Thomas E. Starzl, MD, PhD
Scientific and clinical pioneers have one thing in common: they move beyond their comfort zone and take calculated risks. One such pioneer, whose calculated risks gave hope to otherwise hopelessly ill people, was Thomas E. Starzl, MD, PhD, who performed the world’s first successful liver transplant in 1967. It would prove exceedingly difficult to overemphasize the effect he had on the practice of medicine in the 20th and early 21st centuries. Dr. Starzl died at his home in Pittsburgh on March 4, 2017, at the age of 90.
Dr. Starzl was born on March 11, 1926, in Le Mars, Iowa. His father, who owned the Le Mars Globe Post, was also a science fiction writer whose work, although largely forgotten now, was influential in the nascent period of the genre. His mother juggled dual professions as a teacher and nurse. One of four siblings, Dr. Starzl originally set out to become a priest, but his career goals changed dramatically when his beloved mother died of breast cancer in 1947 at the age of 50. Dr. Starzl attributed his respect for the doctors who treated his mother throughout her illness as his inspiration to pursue a career in medicine.
As a boy, Dr. Starzl worked various jobs at his father’s newspaper (then called a “printer’s devil”), first as an apprentice who mixed tubs of ink and fetched type and then as a beat reporter. He would later attribute quickly sorting type at the newspaper as a task that helped build manual dexterity, which served him well in his surgical career. Despite growing up during the Great Depression, Dr. Starzl described his childhood as “normal.” He excelled in high school academics as a star athlete on the school’s football team and was a champion trumpet player.
Medical and Surgical Training
After high school, Dr. Starzl served a year in the U.S. Navy, from 1944 to 1945, after which he obtained a BA from Westminster College in Missouri. He then attended Northwestern Medical School in Chicago, obtaining an MS in anatomy followed in 1952 by a PhD in neurophysiology and an MD with distinction.
Dr. Starzl then did an internship at The Johns Hopkins Hospital in Baltimore, a career-growing period from 1952 to 1959 of postgraduate surgical training. He acquired a wide range of surgical skills at the University of Miami and Northwestern University. During this period, his surgical and research trajectory began to form, especially during discussions with colleagues about the liver’s double blood supply.
Groundbreaking Work in Transplantation
For Dr. Starzl, the key was whether hormone and nutrient-rich portal blood was important for optimal metabolism and liver health. These scientific explorations led the way for his groundbreaking work in organ transplantation. Between March 1 and October 4, 1963, Dr. Starzl attempted five liver replacements; all five patients died of multiple causes.
After 3 years of nonsurgical self-reflection, Dr. Starzl and his colleagues tried again. They first considered inserting a second liver, to function beneath the impaired one, as a possible route to avoiding the heavy bleeding caused by organ removal. But promising results obtained from liver surgeries on dogs could not be replicated in humans, and that avenue was abandoned.
Dr. Starzl and his team transplanted a healthy liver in a 19-month-old with hepatic cancer. The transplanted liver functioned normally for more than a year, but the young girl died of other causes. Dr. Starzl would later describe the early transplants as “tests of endurance: brutality as you’re taking the liver out, then sophistication as you put it back and hook up all these little bile ducts and other structures.”
Preventing Liver Rejection
Although there was enough success in the early transplants to keep hope alive, Dr. Starzl and other transplant pioneers realized that long-term survival would depend on preventing the patient’s immune system from attacking the new liver. In the late 1970s, Dr. Starzl helped investigate cyclosporine to prevent liver rejection; after a series of trials at the Universities of Minnesota and Texas, cyclosporine won U.S. Food and Drug Administration (FDA) approval in 1983.
During this period, Dr. Starzl also began investigating an experimental antirejection drug called FK-506 (tacrolimus), using it on a multiple-organ transplant patient in 1984. Tacrolimus went on to become widely used in transplant surgeries.
Dr. Starzl lobbied intensely for the use of tacrolimus, studying it and publishing his findings in the The Lancet in 1989; the FDA approved it in 1994. The use of tacrolimus led to a medical breakthrough for patients and to Dr. Starzl’s appointment as Director of the University of Pittsburgh’s transplant unit in 1990. Some years later, the transplant unit was officially renamed the Thomas E. Starzl Transplantation Institute.
‘Uncompromisingly Difficult Life’
Dr. Starzl would become famous for his heart and liver transplant of Stormie Jones, a 6-year-old girl from White Settlement, Texas, who was born with a congenital condition that caused very high cholesterol levels. After becoming a national celebrity of sorts, she died in 1990 at age 13 due to rejection complications from the heart she received during her transplant surgery. Her death affected Dr. Starzl deeply; that same year, he announced his retirement from surgery, noting he was emotionally exhausted from an “uncompromisingly difficult life.”
Dr. Starzl remained active in research as Distinguished Service Professor at the University of Pittsburgh. He received numerous awards during his remarkable career, including the Lasker Award for Clinical Science in 2005. His memoir, The Puzzle People: Memoirs of a Transplant Surgeon, was named by The Wall Street Journal as the third best book on the lives of physicians. ■