Joseph Murray, recipient of the 1990 Nobel Prize in Medicine, at a ceremony held in his honor at the Brigham and Women's Hospital in 1996. The event featured the unveiling of a permanent display that traces the transplant pioneer's historical work in organ transplantation. Murray is flanked by Edith Helm (left) and her twin sister, Wana Foster. In 1956, Helm received one of the first kidney transplants; the donor was her sister Wanda.

On the face of it, there doesn't appear to be a connection between kidney transplants and plastic surgery.

But to Joseph E. Murray, MD '43, professor of surgery emeritus at the Medical School, the relationship couldn't be closer. It is part of the seamless web of his life in surgery, which started 55 years ago at Harvard-affiliated Peter Bent Brigham (now Brigham and Women's) Hospital and Children's Hospital in Boston.

"The average person may think of surgery in lifesaving emergency room situations, but that's only about 10 percent of the picture," says Murray. "Most of our work is restoration of function."

Murray first confronted the challenges of reconstructive plastic surgery during his random assignment to Valley Forge Army Hospital in Phoenixville, Pa., during World War II. There he treated many burn victims and other battle casualties from the European, African, and Pacific theaters.

Since he views transplantation as a form of reconstruction, "the next logical step was replacement surgery," says Murray. "If you can't fix it, replace it."

Murray and E. Donnall Thomas, oncologist at the Fred Hutchinson Cancer Research Center in Seattle, shared the 1990 Nobel Prize in Medicine for discoveries that have enabled the development and expansion of organ and cell transplantation in humans. Their studies helped open the era of transplant surgery.

A painting of Murray.

Murray's role in the dawning of this new era was, of course, as the transplant surgeon. On Dec. 23, 1954, Murray transplanted a kidney from Ronald Herrick to his identical twin brother, Richard.

"I am often asked if, at the time of the Herrick operation, I was aware of its historic significance," says Murray. "I knew the operation was potentially momentous, but in truth I treated it as just part of the week's work. Two days prior to the Herrick operation I repaired a double cleft lip, resected a recurrent cancer of the mouth, corrected lop ears in a child, and closed a burn of the buttocks. Two days after the operation, Christmas Day, I found myself in the Newton-Wellesley Hospital emergency ward, suturing a laceration of a child's forehead.

"To the patient, any operation is momentous. As such, one prepares for each operation as it comes, thinks about it ahead of time, and anticipates and identifies trouble spots that could waste time or lead to complications. In that sense the Herrick operation was no different from all the procedures I had performed during that week."

A Calling

After three years of active duty, Murray was discharged from the Army Medical Corps in 1947 with the rank of major. He returned to the Brigham and Children's hospitals to complete his general surgical residency and joined the staffs of both hospitals and the Harvard Medical School (HMS) faculty in 1951.

With a special interest and experience in the treatment of facial cancer in adults and congenital facial problems in children, Murray has worked closely with the general surgical, neurosurgical, and dental departments in both hospitals as well as the Dana-Farber Cancer Institute (formerly the Jimmy Fund Center).

In 1951, he enthusiastically joined the kidney transplant group at the Brigham under George W. Thorn and Francis D. Moore to pursue the study of transplantation biology that originally had aroused his curiosity during his military experience.

Working in the HMS surgical research lab, he developed the techniques for immunosuppressive regimens for kidney transplantation that eventually were used in the first successful organ transplants in humans -- first between the identical twins in 1954, then between siblings in 1959, and finally from an unrelated cadaver in 1962.

Though Murray felt a strong calling both to transplant and plastic surgery, the young doctor heard many a negative comment about his chosen specialties. Early in his career, Murray recalls, "a lot of people said it was ridiculous to get involved in a transplant program, that it would never work. I was advised by one of my closest friends not to get involved in this -- that it would ruin my career!"

Others pooh-poohed plastic surgery. As Murray said in an interview in the Annals of Plastic Surgery (January 1984), "When I returned from the Army to my surgical residency, everyone tried to discourage me from entering plastic surgery, saying 'It's essentially the backwater of surgery.'"

Murray pursued his heart's calling anyway. "I never paid much attention to people who tried to dissuade me," he says. "I don't mean this in a high-handed way. This is just the way I look at life. Perhaps I was influenced by Dean George Berry's quote from Thoreau at his final HMS Faculty meeting: 'If one advances confidently in the direction of his dreams, endeavors to live the life he has imagined, he will meet with a success unexpected in common hours.'"

To Look Human

To Murray, reconstructive facial surgery is not just about manipulating muscles and moving bones. "We correct a hand, but we also change the psyche," he says. "I have always considered that reconstructive facial surgery can be 'surgery of the soul.' We are altering the internal spirit of the patient. As Will Mayo, one of two country doctors who founded the world- famous Mayo Clinic, said, 'It is the divine right of man to look human.'"

One soul whose life was altered by Murray's craft was a man named Raymond, who, abandoned by his parents, spent the first 12 years of his life in institutions because of his deformities.

"But somehow, in the mid-'60s," Murray recounts, "he was referred to the plastic surgery clinic at the Brigham for facial differences. We corrected his mal-aligned jaws, his drooling. We switched around a few muscles and gave him the ability to smile and chew."

Raymond grew to love Murray as a child loves a parent. He obtained his high school equivalency diploma at Murray's urging, and when Murray suggested that the young man take up writing, he did.

Raymond's handwritten biography, which surfaced after his death at age 54, broadcasts optimism rising from the depth of despair. Wrote Raymond, "Many people have severe facial deformities, either congenitally or as a result of injury or disease. They do not look like other people and because they are different, . . . they may even come to think of themselves as less than human." But "beauty is not determined by a perfect figure and features -- it is determined by the way you respect and honor yourself."

Patients like Raymond have inspired Murray over the years. He often speaks of his patients when giving talks, and inevitably a member of the audience says to him, "You should write a book about that!"

Recently, Murray has written that book, profiling patients at five-year intervals in his 50-year career. "I started writing it about 18 months ago," Murray says, "and it has been so satisfying." He has not yet chosen a publisher, but expects it will be available by the spring of 2000.

If the past half-century has proved fulfilling for Murray and his patients, the surgeon-scientist sees even greater promise for the future. "Even now," he says, "we're trying to extend the limits of what can be done on the genetic and cellular levels in reconstructive surgery."

Murray's excitement about such prospects originates in his observations of the human fetus. "The growth of the human embryo is just mind-boggling," he says. As an example he holds up his hand. "The upper extremity starts as a glob of a few cells that eventually proliferate and turn into bones, muscles, nerves, and tendons." Spreading his fingers, he explains how the hand begins in the shape of a mitten. "Soon the individual digits begin to emerge and the cells between them die. Each cell can be considered a stem cell for the whole body. It's amazing, how the body knows which cells are to become the fingers and which are to die.

"If I could have another lifetime," he muses, "I'd like to concentrate on inductive surgery, to 'set the table' so the body can create its own cells and tissues. There's no question I'd be a surgeon-scientist because my life combining humanism and science has been so much fun."

The Medical School has endowed a Joseph E. Murray Professorship in Plastic and Reconstructive Surgery at both Brigham and Women's Hospital and Children's Hospital.