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The First Transplant Surgeon: The Flawed Genius of Nobel Prize Winner, Alexis Carrel, edited by David Hamilton. World Scientific, London, 2017. 587 pages

2017; Elsevier BV; Volume: 17; Issue: 6 Linguagem: Inglês

10.1111/ajt.14264

1600-6143

David K.C. Cooper,

Medical History and Innovations

Most of us who are involved in organ transplantation know that Alexis Carrel was a pioneer in anastomosing blood vessels, which is essential if one is to transplant an organ. This was no mean feat in the first decade of the 20th century, when all he had available were straight needles threaded with silk. For these efforts he was awarded the Nobel Prize for Physiology or Medicine in 2012, becoming the youngest laureate of this category of the prize to date and the first American-based winner. He also made significant contributions to tissue/cell culture, to the treatment of wounds during World War I, and to ex vivo organ perfusion, in which he collaborated with the pioneer aviator, Charles Lindbergh. He carried out one of the first successful blood transfusions when he anastomosed an artery of a father to a vein in his desperately ill baby daughter, a surgical tour de force in those pioneering days. Those of us in xenotransplantation will also be aware of his remarkable 1907 prediction—“The ideal method would be to transplant in man organs of animals easy to secure and operate on, such as hogs, for instance. But it would in all probability be necessary to immunize organs of the hog against the human serum.” He thereby predicted exactly what we are doing today, more than 100 years later—genetically engineering the pig to protect its organs from the human immune response. He predicted that the future of transplantation would be xenotransplantation, and I believe he will ultimately be proved correct. And so Alexis Carrel, who lived from 1873 to 1944, was a visionary and one of the first true surgeon-scientists. But there was more to his life than that, and his other activities are comprehensively reviewed by retired Scottish kidney transplant surgeon and medical historian David Hamilton in his excellent new biography. By accessing many new primary sources of information (and not relying on previous biographies), Hamilton has been able to assess Carrel’s work and life anew. Throughout his life, Carrel was a controversial figure, leaving his native France disconsolately when he did not obtain a faculty position in his alma mater in Lyons, enjoying (and encouraging) the considerable media attention that his early scientific work in Chicago and New York engendered, writing a best-selling book in the 1930s (Man, the Unknown) on the “decline of the human race” and how this could be reversed (in which he expressed views that can only be described as “fascist”), and finally returning to France during World War II supposedly to help his beleaguered country but doing so through what many considered to be “collaboration” with the Vichy government (overseen by the Nazis). Although his scientific life was successful until about 1920—involving as it did limb, kidney, and many other transplants in dogs and cats, the identification of “rejection” of an allograft and the suggestion that radiation and certain chemical reagents could suppress this response, and some innovative heart surgery experiments—thereafter he appeared to lose his scientific focus and spent time and money on ill-conceived investigations that failed to provide valuable or conclusive results. His high profile with the public and his other interests may have distracted him from his core activities, and he contributed little of scientific significance during the last 25 years of his life. Nevertheless, David Hamilton maintains our interest in Carrel to the ignominious end of his life and discusses how Carrel’s legacy has fluctuated over the subsequent 70 years. As a surgeon-scientist, Carrel deserves our respect, but as a political thinker and humanitarian, he certainly does not. Nevertheless, anybody working in organ transplantation, vascular surgery, tissue culture, or organ perfusion will find Carrel’s early achievements of considerable interest. With his surgical insight, David Hamilton has thrown new light on many aspects of Carrel’s work and life, and his book is to be strongly recommended. The author of this manuscript has no conflict of interest to disclose as described by the American Journal of Transplantation.