The Puzzle Solver

UPDATED 09/07/1992 at 01:00 AM EDT Originally published 09/07/1992 at 01:00 AM EDT

WHILE SHOWING A VISITOR AROUND HIS stately 75-year-old home in Pittsburgh, Dr. Thomas Starzl, the celebrated surgeon responsible for last June's first baboon-to-human liver transplant, gestures toward a small stack of books near his collection of Mozart CDs. "My escape," he says. "But I don't read fiction. All my career, I've had sensory overload with the real-life cases of my patients—painful stories that still bring on the tears."

One indelible story is that of a tiny girl who can be seen delicately picking long-stemmed flowers in a portrait that Starzl has hanging in his bedroom. He replaced her cancerous liver with a healthy donor liver in 1967, but the cancer soon appeared elsewhere in her body. She died at age 2½. "Her name was Julie," says Starzl, who was captivated by her courage and fragile beauty, "and the portrait is the dearest thing I own."

When Starzl began organ-transplant surgery three decades ago, the field was in its infancy; virtually no doctors specialized in such operations then. Now there are thousands, and organ transplantation is a standard medical procedure worldwide, in large part because of Stand's pioneering work. A bold, maverick surgeon, he performed the world's first successful human-liver transplant in 1967, and last June 28 he made more medical history, supervising the surgical team that transplanted a baboon's liver into a 35-year-old man who was dying of hepatitis B, a virus that had destroyed his liver. (Baboons do not get hepatitis B; if a human liver had been transplanted, it probably would have become infected itself.)

"Our baboon-liver guy," as Starzl affectionately calls him, continues to recover with nearly normal liver function at the University of Pittsburgh Medical Center, where Starzl, 66, directs the Transplantation Institute. "He wants to stay anonymous for the time being," Starzl says, crediting the man's survival after the 11-hour operation to the use of an experimental anti-rejection drug, FK-506, in combination with three other drugs. (The last animal-to-human transplant was in 1984, when Baby Fae, a 2-week-old girl, received a baboon's heart at the Loma Linda University Medical Center in California but died 20 days later.) "It's a tremendous breakthrough and could lead to relieving the shortage of human organs for transplantation," says Starzl. "We couldn't be happier."

Not so happy, however, were a dozen or so local animal-rights activists who picketed the sprawling medical complex. "Animals are not spare parts," they chanted after the operation had been made public. Starzl dismisses such attitudes as shortsighted. "I don't think it's unethical or immoral to sacrifice animal life for human life," he says. Each week, he points out, about three patients die at the center while waiting for a human-liver transplant. "We have our priorities straight," he says, "and they start with our patients."

Starzl no longer performs surgery himself; he has been on a self-imposed slowdown regimen since he had heart-bypass surgery two years ago. But he continues his role as an energetic, often contentious leader in the transplant arena. (He once quit a prestigious surgical-training program at Johns Hopkins, condemning it as "rigid and authoritarian.") He oversees dozens of projects at the Transplantation Institute, and this month he published his autobiography, The Puzzle People: Memoirs of a Transplant Surgeon (University of Pittsburgh Press), a title he chose because he views organs as pieces of a human puzzle.

His daily schedule includes often unannounced meetings with staffers, during which Starzl exhorts his colleagues to "Go get 'em!" and "Be aggressive!" Once a notorious junk-food eater with an ulcer and a four-pack-a-day cigarette habit, Starzl still has "ulcerative days" that drive him to a nearby ice-cream store for his favorite remedy: chocolate-chip milk shakes.

The surgeons who perform the actual operations find Starzl's inspiration invaluable. "We're the eyes and hands," says Dr. Satoru Todo, one of the three surgeons who performed the baboon-liver transplant. "He's still the brain." In the days when he was doing the cutting himself, Starzl was legendary for his intensity in the operating room. Dr. John Fung, Starzl's successor as the Medical Center's transplant chief, recalls the time during surgery when his mentor's view was obstructed by an errant hand. "Move that hand!" Starzl kept shouting to the attending staff. When the hand didn't move, he whacked it with the blunt side of a scalpel. "It was his own hand, but he hadn't realized it," says Fung. "That's how focused he is."

Starzl has always been focused on the job at hand. He was born in Le Mars, Iowa (pop. 8,454), the son of R.F. Starzl, a newspaper editor and publisher, and Anna Laura Fitzgerald, a surgical nurse whom he calls his guiding light in entering medicine. One of four children, Thomas helped set type at the newspaper while earning nearly straight A's in high school. He was also on the debating, football and basketball teams and was a trumpet player in the band. "Playing trumpet at halftimes was hard," he recalls, "so I decided to drop music."

In 1947, after finishing his premed studies at Westminster College in Fulton, Mo., Starzl was at home caring for his ailing mother when she died of breast cancer at the age of 47. "I was supposed to give her an injection for pain," he says, "and I was a few minutes late because my hands were trembling so much I dropped the spoon with the medication. I fell I failed, and this affected me for years." Later that year, encouraged by a local doctor who had let him watch operations, Starzl entered Northwestern University Medical School in Chicago. Eventually he earned a master's degree in anatomy, a Ph.D. in neurophysiology and his M.D., all the while moonlighting as a paramedic for a factory employee doctor, working as a Chicago Tribune proofreader and playing trumpet with a weekend jazz combo. In 1958, after surgical residencies at Johns Hopkins and the University of Miami, he returned to Northwestern, where he practiced surgery and conducted animal experiments. "I was the designated rat doctor," he says, adding that he chose transplant work because it was the most challenging and least explored medical field. "It's all about compassion and saving human lives."

Along the way he married, and in 1962 he moved with his first wife, Barbara, and three children (Tim, now 36, Becky, 35, and Tom, 34) to Denver, where he joined the University of Colorado's medical faculty because he felt opportunities for starting a transplant program were better there. The following year he attempted his first human-liver transplant. Though the patient died, he refused to abandon the field because, he says, "I knew it was feasible and couldn't turn my back on it." Thirty years later, Starzl has done about 3,000 liver transplants, and the operation now has an 80 to 90 percent success rate. One casualty of his obsessive work schedule was his marriage, which ended in 1976—partly, he says, because he spent so much time with Mistress Surgery.

In 1981 he joined the University of Pittsburgh, where he pioneered multiple-organ transplants and the use of new anti-rejection drugs. That year, he also married Joy Conger, now 37, a lab technician he had met in Denver. "Because our marriage is interracial," says Joy, who is black, "a lot of people said it wouldn't work. Well, they're wrong and it's wonderful." Equally indicative of the brave new world they live in, says Starzl, "are the tremendous changes still ahead in transplant work. Today we're putting a baboon liver into a human. Tomorrow we may be transplanting all kinds of animal organs into people. There are no boundaries."

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