Pioneering transplant surgeon who hated surgery

most widely cited Dr died transplantend author Thomasof aged thein clinical90, 20th surgeryE. was Starzl, century, medicine,a and, pioneerwho by the hasthe in having articles. publishedBut he was more not thana “stereotypical2,200 scientific surgeon bristling with self-confidence, and waving his scalpel like a wand”, said The Times. Performing surgery made him sick with fear, and though his work saved countless lives, he dwelt more on his failures than on his successes. For him, the patients were at the centre of the story, and the memories of those who’d died during surgery, or soon after, never left him.

Starzl was famous for carrying out the world’s first successful human liver transplant. But his real achievement was not in connecting the organ – that was technically difficult, but could be learnt by a skilled surgeon: it was in working out how to stop it being rejected by the body. In the 1970s, the received wisdom was that better tissue matching was required, a theory that was fiercely defended. Starzl, however, perceived that success depended on better drugs to suppress the body’s immune response. The result of the tissue matching “dogma” was, he maintained, many wasted years. A believer in Thomas Kuhn’s theories about scientific advance coming not only through the accumulation of wisdom, but also through revolutions when the norm is challenged, Starzl saw this as an example of how “groupthink” inhibits progress. “It was amazing how fast progress was made when there was no clinical field of transplantation, and how difficult it became when transplantation was accorded speciality status and began to develop a collective wisdom,” he noted.

Born in Iowa, Thomas Earl Starzl was the son of a teacher, Anna, and Roman, who ran the local newspaper, the Globe Post. Thomas helped out at the paper from the age of 12, doing everything from writing to typesetting. To spend time in an old-style print room, he would later say, is a valuable lesson for any aspiring surgeon in “precision of movement”. After medical school, he trained in surgery at the Johns Hopkins Hospital in Baltimore, then joined the University of Colorado School of Medicine, in 1962 – a time of rapid developments in kidney transplantation. He performed the first ever liver transplant the following year on a three-year-old boy, Bennie Solis, who had been born with incomplete bile ducts, leading to liver failure. Bennie suffered a haemorrhage on the operating table and died: none of Starzl’s next four patients survived more than a few weeks. After that, he abandoned human trials, and instead conducted research into crucial areas including the storage of organs outside the body. He also worked on kidney transplants, and xenotransplants – cross-species transplants using animal (mainly baboon) organs. In 1967, he felt confident enough to resume the liver transplant programme; seven children were operated on, and all survived the surgery.

Organ rejection, however, remained a serious problem until, in the late 1970s, Starzl heard of a powerful new immune suppressant drug – cyclosporine. It had potentially fatal side effects, but by mixing it with steroids he was able to make it safe, said The Daily Telegraph. “Over the next decade, transplant surgery was transformed from a last-ditch experimental treatment into a clinical service.” Even so, Starzl continued to find performing surgery highly stressful. The pressure led to the breakup of his first marriage; he suffered from ulcers, and had a 60-a-day smoking habit. In 1990, he underwent heart bypass surgery. That year, one of his most famous patients, a girl named Stormie Jones, who at the age of six had become the first ever recipient of a heart-liver transplant, died aged 13, nine months after receiving her second liver. Her death affected him deeply, and though he would remain at the forefront of research for many years to come, Starzl decided to lay down his scalpel. He was 65. “It is true that transplant surgeons saved patients, but the patients rescued us in turn, and gave meaning to what we did, or tried to,” he once wrote.