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Transplant History: In transplant surgery it is desirable to create a condition in which the recipient permits certain antigens to dwell in the body unmolested. A number of ways are utilized today and will be developed in the future to achieve such a state of immu-nologic tolerance. Indeed, the ultimate success of transplant surgery depends upon the development of safe, specific immune modification.
Philosophical and ethical questions are especially pointed in heart transplant cases. Is the donor actually dead if his heart can be resuscitated in another individual? Should a heart transplant be performed on a particular patient? The donor's heart must be removed as irrevocably as in an Aztec ritual. If the transplant should fail—the graft not function—the surgeons would have killed the donor no matter how altruistic their motives. It is, indeed, a very final step.
Early in transplant history, survival of kidney grafts was found to be prolonged in animals receiving the drug 6-mercap-topurine. Later, Imuran (azathioprine) became the immunosup-pressive drug of choice. Both of these agents are known as antimetabolites, which are substances that disrupt specific metabolic processes because they closely resemble the beneficial materials used in these processes. |
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