(gentle music)
- Tom. What are you doing here?
- Antilymphocyte globulin.
A chain with 10% cortical steroids and azathioprine.
- What?
- Look, we need the azathioprine
because it prevents allograft rejection.
It kills the healthy immune cells.
So we added corticosteroids, which helped
but then the toxicity levels were too high.
With ALG, we get the same immunosuppression response
with lower doses of azathioprine, lower corticosteroids.
- What's that?
- This is a patient.
I just need you to sign off on it.
- Tom, they put a moratorium
on liver transplants everywhere.
Not just here. Everywhere.
The whole world has its eyes
on the danger of these procedures.
(suspenseful music)
- She's going to die.
We are the best chance that she's got.
- How sure about this are you?
- I am 100%.
- It's your reputation, not mine.
(suspenseful music)
Tom, If you lose her,
I'm not sure I can have you on staff here.
(suspenseful music)
(water running)
(heart beat thump-thump)
(clock ticking)
(suspenseful music)
- Dr. Starzl.
(suspenseful music)
(heart beat thump-thump)
(suspenseful music)
- Nurse, hemostat.
- Oh, it's coming.
- [Assistant] BPs dropping.
- Ruby.
- [Surgical Assistant] Jesus Christ.
- Where's the heart rate?
(suspenseful music)
(gentle music)
- Horne.
(knuckles knocking on door)
I'm gonna have to call you back.
- Did you wanna see me?
- Yeah. Can you tell me about this?
- She's, she's turning two
and her parents asked if you could make it.
- Dr. Horne. Which outlet is at this time?
Hang on a second.
It's for you.
New England Journal of Medicine.
(upbeat music)
I told you, this is your reputation, not mine.
- Dr. Starzl.
(upbeat music)
- Dr. Thomas Starzl was certainly a pioneer
in the field of organ transplantation.
Once surgeons remove an organ
it is separated from its blood supply.
It no longer gets oxygen or nutrients.
Classically, the way that was mitigated
was to cool the organ down.
That way it would slow the metabolism.
We would take them out quickly, put them on ice
and try and get that into someone
who needs a transplanted organ
within four to six hours.
When we look at the number of organs
that are donated nationwide, there is a high wastage.
A lot of those organs cannot be used.
(upbeat music)
In our laboratory back in the 1990s,
we were looking at the viability of cold storage.
We thought we could come up with
a more physiologic way of preserving organs.
That that would be a better solution.
Warm perfusion, as a way of maintaining a donated organ
is a more natural state
by using blood to perfuse an organ to keep it beating.
Using warm perfusion,
we were able to keep it alive for 12 hours.
The intracellular pH was just as good
as if the organ was never taken out of the body.
(upbeat music)
The percentage of organs that can be used
far surpasses that of cold storage.
This is a way to keep donated organs going for a long time.
It made me feel proud that we had had an innovation
that was recognized by the U.S. Patent office.
I've always been driven by the mission
of taking care of veterans
to make sure that their care was as good or better
than any place in America.
(gentle music)
- I served the United States Army for eight years.
When I initially came to the VA as an employee
they give you a complete physical.
And I remember the human resource specialist calling me
and saying, "Hey, you know, we wanna hire you
"But we need you to see a nephrologist.
"Do you know that you're in kidney failure?
And I remember saying, "Excuse me."
(gentle music)
They connected me to the nephrologist at the VA.
I said to him, "If I don't want dialysis
"What is that gonna look like?"
He said, "Well, I'm gonna be honest.
"If you don't, then you would expire."
And at that moment I knew it was getting real.
I went on a kidney transplant list.
It was about 13 months.
I was retaining a lot of fluids and was getting rather weak.
The day I got the phone call from the VA, they said,
"Hey we got a kidney for you,
"But it's been outside of the body now
"For about 12, 14 hours.
"There's a 75% chance
"That it will not wake up inside your body.
And I'm like, "Call my surgeon. Let's do it."
I remember waking up in my room
and I looked down and I saw the staples.
And I knew that that organ was inside of me
and it was working.
My daughter was there.
She said, "Mom, you look so much brighter."
And I felt it. I felt another life inside of me.
And I remember the tears rolling down my face.
I wake up every day with gratitude for him.
He was a 22-year-old, young, hopeful college student
who had a fatal accident.
And his mother wrote me a beautiful letter.
And his mother said her only solace is in life
is knowing that her son's kidney
is keeping someone else alive.
So I feel like I'm not doing it just for me,
but I'm doing it for them.
- Dr. Starzl's contributions to medicine in general,
and certainly the field of transplantation
using cold storage, the old-fashioned way,
were huge.
But this is a different paradigm.
Warm perfusion is expanding the pool of donors.
I still keep in contact with some of the patients
that I've operated on.
Doctor-patient relationship is what drives every physician.
It is that interaction that you cherish every day.
- I can honestly say the care I received at VA.
They loved me well.
- To fix that problem and then have the patient come back
and is better, is a joy that really cannot be matched.
(suspenseful music)