Thomas Starzl, father of organ transplantation, dies at 90
Dr. Thomas E. Starzl, the organ transplant icon who revolutionized medicine by performing the first successful liver transplant and set the standard for the life-saving surgery, died Saturday. He was 90.
His death was confirmed by UPMC and the University of Pittsburgh, where he was a Distinguished Service Professor of Surgery in the School of Medicine. A joint UPMC-Pitt statement issued Sunday did not indicate a cause of death but said Starzl died peacefully at his home in Pittsburgh's Schenley Farms neighborhood.
“Thomas Starzl was many things to many people. He was a pioneer, a legend, a great human and a great humanitarian. He was a force of nature that swept all those around him into his orbit, challenging those that surrounded him to strive to match his superhuman feats of focus, will and compassion,” the Starzl family said in a statement provided by UPMC and Pitt.
Known as the father of transplantation, Starzl's influence and renown extended worldwide, as his discoveries and achievements put an indelible stamp on clinical medicine and established him as one of the most celebrated figures in the scientific community.
In 1991, the Institute of Scientific Information identified Starzl as the most cited scientist in clinical medicine. The institute says Starzl at one point published a scientific paper once every 7.3 days.
With Starzl at the helm, UPMC's transplant center in the 1980s became known as the transplant capital of the world. Sick patients came from across the globe in search of an organ. The number of surgeries escalated, with a record-high 471 liver transplants in 1990.
“We've lost a great man,” said Dr. John Fung, Starzl's protege in the late 1980s and early 1990s at Pitt. Fung, who left UPMC in 2004, is director of the University of Chicago Transplant Institute. He said Starzl's contributions extended beyond transplantation and influenced other areas of medicine such as anesthesia, radiology and critical care. “Hundreds of millions of people in this world have benefited from what he has done.”
In one of his last interviews with the Tribune-Review, Starzl in February 2008 said his legacy was more about what was accomplished in the field rather than his personal achievements.
“I never did have a big game plan,” he said. “If you don't have a big game plan, then you really don't have something that you strive for and accomplish and have as your cherished legacy. I just came to work every day and did the best I could.”
His clout and name notwithstanding, Starzl in the past several years insisted he exerted no influence over the daily operations of UPMC's organ transplant program.
But Starzl, who joined UPMC in 1981, was hardly in the dark.
While officially retired from clinical medicine since 1991, he until recently maintained an office on Fifth Avenue in Oakland, across from the former site of Children's Hospital of Pittsburgh. Even in his 80s, he went to the office daily, usually accompanied by several of his dogs. He had found Ophelia, a half-collie, at the doorstep of his home several years earlier. At the spartan office, with aging furniture and rusting cabinets, the dogs ruled as Starzl conducted much of his business alongside longtime assistant Terry Mangan.
In February 2008, Starzl told the Tribune-Review that he had “battle fatigue” and planned to focus on organizing his vast collection of books and scientific papers.
Until then, Starzl had devoted most of his time to a slippery goal: finding a way for transplant recipients to avoid taking lifelong doses of often harmful antirejection medicine.
His impetus was a 1992 discovery of kidney transplant recipients who had a trait known as chimerism.
The patients, all of whom had transplants decades earlier, didn't reject their new organ because during the transplant they had received donor immune cells that coexisted with their own immune cells. The patients were weaned off immunosuppressive drugs that typically have serious side effects.
While those patients are counted as a huge success story, a debate rages about the possibility of weaning patients off drugs.
In the last years of his life, Starzl spent countless hours analyzing data about complications in live-donor liver transplants. The controversial surgery had become a staple at UPMC, as doctors found a way to stave off a clinical shortage of organs.
Starzl became interested in the surgeries' complications after the death of Katy Miller of Creekside, Indiana County. Miller was a college sophomore enrolled in a UPMC study that aimed to wean 10 live-donor liver transplant patients off immunosuppression.
A high-rate of complications among those recipients, including Miller, alarmed Starzl, and a rift ensued between him and then-transplant chief Dr. Amadeo Marcos, an advocate of live-donor surgeries. The complications were higher than reported elsewhere, Starzl said, and he wanted to encourage all transplant centers to report accurate data about live-donor transplants.
“The end results are OK, but the firestorm that you have to go through with that operation to get to where you want to go is much bigger, I think, than people have said,” Starzl told the Trib in 2008.
Randy P. Juhl, a former vice chancellor at Pitt who became Starzl's ally, said at the time that Starzl sought to shed light on the complications because he didn't want to focus only on successes.
“What's kept Dr. Starzl at the forefront all these years is to look at the failures. ... If people didn't do well, that teaches us,” Juhl said during an interview in November 2008.
Early days
Born on March 11, 1926, Thom‑as Starzl grew up in LeMars, Iowa, the son of a newspaper publisher. He once worked as a proofreader for the Chicago Tribune and thought of becoming a priest. But his mother's breast cancer compelled him to attend Northwestern University Medical School in Chicago.
Starzl graduated in 1952, but even then “the word transplantation was not yet in my daily vocabulary,” he wrote in his 1992 autobiography, “The Puzzle People.”
It was during a surgical internship at Johns Hopkins Hospital in Baltimore and later at Jackson Memorial Hospital in Miami where Starzl began experiments that lay the groundwork for this virtually unheard of area of medicine.
The first experiments, done in an empty garage across from Jackson Memorial's emergency room, didn't come without worries. Starzl wrote in his book he didn't like to operate and harbored anxieties he never talked about until he retired.
“I had an intense fear of failing patients who had placed their health or life in my hands,” he wrote. “Even for simple operations, I would review books to be sure that no mistakes would be made or old lessons forgotten.”
In 1958, Starzl for the first time sewed in new livers in dogs whose organs had been removed. Those first attempts were bloody operations whose failures he deemed a serious blow to his career. His spirit dampened, Starzl considered entering private practice, but mentors recognized his potential and encouraged him to apply for a government grant to study transplantation.
He began experiments to cool and preserve livers awaiting transplantation. He did so by trying to immerse the anesthetized dog in a bath and, when that didn't work, by running a cold salt-water solution into the organ through its portal vein.
Eventually, Starzl and his colleagues reported 18 dogs with survival greater than four days, with one animal living 201⁄2 days.
On March 27, 1962, at the University of Colorado, he performed the first human kidney transplant. Less than a year later, on March 1, 1963, he made his first attempt to replace a human liver.
It was a 3-year-old boy named Bennie Solis, who had a condition known as biliary atresia. The boy bled to death. His death, and that of three other patients, pushed Starzl to back away from performing more liver transplants.
When that happened, Starzl hunted for better antirejection therapy, looked for better ways to procure organs and examined the role of tissue type in transplants.
On July 23, 1967, he performed the first successful liver transplant, on a 19-month-old girl named Julie Rodriguez. She survived more than a year.
The case was so remarkable that Starzl wrote in his book that his most important possession is a portrait in memory of Julie done by a Swedish artist. It shows a child bathed in sunlight, picking long-stemmed flowers. Upon his death, Starzl wanted the portrait to go to the person who was closest to him, he wrote in his book.
Pittsburgh arrival
Starzl arrived in Pittsburgh in 1981 after a shake-up at the University of Colorado that prompted him to resign.
He brought with him the breakthrough of having treated dozens of patients with cyclosporine, a medicine to prevent organ rejection. Pitt's fledgling kidney transplant program quickly grew to perform 106 surgeries in 1981, three times more than in prior years.
In 1989, Pitt scientists announced that a better antirejection drug, called FK-506, resulted in fewer deaths and side effects in patients who received the drug in a clinical trial. The drug was later approved by the U.S. Food and Drug Administration, a feat that cemented the university's standing as a transplant giant.
By the time Starzl retired in 1991, the UPMC transplant center was performing more than 200 kidney transplants a year and 600 overall transplants. The center was named after him in 1985. A biomedical tower at Pitt also bears Starzl's name.
Surgeons there have performed more than 12,000 organ transplants in the last 20 years.
In May 2004, Starzl offered the graduating class of Pitt's School of Medicine what he called “two bits of simple advice.”
He told graduates to make a genuine attempt to contribute something worthwhile “that will be here long after you're gone.”
And he encouraged them to not make decisions based on the money they would make.
“Just do what you believe in your heart to be right,” he told them. “You will respect yourself for this, others will respect you, and the money will take care of itself.”
Luis Fábregas is editor of the Tribune-Review's digital Pittsburgh edition. Reach him at lfabregas@tribweb.com. Follow him on Twitter at @LuisTrib.
