mama This micro-well tray, a proto-type produced in the early 1970s by Nunc A/S, was recently added to the collections of the Medical Museion. The tray, referred to as the Kissmeyer-Nielsen tray, was developed by Flemming Kissmeyer-Nielsen, head of the Tissue Type Laboratory at Århus Kommunehospital (now Skejby Sygehus). Kissmeyer-Nielsen was the leading Danish figure in transplantation immunology and a prominent member of the international tissue typing community, which had come together during the 1960s and worked to develop more sensitive and standardized methods for tissue typing as a means prospective matching of donors and recipients in cases of organ (mainly kidney) transplantation.
The first major progress in the field of histocompatibility testing was the microdroplet test developed by Paul I. Terasaki at the Tissue Type Laboratory at UCLA in 1964. The testing was done in micro-well trays in which tissue samples were mixed with test sera and color in order to allow identification of leucocytes recognized and destroyed by specific antibodies. Terasaki began a production of microwell-trays (from then on commonly known as Terasaki-trays and still produced today by a number of companies world wide), which became an important source of funding for his pioneering laboratory. Famously, when the NIH withdrew their funding in 1972 of Terasaki after he had published results showing little correspondance between tissue type match grades and survival rates for cadaver kidney grafts, Terasaki was able to continue research on the income from test trays.
Expectations to the beneficial effects of tissue typing for organ transplants were enormous in the late 1960s and early 1970s (which was one of the reasons why the NIH was unwilling to accept results undermining this hope), and the race was on to come up with with sensitive methods that were sufficiently standardised to allow cooperation between groups of hospitals and tissue type laboratories, something that was seen as indispensable if the use of cadaver kidneys were to gain any real significance in kidney replacement therapies. In 1967, Kissmeyer-Nielsen presented his modified version of the Terasaki method, the KN-technique, which proved superior in comparison with other known methods. The method became standard in Scandiatransplant, the Nordic cadaver kidney exchange organisation set up in 1969 with Kissmeyer-Nielsen as the driving force and with its main office in Århus Kommunehospital. The method did, however require a modification of the Terasaki tray, mainly because a reverse microscopy was used. The Kissmeyer-Nielsen tray was an early attempt at this.
As was the case with the Terasaki test, KN-technique could be carried out with very small amounts of test sera. In order to prevent the samples from evaporating, the micro-wells were covered with parafin oil. Yet because of the three-part design of the Kissmeyer-Nielsen tray (a base which had to be glued manually on to a frame and then covered with a lid), leaks were common, and parafin oil would spill onto the optics. This particular design was therefore abandoned, and Kissmeyer-Nielsen went into cooperation with Norwegian Hamax, that managed to produce a tray with a fixed base, and thus no leaking. Hamax still produces trays for KN-technique, but use of this method is declining, partly because of the increasing use of flow cytometry in tissue type laboratories, and because many laboratories reverted to the Terasaki method. Nunc A/S continues their production of Terasaki-plates, as they did before their short-lived cooperation with Kissmeyer-Nielsen.
The Kissmeyer-Nielsen tray is now part of the collections of Medical Museion, and therefore also part of the problematic regarding the collection, storing and exhibition of recent biomedical objects. The story surrounding the tray, a story which has only been sketched here, is interesting and offers a chance to enter not only an important period in the history of kidney transplantations, but also to discuss more general issues in the historiography of recent biomedicine, such as attempts at standardization, cooperation between public and private actors in the health care field, and the transformation of patients and the many shapes and sizes they appear in. Yet the thing in itself, the actual tray, is inconspicuous, bordering on dull. It offers no clues to the drama of life and death that it took a central part in, or to the professional struggles for health, fame, and funding that brought it into being. Of course, the transparency and anonymity of the thing may be a point in itself, evidence to the quest for impartiality in the distribution of the scarce resource of donor kidneys that histocompatibility testing was very much about. But that story is less in need for the actual tray in order to be told, than the tray is in order to evoke a sense of relevance or presence in the beholder.
