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Thomas Starzl
Thomas Starzl
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Thomas Starzl Interview

Father of Modern Transplantation

September 30, 2010
Pittsburgh, Pennsylvania

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  Thomas Starzl

Dr. Starzl, you undertook your surgical training at a time when there were many new developments in surgery. Do you think that luck -- or perhaps timing is the better word -- was a major factor in the development of your career?

Thomas Starzl: Timing is everything. And I'm sort of inclined to go along with the word that you just swiftly bypassed: luck. The timing was lucky. How was that to join those up? I was very lucky about timing, not only because there were new fields emerging and they included open heart surgery -- this is pushing the clock forward a few years -- cancer was an infantile field at that time, and there were other great developments that were going on, five or six of them all together. But at the time I finally had to make a definitive decision, I was in my early thirties, and the two fields that looked like they could not be conquered, or hadn't already been spoiled by previous pioneers, were transplantation and cancer. People at that time, this was still in the '50s, were making pronouncements that the cure of cancer was right around the corner. I thought, well, I missed that one too. And so transplantation was a field that was thought to be a Jules Verne type of figment of the imagination. So I went into that field. But the other elements of timing were the massive amount of research money that became available after the Second World War. A decision had been made at a federal level that the United States, to stay current, would have to invest heavily in research. And so really for the first time, federal-supported research became available just at the right time for me to pick that, to get into that golden stream.

In your book, The Puzzle People, you talked about your experience as a young surgical resident in Miami. You were given an enormous caseload there. Did you leave because you couldn't do your research there? Was it the institution itself or just the caseload?

Thomas Starzl: I had so much work down there over a period of two years that I did something like 1,000 majors a year for two years. And normally you go through a surgical training program and if you end up doing 100 majors that would be considered quite enough. And most of those cases, I was doing what I was doing without any supervision. But I was prepared for that, because I had already spent four years at Johns Hopkins. I had already had the equivalent of a normal surgical training program. So I didn't have any uneasy feelings about shouldering the responsibility, but just the mere root volume was such that I got to the point where I really didn't want to operate anymore. And I never wanted to do high volume surgery from that time onward, even though I was eventually forced into that situation, most acutely after I had come here. When we were doing procedures that weren't being done any place else in the country, or for that matter in the world, now the volume came up again, just as it had way back then.

[ Key to Success ] Preparation

There was no period that wasn't highly fruitful, including the time I spent in Miami. But I didn't leave there for any non-specific reason. I didn't get along at all well with the Chairman of Surgery at the time, my boss. I don't want to say too much about that, because he's dead, or long dead. He died young, and he died actually from complications from the very reason that I didn't get along very well with him. He died of complications of alcoholism. And he was -- in fact when he was my boss -- he was an alcoholic. So you couldn't trust what you would get from him in response to any one of a wide range of circumstances, including performance in the operating room. So it was a good lesson. In fact, later on I had some kind of a reconciliation with him. I mentioned in that book how I met him after he had taken the inevitable spill that happens to people who have that lifestyle. I met him at a meeting of the American College of Surgeons in Atlantic City and had a long discussion with him. And I thought, "What a nice man this might have been," if he hadn't -- by luck or whatever you want to call it, timing, whatever -- taken a pathway that was beyond his reach.

What lessons did you take away from that experience that were most important to you professionally?

Thomas Starzl: I would almost have to say none, although...

You have to concede that the acquisition of skill is a big deal. And Miami was a place where the skill level went from -- and confidence level -- went from here up to here, especially when I had come to realize that I was getting as referrals -- I was a resident there, but I was getting referrals from people all over town, all over Miami -- of difficult cases, so that certain operations were available in Miami only if I did them. But that's just the acquisition of skill. The lasting trail that began in Miami was the research that I had done there in dogs, in a makeshift laboratory that was created by stealing stuff from -- the equipment maybe, and fluids for IV treatment -- and I did some experiments with the liver that eventually resulted in the development of liver transplantation. In fact, the first steps were taken in Miami. So as soon as I left Miami and went to Chicago I picked up where I had left off in Miami.

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Thomas Starzl Interview Photo
Thomas Starzl Interview Photo

You worked on liver transplantation for many years, but there was a period in the early 1960s when you took kind of a break to work with the kidney. Was this an agreement you had with your chairman at the University of Colorado, Bill Wadell?

Thomas Starzl: Yes, actually we had that agreement before we ever did a liver.

I started working on liver transplantation in 1958. That was when I was still in Miami, as we discussed earlier. And then, when I went back to Chicago in June of 1958, I simply continued that and really expanded it, all the while taking a final year of thoracic surgery, heart and lung, but especially open-heart. It looked like that's where I was going. But on the side, as a hobby, I was pursuing the liver transplantation in the laboratory. And it was really weird, because I had been identified by Northwestern as one of their good prospects for a long-term academic career, and solely for that was the reason that Northwestern put me up for a Markle scholarship. Every university only got one candidate, and they picked their most promising young person. Okay, they picked me, thinking that naturally I was going into heart surgery, after all I was in my last year of training. But all the while I was over in the lab working on this liver project. And within a few months, I realized that I've got to finish this year in thoracic surgery and get my boards and maybe even practice thoracic surgery, which of course I did. But those jobs and those experiments were going to have to be followed. So when I went to be evaluated by the Markle evaluation committee, I didn't have a word to say about the heart, the lung, the chest. I proposed as a lifetime objective to do liver transplantation, which was kind of absurd, because no organ of any kind had ever been successfully transplanted in any species, in any animals, any humans. It just looked like a brick wall. And all this because I had a question about the portal blood, and a theory altering the portal blood flow to the liver might make diabetes better. Instead, it made it worse in the animals. Probably the need to explain that was the driving force that pushed me over onto the transplant side.

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