Having a Baby on One Kidney

The resourceful doctors at Boston's Peter Bent Brigham Hospital knew how tough a problem it is to transplant a human kidney under the most favorable circumstances. They had already done transplants from two men to their identical twins--and each operation was apparently successful. But what would happen to a transplanted kidney if the recipient were a woman and she later became pregnant?

The Brigham doctors were well aware that pregnancy is notoriously hard on a normal woman's paired kidneys. Various degrees of blood poisoning, including the deadliest form known as eclampsia (marked by coma and convulsions), are somehow involved in a pregnant woman's kidney disturbances. Could a single kidney bear the added stresses of pregnancy? The question became a crisis early in 1956 when Wanda Foster and Edith Helm went to Boston from Oklahoma. The twins were 21 years old and both were married, though neither had yet had any children. Edith's longstanding kidney disease had become unmanageable, and the Brigham doctors concluded that only a transplant could save her life. Sister Wanda was willing, and graft tests showed that the twins were indeed identical.

Just as in both previous operations, the doctors put the transplanted kidney into the patient's flank. Nature's plumbing is so delicate and complex that the surgical feat of putting a transplanted kidney into its normal place in the human body would have been forbiddingly difficult. And the operation would have been so heroic that a patient as near death as Edith might not have survived.

The doctors relaxed when the kidney graft took. But they became understandably tense in January of 1958, when Edith Helm arrived from Sand Springs, Okla., about seven months pregnant. On March 10 she had a normal baby boy by caesarean. Little more than two years later she had a girl, also by caesarean, in Gushing, Okla. Meanwhile, Sister Wanda had had three normal pregnancies and deliveries.

The case of Edith Helm has proved that a kidney transplanted to an unnatural location can do double duty and also withstand the strains of repeated pregnancies. As the Brigham team headed by Surgeon Joseph Murray reported in the New England Journal of Medicine last week, this is "gratifying." Beyond the doctors' Yankee reserve, though, is the knowledge that no tougher test of their technique could be devised.

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