Dr. Tom Starzl, a Surgical Pioneer, Gambles with Long, Long Odds in Human Organ Transplants

The lifesaving procedure always begins in death: Someone must die to provide the organs for transplant. No matter how many times the doctors have asked a bereaved family for permission to remove them from a body, it is still hard. This night, members of the surgical team are sitting with a middle-aged man whose 16-year-old son has suffered fatal brain damage in a shooting. The father has marked his driver’s license application that he wishes to subscribe to a volunteer donor program. But can he make the same decision for his boy?

Beads of sweat glisten on the doctors’ foreheads; they shuffle papers and gulp coffee as a hospital official gently explains the transplant program and the laws governing it. “I just want to sign the papers,” blurts the sobbing father. “My son can live through others.”

A few hours later, across town at Colorado General, the Boss and his staff of 20 specialists are scrubbed and ready for the tense, long night.

Dr. Thomas E. Starzl’s official titles are chief of surgery at Colorado General Hospital and chairman of the surgery department at the University of Colorado Medical Center, but the staff at the medical center’s organ transplant unit refers to him simply as “the Boss.”

He is one of the world’s pioneers in transplant surgery—the first, for example, to transplant a human liver. It was an effort that began in 1963, four years before South Africa’s Christiaan Barnard performed the first heart transplant. Starzl has never received the public acclaim given heart transplant specialists, yet doctors agree that replacing a human liver is a more difficult procedure. “Tom Starzl is one of the greatest technical virtuosos that surgery has ever had,” says a colleague.

Of the approximately 360 liver transplants performed in the world to date, 156 have been the work of Starzl’s crack surgical team in Denver—the major group now doing the operation in North America. It has also performed some 1,000 kidney transplants and recently resumed heart transplants after a four-year hiatus.

Kidney transplants cause the least problems—90 percent of them are now successful, meaning patients live for a year or more. Dr. Starzl has also increased the liver transplant survival rate from 30 to 50 percent in the last five years. His most remarkable triumph is Kim Hudson, 12, of Oregon, III. She received a new liver nearly nine years ago.

For all the hope the intricate transplant holds out, Starzl admits the odds remain long. “It is pretty maddening, especially if we know we could have done something better,” the slightly graying, 52-year-old surgeon says. “What makes it more difficult is that we can’t rationalize a death by saying the odds were against survival. We have to analyze and ascertain the cause of failure in as brutal a way as possible.”

In the operating room, the mood is cautiously optimistic for the two patients from the transplant ward who have been selected to receive the youthful donor’s organs. One is a 28-year-old man with terminal liver disease, the other a 21-year-old woman with a congenital kidney problem. She has undergone five previous transplants.

At 7:30 p.m. doctors begin removing the healthy organs while another team prepares the liver patient for surgery. Three hours later—crisis. The principal vein into the patient’s diseased liver is discovered to be clotted, which makes it impossible to connect the new organ. The Boss must make a horseback decision—abort the surgery and leave the patient to face certain death, or try to reconstruct the vein, a delicate, rarely attempted operation within an operation. The patient’s family gives Starzl the go-ahead.

It is 11:48 and the tension mounts. An attending surgeon applies a bit too much pressure to the patient’s rib cage, tearing some tissue. “Dammit,” Starzl snaps, “we’re here to help the patient. Be more careful.” All the care in the world, however, seems unable to halt the progressive decline of the patient’s blood pressure, now down to an alarming 45/0. (Normal for this patient: 120/70.) Grimly, Starzl turns to transplant unit coordinator Paul Taylor and asks, “Have you told the family?”

At 1:09 a.m., despite massive blood transfusions, the man is still slipping. In the midst of the critical reconnection, Starzl stops for a moment, looks up at the ceiling and blinks twice to relieve the tension, then turns resolutely back to his labors. The patient’s blood pressure drops to 40/0 before it finally begins to rise. The worst may be over, and, with a fresh team of doctors hovering over the table, the Boss takes a break. Pale and exhausted, he sinks into a battered chair in an adjacent lounge and chain-smokes. His surgical team trails out after him, collapsing with fatigue amid half-eaten dinners, empty Dr Pepper cans and overflowing ashtrays.

At 3:30 a.m. Starzl assigns himself to slip across the street for a bag of doughnuts. Later he catnaps without even removing his shoes; his reputation for going without sleep is prodigious. Thus refreshed, he decides to do the kidney transplant. There is no time to be lost, for the donor kidney will lose its vitality in 24 hours. At 6:30 Starzl has begun his second operation while the relief team finishes the first. By noon both are completed.

After what he calls a “typical night” in transplant surgery, Starzl feels hopeful but will not know the outcome for four weeks. The results are bittersweet. The liver patient dies from complications related to the faulty vein. But the kidney recipient appears to have had a successful sixth transplant. She will soon be on her way home.

Tom Starzl’s father was an Iowa newspaper editor and publisher, his mother a nurse. They instilled in their son the philosophy, “You can be whatever you want to be.”

Paradoxically, young Tom’s problem was that he did too many things well. A straight-A student at Central High School in rural Le Mars, he was a member of the debating team, an end in football, a forward in basketball and a trumpet player in the band. “It was hard to compete in a football game and be in the band at halftime,” he recalls of his discovery of the limits of overachieving. “I decided to drop music and debate.”

His interest in medicine was nurtured partly by his mother and partly by a local doctor who allowed him to watch operations. After premed at Westminster College in Fulton, Mo., he went to Northwestern University Medical School, where he eventually earned an M.A. in anatomy, a Ph.D. in neurophysiology and his M.D. Meantime he moonlighted as a paramedic for a factory doctor, read proof at the Chicago Tribune and played trumpet with a weekend jazz combo.

Surgical internship at Johns Hopkins in Baltimore, marriage and a series of appointments to hospitals and universities followed in orderly procession. Starzl’s reputation as a medical researcher soared after he joined the University of Colorado medical faculty in 1962. Over the years he has made significant contributions to techniques for controlling the body’s natural rejection of implanted organs—the bane of all transplant surgery.

In spite of Starzl’s vast experience with liver transplants, he still finds it “a very difficult operation. The plumbing is complex, but that’s not the whole explanation. The problem with the liver is that it has to function perfectly right away, whereas the kidney doesn’t.” (Dialysis can serve as a backup.) His surgical colleagues find Starzl’s demand for perfection inspiring—if also somewhat intimidating. “He will redo and redo something like an artery or vein reconnection until it is perfect,” says one associate, “though he can recognize when things can’t be done any better. In the early days he used to throw temper tantrums in the operating room. He has learned to be more sensitive toward other people.”

Dr. Starzl takes a certain pride in his idiosyncrasies. He keeps a comfortable penthouse apartment only a few blocks from the medical center. Yet, because of his schedule, he often doesn’t get home for days at a time. His eating habits would scandalize a dietician—fast food or meals gulped on the run in hospital cafeterias where he subsists for “under $3” a day. A fairly casual dresser, he is sometimes mistaken for an orderly. But woe to anyone he catches treating an orderly—or even someone who looks like an orderly—with disrespect.

Divorced from his wife, Barbara, two years ago, he acknowledges that a transplant surgeon’s round-the-clock routine hardly helped the marriage. “I’m surprised she put up with me for 22 years,” Starzl says evenly. Nonetheless, he makes every effort to remain close to his three children, time and geography permitting. A daughter, Rebecca, 21, lives in England, but Tim, 23, is a graduate student in philosophy at Colorado U, where Tom, 20, is a liberal arts undergrad. His sons often join him on overseas trips, including a 2,000-mile bicycle ride across the sub-arctic tundra of Scandinavia in 1972. “It was supposed to be a vacation,” laughs Tim, “and we were biking 18 hours a day through no-man’s land.”

Even on off-duty weekends the doctor’s pace doesn’t slow down much. A devoted football fan, he has season tickets for the Denver Broncos and the University’s Buffaloes. He is an enthusiastic and accomplished amateur photographer. He dates regularly and is no stranger to Denver’s discos. When he travels, he is prepared for almost any eventuality. His little orange Honda is equipped with a ski-and-bike rack, a baseball glove, a Frisbee and a selection of Linda Ronstadt and Al Stewart tapes.

Now something of a Colorado loyalist, he reads the Rocky Mountain News religiously and drinks only Coors beer. In most things he manages an effortless versatility. Though the six-foot, 155-pound Starzl deprecates himself as a run-of-the-mill skier, his friends say he can handle expert-rated slopes with style.

Nowhere is his combination of intensity and outward matter-of-factness demonstrated better than in the operating room. “I’m happy when everything we do in the OR works,” Tom Starzl says. “I’m pretty unhappy if it fails. But we have to guard against being happy when the operation is only a technical success. The long haul is what counts.” His son Tim adds: “Dad is a semi-austere, hard-working, driven Teuton. It is not a role. It is his life.”