Thomas Starzl Interview (page: 3 / 8) Father of Modern Transplantation	Print Interview

Who was Royal Jones, and how did he contribute to transplant research at Colorado General and the Veterans Hospital in Denver?

Thomas Starzl: Royal Jones was like a burr under the saddle, or like a guy that lit a match to the medical establishment that was doused with gasoline and was racing toward the nearest water hole, because...

Get the Flash Player to see this video. When I went to Colorado, Royal Jones had just started kidney dialysis. And kidney dialysis -- chronic kidney dialysis -- was simply not available except -- or I should say with two possible exceptions. In 1962, the exceptions were the University of Washington, where a guy named Belding Scribner had a small group of beds where six people could be treated with dialysis three times a week, and Colorado had a guy named Joe Holmes, who was running a chronic dialysis service out of his back pocket. And Royal Jones was one of those lucky enough to get one of those slots. But the ability to give dialysis -- every time a dialysis was done you had to cut down on vessels, and you worked your way up one arm, down one leg, then the other. And after six months or a year, you used up all the vessels that you could use for dialysis and then that was end of it. So Royal was near the beginning of his way to the cross, if you will, and it was that kind of suffering. He dropped right in my lap. So we went into a rampage to find out -- by this time we've already covered that period of time. By his time, we'd come to realize that we had to make kidneys work first. Here was a kidney recipient, we were unprepared to do him. So we took about six months, with an enormous effort in the laboratory, and we made the discoveries about how to use these drugs in a way that would allow success, and applied them to Royal Jones for the first time. So Royal Jones, this little black boy with a very devoted mother who gave him a kidney, he ended up having a nice silver anniversary celebration 25 years later. But he was a perfect example of an otherwise lethal clinical situation in which there was a little hole of escape that might be available, but we had to know how to find it. And we found it just in time. So that was rather amazing. He did all this suffering during the preparation, while the place was going nuts trying to make discoveries. And he got through it and was back in school six weeks later.

If this boy hadn't been dying before your eyes, would things have happened that fast?

Thomas Starzl: They probably would have happened, because that was part of the game plan, but the time frame was three to five years, not three to five months. It was like everybody was on speed.

What was the catalyst for restarting the liver transplant practice in 1967?

Thomas Starzl: I think the fact that we had fully expected to succeed in 1963 and then fell on our butts -- all the humiliating failures -- was a devastating scar that had to be removed.

Take us back to 1967. You're going to start transplantation again. What were you looking for in a candidate for liver transplant? How much did you consider a potential candidate's disposition?

Get the Flash Player to see this video. Thomas Starzl: Every case of liver transplantation required some specific recipient qualities, because everybody out there in a conventional practice, the mere thought or mention of transplantation promptly pronounced it to be folly, a pie in the sky, and without merit. So to actually get even to the point of candidacy required a proactive approach by the patient or by the patient's family. So there was really an ultra filter between having the disease and actually getting to Denver. So that was a culling, highly efficient and real culling device, just getting there. Once they got there they'd already demonstrated a strong disposition to live. And that was very important, because what lay ahead was like running a gauntlet.

[ Key to Success ] Perseverance

When you started the trials again in '67 with those first patients, did you know it was going to be a whole different experience from the first day?

Thomas Starzl: We expected the first time that we would succeed. In the long run we knew precisely why we had failed, so we fully expected to succeed. In fact, it was a bit of a disappointment that we did not succeed more than we did. Once that was realized, which took about two years, I think by 1969 or 1970 we realized that we'd carved a new pathway, but this one was almost as lumpy as the one that had preceded it. That went on for about a dozen years. During that time, there was another program started in England by a guy named Roy Calne, but the only liver programs in the world for much of the next 12 years were the one in Denver and one at Cambridge, in England. And I think that if either one of those had caved in, probably the other one would have to stop also. So then, shortly after the livers, the first hearts were done. And there also, the results in terms of real patient service were not good enough to be generally used. So the heart transplant surgeons and liver surgeons were on a lonely road for much of that time. In some ways that halfway victory -- or you might call it a Pyrrhic victory and utter failure -- was somewhere in between maybe "waiting for Superman" syndrome, waiting for a super drug, a better drug. When the better drugs came, it was off and running.

Let's fast forward a bit to 1981 when you moved to the University of Pittsburgh, School of Medicine. You've overseen the largest transplant program in the world. Could you tell us about the goals and achievements of the University of Pittsburgh medical facility?

Thomas Starzl: There really was no program here at that time. I think the contribution to Pittsburgh shouldn't quite be so inward looking. The importance from a societal point of view, the important contribution was to train a large number of people thoroughly in multiple layers so that they could go out and disseminate a new technology worldwide. The technology that was taught wasn't just liver, although that was a particular item because it wasn't really being done anywhere else, but it was the training of people who could do kidneys. That always remained kind of the platform from the beginning that was continuous. It never was interrupted by a moratorium. Lungs, hearts, they all ate from a common trough. And then the first intestinal transplants ever done in the world. At first it was occasional, but ultimately intestinal transplantation became just as much of a service as the liver or kidney. The continued development of better and better ways of immunosuppression, anti-rejection therapy, all of those things stemmed from here. Not only stemmed from here, but were exported in the form of the fellows and trainees that came here in droves. So I don't think the size of this activity was half so important as its quality and of the cutting edge component of it. And the cutting edge component kept five years ahead of the pack for quite a long time, 20 years or so.

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