MOORE, Francis Daniels and Thomas Earl STARZL

MOORE, Francis Daniels (b. 17 August 1913 in Evanston, Illinois; d. 24 November 2001 in Westwood, Massachusetts), and Thomas Earl STARZL (b. 11 March 1926 in Le Mars, Iowa), surgeons who pioneered human organ transplant operations and, although they did not directly collaborate, together led the way in the 1960s toward making kidney and liver transplants standard surgical procedures.

Moore was the youngest of three children of Philip Wyatt Moore, a businessman, and Caroline Seymour Daniels. He graduated cum laude with an A.B. degree in general studies from Harvard University in 1935 and earned his M.D. from Harvard Medical School in 1939. He married Laura Benton Bartlett on 24 June 1935; they had five children. Following Laura's death in 1988, Moore married Katharyn Watson Saltonstall on 13 May 1990. During his surgical internship and residency at Massachusetts General Hospital from 1939 to 1943, especially through treating victims of the 1942 fire at the Cocoanut Grove nightclub in Boston, he became interested in the occasional need to replace body parts. From 1943 to 1981 he taught surgery at Harvard Medical School. From 1948 until he retired from practice in 1976 he was surgeon in chief at Peter Bent Brigham Hospital, which merged in 1980 with Robert Breck Brigham Hospital and the Boston Hospital for Women to form Brigham and Women's Hospital. As his health declined, he chose to commit suicide rather than suffer the debilitating effects of chronic heart failure.

Starzl was the second of four children of Roman Frederick Starzl, a newspaper publisher, and Anna Laura (Fitzgerald) Starzl, a nurse. Starzl earned his B.A. degree in biology in 1947 from Westminster College, Fulton, Missouri, his M.A. degree in anatomy in 1950, his Ph.D. degree in neurophysiology in 1952, and his M.D. degree in 1952, all from Northwestern University Medical School (since 2002 the Feinberg School of Medicine). He was surgical intern, fellow, and assistant resident at Johns Hopkins Hospital in Baltimore from 1952 to 1956, chief resident in surgery at Jackson Memorial Hospital in Miami from 1956 to 1958, and resident in thoracic surgery at the Veterans Administration Research Hospital in Chicago from 1958 to 1959. He taught surgery at Northwestern from 1958 to 1961, at the University of Colorado School of Medicine from 1962 to 1980, and at the University of Pittsburgh School of Medicine from 1981 until he retired in 1998. On 27 November 1954 Starzl married Barbara June Brothers, with whom he had three children. The couple later divorced, and he married Joy D. Conger on 1 August 1981. Starzl wrote prolifically and is among the most widely cited of all medical authors.

When Moore and Starzl entered medicine, human organ transplantation was a future prospect and a fond hope. Bioscientists believed that transplanted bone marrow could cure leukemia, transplanted kidneys could substitute for the inconvenience of dialysis, and transplanted livers, hearts, and lungs could save patients from many fatal chronic conditions. The ground was broken on 17 June 1950 when Richard H. Lawler performed the world's first successful human organ transplant at Little Company of Mary Hospital in Chicago. The patient, Ruth Tucker, a forty-four-year-old victim of congenital polycystic renal failure, received one kidney from a forty-nine-year-old woman of the same blood type and survived until 30 April 1955. The first successful bone marrow, liver, heart, and lung transplants all occurred in the 1960s.

Moore, Charles Stuart Welch, and several other surgeons performed experimental liver transplants on dogs in the 1950s and early 1960s. Following the pioneer work of Alexis Carrel in animal kidney transplantation, David Milford Hume and John Putnam Merrill at Brigham achieved limited success with human kidney transplants in the 1950s. As surgical chief at Brigham, Moore vigorously promoted organ and tissue transplantation research, enabling Joseph Edward Murray to perform the world's second successful human organ transplant, a kidney from one monozygotic twin to another, on 23 December 1954. Murray won the 1990 Nobel Prize in physiology or medicine for this work.

Moore and Starzl began corresponding about liver transplantation in the late 1950s and met at the 1960 conference of the American Surgical Association. Starzl wanted to work for Moore in Boston, but since Moore believed that Starzl would do better in a less competitive environment, he helped to arrange Starzl's appointment in Colorado, where, under William Rhoads Waddell, Starzl flourished.

A great uncertainty in transplantation is whether the recipient's body will tolerate or reject the transplanted organ. This problem is lessened when the donor is a blood relation, especially a twin, but since such donors are seldom available, pharmaceutical means are necessary to improve tolerance and fight rejection. Starzl's experiments with azathioprine, corticosteroids, other immunosuppressants, and supplement drugs enabled him to perform many successful transplants of allogenetic (genetically different) kidneys in 1962 and 1963.

Starzl performed the world's first three human liver transplants on 1 March, 5 May, and 24 June 1963 at the University of Colorado Hospital in Denver. The first patient, a three-year-old boy with congenital liver defects, died on the operating table. The second, a forty-eight-year-old man with cirrhosis and cancer, survived twenty-two days after the operation. The third, a sixty-seven-year-old man with jaundice and cancer, survived seven days. Moore also tried a liver transplant in 1963, but the patient died of pneumonia caused by the immunosuppressants.

Over the next several years, the most productive research on liver transplantation was conducted by Moore in Boston, Starzl in Denver, and Roy Calne in England. Moore's classic text Metabolic Care of the Surgical Patient (1959) did not deal specifically with transplant cases but offered biochemical and physiological principles that proved germane throughout the 1960s and early 1970s in the management of transplant patients. It helped surgeons reduce rates of transplanted tissue rejection and thus ensured longer and less complicated survivals for transplant recipients until the advent of cyclosporin A and other powerful immunosuppressive drugs in the 1970s.

Using prednisone and azathioprine, Starzl performed the world's first successful liver transplant on 23 July 1967. The patient, a nineteen-month-old girl with primary liver cancer, died 400 days after the operation, not from tissue rejection or any complications of the surgery but from metastases of the cancer throughout her body. Until the 1970s she remained the longest liver transplant survivor. Complications, such as liver gangrene, late rejection, and jaundice, killed many liver recipients between 1967 and 1970, but her case gave Starzl and Moore and their colleagues new optimism that bore fruit in the next decade.

Paradoxically, the advent of major organ transplants limited rather than expanded the physician's traditional paternalistic power over patients. As workable health care options became more varied, patients began in the 1960s to demand more freedom of choice over their personal health care decisions. Patient autonomy began to take its place among physician beneficence, physician nonmaleficence, compassion, confidentiality, competence, and social distributive justice as the primary principles of medical ethics.

Moore's autobiography, A Miracle and a Privilege: Recounting a Half Century of Surgical Advance (1995), and Starzl's autobiography, The Puzzle People: Memoirs of a Transplant Surgeon (1992), each provide detailed personal observations and analysis. Starzl's article, "Transplantation of the Liver," in Progress in Liver Disease 3 (1970): 495–542, describes the history of this procedure up to that time. Transcripts of interviews with Moore recorded in 1991 and 1992 by the Harvard Medical School Oral History Committee are in the Countway Library of Medicine, Boston. Starzl donated his papers to the University of Pittsburgh Library in 2001. Manuscript material on Starzl is also available at the National Library of Medicine, History of Medicine Division, Bethesda, Maryland, in the archives of the American Surgical Association. An obituary of Moore is in the New York Times (29 Nov. 2001).

Eric v. d. Luft