How Death Becomes Life by Joshua Mezrich

Author:Joshua Mezrich
Language: eng
Format: epub
Publisher: Atlantic Books

AFTER HIS TIME in Miami, Starzl returned to Northwestern in 1958. He decided to take an extra year of training as a fellow in chest surgery. He knew his passion was the liver, but despite being gifted at surgery, he was tortured by the idea of performing it, and much preferred research. During his fellowship at Northwestern, he conducted liver transplants in dogs in his lab (with no assistants). All the dogs died. This would be harder than he’d expected. As he completed his last year of training, he agreed to stay on at Northwestern to continue his research. After obtaining a couple of national grants, he was off. Not only did he develop the techniques in dogs that would be necessary for attempting liver transplantation in humans, but he also was finally exposed to the handful of other investigators working in the field of liver transplantation.

At the Brigham more or less at the same time, Francis Moore also had turned his attention to the liver. He put a group together and performed numerous liver transplants in dogs. Early attempts failed for him, too, as the dogs did not tolerate the clamping of the vena cava and portal vein that was required at the time to get the liver out.

Both Starzl and Moore came up with the same solution to this problem. They obtained plastic tubing and shunted blood from the lower extremities into a vein in the neck that drains into the heart. In this way, when they clamped the cava, blood would bypass the clamped vein and make it back to the heart. (Their technique is still used today in some programs.) Once this problem was solved, both groups were able to transplant the liver in dogs successfully and saw slowly improving survival rates. Of course, neither group was using immunosuppression, as there was none at the time. But even though all the livers were rejected in about a week, during that week, the labs normalized, suggesting the livers were functioning, and the dogs behaved normally.

At the annual meeting of the American Surgical Association, Franny Moore presented the Brigham data. His description of liver transplantation was seen as groundbreaking—until Tom Starzl got up to discuss Moore’s paper. As Starzl recalls:

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