The start of clinical transplantation in Russia ( 1964 – 1965 )

https://doi.org/10.23873/2074-0506-2020-12-2-143-154 PHENOMENON OF DEMIKHOV. At the Sklifosovsky Institute (1960-1986). Doctor of Science − inexplicable oblivion − scientific horizons. The start of clinical transplantation in Russia (1964–1965) S.P. Glyantsev A.N. Bakoulev National Medical Research Center for Cardiovascular Surgery, 135 Roublyevskoe Hwy., Moscow 121552 Russia; N.A. Semashko National Research Institute of Public Health, 12 Bldg. 1 Vorontsovo Pole St., Moscow 105064 Russia; Correspondence to: Sergey P. Glyantsev, Prof., Dr. Med. Sci., Head of the Department of the History of Cardiovascular Surgery at A.N. Bakoulev National Medical Research Center for Cardiovascular Surgery; Head of the History of Medicine and Factual Account Unit within the History of Medicine Department at N.A. Semashko National Research Institute of Public Health, e-mail: spglyantsev@mail.ru

In the 1970s, she was the Head of the Department of Congenital Heart Diseases in Infants in the Bakulev Cardiovascular Surgery Institute of the USSR Academy of Medical Sciences; in the 2000s she was the Deputy Director of the Bakulev National Research Center for Cardiovascular Surgery of the Russian Academy of Medical Sciences. 2 The reader may have three questions: 1) why V.P. Demikhov rejected V.V. Kovanov's proposal; 2) Why his manuscript was accepted by the Central Medical Publisher's of the country; 3) Who contributed to its publication? It is difficult to answer these questions, since only V.P.Demikhov knows the answers to them. But we can still assume the following: by 1960, he had accumulated the material adequate for several dissertations, so he did not see the point to defend a Thesis on transplantation, say, of the heart only, without to publishing the data on other organ transplants. It's either everything or nothing. Understanding that V.V. Kovanov will not allow it him to use the whole material for defending his Thesis, V.P. Demikhov decided to submit the manuscript to Medgiz Publisher's. Obviously, we will never know why his book was published, and who contributed to it. But his fame in his country and abroad after two trips to Germany in 1959 was such that his name could work for him. In addition, as stated in the Preface, the Editorial Board considered it appropriate to remind of their differences in views with the author. second, additional heart", "Replacement of the heart and lungs", "Replacement of the heart only (without lungs)", "Transplantation of lungs (without heart)", "Renal transplantation", etc.
We believe that, changing the place of work from the Department of  According to O.V. Demikhova, the Thesis paper was titled the same as the monograph ("Experimental transplantation of vital organs"), it was rather large, printed with a typewriter on yellowed paper, and had a dark blue calico cover. In other words, it was the same work that V.V.
Kovanov "rejected" at one time. If this is so, then its defence as the Thesis for a Candidate academic Degree was indeed a heated discussion. This is how M.M. Razgulov, Dr of Med. Sci., who had been one of V.P. Demikhov's students recollected about it: "And then came that remarkable day. In a huge hall with rows of seats rising up, all the seats were occupied, and the aisles between the rows, too.

May 28, 1964
Demikhov in a confident voice told about half of the work he had done to create a cardiopulmonary complex, a heart transplant with the lungs, showed 10-15 schemes for a second heart transplantation, etc.
Exactly 20 minutes later, Demikhov completed his presentation. Applause reappeared in the hall. Impressed scientists rose from their seats and applauded for a long time, despite the remarks of the Chairman.
Then suddenly a poet stepped on the scene and without any permission read a poem dedicated to the brilliant scientist, discoverer V.P.
Demikhov. Neither we, nor Demikhov knew him. With difficulty, almost with a scandal, the poet was put back to his seat. But he was also applauded.
"Are there any questions regarding Demikhov's speech?" the Chairman asked the audience. We were wary, looking at the 2nd and 3rd rows on the left, where the representatives of the "opposition" were sitting, and were determined to repulse them. But there were no questions. Androsov said that this work was worthy more than a Candidate Degree, and each of its chapters is worth of awarding a Doctor's Degree to Demikhov. And there were seven such chapters. He noted that all the ideas of the Applicant would find a clinical application in the next 10-15 years.
And the opponent suggested that the Academic Council should provide another 20 minutes to the Applicant for the defence of a Doctoral Thesis.
The second opponent, Professor Aron Evseyevich Gurvich 4 , Doctor of Biological Sciences, completely agreed with Professor Androsov.
Demikhov had previously assumed that this would be so, and prepared a second report on the developments not included in the first one.
Voting ballots were handed out to the Academic Council members, and soon the Chairman of the Counting Committee announced that everyone voted "yes", there were no spoiled ballots.
Then Demikhov was given another 20 minutes of time, but that time to defend a Thesis for the Degree of the Doctor of Biological Sciences.
During a short break, when the Counting Committee counted the votes, the opponents of Demikhov left the hall. They realized that they had lost. If any of them spoke out against Demikhov, then they would not have been greeted.
By the way, many of those who were sent to this Thesis defence Session did not really know well the work of the Applicant. They were only told that Demikhov did not recognize immunology, but was only a tech guy and a dreamer. And when they learned from his first speech about his contribution to transplantology, many of them changed their minds. <…> After 20 minutes, Demikhov completed his second presentation. The audience applauded him standing.

Inexplicable oblivion
In 1964, the Scientific Council of the Sklifosovsky Institute was renamed into the Academic Council. The Council worked in its own regime, V.P. Demikhov did in its own (Fig. 2). He was not a member of the Scientific Council, and therefore he did not attend its Meetings if he was not interested in the topic under discussion. Even when he attended them, he listened to the speakers silently, without asking questions (Fig.   3). The Council "paid" him back the same: not a single report on the Organ Transplantation Laboratory work was on its agendas either in 1962, or in 1963, or in 1964, but as we shall see later, and nor in subsequent years 6 .

Shimanko, Prof. P.N. Petrov
What did the Council do? At its Meetings, held once a month, as a rule, various Institute departments presented the reports on their clinical work, research and developments and also the applicants seeking for the 6 As should be noted, at least one Report did take place. In May 1966, V.P. Demikhov briefly presented his research at the Session of the Institute Academic Council. But, that report came out of schedule, as the next article will show. In fact, it was V.P. Demikhov who initiated it when he nominated himself as a Corresponding Member of the USSR Academy of Sciences. The text of the article refers to the fact that no planned Reports on V.P. Demikhov's work were included in the Council's Working Plans in the 1960s.

Scientific horizons
And V.P. Demikhov continued his work (Fig. 4). In the first half of the 1960s, many foreign surgeons visited his Laboratory (Fig. 5). Against the line "Junior Researcher", someone put a check mark in ink and wrote the number "1". The same check marks were put against the "Forensic Examiner" and "Head Nurse", a dash was against the "Houskeeping Nurse." And that's about it.
Who made those corrections? Did the Memo reach the Minister? We do not know this, but, according to our data, no changes in the Laboratory staffing took place after that 9 (Fig. 6). Demikhov, who could have made the same report at the same forum, and who had been using that method for a long time to successfully revive his "tailed" patients. However, he did not speak at that Session. And here is what was said in the summary describing the topic: "Entire organs cannot be preserved by freezing or drying, as is done for individual tissues (bones, blood vessels, skin). The best way (and so far the only way) to preserve the revitalized organs is the physiological method.
The creation of cross blood circulation makes it possible to revitalize cadaveric organs and keep them in a vital state <...> In practice, this can be done as follows:> When a patient with irreversible brain damage, but having a viable body, is delivered at the clinic, you might revive the heart in it, create artificial respiration, nutrition, special care, and in this way (in a thermostat at a temperature of +37 degrees C) maintain the body's life for a long time.
Vascular prostheses might be sutured to the femoral vessels of this revitalized body (without the function of the head), thanks to which the organs from other fresh corpses can be revitalized in the neighbouring compartments for long-term preservation of them in a vital state and for transplantation.
Many different organs can be connected to a single such body, which will physiologically provide self-service of the entire system (italics ours − S. G.).
Prostheses can be drawn from the system of revitalized organs to neighbouring wards, in which cross blood circulation will be used to perform open heart surgery, to maintain a living state of the body after removal of vital organs (until transplantation), and for other purposes.
In the experiment, we have shown the feasibility of maintaining the life of a body without a head, [and also] of many organs in compartments connected to the same body.
There were four hearts with lungs and with abdominal organs in 4 compartments that were connected to one dog. All organs in the compartments were functioning. The experiments were documented by shooting a popular science film in 1965.
Recommendations for implementation in practice: The above method of preserving revitalized organs can be put into practice" [13].
It follows from the text of the document that in 1965 V.P. Demikhov continued working actively at organ revitalization, the main topic, for which he had come to the Institute 5 years ago, and also advanced ahead.
If earlier (in 1963), he only theoretically proposed to connect functioning or revitalized organs to a revitalized body, that time he said that he had done it in practice and was ready to implement the method in clinic.
Apparently, this is the first mention of establishing the country's first primitive "bank of organs", as well as of organizing a kind of "resuscitation department" with the biological apparatus of artificial blood circulation being the centre of it. But in 1965, some of V.P.
Demikhov ideas that used to be advanced ones some day, but never being implemented in the Soviet Union, turned already hopelessly outdated. and after the perfusion of its vascular bed, was transplanted onto the iliac vessels of the recipient, then the stump of the ureter was sewn into the bladder 12 . The surgery was performed successfully, but not up to the twostage scheme that V.P. Demikhov once proposed. 11 The first clinical kidney transplantation in the United States was performed on June 17, 1950. The Patient with the transplanted organ lived for 5 years. 12 It is known that the first kidney transplantation in the USSR in 1933 was made by Yu.Yu. Voronoy from Kharkiv. But it was what transplantologists call an "engraftment" rather that transplantation, since Thus, the train of Soviet clinical transplantology started off.
Unfortunately, without V.P. Demikhov. Note that V.P. Demikhov, who had always taken an active life position in organ transplant issues until then, did not even try to jump on its footboard. In any case, he did not write any more letters to the Healthcare Ministry or Party Bodies, for example, requesting them to transfer his Laboratory to the NIIKiEH base.
In any case, we are not aware of such letters. But more about that is in the next article. the kidney was "engrafted" on the hip vessels and was positioned outside the body for a temporary detoxification of the body after poisoning. Earlier we mentioned that a similar operation had been performed by V.P. Demikhov using his original "two-stage" scheme at the Botkin Hospital in Moscow in 1962. The kidney transplantation made by B.V. Petrovsky and colleagues has been considered the first one because the kidney was transplanted orthotopically and designated for a long period of functioning.