A farewell to a medical giant and a great humanitarian: Thomas Starzl, M.D. PhD.

We went to Dr. Thomas Starzl’s memorial service at Heinz Memorial Chapel on March 11, 2017.  It was to celebrate a life of a medical giant and a great humanitarian.  We arrived at the chapel one hour before the service beginning at 1pm to guarantee a seat. After more than 400 or probably 500 people crowded into the chapel, many could only stand in the back.  Katy, representing the World Journal (世界日報), was sent to the press section and couldn’t get a good spot as the reporters from various agencies have been there for hours.

We went on behalf of Dr. Dr. Chao-Long Chen, (陳肇隆醫師), a Dr. Starzl’s protégé

We went to this “Homegoing Celebration” not only to pay the respect to the father of liver transplant but also to represent Dr. Chao-Long Chen, (陳肇隆醫師, a Dr. Starzl’s protégé) who couldn’t make the trip from Taiwan.

The service was followed by a reception at the Cathedral of Learning Tower across the lawn from the Heinz Chapel.  Thus we had a chance to talk with Joy Starzl, the wife and soul mate to Dr. Starzl, “whose love propelled him throughout their 36 years together.” (quoted from the statement in the memorial service program).

I have written about a special event of celebrating Joy’s birthday (when Dr. Chen was trained under Dr.Starzl at the University of Pittsburgh in 1983) that earned Dr. Chen a title of “Master Cook” from Dr. Starzl.

grand celebration of a 90th birthday party: Dr. Chao-Long Chen, Dr. Thomas Starzl and Joy Starzl

“Giants in medicine: Dr. Thomas Starzl (father of liver transplant) and Dr. Chao-Long Chen 陳肇隆醫師 (father of liver transplant in Asia)” 

http://doctorjytsai.blogspot.com/2016/03/giants-in-medicine-dr-thomas-starzl.html

Joy Starzl: an amazing lady

Joy was indeed an amazing lady as Dr. Chen told us; she treated us as if we were Dr. Chen, reminiscing the fond memory of event that happened long ago. She vividly remembers the great work that Dr. Chen, the master chef, turned out on her birthday party for more than 100 people.  She kept reminding us not to forget to ask Dr. Chen about the recipe for his delicious soup.

Dr. Chen was glad that he came to attend Dr. Starzl’s 90^th birthday party last year. We showed Joy many of the photos taken at the grand party of birthday celebration that Dr. Chen sent us.  Katy also showed the report of Dr. Starzl in the World Journal (世界日報).  Thus we shared a brief moment of fun and joy at the time of sorrow.

What Carl Sandburg felt about Lincoln is what I did Starzl

Being a history buff and medicine man, I am naturally interested in the history of medicine (limited to modern medicine as my first love is still science). History of organ transplant is one of the topics I have been reading for years. I have read every article about Dr. Starzl in Pittsburgh Post-Gazette, NY Times, or even in Scientific American that I could lay my hand.  His more scholarly articles, especially about advanced immunology, are beyond me.  I have read many chapters in Dr. Starzl’s autobiography more than two or three times, “The Puzzle People: Memoirs of a Transplant Surgeon”.

When interviewed at the time Carl Sandburg just finished his monumental Lincoln (2,400 pages 1,200,000 words), he said “That son-of-a-gun Lincoln grows on me,” he was shaken, he felt as if he “was parting with him [Lincoln], after all those years, like people who had live with him.  When Lincoln died, for a time light went out for me, the tears came.”

I never met with Dr. Starzl and yesterday was the first time we met and talked with Joy Starzl, but what Carl Sandburg felt about Lincoln is what I did Starzl.  After many years of reading him and about him, “that son-of-a-gun Starzl grows on me.”  Like Dr. Chen uttered, “震驚、不捨、衰悼” upon hearing the passing of Dr. Starzl.

 From the many speakers of “Words of Remembrance” we learned the many aspects of a great life other than his achievements in medical field.  For those interested in Dr. Starzl’s professional achievements, one can read the post I mentioned above and below.

“Cyclosporine brought the liver transplants out of dark age: The stories related to Professor Jean Borel, Dr. Thomas Starzl and Dr. Chao-Long Chen (陳肇隆醫師)”

http://doctorjytsai.blogspot.com/2017/01/cyclosporine-brought-liver-transplants.html

The legacy of a transplant pioneer and a true humanitarian

It is difficult to measure Dr. Starzl’s immense contribution, as the former Pitt Chancellor, Mark Nordenberg, said, “We cannot know how many lives Tom already has saved, directly and indirectly. But we do know that lives will continue to be saved for as long as we can imagine because of his work. . . Dr. Starzl was a true gift to humanity.”  This is also reflected by what Dr. Chen said of his mentor, “今後仍有無數病人與家庭受惠， 是醫學史上偉大的開創者與恩師”.

He is better known as the father of liver transplant; it is less well known he also single-handedly saved the kidney transplant fate in 1963.

After returning to Taiwan, Dr. Chen has since become the father of liver transplant in Asia and has trained hundreds, if not more, of transplant surgeons from various countries across the world.  It is very gratifying for Dr. Starzl to know what Dr. Chen’s team has achieved.  Whatever Dr. Starzl sowed, It reaped through the work of Dr. Chao-Long (陳肇隆醫師), 李伯皇醫師 and 鄭隆賓醫師. 
The torch was passed. The light didn't, doesn't and will not go out.

Dr. Chen personally knows many fellows from all over the world trained under Dr. Starzl and have since established their own liver transplant centers in their respective countries.  I am personally aware that two other liver transplant surgeons (台灣大學醫學院外科教授李伯皇醫師 and 台中中國醫藥大學附設醫院器官移植中心院長鄭隆賓醫師) in Taiwan were also trained by Dr. Starzl.

A great intellectual, a loving husband, father and grandfather and a humanitarian

His grandson, Ravi, talked about the time he spent together with grandfather, many of the topics were apparently esoteric and abstract that were difficult to understand, he said “I loved my grandpa.  In our time together, we spoke about things in dimensions and ways that were often difficult for others to understand.”  Dr. Starzl was not afraid to challenge his grandson, as Ravi continued, “Yet no matter how deep, abstract or esoteric the intellectual constructs we would build became, neither my grandpa nor I ever feared the other could not follow. Our minds crossed the thresholds of alien worlds effortlessly. We were dolphins playing in a sea of information.”

The service program statement said he had “an expansive knowledge of an appreciation for all music from classical to modern jazz,” we saw a photo of him playing trumpet.  “He enjoyed watching and analyzing movies, often researching their production and topic matter for hours, both before and after repeated viewings.”

 I am glad that I share this characteristic with him.  I do not watch movies often, but I “studied” some old classic movies, the likes of Casablanca, The Big Country and Duel in the Sun.  To study Casablanca I had to read Ingrid Bergman’s biography.  I have watched and studied one of the last scenes (“I will be there” by Tom Joad, played by Henry Fonda) of The Grapes of Wrath numerous times.  I have read and studied George Eliot’s Middlemarch for many years and still haven’t finished yet, but have read many chapters many times.  I have read several books about George Eliot and Middlemarch and studied many characters in depth.  It is fun to search all archaic articles about Eliot in NY Times.

This post is not about myself; but to show you why and how I appreciate and respect Dr. Starzl, for his being a great doctor, an intellectual, and a relentless knowledge seeker.  Many of the anecdotes and personal experiences of the speakers can attest to it.

Seeing the sad Chooloo next do Joy Starzl, my heart was heavy (photo credit: PGH Tribune)

Dr. Starzl’s love to his family and friends extended to his many canine companions, including Bevo, Thor, Maggie, Tiki, Shelby, Basta, Chooloo, and Ophelia (is it from Hamlet?).  Chooloo sat in the front row with the family.  Seeing the sad Chooloo my heart was heavy.

Taps and flag presentation from U.S. Navy Honor Guard

After serving in the Navy (1944-45), he earned a B.A. degree in 1947 from Westminster College (at Fulton Missouri) where he served as Churchill’s go-fer [running errand] for Winston Churchill when he went to delivered his famous Iron Curtain speech on March 5, 1946.  He then obtained his M.D. and Ph.D. from Northwestern University before he went to Johns Hopkins for post-graduate training.

This is why we saw a solemn Taps and Flag presentation to the family, Joy Starzl, by U.S. Navy Honor Guard.

Dr. Starzl put Pittsburgh in medical map of the world

Dr. Starzl came to University of Pittsburgh on January 1, 1981 and has since created a legend and legacy, putting Pittsburgh in the medical map of the world.

John Fung M.D. Ph.D.

Sen. Bob Casey also attended the memorial service. His father, former PA Governor Robert P. Casey, received a heart and liver transplant in 1993 by Dr. John Fung, who also spoke at the memorial service.  Dr. Starzl retired from the surgery in 1990, but continued to be active doing research in the Transplantation Institute that now bears his name.  He did come back to do a baboon-to-human liver transplant in 1992.

Sen. Bob Casey shaking hands with the former and current Pitt Chancellors (photo credit to Pittsburgh Tribune)

Dr. Starzl arrived at Pittsburgh at the end of 1980 and Joy joined him shortly thereafter, in his Puzzle People, we read “When she [Joy] walked down the center of aisle in an orange and yellow gown, there was silence then a thunderous ovation.  We were in the right city.”

It is of interest and significant to mention that Burl Osborn, the published of Dallas Morning News sent a professional photographer for their wedding.  Burl Osborn received a kidney transplant by Dr. Starzl in 1966 about 15 years before the wedding and lived on to become the publisher.

Starzl was chosen Pittsburgh Man of the Year in Science and Medicine in 11/1981.  I also saw a photo of him throwing the baseball to open a Pittsburgh Pirates game.  The Pittsburgh Chancellor also mentioned how Dr. Starzl received a tumultuous standing ovation when he showed up in the university game.

A compassionate humanitarian: a touching testimony from a kidney transplant survivor

During his talk, a successful kidney survivor (Hollis Hurd) recalled one day in the hospital when Dr. Starzl grabbed him from behind telling many nurses around that he was his favorite patient.  Hurd ended the talk by saying “Doc, when I see you again, and I know I will, I will be hugging you and telling everyone you are my favorite physician. And it will be true. It may sound crazy, but I can't wait.”

In a 7/7/1992 article at NY Times, Lawrence Altman wrote, “In advancing the frontiers of surgery, he sometimes fell short of the perfection he sought. Many patients died. Other surgical colleagues could protect themselves by excusing their errors or by quickly erasing bad memories, he wrote in an autobiography to be published this year. By contrast, he wrote, he still painfully remembers patients who died many years ago.”

We read in the NY Times obituary of 3/5/2017 that it was the death of Stormke Jones at age of 13 in 1990 that took its toll emotionally, the exhaustive Starzl decided to call it quit from surgery in 1990, stating it was “an uncompromisingly difficult life.”  Few people could grab the truth of what kind of a life a medical pioneer and a sensitive and compassionate humanitarian went through.

A great compassionate doctor treats each and every patient as a person with a precious life, not as a “case”.

Happy birthday to you, Dr. Starzl

Yesterday (March 11) would have been Dr. Starzl’s 91^st birthday, at the end of Joy’s talk, she kindly asked everyone inside the chapel to sing “Happy Birthday” to Dr. Starzl. All rose to sing a “Happy Birthday” chorus; it was quite an emotional moment.

John Fung,M.D. Ph.D. (credit to Pittsburgh Tribune)

photographers at work

photographers at work

Cyclosporine brought the liver transplants out of dark age: The stories related to Professor Jean Borel, Dr. Thomas Starzl and Dr. Chao-Long Chen (陳肇隆醫師院士)

My interest in history in general evolved from the interest in medicine in particular that began right after my residency training.  Recently I have been reading about the developments of liver transplant and monoclonal antibody.  Speaking of liver transplant, one cannot escape the story of cyclosporine.

In a 7/30/1981 New York Times report showing a stunning success of liver transplant, using cyclosporine (or cyclosporine A) to overcome the rejection of the transplant organ.  This report was based on a New England Journal of Medicine article of the same date.

In the NEJM article as well as NY Times article, Dr. Thomas Starzl reported 10 of the 12 persons survived one year after surgery or 83% (two died on the operating table).  The survival rate was 32% among the 170 liver transplants that he performed over the 17 years period before using cyclosporine.

Dr. Starzl performed the first liver transplant in a 3-year-old boy with biliary atresia in 1963; the boy bled to death on table.  He did five more cases of liver transplants in 1964; all died of hemorrhage or infection within 23 days of transplants.  This was followed by four years of moratorium.  Dr. Starzl began to use cyclosporine at University of Colorado before he moved to University of Pittsburgh January 1981.

The success of cyclosporine lies in the fact that it suppresses the body’s natural immunity so that it will not attack the transplant organ and yet it doesn’t hamper the body’s ability to fight off infections.

Cyclosporine was first used in 22 kidney transplants (survival rate of 85%) before it was used in liver transplant.  Dr. Roy Calne of Cambridge University was the first to use cyclosporine in liver transplant.  The development of cyclosporine was not all rosy and smooth, at one time Sandoz threatened to discontinue the project because of the toxicity to kidney.  Dr. Calne flew to Basel [where Sandoz based] and successfully appealed the decision, allowing an experimental supply to continue.  Dr. Starzl and Dr. Calne shared the 2012 Lasker Award.

Speaking of cyclosporine, it would be remiss of me not to mention Dr. Chao-Long Chen (陳肇隆醫師院士), the father of liver transplant in Asia/Taiwan.  After completing the liver transplant training with Dr. Starzl in 1983, he returned to Taiwan, at which time cyclosporine, not yet approved by FDA, was still an experimental drug.

Realizing there cannot be a success of liver transplant without cyclosporine, Dr. Chen, armed with a recommendation letter from Dr. Starzl, flew to Basel, Switzerland (where Sandoz is based) to apply for the use of the then experimental cyclosporine and was granted for the supply for five patients.

Dr. Chen had a photo taken with Dr. Borel then and again had a photo taken with him in October 2016, 33 years and more than 1,500 liver transplants later, when Dr. Chen was invited to give a talk at the prestigious 15^th Borel-Stӓhelin Lecture, named in honor of Dr. Jean Borel.  Dr. Chen was the first non-European/American doctor to be granted for this honor.

In the late 1960s Sandoz discovered two strains of fungi in soil samples.  The fungi produced substance that they hope can be developed into antibiotic.  It was a fateful twist that Professor Jean Borel of Sandoz who discovered the substance can suppress body’s immune system in 1970-73 and eventually cyclosporine came into being.

Dr. Chen’s lecture at University Hospital Zurich on October 11, 2016 was “Perspectives on Liver Transplantation, Innovation, Education and Beyond”

(I gave a talk of liver transplant to the Taiwanese American community, this is the Power Point)

Dr. Starzl spoke at Dr. Borel’s retirement banquet in 1999; this is how Dr. Starzl began,

“THANK YOU, ladies and gentlemen, and especially Jean Borel. I am honored to be here, and especially by the chance to speak. More than a retirement banquet, we celebrate tonight and tomorrow the descent of a hero from Mt. Olympus. How you, Jean Borel, managed to scale such heights, and returned unscathed is a question to which I will return in a moment. But first, I want to say something about what your journey meant to me personally, and eventually to everyone else in this room, and in the world.”

After talking about the dismal outcome of liver transplants of 17 years prior to the era of cyclosporine came around, Dr. Starzl said,

“At the darkest and most unexpected moment, a mounted torch-bearer appeared in the distance. The torch was cyclosporine; the bearer was Jean Borel, and the horse was the Sandoz Corporation. How the next steps were taken by Roy Caine and his English colleagues is the material of legends. Suffice it to say, both the patients and those who cared for them were liberated from a terrible bondage. There have been improvements in treatment since then, and there will be more. None, in my opinion, will compare in magnitude to those that occurred between 1978 and 1980 as the result of Jean Borel's initiative.”

Professor Borel’s first love was art and that “allowed him to exercise the imagination and creativity of the artist in the pursuit of science. The result was vision.”

Dr. Starzl closed his remark very appropriately at a retirement banquet,

“As for Jean Borel, don't count him out.  There are pictures to be painted, music to be composed, and words to be written.  And there is still plenty of time.”

Cyclosporine brought the  liver transplants out of dark age.  Dr. Thomas Starzl felt he owed his career to Professor Borel’s ingenious and creative work on cyclosporine; this feeling, I think, must be shared by Dr. Chao-Long Chen.

Giants in medicine: Dr. Thomas Starzl (father of liver transplant) and Dr. Chao-Long Chen 陳肇隆醫師 (father of liver transplant in Asia)

Being an internist, I rarely wrote about surgery as I am not comfortable in writing something I am not familiar with.  This is probably why Dr. Thomas Starzl was never mentioned in this blog.

This is to show how great this transplant pioneer is from the perspective of an internist, not encompassing the breadth and depth of his contribution to humanity in general and medicine in particular.  The transplant surgery stimulates and propels the advance in almost every field of medicine.

The development of the University of Pittsburgh Medical School can be safely said to be in two stages: The period before and the period after Dr. Thomas Starzl.

Dr. Thomas Starzl and Dr. Chao-Long Chen: The mentor and the protege

“One of the great biomedical scientists of the century”

Although Dr. Starzl is often called a great transplant surgeon, the father of liver transplantation, but Dr. Francis Moore (the former President of American College of Surgeons, sometime a fierce competitor/rival in the transplant profession) said of Dr. Starzl, “he is much more than that.  He is one of the great biomedical scientists of the century.  He emerged virtually to stand alone in the breadth of his study, and in the depth of his scientific penetration.”  If one reads some of his articles in the New England Journal of Medicines and doesn’t know who he is, one would think he must be an expert in immunology, and he is, indeed.

Dr. Starzl left Northwestern University Medical School for University of Colorado Health Science Center in 1962 with a determination to pursue liver transplant, at which time he began to test the use of Imuran (azathioprine) with or without Prednisone for rejection on animal transplants.

He made a strategic decision to concentrate on animal kidney transplant as the liver transplant in dog was technically too difficult then, he wouldn’t attempt liver transplant in dog without succeeding first with kidney transplant with immunosuppressive therapy with Imuran and Prednisone.

“Let a genie out of the bottle”—establishing a standard protocol of immunosuppressive therapy

A group of about 25 transplant experts (among them Dr. Joseph Murray who performed the first kidney transplant between identical twins in 1954, for which he was awarded a Nobel Prize in Medicine in 1990; Dr. Murray worked with Dr. Francis Moore at Peter Bent Brigham Hospital then) gathered in a “National Research Council” conference in 1963; it turned out to be a watershed event.

It was a very gloomy report, the kidney transplant outcome was terrible; among about 200 recipients, only 10% lived beyond 3 months and only 6 lived a year.  Even Dr. Murray had only one patient survived beyond 6 months with Imuran.  The experts felt the kidney transplant was not justified and about to call it quit.  The gloom mood of the conference was then dispelled by Dr. Starzl’s presentation reporting an 80% success of his 30 patients, which is more surviving patients than all the world experts combined, leading to a transplant surgeon from Harvard to say “it is like letting a genie out of the bottle.”

Many of the conference attendees followed him after the conference to Denver to learn his method and his Imuran-Prednisone regimen became the standard immunosuppressive protocol for the next two decades.

I cannot emphasized enough that though a skilled and innovative surgeon he is, his other non-surgical contribution to this field is enormous and beyond measure. He is a transplant surgeon with a knife and a mind.  It is less well known that “the father of liver transplant” (a “new kid in the block” then) also single-handedly saved the fate of kidney transplantation.

Dr. Thomas Starzl: a man of conviction, of courage and of perseverance

The story of Dr. Starzl’s liver transplants in the early days (1963 to 1967) was not rosy. His first patient died on the operating table; the way he described the case in his autobiography, The puzzled People: Memoirs of a Transplant Surgeon, was touching.  The next four patients all died of either hemorrhage or infection.  He had self-imposed moratorium of three years, during which he refined the surgical technique on animal studies.  The break came in 1967 (or 1968) when he had the first successful liver transplant.  He had many successes during Imuran era (1967 to 1979), but the success rate was only 50%.  Losing the recipients to death, Dr. Starzl said it is “a tough pill to keep swallowing.”

Starzl rescued Cyclosporine and Tacrolimus (Prograf)

When Cyclosporine came along in 1979, about the time he moved to University of Pittsburgh, it greatly reduced the rejection and improved the outcome.  But Sandoz has made a decision to take it off the market because of its great toxicity.  Dr. Starzl demonstrated that it Cyclosporine can be safely used at a reduced dosage in combination with Prednisone.  The similar story happened in Tacrolimus (Prograf); he endured all sorts of criticisms and strain.  It is through his assiduous perseverance (and that of Dr. Roy Calne--see below) that led to FDA approval of Cyclosporine in 1983 and Tacrolimus in 1994.

Dr. Starzl and Dr. Calne shaking hands: Lasker Award

Dr. Thomas Starzl and Sir. Roy Calne: The trans-Atlantic alliance

Like Dr. Starzl, Dr. Roy Calne of Cambridge University in England is the father of liver transplant in Europe.  They both began with kidney transplant.  They both pursued and perfected the anti-rejection therapy relentlessly.  Dr. Starzl spent his sabbatical in London in the summer of 1975, during which he went to see Dr. Calne in Cambridge.  In his The Puzzle People, Dr. Starzl wrote, “. . . the fate of liver transplantation would depend upon an unspoken trans-Atlantic alliance between Cambridge and Denver without which further efforts would not have continued, much less succeeded, on either side of the ocean.  These mutually supportive moral and scientific bonds pulled liver transplantation into the mainstream of medical practice but not until the decade was finished.  By then, Calne had been knighted.”

It is fitting that Dr. Starzl and Dr. Calne shared the prestigious Lasker awards (a Nobel precursor or America Nobel) in 2012.

Dr. Chao-Long Chen at “Dr. Starzl’s exhibit” in Senator John Heinz History Center

Quit surgery, but never retired from research

Dr. Starzl not only established a new field of liver transplantation, but also trained numerous surgeons from all over the world.  After the coronary artery bypass surgery he stopped doing transplant surgery in 1990 (or 1991) at age of 65, but continued to very actively pursue and supervise the research. 

I recall reading an article of “Graft and Host, Together Forever” in Scientific American (2007), which was about the concept of what Dr. Starzl called microchimerism that explains why patients’ bodies were able to accept foreign tissues.  He theorized that cells from donated organ infiltrate tissues and organs throughout the recipient’s body, causing it to begin accepting the new tissue as its own.

The sacrifice and peril of a dedicated transplant surgeon

In his The Puzzle People, Dr. Starzl wrote about his divorce from his first wife, Barbara, “The marriage had lasted for almost twenty-two years before Barbara’s forbearance ran out.  Her rival, Mistress Surgery, had been too strong.”

In his autobiography, In Search of Memory, Dr. Eric Kandel (the 2000 Nobel laureate in Medicine for his elucidation of the molecular biology of memory) wrote that in one of the family gatherings, he apologetically said he probably could only get a grade B as a father due to the demand and devotion of his research work, his daughter said, “dad, that is grade inflation!”

When the children were out of school in the summer of 1975, Dr. Starzl brought the whole family to London for his sabbatical.  He must have struggled mightily to balance his family life and the demand of his work.  He wrote “the second priority for the sabbatical was to review with Porter the reasons for success or failure in each of the first ninety-three cases of liver transplantation in Colorado.”  He bicycled with his son from London to Cambridge to meet with Dr. Calne.

In his autobiography, For the Love of Enzymes, Dr. Arthur Kornberg (The Nobel laureate for his discovery of DNA polymerase) wrote that when he went to NIH, he stopped by NIH first before going to his new home, just to say hello to his future colleagues.  Once inside NIH he forgot about his wife and children who ended up waiting outside in the car for the whole afternoon.

桃李滿天下

What prompted me to write this post is the occasion of the 90^th birthday party for Dr. Starzl, which was held at the UPMC Club Lounge at Heinz Field in the evening of March 12.  I do not have the details of the party at the time of this writing, but I know there are more than 200 transplant surgeons from all over the world “coming home” for the celebration; Dr. Chao-Long Chen (陳肇隆醫師) from Taiwan is one of them.  The fellow reunion took place in the evening of March 11.

In the fellow reunion (March 11) Dr. Starzl expressed his gratification and pride for the accomplishment of Dr. Chao-Long Chen.  Dr. Starzl has followed the work of all the surgeons he trained over the years.

1926 Chateau Grand Corbin Despagne 謝師酒

Dr. Chen presented a very precious and thoughtful 90^th birthday gift to Dr. Starzl: an extremely rare 1926 Chateau Grand Corbin Despagne.  The accompanied beautifully written greeting card summarizes what this giant and legend in medicine is all about and why this celebration is “a special and momentous occasion. There is an air of jubilation and a galaxy of experts from transplantation field has descended to witness this gala event.”

Some years ago we gave 100 one-dollar coins for the 100^th birthday gift to our neighbor, Dr. Greenlee, a Mayo Clinic trained surgeon, with a card, saying “How much do we love thee, Let us count the ways/coins . . .”

Presenting the precious and thoughtful birthday gift: Protege to Mentor 

名師出高徒: Dr. Thomas Starzl and Dr. Chao-Long Chen 陳肇隆醫師

Dr. Starzl moved to the University of Pittsburgh in 1981 and the ensuing ten years was his most active period of doing transplant surgeries in a furious pace; more than a dozen a week or more than 600 cases a year.  It was at this time that Dr. Chao-Long Chen came to train with Dr. Starzl.  Dr. Goran Klintmalm, head of the Baylor Regional Transplant Institute in Texas, once said Dr. Starzl “had an extraordinary ability to spot talent, and if you didn't have that talent, you were out.” If one didn’t have what it took, one couldn’t survive the training.  It must be a gratifying and hilarious feeling to have Dr. Starzl as a mentor.

Dr. Starzl and Dr. Chen is the best example of 名師出高徒. After graduating from Kaohsiung Medical University, Dr. Chen had his surgical training at Chang Gung Memorial Hospital in Taiwan and the Hospital for Sick Children in Toronto, Canada.  He then trained in liver transplantation with Dr. Starzl at the University of Pittsburgh in 1983.

Accomplishments and awards

Dr. Chen performed the first successful liver transplant in Asia in 1984 and has since done more than 1,500 cases.  He did the first split liver (one donor liver to two recipients, such as larger right lobe to adult and smaller left lobe to child) transplantation in Asia in 1997 and performed the first pediatric living donor liver transplantation in 1994 and the first adult living donor liver transplantation in 1999 in Taiwan.  He has been the foremost in many surgical innovations of liver transplantation in Asia; he performed the first dual graft (such as two adult smaller left lobes to one recipient) living donor liver transplantation in 2002, and the first segment 2 monosegment (I believe this applies to small infant recipient) living donor liver transplantation in 2013 in Taiwan.  Dr. Chen indeed is the father of liver transplant in Asia; Dr. Starzl of Taiwan/Asia.

Dr. Chen has published more than 440 SCI-cited scientific articles, has lectured in more than 280 international congresses, and has received several honorary and visiting professorships. He is an associate editor of the American Journal of Transplantation and serves on the editorial board of several journals, including Annals of Surgery, Transplantation and Liver Transplantation.

He was appointed as Superintendent of the Kaohsiung Chang Gung Memorial Hospital in 2003 and became Superintendent Emeritus in October 2015.  The list of his awards and accomplishments is as long as your arm.

It is no surprise that Dr. Chen was recently appointed to the prestigious and influential Advisory Board of Center for Asia Pacific Policy. He is one of the two from Taiwan to join this USA based institute.

Joy Starzl (wife of Dr. Starzl), Dr. Starzl and Dr. Roy Calne (speaker) in Pittsburgh

Dr. Starzl “had an extraordinary ability to spot talent,” whether it is a surgical scalpel or a kitchen knife

Dr. Chen reminisced an unforgettable event when he was trained with Dr. Starzl in 1983.  One day Dr. Starzl asked him to cook for a birthday party for his wife, Joy, saying several friends will come; the number increased to “may be 25 people”, and a day before the birthday, Dr. Starzl announced there will be 100 people more or less.  Dr. Chen hurried to Shiow-bih’s (Dr. Chen’s medical school classmate) home to grab every pot and pan.  The party was a great success.  Dr. Chen (then not married yet) said his wife never believed he could cook for more than 100 people.

As I said earlier that Dr. Starzl “had an extraordinary ability to spot talent,” whether it is a surgical scalpel or a kitchen knife.  It might have become a “folklore” among international transplant community, as Dr. Barry Kahan, Professor and Director of Immunology and Organ Transplantation at the University of Texas Medical School at Houston, asked Dr. Chen when he visited Taipei in 1990 whether he knows who was that famous “master cook”.

The photo below shows Dr. Starzl apparently still had fond memory of the event when he autographed his Memoirs of A Transplant Surgeon (The Puzzle People) to Dr. Chen twenty some years ago.

Dr. Chao-Long Chen and his medical school classmates

The pleasant unexpected side trip

Thanks to Shiow-Bih’s (秀碧) kind and considerate arrangement, Dr. Chen was able to meet with several of his classmates (林琪雄醫師, 王明仁醫師 and 廖泓淼醫師) coming from New Jersey, Toronto and Washington D.C., reminiscing good old medical school days.  Dr. Chen also met some of the people he made friends with when he was in Pittsburgh in 1983.  He was grateful that 黃呈昌夫婦 were able to drive him around to Phipps Conservatory and Botanical Gardens, Senator John Heinz History Center and Thomas E. Starzl Transplant Institute during his spare time before the fellow reunion.

陳肇隆醫師 黃呈昌夫婦

能者多勞  前人種樹, 後人乘涼, 為後人造福

Burdened with the administrative work of the superintendent of a 2,745-bedded hospital managing the affairs of a very busy liver transplant program, Dr. Chen has been abroad more than twenty times a year, with the purpose of giving lectures, surgical demonstrations and help establishing liver transplant programs across Asia and Central and South America, or receiving medals, award and honorary doctorate. Despite such a busy schedule he still managed to plant more than 5,000 of the 9,000 trees around his hospital.

The Chinese idiom of 前人種樹, 後人乘涼 means planting trees is to benefit the generations to come.  Being a pioneer of liver transplant in Asia and training so many surgeons, Dr. Chen is also “planting trees” as a transplant surgeon, not only benefitting his patients, but also elevates and advances the level of care in his hospital in years to come.

創造1400個重生奇蹟 : 新肝情願 2

It is very kind of Dr. Chen to give me his autographed book (創造1400個重生奇蹟 : 新肝情願 2), unfortunately, we’re in a hurry to leave and the book was left behind at Shiow-Bih’s house, otherwise I would have more story to tell about the father of liver transplant in Taiwan/Asia.  Now I have more incentive to visit Rong-Chung and Shiow-Bih soon again to get the book,

Dr. Tsai     Dr. Chen

陳肇隆醫師 黃呈昌夫婦 陳飛