The British Transplantation Society papers (1972-2007)

The recently catalogued papers (SA/BTS) of the British Transplantation Society (BTS) document changing attitudes towards organ and tissue transplantation, in the medical community and more broadly, over a 35-year span. The papers provide an insight into the rapid medical advances in transplantation and immunology, and bear witness to heated public debates about the ethics of the practice.

The idea of transplantation is certainly not new; for centuries, humans have toyed with the possibility of transplantation. One particularly gruesome painting from the fifteen century depicts the saints Cosmas and Damian performing a miraculous cure by transplanting the leg of a deceased Ethiopian onto another patient.

A verger’s dream: Saints Cosmas and Damian performing a miraculous cure by transplantation of a leg. Oil painting attributed to the Master of Los Balbases, ca.1495. Wellcome Images L0019549

However, despite this early curiosity about transplantation, the practice of transplantation is a fairly recent phenomenon. Early transplants were rarely successful; organs would often be rejected by the immune system, or become infected. It was not until the discovery of immunosuppressive drugs in the 1970s that organ transplantation became a more successful, reliable and routine practice.

The papers of the British Transplantation Society date back to 1972, when the medical world was buzzing with enthusiasm about the possibilities of organ transplantation. These early papers document discussions on issues of the time, including the development of immunosuppression, tolerance and enhancement.

Without organ rejection to worry about, organ transplantation became an established and routine practice. As a result, every region in the UK had a unit offering transplantation and dialysis for chronic or end-stage renal failure. Demand quickly outstripped supply.

This shortage of organs led to a growing debate about how – and from whom –much-needed organs should be obtained. By the mid-1980s, discussions at BTS meetings had shifted away from tolerance and the immune system, towards concerns about ethics and the shortage of organs for transplantation.

The BTS papers from this period reveal the medical community’s debates around organ shortage, including the pros and cons of ‘opt out’ legislation, the shortage of transplant surgeons, and how to ensure that organ transplantation followed good practice.

A glance through the Press and Journal Cuttings series (SA/BTS/B/5) reveals the extent of public interest in organ transplantation. As a particularly emotive subject, the practice sparked many rumours and myths, which circulated in the media, and added fire to the transplantation debate. In particular, concerns were raised by BTS members over the portrayal of transplantation in episodes of the BBC programmes: Panorama and Casualty.

In 1980, the Panorama broadcast, ‘Transplants: Are the donors really dead?‘ caused a public backlash against organ donation, as the programme reported that donors diagnosed as brain dead, whose organs might have been used for transplantation, were still alive.

One particularly sensationalist headline, ‘Doctors cut hearts out of living patients’, demonstrates the public unease stirred up by the Panorama programme. In response to the programme, BTS maintained that doctors had been quoted out of context, and that the American patients seen in the programme would not have met the British criteria for brain death.

Press clippings on the BBC Panorama programme “Transplants: are the donors really dead?”.  SA/BTS/B/5/2: Press and Journal Cuttings: Brain Death, 1975-1981. Image credit: Elena Carter

As well as journal cuttings debating the exact definition of brain death, press file SA/BTS/B/5/2 also contains letters from two outraged viewers of Panorama; one correspondent even returning her donor card in protest.

In 1994, the BTS flagged up an episode of BBC drama Casualty, concerned that the programme inaccurately dealt with organ donation. In the programme’s synopsis (SA/BTS/D/1/1) a character sells her kidney by claiming that the recipient is her brother, only to later discover that her remaining kidney is damaged. The secretariat of the BTS highlighted the show’s lack of medical accuracy, and expressed concern about the impact that the programme could have on potential donors.

The papers of BTS include correspondence, reports and guidelines, programmes and abstracts, press and journal cuttings, and subject files.

The BTS website has been archived as part of the British Library’s UK Web Archive, and can be viewed here.

Author: Elena Carter, project archivist at the Wellcome Library.