Joe Burnside, heart transplant

The night Joe Burnside had his heart taken out at Harefield hospital near London, surgeon Magdi Yacoub flew in from Liverpool by helicopter. Howling wind and rain made landing difficult, so Yacoub had to jump from the aircraft as it hovered outside the hospital, Joe's replacement heart in a cardboard box clutched to his chest. The organ had come from Peter Everett, a promising 18-year-old athlete from Liverpool, who had died from a brain haemorrhage earlier that day after finishing a race. A few months before, he had placed himself on the organ donor list.

"I said, 'Oh my God, that's Joe's heart'," recalls Joe's wife, Mary, who watched Yacoub's dramatic arrival. "I knew Joe was laying there with no heart, they'd put him on bypass. I thought, if anything happens to this heart now, he's gone, dead."

At the time, in 1980, heart transplants were newcomers to routine clinical practice. The world's first successful transplant had been carried out by South African surgeon Christiaan Barnard in 1967 and the UK's official national programme had begun at Papworth hospital in Cambridge in 1979. Joe's operation would be one of the first under that programme.

As Yacoub made his way to the operating theatre, Mary remembers, "He was running with the box and he kicked his legs out to one side in joy. I thought, why's this man carrying on like that, doesn't he realise how serious it is?"

In 1979, at 49, Joe had his second heart attack in 18 months. Decades of a daily routine that included several pints of beer, 30 strong cigarettes and a fish and chip supper were taking their toll. As a young man he'd been fit and strong, with a physical job that made up for the beer-and-chips lifestyle, but that changed when he went into the carpet business: "I just sat and waited for customers to come in."

After his heart attack, Joe couldn't walk the length of a room and found it difficult to get up stairs or even fasten his shirt buttons. Local doctors had all but given up on him, one even telling Mary there was little they could do except wait for her husband to die, but she didn't give up. She'd heard the story of Keith Castle, the first Briton to receive a heart transplant, in 1969: perhaps that was the answer.

It was a new and unproven technology, though; Joe wasn't keen and nor were his doctors. Against their advice, Mary wrote to Yacoub and asked for help. Less than a week later she had a response: could Joe come to Harefield hospital that week? She didn't tell him why: "I thought I was going for a check-up. Heart transplants were a new thing then, and I thought I was going to get better." When a young doctor casually mentioned to Joe that he was suitable for a transplant, "he nearly dropped down dead," Mary says. "His eyes were full of tears."

It took weeks for him to come round to the idea of a transplant. But seeing other people walking up and down made him realise how ill he was - and that there was no alternative. He was on the waiting list for three months, his condition gradually worsening, and remembers a flash of intense fear just before the operation. It lasted from before midnight until dawn. The first thing Mary noticed the next day was Joe's toes. "They'd always been blue, but now they were pink. And he had this lovely colour in his cheeks."

Yacoub's team were anxious to ensure Joe didn't catch any infections as a result of the immuno-suppressing drugs he had to take. Food would arrive in sealed boxes, which would go into the microwave again before Joe ate. If he was brought a newspaper or a letter, they had to be passed through a steamer to kill any bugs. His skin was rubbed raw from four daily showers with carbolic soap - even visitors had to shower and wear sterilised gowns.

Joe went home to Darlington six months after the operation - and in February celebrated 28 years with his new heart. He is officially the longest-living heart transplant survivor in the UK.

Mary still chokes back tears when talking about Peter Everett. "It's hard when you think how unselfish a young man can be. His mother said it was only days before he died that he sat them down and said if anything happened to him, he'd like to donate his kidneys. Later, she volunteered his heart, too." It was this that allowed Joe to see his 11 grandchildren and four great-grandchildren. "Without it, I wouldn't have had anything like that, would I?"

Alok Jha

Peter Leslie, kidney transplant

Peter Leslie was 24 when he began vomiting. It was the late autumn of 1964 and he was living with his parents in Belfast, working for Post Office Telecommunications, and engaged to be married. His GP referred him "for a few tests" and on December 18 that year he was admitted to hospital. "The doctor said they'd have me out by Christmas," Leslie recalls. "He didn't realise it would be the next Christmas, and with a new kidney."

At first the doctors suspected leukaemia, but found cysts on his kidneys, reducing their capacity to filter - "A bit like running a Ferrari on paraffin oil." A month later he was transferred to Belfast City hospital and put on a daily regime of peritoneal dialysis - the precursor to modern hemodialysis. "It was what they used to call a wash tub, a catheter and a solution that flushed out your rubbish. It wasn't a very pleasant experience."

In April, his doctor came to see him. "We looked at each other and she said, 'We have two options. We keep you on dialysis, sort of for ever.' I said, 'What's the other option?' She said, 'A kidney transplant.'

"Now, if someone says that, you say, oh yes, fine. It's a bit like these ladies getting their bits and bobs done. But back then she didn't even say transplant. It was called a kidney graft. I said, 'What's the success rate of that?' She said, 'It's very difficult to say.' I said, 'What's the chance of success if we keep on dialysis?' She said, 'You have three months'."

Leslie is now 67. One of the first people in the UK to undergo a kidney transplant, he is also one of the longest-surviving patients. When I went to meet him and his wife, Peggy, at their home in Staffordshire, I expected them to talk about how it had felt to become a medical guineapig. But, they explain, it wasn't like that at all, because Leslie had no idea what a kidney transplant was.

The first UK kidney transplant had been carried out in 1960, donated by a living twin to his brother. The first recorded transplants from a deceased donor took place in 1965, the year of Leslie's operation. He had never heard of them, so when in April he was transferred to London, he had no understanding of what lay ahead.

Leslie spent four months in St Mary's hospital, waiting for his operation. At night he would be on dialysis, but in the day he would meet his brother and go to the cinema or walk in the park. He had to phone in every day, and twice was told to jump in a taxi and come back to hospital, though nothing came of it. What did he think was happening?

"It sounds contradictory, but it's a bit like, if you know something, you can talk about it. But no one said, 'We are going to have your kidney taken out, and someone else's put in.' And I didn't speculate. It sounds ridiculous, but my interpretation was that there was going to be this mystical kidney that was going to make me better. Maybe that was naive."

His wife says softly: "I'd realised what was happening. After all, he was waiting for the kidney. Well, where was the kidney coming from? But we didn't realise someone would have to die. They just didn't talk about things in those times."

Listening to their memories, it feels as if our familiarity with transplant surgery is less of a change than the shift in the doctor-patient relationship. "The medical psychology, or philosophy, call it want you want, of that era was different. The amount of knowledge or information passed to me at any time was nil. This is not a criticism of the profession," Leslie stresses. "This was just the way it was."

Even after the night in August when Leslie was wheeled into surgery, and woke up three days later full of tubes, feeling miraculously better, he did not understand that inside him was the kidney of a dead stranger. "There was no particular time when actually I realised it. I can't say on such and such a day the penny dropped." His donor was a car crash victim, and slightly older; that is all he knows.

By January 1966 he was back at work, and that summer he married Peggy. In the wedding photograph, his face is still slightly swollen, a common side-effect of the surgery. They had three children, moved to Staffordshire in 1970, and he remains healthy and active. He visits the local renal unit every three months: "And from a medical point of view, my results are so spot-on, the doctors say they're boring."

He takes immunosuppressive drugs every day to prevent rejection, and in the past 15 years these have caused what he calls "nasties" - skin disorders and sudden, hard eruptions on his hands or head which have to be surgically removed, sometimes requiring skin grafts. He makes light of them - just as he makes light of his entire medical history. Only once, when I ask about the seven other renal patients in his ward in St Mary's, does he allow a glimpse of something else. Every one of them, he says, died. And he covers his face with his hands and weeps.

Decca Aitkenhead

Timmie Jean Lindsey, breast enlargement

In her late 20s, Texan Timmie Jean Lindsey decided to divorce her first husband and get her first tattoo. "I'd led a very protected life," she says. "I went from being under my dad's hand to being married at 15, and I wanted to do something to surprise people. So I got a pretty rose on my chest - and was immediately disenchanted with it."

So Lindsey went to see a doctor, Frank Gerow, in her home town of Houston about getting the tattoo removed. As it happened, Gerow was one of a group of plastic surgeons who were pioneering breast augmentation using silicone prostheses. He was looking for 12 women to take part in the first human trials, and asked Lindsey if she'd be one of them. She agreed. "I had a cousin who'd had her breasts done several years before, but they weren't with the silicone implant. She told me that when she went to bed, they would roam around in her chest."

Earlier experiments with augmentation involved injecting various materials, including glass, paraffin and silicone, into the breasts. The consequences were disastrous, with side-effects ranging from inflammation to organ damage. What Gerow and his team had created was the first implant that would, in theory, keep its shape and not damage the woman's health.

Gerow told Lindsey of the need for breast augmentation; that silicone implants would mean women who had had breast cancer could have their breasts repaired. He also said he could improve her looks. "I'd never thought about it before," Lindsey says, "but I suppose after children your breasts aren't what they used to be. Dr Gerow said he could lift my breasts back to how they used to be and I thought, oh, I'd like that. I'd like them to be perkier." Gerow then asked Lindsey if she knew anyone who might be interested in taking part in the trial. She told her sister-in-law, Barbara, about it; Barbara told her sister-in-law, and so on, until a group of 12 were assembled as guineapigs.

Lindsey's operation went smoothly. "I wasn't afraid to have it done - I had complete trust in the doctors. Maybe I was too young to be afraid. And, besides, I was just so glad to get that eyesore of a tattoo off my chest. Before the surgery, they asked if I wanted to see the prostheses, but I said no. I didn't want to dwell on the idea of something foreign inside me. Out of sight, out of mind. When they unwrapped me, I looked at them and thought, they're just like my old breasts, but now I can go without a bra if I want. After that, I went home and never really thought about them again."

Did anyone notice? "I had a brief period of getting noticed more by men - I got wolf whistles and things like that - and I liked it. But I didn't tell many people. A few months after the operation, I met and married my second husband, and he made it clear that he didn't want to discuss the implants. He asked me to stop wearing tight jumpers and shirts, which I didn't mind because I was married and didn't want to wear things that drew attention to me any more. It wasn't that I was ashamed - I'd have talked about the implants if anyone had asked - but it's just not something that came up."

Lindsey is now 76 and says she has had few problems with her implants, although she does admit that, over the years, they have hardened. "You can feel the prostheses if you press, but I have enough breast tissue so it really isn't that noticeable. And they've aged, like I have. They haven't stayed straight up and perky; they've drooped, too. They feel like part of me now."

What about the other women involved in the trial? "I think I was the only one who came out good. Barbara got very ill. She had arthritis and liver disease, and she blamed the implants. Lots of women had trouble with silicone leaking into their systems. Some of them died."

During the 80s and 90s, 15,000 women took action against Dow Corning, the company that manufactured the implants Gerow helped formulate. In 1998 it made a multibillion-dollar payout. Even so, Lindsey remains a believer. "After the lawsuits, scientists pretty much proved that silicone is safe. When I got osteoarthritis, people told me it could be connected, but I think it's just something that happens as you get older."

The week after we speak, Lindsey's 32-year-old granddaughter will be getting implants of her own, and Lindsey says the thought frightens her. "In my early years, I didn't think about the dangers, just the end result, but a few months ago a 16-year-old having implants died on the operating table from the anaesthetic. Kids of 16 haven't developed their true thoughts about things. They should be made to wait. But for women who've had breast cancer, or who have had children, then I think it's good - it can be empowering to fix yourself up. I'll just have to trust that my granddaughter gets a good doctor."

How does it feel to have been involved in the first trials of a procedure that has become so common? "My granddaughter says she's proud of me - she thinks I'm a pioneer. As I've got older, I can see that test trials can be a good thing. I'm sure somebody was in a test trial for the knees they've put in me for my arthritis. And heart bypasses - there had to be somebody who was first for that. Someone has to be the first for just about everything."

Becky Barnicoat

Aleshia Brevard, gender reassignment

"Until the surgery I just had no control," Aleshia Brevard tells me, her long hands tracing circles around her head. "I felt like life was swirling around me."

Brevard, now 70, has lived a full life, fuller than most. In 1962, at 23, Brevard was in many ways reborn. The then female impersonator, who went by the name of Lee Shaw but had been born Alfred Brevard "Buddy" Crenshaw, travelled from San Francisco to Los Angeles to have gender reassignment surgery under Dr Elmer Belt.

"He was a man's man," remembers Brevard, sitting in her apartment in the foothills of the Santa Cruz mountains in central California. "I even made a complaint about him, but I don't think anything came of it." The approach of the pioneering Dr Belt sounds obscene to today's ears, but to Brevard at the time it served as a useful introduction to her future life as a woman. "It was all about the penis," she says. "He said, 'I'm going to make a hole in you the size of that bread roll' then he offered to measure the dimensions of my sexual partner to make sure there was a good fit. Uggh."

Brevard was referred to Belt, a urologist and founder of one of the leading hospitals in California, by Dr Harry Benjamin, a German-born sexologist who coined the term "transsexual". Benjamin achieved some fame in 1952 when the media pounced on the story of his patient Christine Jorgensen, one of the first Americans to undergo sex reassignment surgery.

Brevard holds herself with the poise and grace befitting a woman who graduated from nightclub routines to a robust career as an actress in TV and film, before settling into a life teaching theatre studies. She laughs with ease at herself and others, and makes light of what must have been at the very least a trying physical and emotional ordeal.

"The pain?" she exclaims. "Let me tell you, it was absolute agony for a year. And I was a wreck. What with the hormones and everything, I was impossible to be near. Poor Hank. He tried."

Tears well up in her eyes, almost 50 years after the event. Hank was Brevard's intended. He supported her throughout the operation, but was eventually run off by her parents. "In a very old-fashioned way, they thought he wasn't good enough for their little girl," she says, with pride.

Brevard, who describes her operation as the mere correction of a biological error - the removal of her penis and its replacement with a vagina - knew about the possibility of a sex-change operation from her schooldays.

"Christine Jorgensen had a lot to answer for," she recalls. "I remember sitting in class after she had made headlines with everyone pointing around trying to work out who the most likely candidate would be." The finger-pointing settled on Buddy, an experience Brevard now says she found deeply humiliating. As a boy she had always felt ashamed of being different, she later wrote in her memoir, but had not made any connection between her childhood discomfort and the nascent sexual reassignment movement.

Years later, after leaving her Tennessee home town for the lights and anonymity of San Francisco, Brevard met a fellow performer who was undergoing hormone therapy in preparation for the operation.

"The next day I went straight to the doctor," she says. Any psychological assessment was negligible. "I think they may have asked me some questions, and later on I did have one session with a psychiatrist, but that was it. You see, they could see. Ahem," she blushes. "My hair was shaved in a feminine form, because I was a performer, so they were persuaded."

The suggestion of a nudge and a wink approach to the procedure extends to one of the most shocking part of Brevard's story: her auto-castration.

In the US it was, says Brevard, "unlawful" to castrate. "When they performed the procedure they sewed the testicles inside the body," she says. "That was useless. They keep releasing testosterone and you'd be up against goodness knows what.

"So I decided to remove them myself, which meant I would be able to afford the $2,500 to have the operation here. I couldn't afford to go to Morocco." Dr Georges Burou, the pioneer surgeon who carried out thousands of sex reassignment operations starting in the late 50s, was based in Casablanca.

Brevard visited her doctor and explained that she needed to neuter her cat. "I had grown up in the country, so I knew pretty well what to do," she says. The doctor drew her a diagram. "Then he discreetly turned his back," she adds, "leaving his medicine cabinet open." Brevard availed herself of the contents of the cabinet and headed home. But the plan for a friend to help out fell foul of the friend's squeamishness.

"I was left there to sew it up," she says. "Afterwards, we flushed them down the toilet. Who knows, maybe they're out there in the San Francisco Bay, or have given some shark a huge dose of testosterone."

The operation, too, brought a shock. "I had never seen a vagina," she says.

After the operation, Brevard went home to Tennessee. "Folk were lining up to stare, we could have got rich selling tickets," she remembers. But Brevard endured, eventually moving to the nearby city and returning to study at the same college she had attended as a boy.

From there, she embarked upon what passed for a regular heterosexual life; some men with whom she had relationships knew her past, some didn't.

But the assimilation - four marriages to three men, stepmother to three children - brought both advantages and disadvantages. All three husbands were unaware of her gender history, says Brevard. The first, unconsummated marriage ended when her husband announced he was gay. The second was undone by his infidelity, the third by her husband's past catching up with him.

Although she has had some difficulties assimilating, she says there are many success stories. "The 'trans community' comprises doctors, pilots, professors, wives, mothers, writers and accomplished professionals. Success stories are exceedingly important to a young transsexual's parents, family, as well as for those in transition who need to know a happy, rewarding life is possible on the other side of their anguish."

Dan Glaister

Glenys Hope, hip replacement

At the age of 24, Glenys Hope had so much pain in her hips that she could no longer even walk. As a child in Liverpool she had been fit and healthy, and by 19 was working in a solicitor's office in the city. But not long out of school, with her life ahead of her, Hope began to suffer terrible pain in her joints, and was diagnosed with rheumatoid arthritis.

A friend suggested she see a consultant at the Manchester Royal Infirmary. The rheumatologist there in turn referred her to a former colleague called John Charnley. Professor Charnley was a local orthopaedic surgeon who had set up a specialist hip surgery centre at the Wrightington hospital, near Wigan, in 1958. It was there, in 1962, that Charnley had performed the first ever hip replacement operation - using an artificial joint he himself had invented.

The Charnley hip was originally made of Teflon. "I remember that being mentioned," Hope smiles, "because I remember thinking that it was the same as nonstick pans." Unfortunately, Teflon turned out to be too weak to bear most patients' weight and soon had to be replaced by a different model made of a plastic called polyethylene. But even this was not guaranteed to last more than 10-20 years - which meant Charnley didn't want to operate on anyone young enough to outlive their artificial joint.

"If I had been more active," Hope recalls, "he would never have done it." But the arthritis was already attacking her other joints and Charnley knew that, even with artificial hips, Hope would never be fit enough to wear out her new joints. The implications of the disease that has confined her to a wheelchair for most of her adult life were what persuaded Charnley to operate on the 24-year-old. "He saw me," Hope says, "and he said he would do my hips."

Within weeks, she was transferred to a ward at the Wrightington, entirely full of patients awaiting hip replacements. Hope was by far the youngest of them and she remembers wondering whether it was going to be all right: "It was just such a big operation." She recalls being shown an artificial hip, but thinks that was probably at her request. "Professor Charnley was a very nice man, but not particularly chatty. He was just very clever, and very into hips."

As soon as the first hip was replaced, her joint pain vanished and two days later she was able to stand. A few weeks later, her other hip was replaced, and shortly afterwards she was able to go home.

Before the operation, her brother and father had had to carry her up the stairs. Now she could walk again. But six years later her knees began to give way. She returned for a knee replacement operation, and further surgery when one of her artificial hips dislocated. For a while she walked with crutches, and she has been in a wheelchair now for many years.

Every two years, Hope returns to the Wrightington for a checkup. The doctors show her the x-rays, and her artificial hips still look exactly as they always do. In 1967, Charnley had warned that he couldn't promise they would last more than a decade: "And they still can't say that my hips will last me for life." But after 41 years she expects they will last as long as she needs them to.

Professor Charnley performed Hope's first hip replacement, but the second was carried out by a colleague called Mr Crawford. When Hope returned to the Wrightington for a checkup a few years ago, her consultant noticed the name in her notes. Wait here, he said, there's someone I want you to meet. He went to fetch a young surgeon visiting from Australia, one of the many from all over the world who still come to the Wrightington to learn pioneering hip surgery. "It was Mr Crawford's son." Hope smiles.

Decca Aitkenhead