Kidney Talk: Thomas E Starzl, MD, transplant pioneer

Selections from Chapter Six of Tom Starzl's book Puzzle People: Memoirs of a Transplant Surgeon, University of Pittsburgh, 1992.

Born in 1926, Starzl was 62 when the book was published in 1992, one year after he retired from the University of Pittsburgh Transplantation Center.

The center was renamed the Thomas E Starzl Transplantation Institute in 1996.

Intensive care as we know it today did not exist [back in 1956-58]. For patients whose kidneys failed, there was nothing to do but wait and pray for a miracle which usually did not come. The musky odor caused by the body’s growing chemical imbalance would fill the room as hope for a spontaneous recovery faded.

After the operation [removing a diseased portion of her lung] her kidneys stopped making urine. Seeing this beautiful and vital person edge toward eternity was a familiar experience. Then suddenly, she began producing urine in quantities that became voluminous after a few days. We were overjoyed and could not refrain from a daily war dance when we came to her bed.

A huge surprise is the anxiety which hounded Starzl for 30 years before every transplant operation.

For the past six years, I had honed my surgical abilities. At the same time, I harbored anxieties which I was unable to discuss openly until more than three decades later, after I had stopped operating. I had an intense fear of failing the patients who had placed their health or life in my hands.

Far from being relieved by each new layer of skill or experience, the anxieties grew worse. Even for simple operations, I would review books to be sure that no mistakes would be made or old lessons forgotten. Then, sick with apprehension, I would go to the operating room, almost unable to function until the case began.

Later in life, when I told close friends that I did not like to operate, they did not believe me or thought I was joking. Most surgeons whom I know have been able to protect themselves, either by rationalizing errors which they had committed or by promptly erasing the bad memories. I could not do this. Instead of blotting out the failures, I remembered these forever.

The incongruity was that I did not like doing the one thing for which I had become uniquely qualified.

Starzl was a leading researcher and surgeon in liver transplantation at the University of Colorado where he arrived from a previous position at Northwestern University in Chicago.

The main hindrance to successful transplantation was organ rejection by the recipient. In 1979, Starzl's team was the first to use the newer and more effective antirejection drug, cyclosporin, which became state-of-the-art.

His constant innovations continued after he joined the University of Pittsburgh Medical School in 1981, soon becoming its director. His efforts led to cutting edge liver transplants and introduction of the better antirejection drug FK506 or tacrolimus (Prograf and Advagraf, extended release).

Like cyclosporin, its active substance was found in soil fungus.

According to the Pittsburgh transplantation website:
In 1992 Dr. Starzl discovered that many organ recipients’ immune systems happily host cells from their donor organs, even decades after their operations. Theorizing that a less aggressive approach to antirejection treatment allows the organ recipient’s immune system to learn and accept the donor organ, Dr. Starzl and his team have been able to slowly and carefully wean transplant recipients to smaller doses of antirejection medications, maintaining their effectiveness while reducing side effects. Some patients thrive while taking antirejection medication as infrequently as once per week.

After I read this last statement, I decided to try and get in touch with Starzl himself. Here's an email I sent to the University of Pittsburgh:

Hi Jennifer,

I'd like to get in touch with Dr Starzl.

I'm going in for a kidney transplant on April 1, 2011. My daughter will be my donor.

Am reading Dr Starzl's great book The Puzzle People. He mentions that a kidney recipient need not be on antirejection meds his/her entire life if the initial dosage of the meds is done in a particular way.

I don't know if my transplant surgeons are aware of this and I want to let them know.

I'll be at Einstein Hospital in Philadelphia. Two of the surgeons are Radi Zaki and Stalin Campos.

Timing is crucial since the operation, again, is scheduled for April 1.

Coincidentally, when I worked as a reporter for a local paper, I did an interview on the first pancreas transplant which was done at Einstein Hospital by Michael Morris. Dr Starzl had been his teacher.

I called Dr Starzl at Pitt and got a nice quote about Dr Morris for my story.

Thanks for your help.Possibly you could forward this to Dr Starzl.

Ruth Z Deming