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If you like Thomas Starzl's story, you might also like:
Tenley Albright,
Keith Black,
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Thomas Starzl
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Thomas Starzl
Thomas Starzl
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Thomas Starzl Interview (page: 7 / 8)

Father of Modern Transplantation

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  Thomas Starzl

At one time, doctors in private practice volunteered their time to universities, and were a group apart from full-time medical school faculty. What was the difference?

Thomas Starzl Interview Photo
Thomas Starzl: When I started practice, or when I went to medical school, or during essentially all of my training, there were two groups of people involved in my education. One consisted of a very small number of full-time clinical faculty. At Northwestern, I was one of two. At Johns Hopkins there may have been four or five, something like that. But most of the teaching and the surgery was being done by people who were in private practice. As years went by, at first slowly, but then in avalanche proportions, the group on the academic side, separated by a wall from those in private practice, became bigger and more and more like a group of practice physicians providing a full range of services: ENT, orthopedics and all brands of surgery. So in a sense, the people inside the ivy walls and those on the other side, as the wall went down, became much the same. The university became like a group practice. That situation exists here at the University of Pittsburgh and many others. The last holdouts, by the way, of the strict full-time faculty receiving the smaller fixed salaries, were the University of Colorado and the University of Chicago. Both of them have since imploded and have eliminated that functional distinction. So nowadays you have a full time faculty, and it competes with the private groups. A lot of the private groups have assembled multidisciplinary organizations, but it's been much easier of course to do that within the medical school.

Why did that system change, or implode as you said?

Thomas Starzl: I think it imploded because of money. Money drives just about every policy decision.

Do you think that staying in an institutional environment is necessary for a career in surgery?

Thomas Starzl Interview Photo
Thomas Starzl: No, of course not. I don't think it's necessary to have a career in surgery to be within an institution within a university. You can have a very successful career in or out of the university. But the prestige element of a professional life is far more easy to follow within a university. There is a rewards system. But the ability for clinicians to do research, real research, has been not eliminated, but greatly reduced.

What do you think it takes to make a university competitive?

Thomas Starzl: Well, two things really. Innovation is one thing, but I think above all is competence, the ability to provide good care, day in and day out.

Let's talk about the classic axiom of the medical profession, "Do no harm." What do those words mean to you?

Thomas Starzl: That's an important rule. It's a self-explanatory statement. You don't want to treat somebody, or operate on somebody, or treat them in any way if the treatment can exacerbate their disease or increase their suffering or make them worse than they were when they came to you and made this moral contract that's called a doctor/patient relationship. So this is a warning from antiquity. "First..." The total statement is "First do no harm." That's in the Hippocratic Oath.

Looking back on your career, is there anything that you would have done differently?

Thomas Starzl: I doubt it. What I really regret is the penalty that was paid by my children, who lost their father for quite a long time. It was not much different than what happened when people went off after Pearl Harbor and didn't come home for six years.

As you see them, what are the pros and cons of the organ procurement process in the 21st Century?

Thomas Starzl Interview Photo
Thomas Starzl: I'm not sure that I'm qualified any longer to comment on that, because I haven't actively practiced since I was 65. When I left the field, I just left and really stayed away from patient care and these mundane matters like where do the livers come from or where do the organs in general come from. But these problems were dumped in the lap of large groups of people with different agendas and different self interests. A great effort has been made, because there's been so much public scrutiny, to be fair, that was made possible by a system that was developed here and was then picked up and used as the national system. But in some ways it's a system that became so muscle-bound that there are delays -- very often very big delays -- where organs are just sitting around waiting to see where they should go. That's probably inevitable if you want to be fair. So the people that run the local procurement agency do a very good job. They are completely independent of control by the hospital. That's a big change, in what I hope was a fair and honest manner. We used to influence those activities much more than now. But because of the obvious conflicts of interest of the user and the provider, it was necessary to create distance. All of those things I think have come on in the last 20 or so years.

I think it's much harder to work today, and probably much more pedestrian than it was. But that is something that you automatically would say about almost any new field of medicine. And bear in mind, transplantation was not a small thing. It was a whole new discipline of medicine that didn't exist before. It's rather unusual for somebody to live for so long that they're able to participate in the birth and the adolescence and maturation and perhaps even the senescence of a field. But there are two people that I know that did that, and the only other one is Sir Roy Calne, the guy that I mentioned before.

That's quite an achievement.

Thomas Starzl: I realize I just gave you a taste of rhetoric, because I never really answered your question, but that's the best I can do.

Understanding that you've been out of the day-to-day minutiae of transplant practice for 20 years, we still appreciate your perspective on the competition for donors and for recipients.

Thomas Starzl: I know. It's too much like feuds going on all the time. It got that way fairly soon after I retired from practice. I think because so many people were trained here, that maybe I was a little bit like a center pole that could maintain amicable relationships for a long time. I wanted out, knowing that staying in would be worse than whatever problems might be entailed by getting out, and I didn't want to be a piñata.

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This page last revised on May 16, 2011 17:01 EST
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