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Thomas Starzl
Thomas Starzl
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Thomas Earl Starzl (March 11, 1926 – March 4, 2017) was an American physician, researcher, and expert on organ transplants. He performed the first human liver transplants, and has often been referred to as "the father of modern transplantation".[1] A documentary, titled "Burden of Genius,"[2] covering the medical and scientific advances spearheaded by Starzl himself, was released to the public in 2017 in a series of screenings. Starzl also penned his autobiography, The Puzzle People: Memoirs Of A Transplant Surgeon, which was published in 1992.

Key Information

Life

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Early years

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Starzl was born on March 11, 1926, in Le Mars, Iowa, the son of newspaper editor and science fiction writer Roman Frederick Starzl and Anna Laura Fitzgerald who was a teacher and a nurse. He was the second of four siblings.[3] Originally intending to become a priest in his teenage years, Starzl changed his plans drastically when his mother died from breast cancer in 1947.[3] He briefly served in the United States Navy Reserve after graduating from Le Mars High School in 1944.

Education

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He attended Westminster College in Fulton, Missouri, where he earned a Bachelor of Science degree in biology. Starzl attended Northwestern University Medical School in Chicago, where in 1950 he received a Master of Science degree in anatomy and in 1952 earned both a Doctor of Philosophy in neurophysiology and an M.D. with distinction.[4] While attending medical school, he established a long friendship with Professor Loyal Davis, MD, a neurosurgeon (whose wife Edith Luckett Davis' daughter from her first marriage was Nancy Reagan[3]).

Starzl spent an extra year at medical school, using the additional time to complete a doctorate in neurophysiology, in 1952. He wrote a seminal paper describing a technique to record the electrical responses of deep brain structures to sensory stimuli such as a flash of light or a loud sound. The paper is highly cited, having been referenced in 384 articles by January 2019.[5]

In 1959, he gained a Markle scholarship.[6]

After obtaining his medical degree, Starzl trained in surgery at Johns Hopkins Hospital in Baltimore and Jackson Memorial Hospital in Miami. At both places, he conducted lab and animal research, showing a keen interest in liver biology.[7]

Thomas Starzl after performing a transplant surgery circa 1990

Career

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Starzl was a surgeon and researcher in the then nascent field of organ transplantation at University of Colorado Health Sciences Center from 1962 until his move to University of Pittsburgh School of Medicine in 1981.

The Institute for Scientific Information released information in 1999 that documented that his work had been cited more than any other researcher in the world. Between 1981 and June 1998, he was cited 26,456 times.[3]

His autobiographical memoir, The Puzzle People, was named by The Wall Street Journal as the third best book on doctors' lives[8] and was written in three months.[9]

Starzl's most notable accomplishments include:

Awards and honors

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Awards

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Thomas E. Starzl Way on the campus of the University of Pittsburgh
Entrance to the Thomas Starzl Biomedical Research Tower at the University of Pittsburgh.

Starzl was named one of the most important people of the Millennium, ranking No. 213, according to the authors of "1,000 Years, 1,000 People: Ranking the Men and Women Who Shaped the Millennium " (Kodansha America, 332 pp.)[1]

Starzl has also received honorary degrees from 26 universities in the United States and abroad, which include 12 in Science, 11 in Medicine, 2 in Humane Letters, and 1 in Law.[27]

In 2006, at a celebration for his 80th birthday, the University of Pittsburgh renamed one of its newest medical research buildings the Thomas E. Starzl Biomedical Science Tower in recognition of his achievements and contributions to the field.[28] On October 15, 2007, the Western Pennsylvania American Liver Foundation and the City of Pittsburgh honored Starzl by dedicating Lothrop Street, near his office and the biomedical research tower bearing his name, as "Thomas E. Starzl Way".[29]

A statue honoring Starzl was unveiled on June 24, 2018 on the University of Pittsburgh campus near the school's Cathedral of Learning.[30]

Honors

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Retirement

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Having retired from clinical and surgical service since 1991, Starzl devoted his time to research endeavors and remained active as professor of surgery at the University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center's (UPMC) program named in his honor: the Thomas E. Starzl Transplantation Institute. Since his "retirement," he earned the additional distinctions of being one of the most prolific scientists in the world as well as the most cited scientist in the field of clinical medicine.[32]

See also

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References

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Revisions and contributorsEdit on WikipediaRead on Wikipedia
from Grokipedia
Thomas E. Starzl (March 11, 1926 – March 4, 2017) was an American physician and renowned as the "father of transplantation" for his pioneering work in developing and advancing solid , most notably , which transformed it from an experimental procedure into a life-saving clinical standard. Born in , Starzl earned a in from Westminster College, followed by a master's in (1950), an MD (1952), and a PhD in from . After completing surgical residencies at (1952–1956), the (1956–1958), and Northwestern (1958–1959), he joined the faculty at the in 1961, where he established one of the first clinical kidney transplant programs in 1962. Starzl performed the world's first human liver transplantation in March 1963 at the , attempting the procedure on a child with , though the patient died during from ; a subsequent attempt in May 1963 on an adult patient at the VA Hospital resulted in the liver functioning post-surgery, but the patient succumbed to infection weeks later. Despite early setbacks due to inadequate , Starzl persisted, achieving the first successful long-term human liver transplant in 1967 using and as immunosuppressive agents, which laid the foundation for modern protocols. In the 1970s and 1980s, he revolutionized the field by introducing cyclosporine in 1978 and (FK506) in the 1990s, dramatically improving graft survival rates and enabling widespread adoption of liver, , , intestine, and multi-organ transplants. In 1981, Starzl moved to the , where he led groundbreaking advancements, including the first combined heart-liver transplant (1984) and a five-organ transplant (1987), serving as chief of transplantation services and director of the Pittsburgh Transplantation Institute until his retirement from active surgery in 1991; the institute was renamed the Thomas E. Starzl Transplantation Institute in 1996, where he served as director emeritus. His research extended to , performing a baboon-to-human liver transplant in 1992, and the concept of donor-recipient , which advanced understanding of transplant tolerance and immune acceptance. Starzl authored over 2,200 scientific papers and four books, influencing global transplantation practices and saving countless lives; he received more than 200 awards, including the (2004) and the Lasker-DeBakey Clinical Medical Research Award (2012, shared with Roy Calne). As founding president of the American Society of Transplant Surgeons (1974–1975), his legacy endures through institutions like the UPMC Starzl Transplantation Institute, which continues to pioneer innovations in organ preservation, , and multi-visceral procedures.

Early Life and Education

Childhood and family influences

Thomas Earl Starzl was born on March 11, 1926, in , as the second son of Roman Frederick Starzl and Anna Laura (née Fitzgerald) Starzl. His father, a first-generation American of German descent, owned and edited the local semi-weekly newspaper, The Le Mars Globe-Post, and was an early pioneer in science fiction writing, which fostered an environment rich in intellectual discourse on emerging scientific ideas. Starzl's mother, of Irish heritage, began her career as a surgical nurse before transitioning to teaching, providing a nurturing household that emphasized education, ethics, and caregiving. The family included an older brother, John, and two younger sisters, Nancy and Marnie, with Roman and Anna Laura's first-generation immigrant backgrounds influencing a strong sense of cultural and moral values, including discussions on scientific progress and ethical dilemmas drawn from the father's journalistic and literary pursuits. As a teenager, Starzl initially aspired to the priesthood, reflecting the Catholic influences in his upbringing and his scholarly interest in Latin. However, the profound loss of his mother to on July 7, 1947—just after his college graduation—reshaped his path, inspiring a commitment to as a means to combat such diseases and alleviate suffering.

Academic and medical training

Thomas Starzl earned a bachelor's degree in biology from Westminster College in , in 1947. His interest in medicine was sparked by his mother's prolonged illness with , which motivated him to pursue a career in the field. Starzl then attended in , where he received a Master of Science degree in anatomy in 1950. He completed both his MD with distinction and PhD in from the same institution in 1952, conducting his doctoral research on the ascending reticular activating system through electrode implantation studies in animal brains, which resulted in several influential publications. Following graduation, Starzl began his surgical training with an internship and residency at in from 1952 to 1956, focusing on general and techniques. Starzl then transferred to in for further residency training from 1956 to 1958, serving as chief resident from 1956 to 1958, during which he developed foundational expertise in thoracic surgery under prominent mentors. He then returned to for a residency from 1958 to 1959. During his residency at , Starzl initiated early research on portacaval shunt procedures in dogs, investigating their effects on , carbohydrate metabolism, and fat metabolism, which laid groundwork for his later advancements in vascular and hepatic .

Professional Career

Early research and kidney transplantation

After completing his residencies, Starzl joined the surgical faculty at in as an instructor from 1958 to 1961, where he began experimental studies on with limited resources. During this period, he focused on developing foundational techniques for transplantation , drawing from his prior research on portacaval shunts that enhanced his expertise in vascular procedures. In 1961, Starzl moved to the School of Medicine as an of , where he established a dedicated transplantation research laboratory at the Veterans Administration . This facility enabled systematic experimentation in animal models, particularly dogs, to refine surgical methods for , including precise vascular techniques to connect renal vessels to the recipient's iliac artery and vein. These innovations addressed key technical challenges, such as minimizing ischemia time and ensuring hemodynamic stability during the procedure. Starzl performed his first human transplants in 1962, initiating one of the earliest clinically relevant programs and achieving the world's first successful series of such operations at the and affiliated hospitals. Early cases involved living related donors, with grafts sourced from family members to reduce immunological barriers. Despite these advances, in the early 1960s faced significant hurdles, primarily acute and chronic rejection, which limited long-term graft function. Initial one-year survival rates hovered around 50%, reflecting the nascent state of and the high risk of infectious complications post-surgery. Starzl's work emphasized iterative improvements in perioperative care and basic immunosuppressive protocols, such as corticosteroids, to mitigate these issues and pave the way for broader clinical application.

Pioneering liver transplantation

Thomas Starzl performed the world's first human liver transplant on March 1, 1963, at the University of Colorado Hospital in Denver, operating on a three-year-old boy named Bennie Solis, who was suffering from end-stage liver disease due to biliary atresia. The patient, however, died during the procedure from uncontrollable intraoperative bleeding, highlighting the immense technical difficulties of the operation at that time. A subsequent attempt in May 1963 on an adult patient at the Denver VA Hospital resulted in the liver functioning post-surgery, but the patient succumbed to infection weeks later. Building on his prior experience with , which honed his expertise in vascular anastomoses, Starzl refined the orthotopic liver transplantation technique, positioning the donor liver in the same anatomic location as the recipient's diseased organ. This approach involved total —complete removal of the recipient's liver—followed by meticulous vascular reconstruction of the hepatic , , and to restore blood flow. Early efforts also grappled with rudimentary organ preservation methods, such as simple hypothermic flushing and ice storage, which limited graft viability to mere hours. Between March and October 1963, Starzl attempted four more liver transplants on patients, including children and one adult, with advanced , but each patient succumbed within days to weeks post-surgery due to complications like hemorrhage and . These initial cases reflected high mortality rates exceeding 80%, with no survivors beyond a few weeks, prompting ethical concerns over the procedure's experimental nature and leading to a self-imposed moratorium on human liver transplants after a total of seven failed attempts worldwide. Starzl persisted through extensive animal model research during the moratorium, addressing key technical hurdles such as bleeding control via improved hemostatic techniques and vascular clamps. Resuming clinical trials in 1967 at the , he achieved the first long-term survivor that June—a 19-month-old girl named Julie Rodriguez—who lived beyond one year post-transplant, demonstrating viable short-term outcomes with survival rates beginning to improve. This breakthrough, coupled with ongoing refinements, paved the way for standardization of the orthotopic procedure by the late 1960s, transforming from an audacious experiment into a feasible clinical intervention.

Innovations in immunosuppression

In the early 1960s, Thomas Starzl pioneered the combination of and corticosteroids, specifically , as a foundational immunosuppressive regimen for post-transplant care in kidney recipients at the . This double-drug approach, introduced in 1962–1963, allowed for the reversal of acute rejection episodes and enabled long-term graft acceptance in a majority of patients, marking a critical advancement that made clinical viable for the first time. Building on this, Starzl collaborated with international teams in the late to integrate cyclosporine into immunosuppressive protocols, beginning its clinical use for liver transplants in 1979 at the . Paired with low-dose , cyclosporine dramatically improved rejection control and patient survival rates, transforming from an experimental procedure with high early mortality to a practical by the early . A major breakthrough came in 1989 when Starzl introduced (FK506) for human use at the , initially to rescue patients with refractory rejection under prior regimens. This potent inhibitor, administered as monotherapy or in minimal combinations, sharply reduced acute and steroid-resistant rejection rates—demonstrated in a multicenter trial where patients experienced significantly fewer rejection episodes (e.g., 43 cases of corticosteroid-resistant rejection versus 82 with cyclosporine). Clinical outcomes showed one-year patient survival exceeding 80%, reaching 88% in primary liver recipients, with graft survival at 82%, establishing as a cornerstone of modern . Starzl further advanced the field by developing steroid-free regimens and concepts of operational tolerance induction, leveraging observations of donor leukocyte chimerism to minimize long-term drug exposure. His protocols emphasized double-drug therapies, such as combined with or low-dose mycophenolate mofetil, followed by gradual weaning, which allowed some liver recipients to discontinue steroids within months or achieve drug-free graft maintenance for years without rejection. These strategies, rooted in host-graft , reduced toxicity while promoting tolerance in over 20% of select patients in long-term follow-up.

Leadership roles and institutional impact

In 1961, Starzl joined the faculty at the School of Medicine, where he established and led the institution's pioneering kidney and programs, serving as chairman of the Department of from 1972 to 1980. Under his direction, the team performed approximately 1,000 transplants and 165 liver transplants, laying the foundation for multi-organ transplantation at the university and affiliated Veterans Administration Hospital. During this period, Starzl trained numerous fellows and residents in transplantation surgery, many of whom went on to establish leading programs worldwide, fostering a generation of specialists in the field. In 1981, Starzl was recruited to the University of Pittsburgh School of Medicine as professor of surgery by department chairman Henry Bahnson, where he assumed the role of chief of transplantation services across Presbyterian University Hospital, Children's Hospital of Pittsburgh, and the VA Medical Center. He revitalized the institution's transplant efforts by introducing his established liver transplantation techniques and integrating advanced immunosuppression strategies, leading the team that performed Pittsburgh's first successful liver transplant in 1982. This move transformed the University of Pittsburgh Medical Center (UPMC) into a global leader in organ transplantation, with the program achieving high volumes—performing over 600 liver transplants by the mid-1980s and expanding to multi-organ capabilities that dominated national outcomes through the 1990s. Starzl's mentorship extended beyond technical training, influencing key figures such as surgeons who later directed major transplant centers, and he actively advocated for the development of integrated multi-organ transplant facilities to optimize patient care and resource allocation. His leadership also shaped policy, as evidenced by his role in developing the FDA-approved Pittsburgh protocol for immunosuppression in the early 1990s, which combined tacrolimus and steroids to improve graft survival rates and facilitate broader adoption of transplantation therapies. Through these efforts, Starzl not only elevated institutional programs but also influenced national standards for transplant center operations and regulatory approvals.

Awards and Recognition

Major scientific awards

Thomas E. Starzl received numerous prestigious awards recognizing his groundbreaking contributions to , particularly in and strategies, including the clinical application of . One of his most notable honors was the King Faisal International Prize in Medicine in 2001, awarded for his pioneering work in that revolutionized surgical practices and patient outcomes worldwide. In 2004, Starzl was bestowed the , the highest scientific accolade in the United States, presented by President at the ; this recognized his foundational advancements in and discoveries in immunosuppressive therapies that enabled long-term organ graft survival. Starzl was honored with the Roche Ernest E. Hodge Distinguished Achievement Award in 2006 by the American Society of Transplantation, acknowledging his lifelong dedication to advancing the field through innovative surgical techniques and immunosuppression protocols, such as the introduction of in the early 1990s, which dramatically improved transplant success rates. In 2012, he shared the Lasker-DeBakey Clinical Medical Research Award with Sir Roy Calne, one of the highest honors in , for developing into a viable clinical therapy and advancing the control of through refined , directly tied to Starzl's work on drugs like . Throughout his career, Starzl received multiple nominations for the in Physiology or Medicine, including being a finalist on four occasions, reflecting the profound impact of his transplantation innovations, though he was never awarded the prize.

Honorary degrees and namings

Thomas E. Starzl received 26 honorary doctorates from universities across the United States and abroad, recognizing his pioneering contributions to organ transplantation. Among these, Northwestern University awarded him an honorary doctor of science degree in 1982. In acknowledgment of his transformative work in transplantation, the University of Pittsburgh's transplant program was renamed the Thomas E. Starzl Transplantation Institute in 1996; originally established in 1985 as the Pittsburgh Transplantation Institute, it became a global leader in the field under Starzl's influence. Further honoring his legacy at the institution, Biomedical Science Tower 1 was rededicated as the Thomas E. Starzl Biomedical Science Tower in 2006 during celebrations for his 80th birthday, serving as a hub for medical research laboratories. Additionally, in 2007, the city of Pittsburgh dedicated a portion of Lothrop Street as Starzl Way, with a commemorative sign at the corner of Fifth Avenue, to celebrate his impact on the local medical community. Starzl's international stature was reflected in his election to prestigious bodies, including membership in the Institute of Medicine—now the National Academy of Medicine—in recognition of his advancements in medical science. Following his death in 2017, the University of Pittsburgh unveiled a life-size bronze statue of Starzl in 2018 near the Cathedral of Learning, depicting him seated on a bench as a lasting tribute to his role as the "father of transplantation."

Later Years and Legacy

Retirement and ongoing research

In 1991, at the age of 65, Thomas Starzl retired from performing surgeries after a career leading transplant programs that performed thousands of liver transplants, marking the end of his direct involvement in clinical procedures. This transition allowed him to concentrate on research leadership without the demands of the operating room. Following his retirement from surgery, Starzl assumed the role of full-time director of the Transplantation Institute, which was renamed the Thomas E. Starzl Transplantation Institute in 1996 in his honor. In this capacity, he shifted his efforts toward investigating transplant tolerance, exploring mechanisms such as chimerism—the coexistence of donor and recipient cells that facilitates long-term graft acceptance without chronic rejection. His work emphasized the bidirectional immune interactions between host and graft, advancing conceptual models of immune regulation in transplantation. Post-retirement, Starzl maintained an extraordinarily productive scholarly output, authoring or co-authoring numerous papers that delved into immune response mechanisms, including the roles of passenger leukocytes and microchimerism in promoting tolerance. These publications, often appearing at a rate of one every 7.3 days during his active years, built on his earlier innovations to refine understandings of allograft acceptance and rejection pathways. Complementing this research, he penned the memoir The Puzzle People: Memoirs of a Transplant Surgeon in 1992, offering introspective reflections on the ethical, scientific, and personal challenges of his pioneering career in transplantation. The book, published by the University of Pittsburgh Press, was translated into multiple languages and provided a narrative framework for the "puzzle" of immune adaptation he continued to study. Into the 2000s, Starzl led ongoing clinical trials at the exploring minimal protocols, particularly for following pretransplant lymphoid depletion. These studies, initiated around 2001, utilized agents like Campath () or for induction, followed by tacrolimus monotherapy and spaced to promote tolerance while minimizing long-term . Results demonstrated high rates of successful —up to 74% with Campath—and equivalent graft survival to conventional regimens, underscoring the feasibility of reduced in select patients. This research extended his lifelong pursuit of tolerance induction, influencing protocols aimed at improving patient beyond traditional multidrug therapies.

Death and enduring tributes

Thomas E. Starzl died peacefully at his home in , , on March 4, 2017, at the age of 90, following a brief illness. Following his death, tributes poured in from the medical community, with obituaries in prominent journals such as hailing him as the "Father of Transplantation" for his transformative role in making organ transplants a viable clinical reality. Similar accolades appeared in , which described his pioneering liver surgeries and research as foundational to saving countless lives worldwide. In 2017, the documentary Burden of Genius, directed by Tjardus Greidanus, premiered to explore Starzl's extraordinary career, including the ethical debates and controversies that arose from his bold early experiments in human , such as high-risk procedures on vulnerable patients. Starzl's enduring legacy is evident in the profound influence of his research, which a 1999 analysis by the Institute for Scientific Information identified him as the most cited clinical scientist globally between 1981 and 1998, reflecting over 26,000 citations during that period and underscoring the widespread adoption of his methods in transplantation medicine. His innovations helped elevate global liver transplant volumes from mere hundreds annually in the mid-20th century to tens of thousands today, fundamentally shifting organ transplantation from experimental rarity to standard therapy. In pediatric transplantation, Starzl's groundbreaking procedures in the 1960s—marking the first attempts at liver replacement in children—paved the way for improved outcomes and inspired ongoing efforts like the Starzl Network for Excellence in Pediatric Transplantation, launched in 2017 to enhance long-term care for young recipients. Additionally, his advocacy for fair distribution shaped organ allocation policies, as detailed in his 1988 co-authored paper on equitable liver sharing, which informed national frameworks for prioritizing recipients based on medical urgency and ethical considerations. In 2018, the University of Pittsburgh unveiled a life-size bronze statue of Starzl outside the Cathedral of Learning, symbolizing his lasting inspiration to generations of surgeons and researchers. As of 2025, the UPMC Thomas E. Starzl Transplantation Institute and the Starzl Network continue to advance transplantation research and care.

References

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