same time.
By the 1980s, transplants had become something of an everyday miracle.
Two teams of doctors worked throughout the early hours of this morning to perform the world's first triple-organ transplant.
The surgeons' success meant that demand for organs rocketed, and a national organ donor scheme was launched.
12 million of these new plastic cards are to be distributed.
The new card is being issued because new techniques are increasing the range of organs which can be donated.
Great in theory, but in reality, demand always outstrips supply.
Organ shortage meant that the hope offered by transplants often turned to despair for those on the waiting lists.
Thousands of people who could be saved are dying because there aren't enough kidneys.
This patient has a husband, if she'd been single or divorced she'd have been turned down.
For the doctors it meant making difficult decisions about who should get a second chance.
'At Guy's Hospital whether or not a patient lives or dies 'is decided at this weekly meeting of the renal unit.
' 'It's very informal, often heated, sometimes agonising.
' Very fit.
Brazilian.
Young.
Tough.
He's got angina.
Yes, but he's dying.
We have changed our policy considerably over the last two or three months.
And changed it in the face of four people coming in through the roof with terminal renal failure, none you know about yet, three are on hospital dialysis waiting.
Have we thought about approaching Thomas' on this? Cos we are very jammed at the moment.
As surgeons became more adventurous, the problems around organ shortage became more acute.
Particularly when it came to living donors.
If one of my brothers or my sister needs a kidney then I am happy to donate.
But what if the organ is less expendable? Would you risk your health for the hope of saving a loved one? Since the '60s, the Laughran family have lived with life-threatening illness.
Last year, medical science confronted them with a terrible choice none of us would wish to make.
I hope it will give her a large number of very happy years, andto give the gift of life to somebody, that is a wonderful opportunity to do something which is undoubtedly going to be the greatest thing I ever do in my life.
Nothing that I have learned has changed my commitment to doing this.
But I have to say I have been horrified by some of the information.
I'm only going to gain, whatever way, I've got nothing to lose.
Even if it gets to the day and they don't want to do it, I don't mind them saying no.
I don't want them to suddenly think, you know, because it is not fair that they should I just don't want them to I don't want it to ruin any part of their lives.
Sheila Batchelor suffers from cystic fibrosis, the most common genetic disorder in this country.
It is an incurable disease which is slowly destroying her lungs.
She needs to be on oxygen 24 hours a day.
By March last year, the family were facing their worst fear.
But then they heard about a radical new surgical procedure called living donor lung transplantation.
Conceived of in America, this controversial operation is being pioneered in the UK by Professor Sir Magdi Yacoub, the world-famous heart-lung transplant surgeon.
Using two living donors, instead of a dead donor, it is the latest attempt by medical science to solve the donor organ shortage.
Going to be given a whole new life again.
Brand-new life.
I don't think many people can be given that.
Unlike living kidney donor operations, lung transplants are both more dangerous for the donors and far less successful for the recipients.
This is because the lung is a very fragile organ, and does not transplant easily.
See you tomorrow.
Bye.
This operation has never been filmed before.
It involves three separate theatres staffed by three surgical teams working to Professor Yacoub.
He estimates Sheila's chances of survival at around 70%.
The first stage of this eight-hour operation is to remove Sheila's diseased right lung.
Two hours in, the professor begins to connect Damian's lobe to the windpipe and blood vessels in Sheila's chest.
It is a slow and delicate process.
Her diseased left lung has been removed in readiness for Josephine's lobe.
Finally, Sheila is ready to leave the theatre.
She is breathing with her new lungs.
The operation has lasted over 12 hours.
Sheila had a rocky first night, because there was a dangerous build-up of fluid on her new lungs.
Two days later, she still needs to be on a ventilator to support them.
Because of this, she is kept sedated.
Damian and Josephine's progress is slow.
They have substantial pockets of air around their lungs.
The pain has been absolutely incredible.
I have no way of describing it.
The feeling of total helplessness.
But part of what I want to do is to look as fit as possible for when Sheila wakes up.
Look like it was a complete breeze.
Despite the medical team's best efforts, they could not control the infection that was raging through Sheila's body.
Three weeks after the operation, Sheila finally lost her fight for life.
Everything has changed.
Everything.
I have tried not to think about it very much, deliberately tried to keep as busy as possible, just locking into a bit of a shell.
Just growing strong on the inside, I think, because I probably look exactly the same but I have the scars to prove it and I have things that have changed inside me.
It is a mesh of perspective on life, I guess.
Every time we lose a patient, there is great sadness.
And what we try and do is to analyse why, and then make a decision about whether to offer this type of operation to people or not.
Despite the risks, the living lung operation is still being offered to desperate families.
Success rates are improving.
Human experimentation has always been the cornerstone of transplant surgery.
But every breakthrough brought new challenges, especially when surgeons moved beyond life-saving to more cosmetic grafting of body parts.
When Clint Hallam was chosen to receive the world's first hand transplant in 1998 after losing his own to a circular saw, little did he know the price he would pay for being a surgical pioneer.
My first thoughts when I saw my hand was that it was a miracle.
The total join actually goes around in quite a jagged join.
It has probably only been in the past six or seven months that I have started to feel uncomfortable, sometimes, with the actual differences in the skins.
The difficulty that I find psychologically is that I want to be able to use my hand to do things.
But it is not always possible to control it.
Brushing my teeth is a safe exercise for using my hand.
When it comes to shaving, I make sure I have got the razor in my good hand.
Fully under control.
No, no, no.
It was not just Clint who struggled with the hand.
I've had people in aeroplanes, one lady asked to be moved to another seat because she didn't like the fact of sitting next to me with this hand that belonged to a dead person.
Clint also began to resent the toll on his health from the heavy regime of antirejection drugs.
The two most physical side-effects that I notice is first, I have diabetes.
The second side effect is more physical, in that my body has gone from chest to breast.
That is a little bit difficult to deal with.
Despite his world fame as a transplant pioneer, Clint took a difficult decision, he decided to cut back on his antirejection meds.
There could only be one outcome.
The redness in the fingertips, the fingernails falling off, are all indicators of a serious rejection problem.
By 2001, Clint's immune system had almost completely destroyed his new hand.
Good evening.
Clint Hallam was at the centre of a medical breakthrough two years ago, but now he wants out.
Having had the hand of a dying man attached where his used to be, he is now begging for it to be removed.
I certainly believe that there must come a stage, yes, my body and mind has said, enough is enough.
The morning after this interview was recorded, Clint's hand was surgically removed.
It was the stuff of nightmares.
A graphic illustration of the difficult truth that when surgeons blaze a trail, they can't always predict the outcome.
Surgery had advanced to the point where virtually every part of the body was up for grabs.
We faced another uncomfortable reality, that mounting demand for body parts left the whole system open to abuse.
In the United States, 1.
5 million tissue transplant operations are performed every year.
It has created an enormous demand for tissue that needs to be met.
It is in tissue for transplant that the body's real financial value lies.
If every useful bit could be recovered, processed, and sold for its maximum value, the proceeds from a single body could be $250,000.
With so much money on offer, perhaps it is little wonder that the abuse of bodies is so widespread.
One of the people attracted to the money was former society dentist Michael Mastromarino.
Michael Mastromarino was an oral surgeon who appeared to have a very successful practice in New Jersey.
He got into drugs, his license to practice as a surgeon was suspended, he had a very nice lifestyle that he needed to keep up.
And so he went into the body parts business.
In 2002, Michael Mastromarino had set up a company, Biomedical Tissue Services, to procure and sell human tissue for use in transplants.
All he then needed was a cheap and reliable supply of bodies, for which, like all good grave-robbers, he turned to the funeral business, and they were only too happy to help.
Before long, he had a network of over 30 funeral parlours between New York and Philadelphia, prepared to let him chop up the bodies in their care.
The useful bits, the bones, the tendons, the skin, were removed and packaged up.
Bodies destined to be buried were reconstructed with PVC plumbing pipe.
When they were exhumed, x-rays provided ample evidence of the body-snatcher's handiwork.
Over four years, Michael Mastromarino made nearly $5 million from stealing the parts of over 1,000 bodies.
One of them was one of the great journalists - Alistair Cooke.
In March 2004, just weeks after recording his last Letter From America, Alistair Cooke died.
He was 95 years old, and had been suffering from lung cancer.
Susan Cooke Kittredge is his daughter.
He would have certainly been intrigued by this story.
He would have appreciated the sort of Dickensian smoke, grave-robber essence of what was going on.
But had he ever imagined that it would happen to him, he would have been horrified.
The tissue was sold to processing companies who turned it into sterile medical products.
But Michael Mastromarino's biggest deception was that he was forging the details of the deceased's health.
He was 95 years old, he was very, very frail, and he had bone cancer.
Now, it's my understanding that I can't contract cancer from those bones, but those are not going to do me a lot of good.
But by the time the bodysnatching ring was smashed, more than 25,000 products, made from the stolen bones, had been distributed all round the world.
Many of them had been implanted into living patients.
But there is a solution to the problem that would ensure a plentiful supply of human tissue.
Could you thwart this whole crime by increasing the supply enormously, by having everyone donate their bodies? It would shut it down right away.
Throughout the long history of transplant surgery, people have had to battle with the twin problems of shortage and rejection.
Not surprisingly, from the early days, others have looked for alternatives that do not have those particular problems.
Just as with the transplant pioneers, they soon discovered that they were beset by death, disaster, and the clash of giant egos.
Back in the early days of heart transplants, a Houston surgeon decided technology was the answer to organ shortages.
Dr Michael DeBakey led a team that created an artificial heart.
We were thinking the heart is just a pump.
It seemed logical that if that was the main function, you ought to be able to duplicate that mechanically.
In the 1960s, Michael DeBakey's team was testing his artificial heart in animals.
The principal researcher, Domingo Liotta, went to Dr Michael DeBakey with a startling proposition.
Dr Liotta was very ambitious to apply the pump in humans, and I explained to him that we couldn't do that because it had been used on seven calves, four of which died on the operating table.
We couldn't go and get approval from the committee.
I didn't realise that secretly, he went to see Dr Cooley about it.
Denton Cooley was one of Dr DeBakey's proteges and colleagues.
He saw an opportunity to do the first human trial, an opportunity the more cautious DeBakey was not prepared to take.
Dr Cooley had no experience with the artificial heart programme at all.
He had no experience in the laboratory, he did not do any laboratory work.
He was a good surgeon, but that was all.
Dr DeBakey seemed to show little interest in using it, Dr Liotta thought that he was just wasting his years in the laboratory working with animals and so on, that this would never be tested clinically.
I thought and I agreed with Dr Liotta the time had come to really give it a test, and the only real test would be to apply it to a dying patient.
The patient was Haskell Karp from Skokie, Illinois.
He was a man with a long history of heart problems.
On 4 April 1969, Haskell Karp became the first human to be implanted with an artificial heart - a version of the device which had been developed in DeBakey's laboratory.
His own heart was completely removed.
Karp was maintained on a heart-lung machine while the artificial heart was implanted.
It was intended to keep him alive only until a donor heart could be found.
Unusually, Dr Cooley had not sought any approval for this groundbreaking operation.
In those days it didn't feel like we needed permission, I needed the consent of the patient.
That was essential, of course.
I think if I had sought permission from, say, the federal agency or the hospital, anybody else, I think I probably would have been denied.
We would have lost a golden opportunity.
I was in Washington when I read in the morning papers about the use of this artificial heart that Dr Cooley had put in a patient.
I was shocked.
I didn't know he had done all this surreptitiously, taken from the laboratory.
Two days after the operation, with Karp growing worse by the minute, his wife made an emotional appeal for a human heart.
Within a day, a donor heart had been found.
But Haskell Karp died shortly after it had been transplanted.
Dr Cooley's justification was he was trying to save the life of this patient.
Which, you know, you don't take an external device to save the life of a patient that has had no evidence that it would do that.
In the ensuing controversy, Dr Cooley resigned from DeBakey's college.
But as the first man to implant an artificial heart, his international reputation had been secured.
I think it is naive to think that we all have the purest of motives in what we do.
I enjoyed the thrill of doing something for the first time, something no-one else had really conceived of, or else they did not have the courage to attempt it.
You realise this is a much more complicated problem than it first seemed.
And after we had worked on this, I came to the conclusion that it probably is best to quit working on the total artificial heart.
But DeBakey did not give up on technology.
The Cooley fiasco simply spurred him on to make it better.
He went back to basics, and developed a device called an LVAD - an implanted pump that boosted a failing heart, rather than replacing it.
The first patient that we had was very impressive.
We were able to relieve the patient of the failure.
So that spurred us on.
This innovation would go on to prolong the lives of thousands of people while they waited for a new heart.
And as waiting lists continue to grow, a group of scientists embarked on a project which they hoped would be a game-changer, it would provide us with a limitless supply of organs by manipulating genes.
Their controversial work was shrouded in secrecy, because the organs would not be coming from humans but from pigs - genetically modified with human DNA.
Unlike the earlier pig fiasco, it was hoped that genetically engineered pig organs would be close enough to human tissue to minimise rejection.
If we were thinking about using pigs as donors, for the first time we could now treat or change the pig in some way so that the organ of the pig was accepted by the patient, instead of trying to treat the patient to accept the organ of the pig.
It is April 1995.
Alexion Pharmaceuticals, an American company that has also bred genetically-engineered pigs, is about to put their theories to the test.
Two baboons will receive the pig's organs.
They are close relations to humans, and if the transplants work, scientists say they will also work in people.
The idea is to see how long the transplants will last.
Normally, they would be rejected in a matter of hours.
If the genetic engineering works, they will last longer.
The pig's heart and lungs are removed first.
We have opened up the abdomen and chest of the animal.
We are preparing to harvest the left lung, which we're going to use for the lung transplant.
The baboon's lung is now removed.
They then bring over the pig's lung, which has been preserved on ice.
When the blood vessels are attached, we will let it start to fuse.
That's the point at which we see how long it functions before it rejects.
OK, that is good.
In the baboon's chest, the pig's lung fills with air.
That is working perfectly, man.
It is good for us, anyway.
Not showing signs of rejection.
Alexion have got pigs' organs to survive for two days in baboons that have not been given anti-rejection drugs.
That is promising, suggesting that with the drugs, they would survive for much longer.
We have yet to see a genetically modified pig's heart beating inside a human chest.
But after decades of research, the first pig-to-man transplant is planned for later this year.
While some scientists swear that genetically-modified pigs point to a golden future, others claim we are on the brink of success using a very different approach, one that could rid us not only of the problem of rejection but organ shortage as well.
The answer, it seems, is stem cells, and the seductive vision being offered is one of bespoke organs created in the lab, using our very own cells.
You've got to land one.
Dean Third was diagnosed with a rare heart condition called dilated cardiomyopathy.
He lives with the chance that his condition could kill him at any moment.
Leaving the children behind, not seeing them grow up, it is really quite difficult to think about it now because it's quite emotional.
In 2009, Dean travelled to the University of Minnesota to find out if Dr Doris Taylor's cutting-edge experiments had the potential to fix his fragile heart.
Are you Dean? Hi, I'm Dean.
I'm Doris.
- How you doing? - Come on in.
- Thank you.
This is my lab.
What we've tried to do is realise that for people with end-stage heart failure Yeah! .
.
really the only true treatment is a transplant, right? That's right, yes.
That's what I've been told.
So, there are not enough hearts to go around.
Our goal is to try and build a heart in a lab.
Absolutely amazing.
What we believe is you need cells and you need a scaffold on which you can put them, because cells in a dish alone do not make a heart, right? We said nature has already built the perfect scaffold, we don't have to learn how to do that.
But look at this, this is a laboratory heart, but this is white because literally we are removing all the cells, and all that is left is what we call the extracellular matrix, the protein underneath that the cells sit on, now we can take that scaffold and transplant cells back on, so that is the before, let me show you the after.
Now, this is only a few days old, so it is not perfect yet, but you can see this heart, it is not white like the other one, you can see it is actually moving.
It is actually beating! It is fantastic.
Isn't that cool? That is cool, that is absolutely amazing.
I'm in awe, Doris, I am, because that is absolutely amazing.
You're researching stem cells, but what you're actually doing is creating hope.
Oh, wow.
Creating hope for hundreds of thousands of people.
Thank you.
- Do you do hugs? - Yeah, I do hugs! We've come a long way since the sacrifices of those early patients who were willing to offer themselves up for surgery.
And millions have benefited from the work of doctors prepared to take risks.
OK.
Does it work? It is hard to predict exactly where the transplant story will take us next.
But I am confident that whatever innovations do occur, they will create moral dilemmas for the surgeons who are pushing the boundaries of what is possible, and patients who are desperate to cheat death.
Being able to cheat death when our organs fail by having a transplant, is one of the great achievements of modern medicine.
Success, the kidney colours and swells as the patient's blood surges through it.
I feel like I've been blessed with the opportunity to live a longer life.
I've felt, since my transplant, absolutely wonderful.
Yet, it's been a long and bloody fight for surgeons who faced ethical hurdles to revive the living with organs culled from the dead.
I the wonder what the fury of heaven would be at the notion our bodies are collections of spare parts.
And also for the patients, willing to gamble and endure almost anything in their bid for a longer life.
Somebody has to find out how it goes.
If the ship's sinking and this is the last life raft, you know? And the two patients, what happened to them? They died.
For the last 45 years Horizon and the BBC have charted the progress of surgeons whose desire to break new ground drove them to glory and disaster.
Cardiac surgeons who knew absolutely nothing about transplantation, wanted to show that they also could transplant the heart with a 100% mortality.
Despite early failures, surgeons have largely succeeded in their attempts to harvest the body.
Now, the challenge of organ shortage is driving science in ever stranger directions.
How far could and should we go in our bid to prolong life? When I was a medical student, things like kidney transplants were relatively commonplace.
But in the 25 years since then I have seen some truly remarkable, and occasionally disturbing breakthroughs.
Most recently, the transplantation of a whole human face.
I've come to Boston to the Brigham And Women's Hospital to meet one of the world's leading face transplant surgeons, Dr Bohdan Pomahac.
Good morning.
Morning.
Hey, how are you? Hi, Michael Mosley.
Good-looking boy, isn't he? He was.
Yes, until he stepped on the live wire about 10 years ago.
'Mitch Hunter was just 20 years old when his car crashed into a pole 'containing a 10,000 volt electrical cable.
'The injuries to his face were horrendous.
' Ooh.
Ah That's the actual arrival following injury.
Poor soul.
That is there's something about it, I was kind of prepared for it, but that wasthat's a shock.
'Despite 16 previous operations, to correct the injuries, 'Mitch's face was still very disfigured.
'So he agreed to become one of the first 'to have a dead man's face transplanted onto his own.
' First, a team of 14 surgeons has to carefully remove his old face.
Painstaking microvascular surgery is needed to attach Mitch's arteries to the new face.
Blood supply is absolutely critical.
Without blood supply the face is not going to be alive.
Finally, the face is stitched to Mitch's own skin.
After 14 hours the operation is complete.
Four months after surgery I went to see how Mitch was getting used to his new face.
I would say within the first month I started getting sensation and, um, I think I'm going on the fourth and fifth month and it's 10 times better than what it was the first month.
You know, I can feel a lot more, like, I can feel the breeze on my face now.
Which is nice, isn't it? It's just amazing how much sensation that I've gained back in such a short time.
It's not perfect, but something that was once seen as bad science fiction is giving Mitch a much-appreciated chance of a normal life.
Yet, just over 100 years ago the very idea of transplantation was unimaginable.
All that changed with the death of a French president.
It was June, 1894, and President Carnot was on his way to Lyons when he was attacked by a knife-wielding anarchist .
.
severing a vital artery.
Surgeons had no idea how to reconnect the severed blood vessels.
And President Carnot bled to death.
A young doctor, Alexis Carrel watched his president die and was appalled.
Now obsessed, he learnt stitching and then spent years grappling with fragile blood vessels before finally perfecting a technique that drew the ends together in a perfect seal.
Carrel had invented vascular surgery.
But that was not enough for Carrel.
Why not, he thought, uses new surgical technique to take an organ from one body and attach it to another? Dressed in his trademark black, he embarked on a series of grisly and sinister experiments.
He took the kidney out of a puppy and put it in a cat.
And then, the front legs off a white dog and put them on a black one.
Carrel had successfully performed numerous organ transplants.
His surgical techniques were perfect, yet within a short while, the organs stopped working and the animals all died.
Carrel concluded that there was some mysterious biological force that made transplantation impossible and he abandoned this work.
He had inadvertently discovered the nemesis of the transplant surgeon - rejection.
Overcoming this barrier would be a major challenge for decades to come.
It wasn't until World War II that scientists had a breakthrough.
Large numbers of fighter pilots were suffering terrible, often fatal, burns.
An Oxford biologist, Peter Medawar, had the idea of covering burns with skin from corpses.
But the skin simply shrivelled up and flaked off.
Determined to find out why, Medawar started experimenting.
An early Horizon explored his methods.
Well, that was briefly as follows, he took two rabbits .
.
and he transplanted skin from one rabbit onto the other.
That piece of skin, in the form of an organ transplant, sloughed off after 10 days.
Then Sir Peter Medawar, a little later, took another piece of skin of that rabbit and transplanted it again on the same recipient.
And that piece of skin sloughed off after five days.
His recipient rabbit had become immunised by the previous transplantation of the piece of skin.
Medawar had discovered how the patient's bodies were projecting the grafts.
The patients are victims of their body's own defences.
Whenever any foreign material finds its way inside the body, white cells like these will attack it and try to destroy it.
This is what happens to the cells of a grafted organ.
The conclusion was a profoundly depressing one.
Unless scientists could find a way of taming the immune system, rejection would always prevent a successful transplant.
The Second World War did see a medical innovation that offered hope to some patients with organ failure - the first artificial kidney.
But the invention of dialysis meant wards were filled with kidney patients living longer, but with no prospect of a cure.
Despite the continuing problems posed by rejection, ever optimistic surgeons decided they now knew enough to attempt kidney transplants.
In Europe and the US, surgeons quietly began experimenting.
This time, on humans.
But first they needed kidneys from the newly deceased, fresh enough to transplant.
This, in an age when organ donation was unheard of.
A French surgeon settled on a macabre solution.
I said, there is no choice, we have to go to the prison.
So I telephoned the director of the prison, to ask whether or not they had, in the near future, some death penalties.
He said, "Yes".
"Well", I said, "could I take his kidneys?" "Yes, yes.
"He will be dead, no head, you can take the kidneys.
" Even when they could get the organs, surgeons resorted to some bizarre strategies in a bid to overcome rejection.
One tried transplanting kidneys in a plastic bag.
Another tried wiping out the patient's immune system with a massive dose of radiation.
None of the patients survived.
The statement is often made that we couldn't do that work now, it would be outlawed, maybe so, but those patients were suffering badly, they certainly needed a try.
Understandably, pessimism set in.
But American surgeon, Joseph Murray, refused to give up.
'Interestingly, many of my older friends, surgical and medical, 'told me as a young surgeon, don't ever get involved in that project.
'It'll ruin your career.
' But the sceptics' views were about to be challenged when in 1954 Richard Herrick came to Murray's hospital dying of renal disease.
Richard mentioned something about himself which gave Murray hope .
.
he had a perfectly healthy twin, Ronald.
Murray reasoned that if he took one of Ronald's healthy kidneys and give it to his sick brother there would be no rejection because identical twins have identical immune systems.
So he decided to operate.
Within 10 seconds, urine began to pour out the uraduct, coming down onto the floor, we had to get the nurses to mop it up.
But this was a first.
And it was very exciting.
Within, oh, a week, he looked like a new person.
You just couldn't believe the transformation.
Murray had done it.
The world's first successful organ transplant.
Both the twins survived, Richard even married his nurse.
If the operation had failed, transplantation would have been set back years.
Maybe decades.
Because there was an inherent feeling against the whole concept.
It was a total victory for all of us.
Because it meant that the problem was not hopeless.
It just redefined the problem.
Now we had to figure out how to break down a rejection.
It would be eight years before Murray's team did just that.
Cancer researchers noticed that a drug used to treat leukaemia also suppressed the white blood cells which caused rejection of a transplanted organ.
The drug was called is azathioprine.
Murray prepared to try it out on his transplant patients.
Inevitably, it meant taking risks.
The first two patients we transplanted died with functioning kidneys, but they died of toxicity of the drug.
And the third patient we used, um with about a quarter of the expected dose, he survived for over one year.
And that started transplantation on a worldwide basis.
Being able to transplant kidneys between unrelated individuals was a huge achievement.
It offered hope where previously there had been none.
But it also forced people to confront an uncomfortable moral dilemma.
Organs had to come from the newly dead.
But how should doctors define when a person was actually dead? At what point in all of this did your donor actually die? I think that's one of these interminable questions and answers.
The old notion of death occurring when the heart stops had to be modified to mean brain death, so organs could be harvested while blood was still circulating.
And as transplants went mainstream, it forced doctors whose goal is normally to save life, into uncharted territory.
Tell them I'll be there in about an hour and a half.
OK, bye! To find organs to transplant they would have to actively target those on the brink of death.
'I think a transplant surgeon 'has only got to look at the list of patients 'that are waiting for transplants 'and he's driven to go and find kidneys.
'Remember, these people are dying.
'The majority of them have no other form of treatment.
' 'There's a little girl now who is running out of time.
'I've got to find a kidney for her.
' 'It's embarrassing, everybody knows you waiting for somebody to die, 'and you've just got to sit there.
' The relatives are here, you can see them in the office.
OhOK.
Are they really upset? Yes, they're very upset.
Do you think I really ought to ask them? I think you should, I think it may even help them a little.
OK-doke.
Let's go.
The donor kidney having been tested arrives at the theatre inside the perfusion machine.
Success.
The kidney colours and swells as the patient's blood surges through it.
The connections are working.
I've felt, since my transplant, absolutely wonderful.
I didn't know it was possible to feel so well, because it's an experience I've never had through my whole life, even when I didn't even know I was ill.
Surgeons had crossed the frontier.
But now they wanted to go so much further.
And for the truly ambitious, there could be no greater goal than the human heart.
Transplanting a heart would mean taking huge risks.
Unlike the kidney, a beating heart would have to function perfectly, from the off.
In the US, several surgeons were vying to be the first.
And one thought he had the edge.
We had a recipient ready, we had the donor identified, in Philadelphia as a matter of fact, and that morning my daughter came in and said some joker down in Africa has done a heart transplant.
The world's first heart transplant has been performed.
Medical history has been made in South Africa.
Newspapers everywhere carry banner headlines and from medical men as far away as the Soviet Union there is a claim for the dramatic breakthrough.
The surgeon was Dr Christiaan Barnard, an outsider who had taken the world completely by surprise.
That was a new experience.
Because I've never seen a human being that was actually alive without a heart inside his chest.
And I realised at that stage that I was doing something different.
I'd never done THIS before.
And I realised that I had to put a heart back here.
The patient was Louis Washkansky.
For the first time, a transplanted heart beat inside the chest of another human being.
It was amazing to see how he lost all evidence of heart failure, the swelling of his legs disappeared, and he was mentally well.
And I really did not believe that it will not be successful.
So we were very optimistic at the beginning.
The whole world was willing Louis to get well.
But two weeks after transplantation, it all went wrong.
I think he died I think he knew he was going to have a wonderful life because he was fine for about 10 days.
I want to thank the doctors who didn't leave a stone unturned and thank everybody all over the world who wished him well, and they did.
Louis Washkansky didn't die of rejection, but rather a lung infection that he was unable to fight off because of the immunosuppressant drugs.
I was completely destroyed that morning, I went down to our office and I lay on the couch there.
And one of my black laboratory assistants came in and he saw I was crying.
Because he was a very likeable man, Mr Washkansky, he was a very nice man.
There was great sorrow that we let him down.
But the sorrow didn't last long.
Despite the death of his patient, Barnard's life was transformed.
He became the man of the moment.
All of a sudden, I'm a celebrity.
Everyone wants to talk to me, wants to meet me.
I get invitations left, right and centre.
It was exciting.
I think, at one stage, I was probably one of the most popular people in the world.
Naturally, other doctors wanted to share his popularity.
In 1968, transplant fever gripped the world.
102 people were given new hearts in 18 different countries.
And perhaps it was this pioneering spirit that led surgeons in one London hospital to attempt a most improbable experiment.
The phone rang about 5:30 .
.
I had Donald Longmore on the phone.
And he was very succinct, he said, "I'm at the National Heart Hospital, "can you supply immediately two 200 lb pigs?" I had tomake the point that it was 5:30 at night.
It isn't the easiest thing in the world in London to find two 200 lb pigs.
He brushed that to one side and simply said, "Find them, "and have them down here as soon as you can.
" For my part, I made my way to the National Heart Hospital, so I'd be there when they arrived.
As the operating team waited, nine miles away a van was leaving the gates of the Animal Research Centre at the National Orthopaedic Hospital in Stanmore, Middlesex.
The time was just after 6:30 in the evening, the first pig was on its way.
Was it difficult to get the pig upstairs? Not particularly difficult.
But pigs aren't used to lifts, of course.
What happened then, when the first pig's heart was brought in? An attempt was made by the surgeon to attach this to the major vessels of one of the patients and having done this, blood was allowed to flow into it.
Can you describe exactly what happened to the heart as soon as it was attached to the patient? The heart became rocklike almost, and obviously had more and more difficulty maintaining its action.
And finally, it itself died.
And it was obviously the end part of a very swift rejection phenomena.
And the two patients? What happened to them? They died.
But of course if we are to progress in this territory, there have to be brave men.
There have to be first times.
There have to be trials and attempts.
Bravery is one thing, but this form of experimentation without ethical committees or anything like it, these days, seems almost jaw-dropping.
As the '60s drew to a close, the heart transplant dream was beginning to die.
The problem was that patients required much higher doses of immunosuppressant drugs than kidney patients.
And the survival rates made grim reading.
Two thirds of patients who had a heart transplant were dead within three months.
And very few made it much further.
Cardiac surgeons who knew absolutely nothing about transplantation, transplant immunity, the immune transaction of rejection, wanted to show that they also could transplant the heart.
With a 100% mortality.
And that was a disaster.
The man who started it all, Christiaan Barnard, may have become a celebrity, but many other medics were getting anxious.
And when the BBC invited him to face his peers, Barnard got a kicking.
The nauseating publicity, I think, has done harm to the profession, it's done harm to your self.
We're going to get so many failures that the public reaction against it will effectively postpone the day when we can all say that this can be safely done.
And even for those lucky few who did survive beyond the first weeks, life after surgery meant living with devastating uncertainty and a punishing drug regime.
Well, in a sense, I guess you could compare it to a man on death row.
Because he knows sooner or later he's going to go.
He don't know when.
And you're kind of hoping that they'll come up with something that will give you a little bit longer lifespan than that.
Prednisone, taken daily against rejection, can have crippling side effects.
I remember the very first time I was given the shot, I just couldn't move, I wouldn't let anybody touch me, the nurses or anybody.
Not even a bed sheet or my own pyjamas, they were painful.
My legs were very, very huge, swollen.
It wasn't the salvation that patients had been promised.
'My day begins at 5am in the morning, 'with the first batch of medicine I take.
'And it ends at 11 o'clock at night.
'You have to be continuously taking medication.
' Even huge quantities of drugs weren't enough to keep the immune system at bay.
And before long, the new organs would inevitably fail.
It looked like the surgeon's old nemesis, organ rejection, would sink their transplant dream once again.
Many governments started ordering hospitals to down scalpels.
But then help came from a most unexpected source .
.
a Norwegian fjord.
Drug companies routinely screened soil samples from around the world for new drugs.
And this one contained a fungus that appeared to possess exquisite immunosuppressant properties, controlling organ rejection without knocking out resistance to infection.
It was called cyclosporine.
Surgeons crossed their fingers and began using it on patients.
Cyclosporine was the breakthrough that everyone had been hoping for.
Finally, they had a drug which could suppress the immune system without so many lethal side effects.
Heart transplant programs reopened and survival rates soared.
Surgeons were able to make great leaps in the organs they could transplant - livers, lungs, bowls, sometimes all at the same time.
By the 1980s, transplants had become something of an everyday miracle.
Two teams of doctors worked throughout the early hours of this morning to perform the world's first triple-organ transplant.
The surgeons' success meant that demand for organs rocketed, and a national organ donor scheme was launched.
12 million of these new plastic cards are to be distributed.
The new card is being issued because new techniques are increasing the range of organs which can be donated.
Great in theory, but in reality, demand always outstrips supply.
Organ shortage meant that the hope offered by transplants often turned to despair for those on the waiting lists.
Thousands of people who could be saved are dying because there aren't enough kidneys.
This patient has a husband, if she'd been single or divorced she'd have been turned down.
For the doctors it meant making difficult decisions about who should get a second chance.
'At Guy's Hospital whether or not a patient lives or dies 'is decided at this weekly meeting of the renal unit.
' 'It's very informal, often heated, sometimes agonising.
' Very fit.
Brazilian.
Young.
Tough.
He's got angina.
Yes, but he's dying.
We have changed our policy considerably over the last two or three months.
And changed it in the face of four people coming in through the roof with terminal renal failure, none you know about yet, three are on hospital dialysis waiting.
Have we thought about approaching Thomas' on this? Cos we are very jammed at the moment.
As surgeons became more adventurous, the problems around organ shortage became more acute.
Particularly when it came to living donors.
If one of my brothers or my sister needs a kidney then I am happy to donate.
But what if the organ is less expendable? Would you risk your health for the hope of saving a loved one? Since the '60s, the Laughran family have lived with life-threatening illness.
Last year, medical science confronted them with a terrible choice none of us would wish to make.
I hope it will give her a large number of very happy years, andto give the gift of life to somebody, that is a wonderful opportunity to do something which is undoubtedly going to be the greatest thing I ever do in my life.
Nothing that I have learned has changed my commitment to doing this.
But I have to say I have been horrified by some of the information.
I'm only going to gain, whatever way, I've got nothing to lose.
Even if it gets to the day and they don't want to do it, I don't mind them saying no.
I don't want them to suddenly think, you know, because it is not fair that they should I just don't want them to I don't want it to ruin any part of their lives.
Sheila Batchelor suffers from cystic fibrosis, the most common genetic disorder in this country.
It is an incurable disease which is slowly destroying her lungs.
She needs to be on oxygen 24 hours a day.
By March last year, the family were facing their worst fear.
But then they heard about a radical new surgical procedure called living donor lung transplantation.
Conceived of in America, this controversial operation is being pioneered in the UK by Professor Sir Magdi Yacoub, the world-famous heart-lung transplant surgeon.
Using two living donors, instead of a dead donor, it is the latest attempt by medical science to solve the donor organ shortage.
Going to be given a whole new life again.
Brand-new life.
I don't think many people can be given that.
Unlike living kidney donor operations, lung transplants are both more dangerous for the donors and far less successful for the recipients.
This is because the lung is a very fragile organ, and does not transplant easily.
See you tomorrow.
Bye.
This operation has never been filmed before.
It involves three separate theatres staffed by three surgical teams working to Professor Yacoub.
He estimates Sheila's chances of survival at around 70%.
The first stage of this eight-hour operation is to remove Sheila's diseased right lung.
Two hours in, the professor begins to connect Damian's lobe to the windpipe and blood vessels in Sheila's chest.
It is a slow and delicate process.
Her diseased left lung has been removed in readiness for Josephine's lobe.
Finally, Sheila is ready to leave the theatre.
She is breathing with her new lungs.
The operation has lasted over 12 hours.
Sheila had a rocky first night, because there was a dangerous build-up of fluid on her new lungs.
Two days later, she still needs to be on a ventilator to support them.
Because of this, she is kept sedated.
Damian and Josephine's progress is slow.
They have substantial pockets of air around their lungs.
The pain has been absolutely incredible.
I have no way of describing it.
The feeling of total helplessness.
But part of what I want to do is to look as fit as possible for when Sheila wakes up.
Look like it was a complete breeze.
Despite the medical team's best efforts, they could not control the infection that was raging through Sheila's body.
Three weeks after the operation, Sheila finally lost her fight for life.
Everything has changed.
Everything.
I have tried not to think about it very much, deliberately tried to keep as busy as possible, just locking into a bit of a shell.
Just growing strong on the inside, I think, because I probably look exactly the same but I have the scars to prove it and I have things that have changed inside me.
It is a mesh of perspective on life, I guess.
Every time we lose a patient, there is great sadness.
And what we try and do is to analyse why, and then make a decision about whether to offer this type of operation to people or not.
Despite the risks, the living lung operation is still being offered to desperate families.
Success rates are improving.
Human experimentation has always been the cornerstone of transplant surgery.
But every breakthrough brought new challenges, especially when surgeons moved beyond life-saving to more cosmetic grafting of body parts.
When Clint Hallam was chosen to receive the world's first hand transplant in 1998 after losing his own to a circular saw, little did he know the price he would pay for being a surgical pioneer.
My first thoughts when I saw my hand was that it was a miracle.
The total join actually goes around in quite a jagged join.
It has probably only been in the past six or seven months that I have started to feel uncomfortable, sometimes, with the actual differences in the skins.
The difficulty that I find psychologically is that I want to be able to use my hand to do things.
But it is not always possible to control it.
Brushing my teeth is a safe exercise for using my hand.
When it comes to shaving, I make sure I have got the razor in my good hand.
Fully under control.
No, no, no.
It was not just Clint who struggled with the hand.
I've had people in aeroplanes, one lady asked to be moved to another seat because she didn't like the fact of sitting next to me with this hand that belonged to a dead person.
Clint also began to resent the toll on his health from the heavy regime of antirejection drugs.
The two most physical side-effects that I notice is first, I have diabetes.
The second side effect is more physical, in that my body has gone from chest to breast.
That is a little bit difficult to deal with.
Despite his world fame as a transplant pioneer, Clint took a difficult decision, he decided to cut back on his antirejection meds.
There could only be one outcome.
The redness in the fingertips, the fingernails falling off, are all indicators of a serious rejection problem.
By 2001, Clint's immune system had almost completely destroyed his new hand.
Good evening.
Clint Hallam was at the centre of a medical breakthrough two years ago, but now he wants out.
Having had the hand of a dying man attached where his used to be, he is now begging for it to be removed.
I certainly believe that there must come a stage, yes, my body and mind has said, enough is enough.
The morning after this interview was recorded, Clint's hand was surgically removed.
It was the stuff of nightmares.
A graphic illustration of the difficult truth that when surgeons blaze a trail, they can't always predict the outcome.
Surgery had advanced to the point where virtually every part of the body was up for grabs.
We faced another uncomfortable reality, that mounting demand for body parts left the whole system open to abuse.
In the United States, 1.
5 million tissue transplant operations are performed every year.
It has created an enormous demand for tissue that needs to be met.
It is in tissue for transplant that the body's real financial value lies.
If every useful bit could be recovered, processed, and sold for its maximum value, the proceeds from a single body could be $250,000.
With so much money on offer, perhaps it is little wonder that the abuse of bodies is so widespread.
One of the people attracted to the money was former society dentist Michael Mastromarino.
Michael Mastromarino was an oral surgeon who appeared to have a very successful practice in New Jersey.
He got into drugs, his license to practice as a surgeon was suspended, he had a very nice lifestyle that he needed to keep up.
And so he went into the body parts business.
In 2002, Michael Mastromarino had set up a company, Biomedical Tissue Services, to procure and sell human tissue for use in transplants.
All he then needed was a cheap and reliable supply of bodies, for which, like all good grave-robbers, he turned to the funeral business, and they were only too happy to help.
Before long, he had a network of over 30 funeral parlours between New York and Philadelphia, prepared to let him chop up the bodies in their care.
The useful bits, the bones, the tendons, the skin, were removed and packaged up.
Bodies destined to be buried were reconstructed with PVC plumbing pipe.
When they were exhumed, x-rays provided ample evidence of the body-snatcher's handiwork.
Over four years, Michael Mastromarino made nearly $5 million from stealing the parts of over 1,000 bodies.
One of them was one of the great journalists - Alistair Cooke.
In March 2004, just weeks after recording his last Letter From America, Alistair Cooke died.
He was 95 years old, and had been suffering from lung cancer.
Susan Cooke Kittredge is his daughter.
He would have certainly been intrigued by this story.
He would have appreciated the sort of Dickensian smoke, grave-robber essence of what was going on.
But had he ever imagined that it would happen to him, he would have been horrified.
The tissue was sold to processing companies who turned it into sterile medical products.
But Michael Mastromarino's biggest deception was that he was forging the details of the deceased's health.
He was 95 years old, he was very, very frail, and he had bone cancer.
Now, it's my understanding that I can't contract cancer from those bones, but those are not going to do me a lot of good.
But by the time the bodysnatching ring was smashed, more than 25,000 products, made from the stolen bones, had been distributed all round the world.
Many of them had been implanted into living patients.
But there is a solution to the problem that would ensure a plentiful supply of human tissue.
Could you thwart this whole crime by increasing the supply enormously, by having everyone donate their bodies? It would shut it down right away.
Throughout the long history of transplant surgery, people have had to battle with the twin problems of shortage and rejection.
Not surprisingly, from the early days, others have looked for alternatives that do not have those particular problems.
Just as with the transplant pioneers, they soon discovered that they were beset by death, disaster, and the clash of giant egos.
Back in the early days of heart transplants, a Houston surgeon decided technology was the answer to organ shortages.
Dr Michael DeBakey led a team that created an artificial heart.
We were thinking the heart is just a pump.
It seemed logical that if that was the main function, you ought to be able to duplicate that mechanically.
In the 1960s, Michael DeBakey's team was testing his artificial heart in animals.
The principal researcher, Domingo Liotta, went to Dr Michael DeBakey with a startling proposition.
Dr Liotta was very ambitious to apply the pump in humans, and I explained to him that we couldn't do that because it had been used on seven calves, four of which died on the operating table.
We couldn't go and get approval from the committee.
I didn't realise that secretly, he went to see Dr Cooley about it.
Denton Cooley was one of Dr DeBakey's proteges and colleagues.
He saw an opportunity to do the first human trial, an opportunity the more cautious DeBakey was not prepared to take.
Dr Cooley had no experience with the artificial heart programme at all.
He had no experience in the laboratory, he did not do any laboratory work.
He was a good surgeon, but that was all.
Dr DeBakey seemed to show little interest in using it, Dr Liotta thought that he was just wasting his years in the laboratory working with animals and so on, that this would never be tested clinically.
I thought and I agreed with Dr Liotta the time had come to really give it a test, and the only real test would be to apply it to a dying patient.
The patient was Haskell Karp from Skokie, Illinois.
He was a man with a long history of heart problems.
On 4 April 1969, Haskell Karp became the first human to be implanted with an artificial heart - a version of the device which had been developed in DeBakey's laboratory.
His own heart was completely removed.
Karp was maintained on a heart-lung machine while the artificial heart was implanted.
It was intended to keep him alive only until a donor heart could be found.
Unusually, Dr Cooley had not sought any approval for this groundbreaking operation.
In those days it didn't feel like we needed permission, I needed the consent of the patient.
That was essential, of course.
I think if I had sought permission from, say, the federal agency or the hospital, anybody else, I think I probably would have been denied.
We would have lost a golden opportunity.
I was in Washington when I read in the morning papers about the use of this artificial heart that Dr Cooley had put in a patient.
I was shocked.
I didn't know he had done all this surreptitiously, taken from the laboratory.
Two days after the operation, with Karp growing worse by the minute, his wife made an emotional appeal for a human heart.
Within a day, a donor heart had been found.
But Haskell Karp died shortly after it had been transplanted.
Dr Cooley's justification was he was trying to save the life of this patient.
Which, you know, you don't take an external device to save the life of a patient that has had no evidence that it would do that.
In the ensuing controversy, Dr Cooley resigned from DeBakey's college.
But as the first man to implant an artificial heart, his international reputation had been secured.
I think it is naive to think that we all have the purest of motives in what we do.
I enjoyed the thrill of doing something for the first time, something no-one else had really conceived of, or else they did not have the courage to attempt it.
You realise this is a much more complicated problem than it first seemed.
And after we had worked on this, I came to the conclusion that it probably is best to quit working on the total artificial heart.
But DeBakey did not give up on technology.
The Cooley fiasco simply spurred him on to make it better.
He went back to basics, and developed a device called an LVAD - an implanted pump that boosted a failing heart, rather than replacing it.
The first patient that we had was very impressive.
We were able to relieve the patient of the failure.
So that spurred us on.
This innovation would go on to prolong the lives of thousands of people while they waited for a new heart.
And as waiting lists continue to grow, a group of scientists embarked on a project which they hoped would be a game-changer, it would provide us with a limitless supply of organs by manipulating genes.
Their controversial work was shrouded in secrecy, because the organs would not be coming from humans but from pigs - genetically modified with human DNA.
Unlike the earlier pig fiasco, it was hoped that genetically engineered pig organs would be close enough to human tissue to minimise rejection.
If we were thinking about using pigs as donors, for the first time we could now treat or change the pig in some way so that the organ of the pig was accepted by the patient, instead of trying to treat the patient to accept the organ of the pig.
It is April 1995.
Alexion Pharmaceuticals, an American company that has also bred genetically-engineered pigs, is about to put their theories to the test.
Two baboons will receive the pig's organs.
They are close relations to humans, and if the transplants work, scientists say they will also work in people.
The idea is to see how long the transplants will last.
Normally, they would be rejected in a matter of hours.
If the genetic engineering works, they will last longer.
The pig's heart and lungs are removed first.
We have opened up the abdomen and chest of the animal.
We are preparing to harvest the left lung, which we're going to use for the lung transplant.
The baboon's lung is now removed.
They then bring over the pig's lung, which has been preserved on ice.
When the blood vessels are attached, we will let it start to fuse.
That's the point at which we see how long it functions before it rejects.
OK, that is good.
In the baboon's chest, the pig's lung fills with air.
That is working perfectly, man.
It is good for us, anyway.
Not showing signs of rejection.
Alexion have got pigs' organs to survive for two days in baboons that have not been given anti-rejection drugs.
That is promising, suggesting that with the drugs, they would survive for much longer.
We have yet to see a genetically modified pig's heart beating inside a human chest.
But after decades of research, the first pig-to-man transplant is planned for later this year.
While some scientists swear that genetically-modified pigs point to a golden future, others claim we are on the brink of success using a very different approach, one that could rid us not only of the problem of rejection but organ shortage as well.
The answer, it seems, is stem cells, and the seductive vision being offered is one of bespoke organs created in the lab, using our very own cells.
You've got to land one.
Dean Third was diagnosed with a rare heart condition called dilated cardiomyopathy.
He lives with the chance that his condition could kill him at any moment.
Leaving the children behind, not seeing them grow up, it is really quite difficult to think about it now because it's quite emotional.
In 2009, Dean travelled to the University of Minnesota to find out if Dr Doris Taylor's cutting-edge experiments had the potential to fix his fragile heart.
Are you Dean? Hi, I'm Dean.
I'm Doris.
- How you doing? - Come on in.
- Thank you.
This is my lab.
What we've tried to do is realise that for people with end-stage heart failure Yeah! .
.
really the only true treatment is a transplant, right? That's right, yes.
That's what I've been told.
So, there are not enough hearts to go around.
Our goal is to try and build a heart in a lab.
Absolutely amazing.
What we believe is you need cells and you need a scaffold on which you can put them, because cells in a dish alone do not make a heart, right? We said nature has already built the perfect scaffold, we don't have to learn how to do that.
But look at this, this is a laboratory heart, but this is white because literally we are removing all the cells, and all that is left is what we call the extracellular matrix, the protein underneath that the cells sit on, now we can take that scaffold and transplant cells back on, so that is the before, let me show you the after.
Now, this is only a few days old, so it is not perfect yet, but you can see this heart, it is not white like the other one, you can see it is actually moving.
It is actually beating! It is fantastic.
Isn't that cool? That is cool, that is absolutely amazing.
I'm in awe, Doris, I am, because that is absolutely amazing.
You're researching stem cells, but what you're actually doing is creating hope.
Oh, wow.
Creating hope for hundreds of thousands of people.
Thank you.
- Do you do hugs? - Yeah, I do hugs! We've come a long way since the sacrifices of those early patients who were willing to offer themselves up for surgery.
And millions have benefited from the work of doctors prepared to take risks.
OK.
Does it work? It is hard to predict exactly where the transplant story will take us next.
But I am confident that whatever innovations do occur, they will create moral dilemmas for the surgeons who are pushing the boundaries of what is possible, and patients who are desperate to cheat death.