Written by Alan Barker: writer, coach, training consultant and academic proofreader. Find out more about his work here.

Transplant surgery goes back a long way. Saints Cosmas and Damian (the patron saints of surgeons) were reputedly trying to transplant legs in the second century AD. In the eighteenth century, John Hunter extracted teeth from the down-and-out (for money but without anaesthetic) and implanted them in the rich. Unfortunately, he also gave some of them syphilis in the process.

The twentieth century saw huge strides forward. The first cornea was transplanted in 1905, and the first kidney in 1933; Christiaan Barnard conducted the first successful heart transplant in 1967. (There’s a full timeline here.) Today, Pankaj told us, we’re transplanting just about every organ apart from the brain. He outlined three main challenges for the future: minimising risk to donors; improving the quality of donated organs; and improving outcomes for recipients.

Pankaj invoked the spirit of his hero, Joseph Lister. He showed us Lister’s antiseptic spray, a tool that revolutionised the quality of surgery. By the 1950s, the tools had diversified, but operations were still hugely invasive. Pankaj’s team worked on the Netflix series, The Crown, reproducing a lung operation on George VI. He showed us the silicon body used on the shoot, which displayed the huge cut that had to be made.

Today, the state of the art is robotic keyhole surgery. Robots improve vision and dexterity, remove hand tremor, and reduce fatigue. The exquisitely precise instruments also offer surgeons more degrees of motion, and reduce the number of keyholes needed. Patients experience less pain, a shorter stay in hospital and a faster recovery. Pankaj was part of the team, led by Professor Nizam Mamode, that conducted Britain’s first successful robotic kidney transplant in September 2016.

Technology is also helping to improve the quality of donated organs. Currently, about 11% of organs are discarded as unfit. Some can be saved. The key technique is ex vivo normothermic perfusion or EVNP: in plain terms, flushing the organ with blood at normal temperature outside the body. Pankaj ran a video of a kidney on the rig, being pumped with blood, nutrients and vitamins – and producing no less than three litres of urine. “Look at that!” he cried. “That was a very emotional moment for me.” 

He wants to go further, to shift the paradigm of rejection. “Currently, we treat the patient with immunosuppressant drugs. Can we introduce those drugs into the kidney before transplanting it? Turns out we can.” Doctors can now cross almost any immunological barrier: deceased donor transplantation becomes possible across any blood group, thus increasing the organ donor pool.

And finally: the recipient. Imagine the challenge of transplanting a parent’s kidney into a baby’s abdomen. “Space is an issue. A baby’s kidneys are walnut-sized.” He faced exactly this problem with Lucy Boucher, a little girl from Belfast. “She came to us after a lot of operations, so her abdomen was quite scarred. How to work out where to fit her dad’s kidney?”

Pankaj produced models of Chris Boucher’s kidney and Lucy’s abdomen, using the 3D printer at Guy’s and St Thomas’ hospitals in London, and the team used them to plan the operation and minimise the risks. “The models also helped us involve Lucy’s parents more fully,” added Pankaj. It’s the first time ever that 3D printing has been used to help transplant a kidney from an adult to a child. And it won Pankaj the Royal Society of Medicine’s Norman Tanner Medal in 2016.

At the end, he returned to Joseph Lister’s golden rule: “There is only one rule of practice: to put yourself in the patient’s place.” And so we did. Chris and Lucy joined Pankaj on stage – Lucy sporting the medals she’s recently won at the Kids’ Transplant Games. How do you top that?

 

Read an interview with Pankaj here.

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