Thomas Starzl, pioneering transplant surgeon, dies at 90
Performed world’s first liver transplant in Denver in 1963 before bringing talents to Pittsburgh
March 5, 2017 12:41 PM
John Heller / Post-Gazette
Thomas Starzl stands in his office on Fifth Avenue in Oakland in 2012.
Associated Press / Unviersity of Pittsburgh Medical Center
Transplant pioneer Dr. Thomas Starzl performs a liver transplant at the University of Pittsburgh Medical Center in Pittsburgh in 1982.
Joy and Thomas Starzl
Jim Fetters/ The Pittsburgh Press
Stormie Jones at Children's Hospital in 1984, after her first heart-liver transplant.
John Heller / Post-Gazette
Thomas Starzl, right, and then-Pittsburgh Steeler Antwaan Randle El are silhouetted during a dinner and fashion show in 2010 to benefit the Thomas E. Starzl Transplantation Institute at the University of Pittsburgh Medical Center
Dr. Thomas Starzl hugs Todd McNeeley, 4, of Darien, Conn., at a party given for him by liver transplant patients June 19, 1983.
John Heller / Post-Gazette
Dr. Thomas Starzl died early Saturday. He was 90.
By Karen Kane, Anita Srikameswaran and Sean D. Hamill / Pittsburgh Post-Gazette
Thomas E. Starzl, whose bold vision, boundless energy and unflagging self-confidence resulted in dramatic and pioneering advances in organ transplantation and anti-rejection medicines that saved thousands of lives, died in his sleep Saturday at his home in Oakland. He was 90.
Dr. Starzl performed the world’s first liver transplant in Denver in 1963 and Pittsburgh’s first liver transplant in 1981 after moving here at the end of 1980. He was the surgeon who performed the world’s first heart-liver transplant in 1984, replacing those organs in Stormie Jones, a Texas girl who died in 1990 at age 13. And, in 1987, he led the five-organ transplant operation on Tabatha Foster, who survived for six months.
During his years in Pittsburgh, Dr. Starzl achieved international renown and celebrity status for those high-profile transplants and transformed the University of Pittsburgh Medical Center into the busiest transplant center in the world.
“The world has lost today the greatest figure in the history of transplant, and I have lost my greatest mentor,” said Abhinav Humar, clinical director of the Thomas E. Starzl Transplantation Institute and chief of the Division of Transplantation in the Division of Surgery at UPMC. “The Starzl Transplant Institute will continue to work tirelessly to carry on his rich legacy.”
Dr. Starzl’s work on drugs to prevent organ rejection also resulted in much higher success rates for organ transplants. In 1989, Dr. Starzl and John Fung, then a colleague and now director of the University of Chicago Transplantation Institute, developed FK506 (better known as tacrolimus), still the most widely used immunosupressant drug in the world.
Dr. Fung, who left Pittsburgh in 2004 but remained close friends with Dr. Starzl, said his friend was troubled with only minor health issues and called his death “very much unexpected.”
“He worked right up to the end of his life,” Dr. Fung said. “He was working four-hour days in the same offices he had worked in for 30 years.”
Dr. Starzl retired from clinical and surgical service in 1991. Until then, he served as chief of transplantation services at Presbyterian University Hospital, now UPMC Presbyterian; Children’s Hospital of Pittsburgh, now Children’s Hospital of Pittsburgh of UPMC; and the Veterans Administration Hospital in Pittsburgh.
He was director of the University of Pittsburgh Transplantation Institute, which was renamed the Thomas E. Starzl Transplantation Institute in 1996. Since 1996, Dr. Starzl held the titles of Distinguished Service Professor of Surgery at the University of Pittsburgh and director emeritus of UPMC’s Thomas E. Starzl Transplantation Institute.
“Tom Starzl’s tremendous respect and affection for his patients became the life force of his career. Countless lives were saved through his advances in technique and his pioneering work to prevent organ rejection,” said Arthur S. Levine, M.D., University of Pittsburgh senior vice chancellor for the Health Sciences and John and Gertrude Petersen Dean of the University of Pittsburgh School of Medicine. “There is not a transplant surgeon worldwide who has not, in some way, been influenced by his work.”
Dr. Starzl’s first liver transplant patient in 1963 in Denver did not survive long. Neither did the next four. But four years later, armed with a mix of drugs aimed at combating organ rejection, Dr. Starzl performed the first successful liver transplant on a patient who survived for a year.
Dr. Starzl performed about 175 liver transplants at the University of Colorado, with a success rate between 30 and 50 percent. He was chairman of surgery at the University of Colorado School of Medicine from 1972 until 1980, before coming to Pittsburgh on New Year’s Eve. Although wooed by the University of California at Los Angeles, he chose Pittsburgh, where the surgery department was headed by Henry Bahnson, who had been best man at Dr. Starzl’s first wedding.
Dr. Starzl brought with him to Pittsburgh an experimental drug called cyclosporin and then showed colleagues and generations of surgical trainees how to do liver transplants.
Dr. Starzl and Pittsburgh achieved worldwide acclaim while he worked at Presbyterian Hospital and the University of Pittsburgh. By 2001, the 20th anniversary of Pittsburgh’s first liver transplant, the center’s team had transplanted more than 5,700 livers, 3,500 cadaveric kidneys, 1,000 lungs and 500 hearts. Much of the center’s success was credited to his insights into the immune system.
Jeffrey A. Romoff, UPMC president and chief executive officer, called him an “extraordinary and compassionate surgeon,” who “brought hope to the sickest of the sick.”
Ngoc Thai, chair of the Department of Surgery at Allegheny Health Network in addition to directing the Center for Abdominal Transplantation, came to Pittsburgh in 1990 as a medical student when Dr. Starzl was at the center, doing more than 500 liver transplants a year at the time.
“It was a 24/7 place,” Dr. Thai said of UPMC Presbyterian, where the liver transplants were performed. “You could go into the lab on the 15th floor and there’d be dozens of people there working.
“There was just always something going on and Dr. Starzl was in the middle of all of it,” he said. “It was a wonderful and compelling time.”
Doctors from around the world came to Pittsburgh to train with Dr. Starzl, and left to become head of their own transplant teams. Today, Dr. Thai said, about 90 percent of all the transplant centers are headed by Starzl-trained surgeons or surgeons who trained under Starzl-trained transplant surgeons.
Dr. Starzl had legendary endurance, performing multiple surgeries that could keep him up for two days straight while surviving on just hour-long naps. He also found time to write numerous medical journal articles “in hours that would take the rest of us weeks or a month to do,” Dr. Thai said.
All of that energy and drive was combined with a vision that was undeterred by conventional wisdom, Dr. Thai said.
“When he did the first liver transplant [in 1963], people called him a ‘monster’ because the surgery was so novel and the first four patients did not survive long,” he said.
If it was someone else doing those surgeries, Dr. Thai said, “I think the field would have given up on it then and there.”
Although Dr. Starzl was driven and a tough administrator who worked long hours, he was famously liberal-minded — an essential element to a man who very quickly became a teacher to surgeons from around the globe in the 1980s and 1990s.
“He tolerated a little bit of mischief and troublemakers,” Dr. Thai said. “You could have long hair, and guys would ride their bikes right into their offices. And, as a result of his attitude, there was a real cast of characters in Pittsburgh at the time. And that all made it work.”
At any time there might simultaneously be teams coming to Pittsburgh from Saudi Arabia, Japan and Italy, with all of them leaning on Dr. Starzl for help. That kind of gravitational pull also made Dr. Starzl more than just a surgeon.
“At one time, when he was transplanting all the Saudi Arabian royal family, I think he could have changed the price of oil,” Dr. Thai said jokingly. “He was a very powerful man, but he never acted like it.”
In 1985, Presbyterian tightened controls over Dr. Starzl’s program after a series of articles in The Pittsburgh Press pointed to favoritism in the kidney transplant program, with rich foreigners being pushed to the top of waiting lists and paying more than Americans did in surgeons’ fees for the same operations. The team also accepted personal gifts and research grants from the foreign patients.
The U.S. Justice Department investigated those issues, but in 1989 announced that no charges would be brought against the doctor and that the matter was closed.
A conflicted calling
In 1992, Dr. Starzl published an autobiography called “The Puzzle People: Memoirs of a Transplant Surgeon,” which revealed that the celebrated surgeon hated doing surgery.
His mother, a nurse whose death from breast cancer devastated her 21-year-old son, wanted Dr. Starzl to be a surgeon and he was determined to satisfy her wish.
“But I had an intense fear of failing the patients who had placed their health or life in my hands,” he wrote. “It was as if I had trained all of my life to become a violin virtuoso, only to discover that I loathed giving concerts or even playing privately.”
Dr. Starzl was born March 11, 1926, in LeMars, Iowa, the son of Rome Starzl, a newspaper editor and science fiction writer, and Anna Laura Fitzgerald.
He attended Westminster College in Fulton, Mo., where he earned his bachelor’s degree in biology. He went on to the Northwestern University Medical School in Chicago, where in 1950 he received a master’s degree in anatomy. In 1952, he earned both a doctoral degree in neurophysiology and a medical degree with distinction.
Following postgraduate work at Johns Hopkins Hospital in Baltimore, Dr. Starzl pursued his interest in surgery and research with a fellowship and residencies at Johns Hopkins, the University of Miami and the Veterans Administration Research Hospital in Chicago.
He was a Markle Scholar in Medical Science, a distinguished honor bestowed annually to a small group of exceptionally promising young physicians in academic medicine. Dr. Starzl served on the faculty of Northwestern University from 1958 to 1961 and joined the University of Colorado School of Medicine as an associate professor in surgery in 1962. He was promoted to professor in 1964 and served as chairman of the department of surgery from 1972 to 1980.
Patrick Gallagher, University of Pittsburgh chancellor, said Dr. Starzl was “a man of unsurpassed intellect, passion and courage whose work opened up a new frontier in science and forever changed modern medicine.”
In 2012, Dr. Starzl and Sir Roy Calne of Cambridge, England, were recognized for their work in the field of transplantation with the Lasker-DeBakey Clinical Medical Research Award. At a ceremony in New York City’s Pierre Hotel, the two received thunderous applause from the crowd of doctors, scientists, friends and family in attendance. They were on hand to recognize men described as symbolizing the “best in human achievement.”
The Lasker awards have often been a precursor to the Nobel Prize. More than 80 Lasker recipients have gone on to become Nobel laureates. By receiving the Lasker award, Dr. Starzl would have been on a list of front-runners to receive a Nobel. However, the Nobel is not awarded posthumously.
Dr. Starzl was the recipient of more than 200 awards and honors. In addition to the Lasker-DeBakey Award, he also was the recipient of the 2004 Presidential National Medal of Science, the nation’s highest scientific honor; the David M. Hume Memorial Award from the National Kidney Foundation; the Brookdale Award in Medicine, presented by the American Medical Association Board of Trustees and the Brookdale Foundation; the Medallion for Scientific Achievement, presented by the American Surgical Association; and 26 honorary doctorates from universities around the world.
Dr. Starzl’s national and international endeavors included membership in more than 60 professional and scientific organizations. He served as president of the Transplantation Society, founding president of the American Society of Transplant Surgeons and founding president of the Transplant Recipients International Organization. In 1992, he was inducted as one of only five American members into the prestigious National French Academy of Medicine.
A sought-after speaker, Dr. Starzl gave more than 1,300 presentations at major meetings throughout the world. He was on the editorial boards of 40 professional publications and authored or co-authored more than 2,200 scientific articles, four books and 300 book chapters.
According to the Institute for Scientific Information, Dr. Starzl was one of the most prolific scientists in the world. In 1999, the institute identified him as the most cited scientist in the field of clinical medicine. The book “1,000 Years, 1,000 People: Ranking the Men and Women Who Shaped the Millennium” ranked Dr. Starzl as 213th on its list of the 1,000 people having had the greatest influence on the world in the preceding 1,000 years.
Mark A. Nordenberg, University of Pittsburgh chancellor emeritus, said Dr. Starzl was a “hero” to transplant patients and “the single most influential teacher in the ground-breaking field of organ transplantation.”
A written statement Sunday from Dr. Starzl’s family, the University of Pittsburgh and UPMC notes not only his medical accomplishments, but also his skills as a teacher and mentor.
“Thomas Starzl was many things to many people. He was a pioneer, a legend, a great human, and a great humanitarian. He was a force of nature that swept all those around him into his orbit, challenging those that surrounded him to strive to match his superhuman feats of focus, will, and compassion,” the family statement said. “His work in neuroscience, metabolism, transplantation, and immunology has brought life and hope to countless patients, and his teaching in these areas has spread that capacity for good to countless practitioners and researchers everywhere.
“With determination and irresistible resolve, Thomas Starzl advanced medicine through his intuition and uncanny insight into both the technical and human aspects of even the most challenging problems. Even more extraordinary was his ability to gift that capacity to those around him, allowing his students and colleagues to discover the right stuff within themselves. Nobody who spent time with Thomas Starzl could remain unaffected. He will be greatly missed.”
Dr. Starzl is survived by his wife of 36 years, Joy Starzl, of Pittsburgh; a son, Timothy Starzl of Boulder, Colo., and a grandchild. He was preceded in death by a daughter, Rebecca Starzl, and a son, Thomas F. Starzl.
According to Dr. Thai, the family was able to arrange his funeral for Saturday at Heinz Chapel. The day would have been his 91st birthday.
Karen Kane and Sean Hamill are staff writers at the Pittsburgh Post-Gazette. Anita Srikameswaran is a former Post-Gazette medical writer. She now works for UPMC Health Plan.