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fatty regions (buttocks) or protrusions (chin) for reconstruction of mutilated noses incurred during wars
[1]
or punishments .

One of the earliest records of organ transplantation, Bian Que, a reported clairvoyant during Han Dynasty
in Ancient China reportedly performed an exchange of hearts. He felt that the attainment of balance was
possible by exchanging organs between men of “strong will” but “weak spirit” with that of one with op-
posite traits by intoxicating a “patient” with fortified wine prior to “cutting their breasts removing their
[2]
hearts and applying numinous medicine” .

The New Testament describes several cases of auto-transplantation by today’s definition; Jesus of Nazareth
reattached the ear of a servant after it had been cut by Simon Peter’s sword. It also describes how Saint
[3]
Mark re-implanted an amputated hand of a soldier . Archaeological records have revealed that in the
Bronze age, the term “trephination” was first revealed whereby bone segments were temporarily removed
[4]
to decompress brain swelling .

Jacopoda Varagine (348 AD) described the “miracle of the black leg” where a gangrenous leg of Justinian
[5]
(Roman deacon) was replaced with that of a dead Ethiopian man .
In 1688, Job van Meeneren successfully grafted a segment of bone from the skull of a dog to a defect in a
[6]
human patient’s cranium . A Russian aristocrat had a fragment of canine skull tissue inserted during a
[6]
repair after an injury. He had it explanted due to threats of excommunication from the church . Such ac-
counts of events highlighted the initial inquisitiveness with the concept of transplantation.

THE PRE-TRANSPLANT ERA
Although organ transplantation had not taken place yet, the early 20th century witnessed the first skin and
corneal transplants. The initial work behind corneal transplant is attributed to Franz Reisinger who experi-
[7]
mented with “keratoplasty” in 1818 . Twenty years later, Samuel Bigger performed the first successful cor-
neal transplant in a gazelle. The first attempted corneal xenotransplantation on a human was performed in
1838 was unsuccessful. Improvements in antisepsis, anaesthesiology and surgical technique played a pivotal
role, alongside ongoing animal experimentation. This subsequently led to the first successful human corneal
[7]
transplant in 1905 by a Eduard Zirm (1887-1948) in Olmutz near Prague . The first successfully grafted tis-
sue however was performed by Jacques-Louis Reverdin, who transplanted small detached skin grafts onto
[8]
a wound and noted hastened granulating of wounds on 8th December 1869 . Solid organ transplantation
would follow a similar path with years of experimentation, before successful results were noted.

French president Marie François Sadi Carnot died from severed portal vein in 1894. This had a profound
[9]
effect on a young surgeon, Alexis Carrell . He mastered vascular anastomotic suturing methods and intro-
duced smaller needles. Carrel coated his needles, instruments and thread with petroleum jelly to reduce the
thrombogenicity of the foreign material. He also perfected the concept of eversion thereby allowing blood
within the vessels continuous endothelial contact. He also revolutionised antisepsis in surgery and pioneered
[10]
methods of extracorporeal tissue preservation, by using salt solution at freezing point .

In 1902, he successfully performed the first heterotopic kidney transplant by inserting a dog’s kidney into its
[9]
own neck. He noted that the kidney began producing urine immediately . He later successfully transplant-
ed organs, including kidneys, ovaries and thyroid glands between different dogs. In 1912, he became the
first surgeon to win a Nobel Prize “in recognition of his work on vascular sutures and the transplantation of
[11]
blood vessels and organs” .
To prevent blood clotting Carrel coated his needles, instruments and thread with paraffin jelly and he used
an everting technique, rolling back the cut vessel ends like cuffs and then stitching the turned-back ends