Invited Commentary

John C. Norman, MD
Arch Surg. 1995;130(1):39. doi:10.1001/archsurg.1995.01430010041008.
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Opportunities to alter, abrogate, or ablate diseases are rare. Nearly three decades ago, our laboratories had eclectic interests and enjoyed the benefits of a burgeoning discipline in transplantation fueled by Peter Medawar's work two decades earlier and improving perfusion techniques created by the increasing needs of clinical cardiovascular surgery.

We constructed isolated ex vivo organ perfusion chambers wherein temperature, humidity, flow and perfusate oxygenation, and content could be controlled. Measurements of isolated organ viability and function became possible. Canine, bovine, porcine, and ovine hearts, lungs, livers, and kidneys were studied. We subsequently found that canine and human spleens consistently added (or synthesized) factor VIII to (in) all perfusates.1 We then reasoned that if the spleen (or liver) was indeed one of the sites of factor VIII synthesis, and if this site could be transplanted with enduring synthesis, an opportunity to alter, abrogate, or ablate classic hemophilia A was, indeed,


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