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Thomas Starzl

Biography: Thomas Starzl
Father of Modern Transplantation

Thomas Starzl Date of birth: March 11, 1926

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Thomas E. Starzl was born in Le Mars, Iowa, where his father, Roman Starzl, edited the town's newspaper. As a boy, Thomas Starzl worked at every job on the paper, from printer's devil to reporter. He later credited his experience sorting type at the newspaper office with helping to develop the manual dexterity he employed in his later career as a surgeon. Starzl's mother had been a nurse earlier in life. Her interest in things medical and her long fight with breast cancer inspired Starzl to pursue a career in medicine himself.

During World War II, Starzl arranged to graduate from high school ahead of schedule and enlist in the U.S. Navy. After the war, Starzl earned a biology degree at Westminster College in Fulton, Missouri, and was accepted to Northwestern University Medical School. He emerged in 1952 with a Master's in anatomy and a Ph.D. in neurophysiology as well as his medical degree.

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Starzl spent four years in surgical residency at Johns Hopkins in Baltimore before accepting a second residency at the University of Miami. At Miami, Starzl found himself called upon to perform an extraordinary number of major operations, nearly 2,000 in only two years, ten times the workload of the average resident surgeon at the time. In this period, Starzl developed extraordinary skills as a surgeon, but he was eager to explore new areas of medicine. In the years following the Second World War, there was a major increase in federal funding for medical research. The first open-heart operations and vascular transplants were performed, and medical scientists began to consider the possibility of organ transplant surgery. Starzl took up the challenge; even with his enormous workload in Miami, he found time to conduct his first experiments with grafting the livers of laboratory animals.

After two years in Miami, Starzl returned to Chicago as a resident surgeon in the Veterans Administration Research Hospital. While undertaking further training in thoracic (heart and lung) surgery, he continued his liver research on the side. From 1958 to 1961, he served on the faculty of Northwestern University. Northwestern nominated him for the Markle Scholarship, an honor bestowed annually to a small group of exceptionally promising young physicians in academic medicine. Although he was expected to apply the scholarship to further study of heart and lung surgery, he proposed instead to pursue further research on the liver. At the time, no successful organ transplants had been performed in any species, but Starzl had specific ideas about the problems that needed to be solved to accomplish a liver transplant. Although he was already set on a tenure track at Northwestern, he accepted a less lucrative position in Denver, Colorado, where he was offered greater opportunities to conduct his transplant research. He joined the University of Colorado School of Medicine as an associate professor in surgery in 1962.

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Dr. Starzl conceived of liver transplant as a last resort for patients in the end stages of liver disease. After five years of research, he attempted the first human trials, but his first five patients died within days of the operation. The complexities were so great he concluded that the technique of organ transplantation would have to be developed with a simpler organ first. Elsewhere in the world, transplant researchers were focusing their efforts on the kidney. In the late 1950s, hundreds of attempted kidney transplants in the U.S. and Europe failed, but Starzl followed these efforts closely, and saw how his own efforts to overcome rejection of the liver might be applied to the kidney. By 1962, a handful of kidney transplant patients had survived for a year or more, and Starzl and his colleagues turned their attention to the kidney as well. Starzl performed his first successful kidney transplant in 1962, and another the following year, employing azathioprine and corticosteroids to suppress the patients' immune responses so they would not reject the organs. Soon Starzl and his team were performing successful kidney transplants on a regular basis.

He also turned his attention to one of the greatest difficulties of transplant surgery, the perennial shortage of donor organs. Starzl saw a potential solution in the use of organs from other species, known as xenotransplantation. In 1963 he performed six baboon-to-human kidney transplants. The following year, Starzl was promoted to full professor at Colorado. His clinic became the leading center for human kidney transplant, while he continued his research into the liver.

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In 1967, Dr. Starzl at last performed the first successful human liver transplant. Over the next 13 years, he and his team would perform 200 liver transplants and 1,000 kidney transplants at Colorado General and at Denver Veterans Administration Hospitals. Starzl also continued his efforts in xenotransplantation. In 1969 he first attempted to transplant a chimpanzee liver into a child patient. In addition to his pioneering achievements in surgery and research, Starzl took responsibility for training a new generation of transplant surgeons. He chaired the University of Colorado's department of surgery from 1972 to 1980.

At the end of the '70s, Starzl began experiments with a new drug, cyclosporine. The introduction of cyclosporine finally brought transplant surgery beyond the realm of experimental procedures into an accepted form of treatment for end-stage liver, kidney and heart disease, and made possible the transplantation of other organs such as the pancreas and the lung. After 18 years in Denver, Starzl accepted an appointment as Professor of Surgery at the University of Pittsburgh, where he soon built the world's largest liver transplant program. He also served as chief of transplantation services at Presbyterian University Hospital -- now known as University of Pittsburgh Medical Center -- and at the city's Children's Hospital and Veterans Administration Hospital. In 1985, he founded the Pittsburgh Transplantation Institute, the largest transplant program in the world.

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In Pittsburgh, Starzl and his team began work with a new anti-rejection drug, known as FK506 or tacolimus. In 1989 he announced the results: FK506 was 50 to 100 times more powerful than cyclosporine. Starzl sought immediate approval of the drug from the U.S. Food and Drug Administration. In 1991, Dr. Starzl retired from surgery and clinical practice to focus entirely on research at the Institute. He retained his post as Distinguished Professor of Surgery at the University of Pittsburgh School of Medicine.

The following year, Starzl announced one of the greatest discoveries of his career. The immune systems of some transplant recipients, decades after their surgery, were now accepting the cells of the donated organs on their own. This phenomenon of the simultaneous existence of donor cells and recipient cells is known as chimerism. The emerging understanding of chimerism means that transplant patients who had expected to depend on daily doses of immune-suppressant drugs for the rest of their lives could be gradually weaned from these drugs, greatly lessening the side effects and their attendant risks.

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In addition to his research commitments, Dr. Starzl has served as President of the Transplantation Society, and was the founding president of the American Society of Transplant Surgeons and the Transplant Recipients International Organization. In 1992 he published an autobiography, The Puzzle People: Memoirs of a Transplant Surgeon, which is ranked among the best accounts ever written of a life in medicine. The book has since been published around the world; Dr. Starzl has donated all of his royalties to the Transplant Recipients International Organization.

It has been estimated that 17 Americans die every day while waiting for the availability of donor organs that could save their lives. Starzl had long hoped that xenotransplantation could meet the demand for transplant organs. In 1992 and 1993 his team performed two baboon-to-human liver transplants, but the procedure continues to pose difficulties. At UPMC, researchers are now breeding genetically modified pigs, whose cells are more compatible with the human immune system.

The following year, the FDA approved FK506 for clinical use. In the years since, it has dramatically improved survival rates for all transplant patients, and for the first time made possible the transplantation of the intestine, which was especially vulnerable to rejection.

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Dr. Starzl is one of the most published scientists in the world. At one point he averaged a published paper nearly every 7.3 days. In 1996 the Institute for Scientific Information identified him as the most cited scientist in the field of clinical medicine. That year, the Pittsburgh Institute was renamed the Thomas E. Starzl Transplantation Institute. It fosters a multidisciplinary approach to the improvement of all aspects of transplantation.

Over the years, Dr. Starzl has received most of the major awards of the medical profession and been decorated by the governments of many countries. He is among the few Americans ever inducted into the National French Academy of Medicine. In 2004, President George W. Bush awarded him the Presidential National Medal of Science.




This page last revised on May 05, 2011 17:32 EST