British medical legend Sir Roy Calne, who revolutionised organ transplant surgery, and pioneered the use of drugs and surgical techniques that gave hope to millions of people for whom organ failure had been a death sentence, died last week aged 93.
The Washington Post reports that as a medical student making the rounds at a London hospital in 1950, Calne was presented with a young man dying from kidney failure. Make him comfortable, he was told, because the patient would die within two weeks.
This troubled Calne (pronounced “Hahn”), who had grown up tinkering with cars in his father’s workshop, learning how to take apart an engine and put it back together again. Wasn’t it possible, he asked, to remove the failing kidney and swop it with a working one, like replacing a spark plug or – his mind drifted to gardening – grafting a rose?
Impossible, he was told.
“Well, I’ve always tended to dislike being told that something can’t be done,” Calne said in a New York Times interview years later after revolutionising organ transplant surgery.
Along with another visionary surgeon, Thomas Starzl, from the United States, he helped turn a risky experimental procedure into a widely accepted treatment, performing some of the first liver transplants and multi-organ transplantations even as colleagues hesitated to back his research.
When Calne began his transplant research in the 1950s, he faced two major problems. One was a matter of technique: how do you remove a faulty kidney or liver and replace it with an organ that worked? The second was biological: How do you circumvent the body’s immune system, which rejects foreign tissue and treats it like an enemy invader?
Early efforts were far from promising. He operated on animals, mainly dogs and pigs, which died almost immediately.
Animal rights activists who found out about the procedures sent him a bomb, he said in 2012: “I was suspicious and phoned up the army – who blew it up.”
He tried stifling the dogs’ immune systems through radiation, which only made them sick. Then he turned to drugs, using an anti-leukaemia agent called 6-mercaptopurine while performing kidney transplants in 1959.
This time, one of the dogs lived for more than a month without the new organ being rejected. “It changed something that had been total failure to a partial success,” he said.
While Starzl developed surgical techniques in Colorado and then in Pittsburgh, Calne followed suit a continent away.
In 1968, the year after Starzl performed the world’s first successful liver transplant, Calne undertook Europe’s first successful liver transplant while working as a surgery professor at the University of Cambridge.
By the mid-1970s, Calne was testing a new immunosuppressive drug, cyclosporine, championed by Jean-François Borel of the Swiss pharmaceutical company Sandoz.
Calne led the first major study on its clinical uses, discovering that the drug increased the one-year survival rate for kidney transplant patients from 50% to 80%.
Cyclosporine became an essential part of organ transplant procedures – Starzl later discovered another effective immunosuppressant, FK-506 – and was credited with transforming attitudes toward a surgery that had previously been regarded, as Calne put it, “as an enterprise for mad surgeons ignorant of immunology, who really didn’t know what they were doing”.
“The discovery and use of cyclosporin made transplantation possible as a treatment to more and more people,” John Wallwork, a fellow transplant surgeon, said in a tribute. “Nearly 50 years on, it is still what is used for today’s transplant patients.”
Together, Calne and Wallwork performed the world’s first successful heart, lung and liver transplant on the same patient, a 35-year-old homemaker, in 1986.
Eight years later, Calne led a team that undertook the first “cluster” transplant, replacing a patient’s stomach, small intestine, liver, pancreas and kidney.
Calne was knighted in 1986 for his contributions to medicine – in Britain, he was widely known as Sir Roy – and received a Lasker Award, considered medicine’s highest honour after the Nobel Prize, with Starzl in 2012.
The surgeons were jointly presented with the Lasker-DeBakey Clinical Medical Research Award for their work on liver transplantation.
The older of two sons, Calne was born in Richmond, now part of London in 1930. His father was a former engineer at the Rover car company, and his mother a homemaker. His brother, Donald, became a Canadian neurologist and a leading expert on Parkinson’s disease.
After graduating from Lancing College in West Sussex, Calne enrolled at Guy’s Hospital Medical School in London at 16. He qualified as a doctor in 1952, according to a biography for the Lasker Award, and served as an army doctor in Southeast Asia for a few years before returning to England, where he was hired to teach anatomy at the University of Oxford.
While there, he attended a lecture by biologist Peter Medawar, a future Nobel laureate, who discussed the results of a successful skin graft between mice.
The experiment suggested that the immune system could be manipulated, although Medawar insisted that there was “no clinical application whatsoever”.
Calne thought otherwise, asking himself, “Why couldn’t we do something like that with kidneys?”
He began working on kidney transplantation at the Royal Free Hospital in London and continued his research through a fellowship at Harvard’s Peter Bent Brigham Hospital in Boston, where the first successful kidney transplant had been performed on identical twins in 1954.
In 1965, he joined the University of Cambridge, where he was a professor of surgery until retiring in 1998. He continued to perform kidney transplants into his 70s and conducted medical research into his 80s, including on the use of gene therapy to treat diabetes.
His death, at a retirement home in Cambridge, was announced by the British Transplantation Society and the University of Cambridge, which did not give a cause.
Calne had said that while he had no concerns about performing organ transplant surgeries for people in need, he was wary that medical advances may have inadvertently contributed to overpopulation.
In 1994, he published the book Too Many People, in which he argued that the world was becoming overcrowded and suggested that legal controls be placed on parenting, including the creation of a potential “permit to reproduce”.
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