Organized by the Turkish Transplantation Society in Honor of Prof. Thomas E. Starzl Keynote Speech Tribute to Professor Mehmet Haberal Thomas E. Starzl, MD, PhD Distinguished Service Professor of Surgery University of Pittsburgh School of Medicine Pittsburgh, PA, USA I am honored indescribably by having my name attached to Along the way, Mehmet founded the Turkish Transplantation this important meeting. It goes without saying that the primary Society, the Middle East Society for Organ Transplantation purpose of the conference is to celebrate the Silver Anniversary (MESOT), and the new journal, Experimental and Clinical of the first liver transplantation in Turkey. It was, in fact, the Transplantation - the official organ of MESOT. It was during first such operation in the Middle East and portions of adjacent this rich and productive period of his life that Mehmet started Eastern Europe, Asia, and Africa. his liver transplant program on December 8, 1988. Because of the importance of this milestone, it is appropriate It is interesting to reflect on the status of liver transplantation to ask who made it possible, and how. The person was a truly at that time. There only had been about 2000 liver transplants exceptional young man who joined my transplant program done in the world. Objectives that had been accomplished at the University of Colorado almost 40 years ago with the included better control of blood coagulation, better means specific intention of bringing back to his beloved country a new of liver preservation, a more thorough understanding of technology that did not exist there. infections, and guidelines for the use of veno-venous bypasses. Dr. Haberal had a list of steps that had to be taken before The most important advances up to 1988 had been reaching his ultimate objective of liver replacement. The first with immunosuppression. While it was true that liver was effective treatment of end stage kidney disease with dialysis transplantation with survival for at least one year was first and kidney transplantation. Within little more than a year accomplished in July 1967, the one year survival was too poor after returning home, Mehmet had founded the beginning of to allow liver replacement to be viewed as a service. Thus, a network of dialysis centers and begun the kidney trail that liver transplantation had reached the status of “feasible but eventually led to his historical liver operation on December 8, impractical”. 1988. Although the one year survival never rose above the 50% level, The presence in Turkey of the young superstar did not go the continued existence of liver recipients who had reached this unnoticed. Mehmet’s presence at medical meetings brought milestone and remained alive was a constant reminder of the distinction and international respect for his country. For the operation’s potential value. Four of these pioneer patients, all record, he is the only Turkish citizen ever to be elected as an treated in Colorado while Mehmet Haberal was working there, Honorary Foreign Member of the prestigious American Surgical have now born their hepatic allografts for 40 to 44 years. These Association, and the even more elite Institute of Medicine of the are the longest-surviving liver recipients in the world. United States National Academy of Science. As of 1980, 4 new liver transplant centers had been added Professor Haberal’s instincts always were those of an educator. to our original one in Denver. All of the new ones were in Between 1982 and the summer of 2007, I made 5 visits to Europe: the center founded in Cambridge, England by Roy Turkey. During that quarter century, I saw the birth and growth Calne, followed in succession by the Paris program of Henri of one of the country’s finest universities in which medicine was Bismuth, the Hannover, Germany center of Rudolf Pichlmayr, only one of the disciplines. It was an accomplishment that I look and the Dutch center of Rudi Krom. Most of the policies of back at, even now, as nearly miraculous. liver transplantation that exist today were developed by the transatlantic alliance of the 5 centers. 1 Organized by the Turkish Transplantation Society in Honor of Prof. Thomas E. Starzl The seemingly grim future of liver transplantation dramatically Meanwhile, we had set in motion preclinical studies of tacrolimus changed with the arrival of cyclosporine. When we combined in Pittsburgh that led to its substitution for cyclosporine and cyclosporine with prednisone, our one year survival rose to fast-track FDA approval. With tacrolimus, there were further 80%. Liver transplantation had now become a “clinical service” improvements in survival with liver and ultimately all kinds rather than an experimental procedure. In a 17-page article of organ transplantation. In addition, procedures that included that I published in The New England Journal of Medicine in the intestine, or consisted of intestine-alone, were elevated by October 1989, the text began with the following statement: tacrolimus to the status of “clinical service”. The world’s longest surviving multivisceral recipient, now a school teacher, is 24 “The conceptual appeal of liver transplantation is so great that years post-transplantation. the procedure may come to mind as a last resort for virtually every patient with lethal hepatic disease.” It was already evident There is little point in going into more detail about the that there would be a large disparity between the availability of, problems and progress of organ transplantation overall or those and demand for, livers. Discussions and disputes now centered of the liver specifically. These issues make up much of the fine around the most efficient and fair way to allocate the organs. program that will begin as soon as I am finished. Suffice it to say, an early start was given to Turkey and to the Middle East generally by Mehmet Haberal’s historical case. 2 Organized by the Turkish Transplantation Society in Honor of Prof. Thomas E. Starzl L1 With Thomas Starzl as my guide and my inspiration, I too Honoring Courage and Dedication: fought against my opponents and circumstances to finally The Legend of Prof. Thomas E. Starzl succeed, and to give life to those who had lost all hope of one. Mehmet Haberal, MD, FACS (Hon), FICS (Hon), The countless lives saved are testament to the miracles borne FASA (Hon) out of the desire to succeed. Starzl’s achievements did not Professor of Surgery only benefit those suffering from liver failure, but many Founder and Founder President, Baskent University, other patients requiring transplants of other organs. He Transplantation and Gene Sciences Institute, and Burn and taught others, like me, who in turn passed on the constant Fire Disaster Institute accumulation of knowledge to their own students. Several Founder and President, Turkish Transplantation Society generations of surgeons will continue to benefit from Starzl’s Founder, Founder President and President-Elect, Middle East inquisitive mind and determination. It is not a secret that the Society for Organ Transplantation world owes him some of the best doctors the profession has Chair, 14th Congress of MESOT 2014 to offer. Lecture Today, the controversies continue, regarding patient choice, treatment options, organ donation, transplant tourism… Of all the branches of medicine, transplantation, since its the list can go on for as long as you choose. It seems to be first inception as a simple idea, has aroused some of the woven into the very fabric of transplantation on every level, most controversy. The issues are tied deeply with ethical and whether scientific, social or economic. The physicians that moral concerns often grounded in religious and cultural are active in the field or newly entering it will continue to beliefs and, dare I say, prejudices. face many adversities, yet they are lucky – few other fields The first physicians and surgeons to begin experimenting are so thoroughly defended; in fact many of our colleagues with transplantation faced the derision of many, often here today are dedicated to ensuring the ethical execution accused of having “God complexes” and meddling with of every aspect of transplantation. And of course, we must nature in a manner more suited for science-fiction novels never forget that the example that has been set by their and movies. It is true, many patients could not be saved and predecessors, legends and pioneers with a vision and a steel many methods were tried and discarded before success was will. They are the Starzl’s of our profession, fighting against achieved. Thomas Starzl faced this and more in his quest the current to extend the horizon for us, for their patients, to follow a “hunch.” Dedicating much of his research to for mankind everywhere. the liver, he believed that there was a way to perform the The risks a surgeon must take are great, for the results may elusive transplant – elusive, as it had never been performed often be fatal. It takes courage and determination indeed to with any organ in any living species to date. weather such storms, to stand tall in the face of hostility and In their attempt to discover the intricacies of the field, adversity and to persevere. Such a man is Thomas Starzl, and Starzl and his team performed the first series of successful we must celebrate such mean and women who change the kidney transplants in the world. However, the success of the world with their dedication. It is a privilege for me to have kidney could not be replicated in the liver. Losing a patient this opportunity to honor Prof. Starzl and it shall always is always a source of pain for a surgeon, and eventually the remain a great source of pride for me to call him a teacher, a program was stopped.