Starzl Persisted in Trying “Impossible” Liver Transplants

(p. D8) In 1967, Dr. Starzl led a surgical team at the University of Colorado in a procedure that many in the medical community had dismissed as impractical, if not impossible. Although kidneys had been transplanted successfully since the 1950s, all previous attempts to replace a liver had resulted in the death of the patient.
Indeed, Dr. Starzl’s first four attempts at liver transplantation, in 1963, had failed when the patients experienced complications from the use of blood-clotting agents, which in some cases caused lethal clots to form in the lungs.
After a self-imposed moratorium that lasted three years, Dr. Starzl and his colleagues tried again. They first considered inserting a second liver, to function beneath the impaired one, as a possible route to avoiding the heavy bleeding caused by organ removal. But promising results obtained from liver surgeries on dogs could not be replicated in human patients, and that avenue was abandoned.
The team then operated on a 19-month-old girl and replaced her cancerous liver. The transplanted liver functioned without ill effects for more than a year, before the infant died of other causes. In the next year, as surgical techniques were improved, this pathbreaking success was repeated in six children and, ultimately, in adults.
Dr. Starzl later described those early liver transplants as both a “test of endurance” and “a curious exercise in brutality.” It involved, he explained, “brutality as you’re taking the liver out, then sophistication as you put it back in and hook up all of these little bile ducts and other structures.”
“Each one,” he said, “is a thread on which the whole enterprise hangs.”
. . .
With Dr. John Fung, a surgeon and immunologist, and others, Dr. Starzl evaluated FK-506, also known as tacrolimus. They published their findings in the British medical journal The Lancet in 1989.
Their investigation was not without risk; other scientists showed that tacrolimus had proved toxic when tested in dogs, and they doubted that it could be safe for humans. But the unexpected result was a medical breakthrough for patients and lavish headlines for the University of Pittsburgh, which Dr. Starzl helped fashion into an international center for training transplant specialists.
. . .
A former colleague from Pittsburgh, Dr. Byers Shaw Jr., praised Dr. Starzl’s “indomitable spirit” and said that FK-506, eventually approved in 1994 by the F.D.A., was a shining example of tenacity in a career spent “challenging the conventional thinking.”
Dr. Shaw, who is now the chairman of the department of surgery at the University of Nebraska, observed Dr. Starzl in the operating room in the 1980s, when a patient appeared to be dying during surgery. Dr. Starzl, he recalled, showed “persistence when everything else looked hopeless.”
“It affected everybody in the room,” Dr. Shaw said, “as if a fear of failure was driving all of those around him.”

For the full obituary, see:
JEREMY PEARCE. “Thomas E. Starzl, Pioneering Liver Surgeon, Dies at 90.” The New York Times (Mon., MARCH 6, 2017): D8.
(Note: ellipses added.)
(Note: the online version of the obituary has the date MARCH 5, 2017, and has the title “Dr. Thomas E. Starzl, Pioneering Liver Surgeon, Dies at 90.”)

Bud Shaw paints a vivid picture of Starzl in parts of:
Shaw, Bud. Last Night in the OR: A Transplant Surgeon’s Odyssey. New York: Plume, 2015.

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