Göran Bo Gustaf Klintmalm, MD, PhD: a conversation with the editor

Göran Klintmalm (Figure 1) was born in Bromma, Sweden, on February 10, 1950, and grew up in the Stockholm area. From the Karolinska Institute he received his bachelor of science degree in June 1971, his doctor of medicine degree in January 1975, and his doctor of philosophy degree in September 1984. He trained in general surgery at hospitals in Stockholm connected with the Karolinska Institute. Early in his career he became interested in organ transplantation. He interrupted his general surgery residency to spend 23 months in Denver and Pittsburgh working with Dr. Thomas Starzl in kidney and liver transplantation. After that 2-year period in the USA, Göran returned to Stockholm for 3 more years of general surgery training. In August 1984, he was offered the directorship of transplantation services at Baylor University Medical Center (BUMC) and moved to Dallas, where he has been ever since.

Figure 1.

Dr. Klintmalm during the interview.

Dr. Klintmalm has developed one of the largest and finest liver, kidney, and pancreatic transplantation services in the world. He has become an internationally recognized authority on immunosuppression and organ preservation and has written extensively on these topics as well as other aspects of transplantation. His publications in peer-reviewed medical journals number nearly 250; in non–peer-reviewed medical journals, nearly 60; and in books, 17. He is the coeditor of 3 books, Transplantation of the Liver in 1996, Organ Procurement and Preservation in 1999, and Atlas of Liver Transplantation, which is in press. Göran Klintmalm has been the major player in the success of BUMC and in the success of liver and kidney transplantation worldwide. He is also a good guy, fun to be around, and a devoted family man to his wife and 3 boys.

William Clifford Roberts, MD (hereafter, WCR): I am in my home with Dr. Klintmalm on January 31, 2002. Göran, I appreciate your willingness to talk to me and, therefore, to the readers of BUMC Proceedings. To begin, I'd like to ask you about your early life, your parents, and your siblings.

Göran Bo Gustaf Klintmalm, MD, PhD (hereafter, GBGK): I was born at the Karolinska Hospital on February 10, 1950. At the time, my parents were living in a small 1-bedroom apartment in a suburb of Stockholm called Bromma. A few weeks later they moved to a neighboring suburb named Solna, and this was where I was raised.

My parents grew up fairly close to each other in the southern part of Sweden. My mother was the third child of my grandparents, who were farmers with 120 acres of land, half of which was forest. My maternal grandparents were both devout Baptists. Even with their very humble beginnings, they realized the importance of education. They picked blueberries in the forest to pay for the schoolbooks. It was a hard life. They had to travel about 5 miles to school, and there was no school bus. They had only 28′ men's bicycles. When the kids were too short to sit on the seat of those bikes, they rode standing under the horizontal bar. They rode their bikes to school even in the deep winter snow. It was a harsh interview. beginning, but they all learned to work. All of their 7 children (5 girls, 2 boys) graduated from college. One of my mother's brothers became a prominent vascular surgeon. He was head of vascular surgery at the Huddinge University Hospital of the Karolinska Institute.

At the end of the 1940s, all the children had moved to Stockholm, which was 300 miles away, and working the farm became difficult. My grandparents sold the farm and moved to Stockholm. My maternal grandfather worked for the Bacteriological Institute, where he was in charge of the animals used for serum production. He remained there until he retired.

My mother was an extremely intelligent and hardworking woman. To help pay for my uncle's medical school tuition, my mother worked as a maid for a couple of years. She later became an elementary school teacher and, eventually, a teacher for the deaf and mute. Finally, she taught those who would become teachers of the deaf at the Stockholm University.

WCR: When was she born?

GBGK: She was born on November 27, 1922, and died on Christmas Eve 1995 after having micro strokes. My father was born on April 27, 1922.

WCR: Is he alive?

GBGK: Yes. He is one of 6 children (1 girl and 5 boys). My paternal grandfather worked at a paper mill as a blue-collar worker. Initially, he drove the horse wagons that carried the logs to the mill. Later, he worked inside the factory. In 1915, my grandparents built a nice 2-story house on the outskirts of a little town in southern Sweden for 300 crowns, which today would be $30. Money definitely had a different value then.

My dad was the third child. He and his siblings were often called the “counts” because they were better dressed than the other kids in the neighborhood since my grandmother was a seamstress. My father's family also learned to work hard. My paternal grandparents did not push for higher education. Some of the children did go to college, however, and became engineers.

My mother and father were engaged when World War II began. Like virtually everyone, my father was quickly drafted in 1940 as the country mobilized for war. He took business correspondence lessons while in the military at the insistence of his fiancée. When the country finally demobilized, he received a business school degree, which is different from a university degree. My mother had finished her training as a schoolteacher by this time, and they decided to move to Stockholm.

My father first worked for a food store. While working for the store, one of the food suppliers wanted to open a store in a new area. The supplier told my father, “If you will open up a store, I will lend you the money and make sure you have groceries and meat and anything else you need.” My father opened a store and ran it for several years.

By 1956, however, he realized that supermarkets were about to open up. These were not like supermarkets today, but they contained all the food a family needed in one place. He knew that getting into the supermarket business would be difficult, and he decided to change businesses. He bought a konditori, which is essentially a coffee shop and bakery, and opened it in the middle of downtown Stockholm. He ran it until he retired. My dad was an extremely hard worker. For many years he worked double shifts, from 7:00 am to 11:00 pm, to pay the high mortgage he had. Money was never wasted. We never threw away clothes. In fact, kids' clothes were handed down from us to the families of my aunts and uncles.

In 1956, my parents bought a house in Solna, not far from the apartment building where we lived. That's where I spent the rest of my youth. A few years later they bought a country house on an archipelago about 30 miles from Stockholm. You had to take a ferryboat to the large island. It was full of brush and was heavily overgrown when we bought it. The 8-acre lot had water and beach property. We worked with our parents clearing the beach, rebuilding the house, building docks, and leveling parts for places to sit. We learned to chop wood for the fireplace. We all got used to using the shovel, pick ax, and saw.

WCR: How old were you when your parents bought that house?

GBGK: I was 12 years old.

WCR: Where did your mother and father meet?

GBGK: They met at the paper mill. My mother worked as an assistant to the head of the company. She was smart and immediately caught her boss's attention. My father worked on the floor of the mill at the time. They started dating—going to open-air dances.

WCR: What did your father do during World War II?

GBGK: He was promoted to sergeant, in charge of a supply section. He ran the platoon and learned to keep ledgers. That was perfect for him for his future vocation.

WCR: What happened to Sweden during World War II?

GBGK: Sweden remained neutral. It was never invaded by Germany, which did invade Denmark, Norway, and Finland. The Russians initially invaded Finland. Commentators have speculated why Hitler did not invade Sweden. First, Sweden was one of the largest iron ore suppliers in Europe. An invasion of Sweden would have interrupted the Germans' steel supply, and they could not buy steel on the open market. Second, Sweden is substantially larger than the other Scandinavian countries. It is twice the size of Finland and Norway combined. Geographically, Sweden is the same size as California and, at that time, had a population of about 6 million. (Now it is 9 million.) It also had a larger army than any of the other Scandinavian countries. An invasion of Sweden would have diverted more attention away from Hitler's other goals. Another theory is that the number two man in the Nazi party, Hermann Göring, didn't want to invade Sweden because he was married to the daughter of a Swedish count, a high-level aristocrat, and spent a lot of summers with his wife's family in Sweden.

WCR: Your mother and father met before World War II but got married after the war?

GBGK: They married Midsummer Day 1947.

WCR: Did most of your aunts and uncles from the large families of your mother and father migrate to Stockholm?

GBGK: Yes, most of them did. All on my mother's siblings moved to Stockholm. On my father's side, 3 moved to Stockholm, by far the largest city in Sweden.

WCR: When you grew up, you were surrounded by a lot of relatives.

GBGK: Yes, all the time. Everybody had children, so I have numerous cousins. There were always family get-togethers for birthday parties and other occasions. There was a lot of playing together. We had very close contact.

WCR: Do you have brothers and sisters?

GBGK: Yes. I have 2 brothers and 1 sister (Figure 2). I'm the oldest. My sister is next, followed by my 2 brothers. We were born in 1950, 1951, 1952, and 1956.

Figure 2.

Göran, Eva, Lasse, and Bengt with their parents, 1957.

WCR: What have your siblings done?

GBGK: My sister, Eva, is a principal at a school in Stockholm. Her husband is in the senior leadership at the headquarters of the Ericsson Phone Company. My first brother, Bengt, took over our father's store. His wife is currently a housewife. They live in a flat in downtown Stockholm. My youngest brother, Lars, lives in Ottawa, Canada. He is married to a Canadian. She is an airline hostess or ground hostess for Air Canada, and he works in import/export.

WCR: You moved into the house in Solna when you were how old?

GBGK: I was 6 years old.

WCR: What was your house like?

GBGK: We thought it was palatial in those days. It was 2 stories. My parents modernized it when we moved in and completely renovated it in 1962. It was 800 square feet on each floor, and when they renovated it, they added a piece of a third floor to get 2 more bedrooms for the 4 kids. It changed enormously.

WCR: Were there a lot of books around your home?

GBGK: We always read, especially my sister and I. I have enjoyed reading for as long as I can remember. We would go to the library and borrow as many books as they would allow us to take home. We read them and returned them a week or so later, at which time we would get a new stack of books.

WCR: What did you enjoy reading?

GBGK: Everything. I read a lot of historical novels. As a teenager I also loved science fiction (Asimov). I read Dune and in 1969 I came across The Lord of the Rings. All of us read. Although my parents were anything but ostentatious, they had been taught by their parents to appreciate what was well made and had aesthetic value. This was imparted to my siblings and me. My mother taught us manners and regularly took us to the opera, ballet, symphony, and the arts. There was a lot of music at home.

WCR: Classical music?

GBGK: Mom introduced us to classical music. When I first started listening to music in my teens, the Beatles and “A Hard Day's Night” had just arrived on the scene, and I liked them. One birthday I heard “Nabboccio” by Verdi. It is a famous choir piece about the imprisoned Israelis and how they longed for their homeland. I bought that black 1-foot-wide LP. I was into stereo and hi-fi in those days. I still am. I played that Verdi record over and over again. I came to realize that some of the arias were much more profound and had more to offer than the choir piece. From then on, I began to lean more and more towards classical. Today, I listen more to opera than to anything else. I always have opera on in the car. In the operating room, I always play classical music.

WCR: During the entire procedure or just during the opening and closing?

GBGK: During the entire procedure. Sometimes I play opera, but I don't want to play it too much so as not to wear out the nurses. Opera gives me great pleasure.

WCR: Do you study the operas? Do you have books on them?

GBGK: I have a few. I read about it.

WCR: Did you play a musical instrument?

GBGK: I took piano lessons for about 8 years.

WCR: Did you practice much?

GBGK: We had to practice every day. We had 5 pennies on the side of the keyboard. We had to play every piece 5 times, keeping track of the number of times by moving those pennies over to the other side. My sister is much more musical than I am. It was more difficult for me.

WCR: Do you still play?

GBGK: No. I stopped my senior year in high school. I haven't played since. It's one of my dreams. When I have more time and can pull back from my professional life, I will have time to start playing again and will resume taking lessons.

WCR: Do you have a piano in your home?

GBGK: Yes, we have a grand piano.

WCR: Was dinner a gathering time for your family when you were growing up?

GBGK: Absolutely. We always had dinner together.

WCR: Your father came home for dinner?

GBGK: During the first few years after he bought the coffee shop, we rarely saw him for dinner. He came home when we were going to bed or after we went to bed. He was up at 5:00 am and gone before we were up. Dinner was a central and essential piece of our social life. You were expected to be there and you wanted to be there. We talked about everything we were doing at dinnertime.

WCR: What would be an example?

GBGK: Anything that happened that day—school, friends and their families, anything that was going on and touched the family at the time. My dad always prepared breakfast for us, except when he had to go in early.

WCR: Your mother prepared the dinner at night?

GBGK: Yes. My father was very much a part of that as well. Our family did things together. Mom and Dad did the washing. We helped hang the wash.

WCR: All of you contributed to the duties of the family?.

GBGK: All of us. Shoveling snow in the winter to get the car out, raking leaves in the fall, etc. We all did our share.

WCR: Was there enough money to be comfortable? You said your parents were quite frugal.

GBGK: Yes, there was enough money for us to be comfortable. As time went by, things improved. When I was 11 or 12, I started working at the coffee shop on Saturday evenings helping do the dishes. My dad would say, “I will pay you what I pay a dishwasher,” and he did. We learned to work from the very beginning. That is how we got our pocket money. We saved. I bought my first stereo from money I had saved.

WCR: How big was the metroplex of Stockholm when you were growing up?

GBGK: In 1960, about 1.2 million.

WCR: How did you get from Solna to your father's coffee shop in Stockholm?

GBGK: We took the bus. It was about 10 miles from home.

WCR: How old were you when you started school?

GBGK: I was 7 years old.

WCR: That's a little later than in the USA. By that time you could already read?

GBGK: Yes, I could. I had gone to preschool the year before. I hated preschool, however, and I ran away from it a couple of times.

WCR: School in Sweden was how many grades before university?

GBGK: Twelve grades.

WCR: You finished at 18?

GBGK: At 19. You graduate the year you turn 19.

WCR: What was school like?

GBGK: It was public school. My first teacher was Mrs. Levin. We had the same teacher and same class for first, second, and third grades. It was believed to be very important to have consistency.

WCR: How many students were in the class?

GBGK: About 25 to 30. Then you went to middle school for fourth through sixth grades. I had a teacher, Mrs. Bjurstrom, who really made an impact on me. A widowed lady in her 60s, she was very prim, sophisticated, and precise. She had traveled around the world a number of times. She lived in a large flat very close to our house with rooms of books and a large collection of antique artifacts. She loaned me books from her collection. I enjoyed history very much. Mrs. Bjurstrom had very high expectations. In those days there was nothing like advanced or special classes. It depended on the teacher. She made sure (as did my mother and dad) that I did my best and did not waste opportunities.

WCR: Did studies come easy for you?

GBGK: Very easy. But I worked hard. It was not that it was given to me free. I enjoyed it. I could memorize long pieces. If we had an assignment in history, I often read an extra book on the subject that she would give me.

WCR: Do you have a photographic memory, or can you just concentrate and focus?

GBGK: I can concentrate and focus in science and labs. I had to work; I studied every night at home.

WCR: What kind of science did you have in early school?

GBGK: The curriculum was very well rounded. We had everything from social studies to geography. Every child learned about geography, social life, culture, and religion. Sweden, being such a small country, is acutely aware of how small it is. We cannot impose our language or culture on anyone else. We have to understand and be understood. In fourth grade we began learning English. It was compulsory. In the seventh grade we had to start a second foreign language. I chose French. In the tenth grade I added German. My mother, being a teacher herself, made sure we had good teachers. The school we went to had good teachers.

WCR: Did your mother teach the same class for 3 years also?

GBGK: Yes. She had the first 3 grades and taught all the subjects in those grades.

WCR: How far was school from your home? How did you get there?

GBGK: I walked. It was about a mile away.

WCR: It was very safe to walk around.

GBGK: Absolutely. The notion that one would not be able to walk to school, or bike to school, was completely foreign.

WCR: What happened from the seventh grade?

GBGK: In seventh through ninth grade, called “high school,” we began to have different teachers in every subject. Tenth through twelfth grades in Sweden are called “gymnasium,” which is high school in the USA. You had to apply to attend a gymnasium and decide on liberal arts, scientific, or college preparatory courses. I went to a gymnasium considered to be very good. It was close to where we lived. We had some excellent teachers who prepared us well.

WCR: Did anybody in either high school or gymnasium have a particular impact on you?

GBGK: In gymnasium there were a couple. One was Dr. Damm, who taught chemistry and math. He taught chemistry extremely well and made the chemistry courses I had later on in medical school very easy. We had physics, biology, chemistry, and mathematics every year for the 3 years in high school. Mr. Kinman taught physics. He was a former refugee from Latvia who had fled from the Nazis in an open rowboat across the Baltic when they invaded Latvia in 1939/1940. He made physics fun. Those were the 2 teachers in gymnasium who made the biggest impression on me.

WCR: Did you take to science quickly?

GBGK: Yes. I had a natural affinity for science and math from the beginning.

WCR: When you applied for gymnasium, you wanted to focus on science?

GBGK: Yes.

WCR: How did gymnasium work out for you? I'm sure you continued to do well academically. When did you decide you wanted to be a physician?

GBGK: That was quite late actually. I enjoyed gymnasium. Every time I was promoted to the next school, I enjoyed myself more because there was a selection process. There was a sorting out of those who planned to go to vocational school and those who planned to go on to university. I was a small kid. I was short and thin, and I did not excel in sports. I was not athletic at all.

WCR: Were sports emphasized?

GBGK: They were emphasized only to the point that they were important for the physical development of children. We played soccer in the summertime and an ice skating game with clubs and balls called Bandy in the wintertime. Ice hockey was not played at school but was a club sport. There were games in school, but not the competitive-type set up we have in the USA. The competitive sports were not played in school.

WCR: How tall are you now? You said you were small. Does that mean you were a late developer?

GBGK: No. I was just a small kid. I didn't get taller until later on. I am now 5″10′ tall.

WCR: Did you have long summer vacations in Sweden? At Christmas time you had time off. What did you do in those time-off periods?

GBGK: In the summertime, we were often just at home. Once we had a summerhouse outside Stockholm, we spent a lot of time boating and fishing. I learned to snow ski when I was 4 or 5. We went cross-country skiing to an inn outside of Stockholm on the weekends with my parents. By the time I turned 10, we started going to northern Sweden to downhill ski during winter break. At Christmas we always stayed at home. About 1962, we started to take trips abroad during the summer. My parents wanted us to see Europe. This was not just a visit to the beach. That was not the way we did it. We traveled around in the car seeing the wonders of Europe. We traveled nearly everywhere. We didn't stay in fancy hotels. That was considered wasteful. During the first years we traveled, we carried tents on a roof rack. We stayed in a bed and breakfast on the way down, and then we stayed about a week at one of the big lakes in Switzerland and camped there.

WCR: Did you visit all the big cities in Europe—Paris, Berlin?

GBGK: You couldn't get to Berlin. No one in his right mind went to Berlin in those days. This was when Krushchev was at the peak of his power. Travel to Berlin in those days was on the autobahn with military convoys. There were continuous exercises. I don't think an American who hadn't been there in those days could ever really comprehend how it was. There were a lot of ruins in Germany then. We saw the cathedrals, museums, and churches of Austria, the Alps, Switzerland, England, and France. We traveled a lot. When I turned 15, I went for the first time on my own. I traveled by train by myself to Folkestone, England, to practice English. I changed trains in Belgium. No one thought that that was unsafe. I went because every Swede was supposed to be completely fluent in English.

WCR: Who arranged for you to go to Folkestone?

GBGK: My mother.

WCR: Did she know somebody there?

GBGK: No. Some Swedes had set up a summer school to give classes in English in Folkestone.

WCR: Where did you live there?

GBGK: At a pension run by an elderly couple in a typical British townhouse.

WCR: Were other students there from Sweden?

GBGK: I was the only Swede there. There were 3 other people attending police school.

WCR: Was that the first time you had been away from your family?

GBGK: I'd been to a couple of horse riding camps in the summertime in Sweden. This was the first time abroad.

WCR: How did you handle everyone's speaking English? Were you pretty good by then?

GBGK: No. I guess I was like everybody else. I had had English since I was 10 years old in school as my first foreign language.

WCR: This was the first time that you had to use it?

GBGK: Yes. I was expected to go and handle it. It was fun. The second time I went to England, I went to a private tutor. She was married to an officer in the Royal Horse Guards. They lived in Devon outside Exeter. A French boy and I spent a month with them. She had about 15 horses that we rode and took care of. My parents picked me up, and we drove around the entire British Isles, Scotland, Loch Ness, etc. I was 16 then. Later in gymnasium, I got a scholarship and was sent off to a classic British public school. (The public school is a private school in England.)

WCR: Where was that?

GBGK: It was Denton High School for Boys, close to Birmingham. It was an extremely interesting time in many ways. The school taught me more about Britain and its culture than anything else I had done up to that time. I lived in the Phillips House, which was a set of 3 boys' dormitories with 30 beds in each dorm. They had to have inherited them from the British Army after World War I. The beds had thin mattresses that sagged. We had thin blankets, and there was no heat. The windows were rusted open.

WCR: Why was it so interesting?

GBGK: It was a stark difference from Sweden—living like that, the organization, the attitudes. Sitting at dinner with hundreds of boys in a huge hall with the headmaster at his table. The bathroom was huge with toilet stalls and shower stalls. There was no heat except for the hot water for showers. It was chilly.

WCR: What did you do during the day?

GBGK: I went to school with the other kids, attending regular classes—history, mathematics, and science. This was an opportunity given to me by the school to broaden my experience.

WCR: The gymnasium school in Stockholm paid your way to go there?

GBGK: Yes.

WCR: That's pretty nice. How many got scholarships?

GBGK: One a year from a class of 180.

WCR: That broadened your perspective. That was an honor.

GBGK: Absolutely. It was very interesting and changed my perspective. In Sweden it was difficult to change what you wanted to do because you were expected to be in a little slot. In Denton there were no such expectations. Even though I wasn't athletic, when I went to Denton, we played basketball. I can't fathom why, but I scored goals there. When I returned to Sweden, I kept on scoring.

WCR: You were actually better than you thought you were?

GBGK: Believe me, I wasn't good, but I realized that there were things I could do that no one else thought I could do. I had been given the freedom that I was never given before. The first time I came back, one of my classmates said, “Wow! I didn't know you could do that.” It made an interesting twist.

WCR: It was a bit of a confidence builder, I presume?

GBGK: Yes. And that is what it is all about, confidence.

WCR: Was there anybody in gymnasium who had a particular effect on you?

GBGK: No. I made a good friend in my class during those days, and he is still one of my closest friends. He's the only one of my old friends in Sweden that I have stayed in contact with. He's a dentist in Stockholm and extremely successful. We went sailing and hunting together.

WCR: Did you sail, hunt, and fish much when you were growing up?

GBGK: I did fish, but the other things I learned later. Once I went to college, or university as we call it, I started doing new things. I had always had an interest in hunting. My dad never did, nor did he sail. I taught myself those things.

WCR: What do you hunt?

GBGK: In Sweden I hunted waterfowl and moose. The big hunt in Sweden is for moose. In Sweden they shoot 180,000 moose every year.

WCR: In northern Sweden?

GBGK: No, the whole country. There is a huge population of moose. I was always interested in sport shooting. I have shot on the range since I was 12 or 13. There was a military range close to where we lived, and I biked there.

After gymnasium I did military service (Figure 3). It was mandatory for us to serve 15 months. They recognized that I was going into medicine. The army, of course, needs doctors. The Swedish Army was organized to mobilize the entire population for defending the country. The doctors were placed in M.A.S.H. units. The military wanted to make sure that you got to the right place. You did boot camp the summer between gymnasium and the fall semester of university. Then you did months during different parts of the year for the next 5 years. You spent 3 months in the summertime and 2 months for winter maneuvers. It was part of our growing up.

Figure 3.

Lieutenant Klintmalm in front of a heavy battle tank, 1982.

WCR: University was 6 years for you?

GBGK: University was 5½ years. University was actually medical school. From gymnasium I applied and got into the Karolinska Institute.

WCR: During medical school how much time did you actually spend for army duty?

GBGK: I spent 15 months, but that was outside those 5½ years. The army was very flexible. They tried to fit it in with the medical school so they got trained physicians for the army as efficiently as possible.

WCR: When did you decide you wanted to be a physician?

GBGK: During my second year in gymnasium, my junior year. I never thought I would be able to get in. It seemed such a lofty goal to me. I always had an interest in the sciences. When it was time for me to apply, I made only one application.

WCR: For the Karolinska Institute.

GBGK: Yes. With my grades I knew I would get in.

WCR: How many students were in your initial class at the Karolinska Institute?

GBGK: The initial class was 160.

WCR: Did you have any contact with a physician, a family doctor? Were physicians in your extended family?

GBGK: Yes. My uncle, my mother's brother, was a vascular surgeon. We were a very close-knit family. His wife was also a physician, a psychiatrist. My uncle was very close to my mother. He visited our house every week.

WCR: You knew him well by the time you applied to medical school?

GBGK: Yes.

WCR: Did you live at home during medical school?

GBGK: Yes.

WCR: Did you have to pay for medical school?

GBGK: No. At that time tuition at the university was free, but room and board was not. The Karolinska was fairly close (3 or 4 miles) to my home. Instead of spending money on student quarters, I lived at home. I was completely free to come and go as I pleased, 24 hours a day. Also by staying at home, I could use my mother's car. I could not have afforded one on my own.

WCR: It sounds like your home growing up was a very pleasant one. There weren't many arguments?

GBGK: It was a very pleasant home. Of course, there were fights; siblings have arguments about things. We all had arguments, sometimes arguments with parents like all teenagers. It was never destructive or aggressive. It was a very natural, good, and loving relationship at home.

WCR: What about religion? Was the family very religious?

GBGK: No. My father was never very religious. There's a state religion in Sweden, the Swedish Lutheran Church. He and his parents belonged to that church. You are born into the church and remain a member unless you purposely leave it. My mother grew up in a Baptist home. During my first 8 or 9 years, we went to Sunday school in the Baptist church. My mother eventually left that church and joined the Swedish Lutheran Church. My siblings and I were all confirmed in the Swedish Lutheran Church. We were not a churchgoing family. After mother left the Baptist church, we infrequently went to church on Sundays. Religion was something that was part of the fabric of the Swedish society in those days. We had a religion class in school. In elementary and middle school, we started every morning by singing a hymn. The teachers played organs that you pump with your feet. I think we had a good exposure to church and religion.

WCR: Was there alcohol in your home? Did your father have a drink when he came home at night?

GBGK: No. When I was in my upper teens my dad would have a light beer for dinner, but nothing stronger than that. My mother came from a Baptist background, and no alcohol was allowed. As she broke away from that church and as we got into our teens, we began to have wine on certain occasions. We could have a glass of wine for birthday dinners within the family, but the use of alcohol was minimal.

WCR: What about smoking? Did your father smoke cigarettes?

GBGK: Yes. About 10 cigarettes a day.

WCR: How did medical school strike you? Did you enjoy it? Did you take to it right away?

GBGK: Yes, I did. I loved it. The first 2 years were essentially basic sciences, the equivalent of premed college classes. It was extremely crammed. There was so much material that after 2 years we got our bachelor of science degree, which normally takes 4 years to achieve at the Stockholm University. There were classes and labs every day in chemistry, anatomy, and dissecting corpses during those first 2 years. The first year we had a whole year of histology and anatomy. We had to memorize textbooks from cover to cover. For the first time I felt like I was among peers. I enjoyed that. For the first time I was developing a social life of my own.

WCR: Prior to that you weren't dating?

GBGK: No.

WCR: Your clinical work started your third year?

GBGK: The third year consisted of clinical preparatory classes, including physiology, held at teaching hospitals and some at the Karolinska. There is only one medical university in Stockholm, the Karolinska, but there are at least 6 teaching hospitals in Stockholm. To apply for a faculty position at the teaching hospitals, you had to be a tenured professor of the Karolinska Institute.

WCR: What was medicine like when you were coming along in medical school? You entered medical school in what year?

GBGK: In 1969.

WCR: How many medical schools were in Sweden at that time?

GBGK: Five.

WCR: How many students were in each class?

GBGK: Probably between 75 and 160 at the different schools.

WCR: The Karolinska Institute was the largest medical school there?

GBGK: It was the same size as the one at Gothenburg University.

WCR: When medicine was practiced in 1969 in Sweden, was it private practice or socialized?

GBGK: Before 1969, it was mainly private practice. All the tenured professors had a private practice in addition to their academic load. Private practice was eliminated in 1969. Thereafter, every patient was part of the socialized medicine plan.

WCR: Private practice vanished the same year you entered medical school. All physicians from that point on were salaried by the government.

GBGK: Correct.

WCR: As you went through medical school, what did you enjoy?

GBGK: In my first courses, I really liked anatomy; I enjoyed the dissections.

WCR: How many students per body?

GBGK: About 4. We frequently used our dissections as demonstrations. I also enjoyed physiology a lot. I hated neurology. I could never keep those nerve systems in order. What had the most impact on me were the friendships I developed.

WCR: With your medical school classmates?

GBGK: Correct. That had a tremendous impact. We had a lot of fun together outside of classes. We went on trips together, skiing the Alps, sailing in the summers. From that time on I started sailing in the summers (Figure 4). I initially rented small boats and, later, larger boats.

Figure 4.

Tina and Göran sailing, 1978.

WCR: Medical school not only broadened you scientifically and professionally, of course, but you came into your own socially. You figured out what you liked.

GBGK: I tried everything that I felt like trying. I always had a love for horses (Figure 5). I rode when I was younger, and when I came to medical school, I did some competitive dressage riding.

Figure 5.

On a dressage horse, 1978.

WCR: That means what?

GBGK: That is when you have the horses move in defined patterns and perform certain movements. It's nothing like what you see at the rodeos here. Dressage is an Olympic sport. The most elaborate dressage is what you see the Spanish Riding School in Vienna do. I took up hunting. I sang. I played tennis. I tried everything I could.

WCR: Were you a good tennis player?

GBGK: I wouldn't say “good.” There was no one to teach me in my family. I had to find someone to teach me. I researched and read about it and took lessons. I figured it out.

WCR: The state paid for your medical school? When you got on the clinical services, did you take to surgery right away?

GBGK: Yes. I liked it. When I came to surgery, I knew I was at home. During vacation times and on weekends, I worked as a sitter in the intensive care unit taking care of the respirators. It gave me pocket money as well as knowledge. I also worked as a nurse's aide. When it came time to do surgery, I knew I had found my niche. I was the first one in my class to do an appendectomy with a staff surgeon assisting me.

WCR: You did an appendectomy as a student?

GBGK: Yes. Surgery came naturally to me. The staff surgeons recognized almost immediately those students who had surgical talent and those who didn't. Therefore, those students with surgical aptitude were allowed to perform surgery while still a student.

WCR: Is it mandatory in Sweden to do a rotating internship?

GBGK: Absolutely.

WCR: How long is the rotating internship in Sweden?

GBGK: Twenty-one months. I finished medical school in 1975 and then applied for my internship. It was a nationwide application and you made your choices. There were no interviews. Depending on the competition you may or may not get the slot. I got my rotating internship in Stockholm.

WCR: I presume that was the crème de la crème of internships?

GBGK: It was. I did surgery, medicine, psychiatry, and general practice internships. I enjoyed it. As soon as you had completed your pediatric and internal medicine rotations, you could work as a family practitioner during call hours in Sweden. I don't know if they can still do this. At that time, there were not enough physicians, though. I made a lot of money (for me in those days) by working Friday, Saturday, and Sunday at the general practitioner stations around the greater metroplex of Stockholm. I saw patients in the doctor's office during the day, and during the night I made house calls. I traveled to the house calls in taxicabs. That was interesting. I enjoyed making house calls, but it was primarily a way of earning an income.

WCR: When did you have to apply for your surgery residency?

GBGK: I did that when I was finishing my internship. I applied for surgery and got a spot at the Huddinge University Hospital, which had opened in the early 1970s as the new university hospital in southern Stockholm. The transplant program in Stockholm in those days was at that hospital.

WCR: How many years was general surgery training?

GBGK: Five years. It's like in the USA. There are mandatory rotations. You have to do anesthesiology, orthopaedics, urology, etc., and you have a general surgery caseload.

WCR: This was 5 years after finishing your 21 months of rotating internship. You are talking about 60 additional months?

GBGK: Yes. After that you have 6 more years where you train in a subspecialty. If you want to become a vascular surgeon, you do 6 years of vascular surgery.

WCR: You do 5 years of general surgery and then 6 more years of vascular surgery.

GBGK: You are board certified then. After the 6 years in your subspecialty training, you are finished and take independent command. You can then be a division chief, for example.

WCR: You are talking about nearly 13 years of training. Whew!

GBGK: Training is very different in Sweden than in the USA. Residents in the USA work harder (longer hours) than in Sweden or in any country in Europe. In those days, the work hours were legislated to 40 hours, but doctors had dispensation. A normal workweek was 48 hours. On-call time was in addition to the 48 hours. An intern was on call once every week; a resident was on call once or twice a week. It was less intense. The caseload was not as large as in the USA, especially at BUMC with its very heavy caseload. I have no recollection of the number of operations a resident was supposed to do in those 5 years.

Everyone in Sweden who wanted to have a chief position or any position of recognition must have a PhD. You have to produce a thesis, and that is usually done in basic or clinical sciences. In Sweden, clinical sciences and a clinical thesis are actually regarded as more difficult than a basic science thesis. With the basic science thesis, everything is controlled. In clinical sciences, patients cannot be controlled as well. A clinical PhD in Sweden is as highly regarded as a PhD in basic science. I quickly began working on my PhD when I came into surgery. My uncle, the vascular surgeon, worked at the same hospital. I started working with him doing vascular flow studies in patients during surgery. I collected data on renal flow under hypovolemia.

WCR: What was your uncle's name?

GBGK: Ruben Cronestrand. He taught me surgical technique. He was regarded as an eminent technical surgeon. He encouraged me to go to the transplant service to study the kidneys.

WCR: He didn't do transplants himself?

GBGK: No. The first to do kidney transplants in Sweden was Kurt Franksson. He did the first kidney transplant in Stockholm in 1964. He read about the maverick surgeon in Denver, Thomas Starzl, who had discovered that corticosteroids could reverse rejections, and in 1966 Franksson sent his protégé, Carl Groth, to Denver to learn from Starzl. Carl Groth returned to Stockholm for a while but later went back to Denver as a faculty member. Franksson was in charge of transplantation at Serafimer Hospital, but he soon moved to Huddinge Hospital. Once he moved he called Carl Groth in Denver and offered him the position of chief of transplant at Huddinge Hospital. When I came to transplant, Carl Groth was running the service.

WCR: You were rotating through that service?

GBGK: Yes. That was not normal. That was arranged for me so I could study renal flow at the same time. That's how I got into it. I started transplants in January 1978 during my general surgery residency.

WCR: That was early on in your general surgery training?

GBGK: Very early on. Before that I had extra rotations in vascular surgery with my uncle. I started writing about transplantation with the aim of getting a PhD in clinical sciences. Only a few diehards went into transplantation in those days. In 1976, the mortality rate for kidney transplant patients in the USA was 30%. The 1-year graft survival was 47%. You had to be a diehard to be in this field because it was gruesome; it was hard work. At that time, the length of stay for an uncomplicated kidney transplant was a month. We would leave to retrieve an organ from a cadaveric donor and come back to find a patient had died from pneumonia after we made rounds in the evening.

I worked for Carl Groth, and in the spring of 1979, Carl Groth went to the USA to a transplant meeting in Chicago and met with Tom Starzl. Tom said he needed a fellow beginning in July 1979 and asked Groth, “Do you have anyone you want to send over?” Carl had the same type of personality as Tom so the thought was to act. I was in surgery at that time and had an intercom call saying that there was a phone call from the USA for me at the front desk. I was closing, but out I went. On the phone was Carl, who said, “I'm here in Denver. I was talking with an old mentor who needs a fellow to come here.” This was now the end of May. He asked, “Can you be here July 1?” I asked, “Do I have to decide now?” Only then did Carl realize he was asking a little bit too much. He said, “I'll call him back tomorrow.” I went to Denver August 1, 1979.

The 3 most important individuals for me in my surgical career have been my Uncle Cronestrand, who got me into surgery and taught me the techniques; Carl Groth, who taught me all the basics in transplant and also, by example, organization; and Tom Starzl, who has meant more to me than anyone else and is undoubtedly the most brilliant man I have ever met (Figure 6). Starzl towers above everyone else. He taught me to focus intensely and never give up. He taught me to cut to the chase. He taught me to follow intuition. He's an awesome individual. He has a mind like no one else I've ever met. He never forgets a conversation.

Figure 6.

With Dr. Tom Starzl outside of the University of Pittsburgh operating room, February 1981.

WCR: When you went there in 1979, you were 29 years old. How old was Starzl at that time?

GBGK: He must have been 53.

WCR: What was Starzl's day like at that time?

GBGK: Starzl slept only 3 or 4 hours every night. He came in at about 5:00 am, he got home at about 1:00 am, 7 days a week.

WCR: Was he married then?

GBGK: No. That was after his first marriage. He was a bachelor.

WCR: You arrived in the midst of this cyclone?

GBGK: That's a good description of him. There was only one issue: once you start, you never stop.

WCR: You must have heard a good bit about Starzl from Carl Groth before you arrived in Denver, but you couldn't really picture it until you got there.

GBGK: Correct. None whatsoever.

WCR: You went to work that first day?

GBGK: The first day I arrived he took me to the football game. He asked that I come to his apartment (he was living in a penthouse) so we could bike to the stadium. He had a beautiful road bicycle actually made out of wood. We rode down a great big hill that ran to the river at the stadium. We rode on the left-hand side against the traffic. That was a ride I'll never forget.

We went to the game. He had 2 tickets in 2 different places. During the game there was an announcement on the public address system that Dr. Starzl needed to come to the phone. Shortly after that, Tom came and tapped me on my shoulder. We biked back then on the same side of the street, but now with traffic. That was my introduction to Tom Starzl. From then on Tom was a cyclone that kept on and on and on.

WCR: Did you have to go salvage a kidney?

GBGK: I was involved with the donor or the recipient or both. From then on I was virtually in the midst of it all and there was no out.

WCR: Where did you live?

GBGK: Tina and I lived in an apartment building 1½ blocks away from the hospital. It would be weeks before I'd get home. I will never ever forget: we had just done a liver transplant and I was so tired I was nauseated. The fastest liver transplant I ever experienced when working with Starzl was 15 hours, and the longest one was 25 hours! It normally took about 20 hours. We kept all the liver patients on a National Institutes of Health– funded unit. The facilities we had were incredibly simple. The floor had a central nursing station. We had patient rooms like mail slots. There was one 4-bed room. “Room” is a poor description. It was a cubbyhole. And we had respirators there. We kept the flow charts in a back room. The flow charts that Tom used were 3″ Z 4″ and very unwieldy. In the back room there was a bed to sleep on. I had fallen asleep on this bed waiting for the next shoe to drop when I got a phone call from the operator about another donor. The thought of doing another transplant after just completing a marathon transplant surgery was insane to me. Of course, we couldn't do another transplant! Everybody was dead tired. I returned the call and said, “No. I don't think so. We are out. We just finished and we can't do another one” and hung up. Of course Tom was aware of everything that went on. The next day Tom chewed me out—left, right, up, and down—because I had turned down a potential donor. I explained, “We just did a transplant; we couldn't do another one.” He said, “We can always do another one. If we have a donor, we can always do another one.” I will never forget that conversation, and since that encounter I have never turned down a donor because of being too tired or because we were “out of resources.”

WCR: Starzl did the first liver transplant. What year was that?

GBGK: In 1964.

WCR: That was actually 15 years before you had come to Pittsburgh. By that time he had done how many liver transplants?

GBGK: One hundred and eighty-four.

WCR: How many other people were doing liver transplants in 1979 around the world?

GBGK: Roy Calne in Cambridge, Henri Bismouth in Paris, and Rudolf Pichlemeyer in Hanover, Germany. Those were the only ones that had done transplants at that time.

WCR: How long does it take you to do a liver transplant now?

GBGK: My average time is 4 hours.

WCR: Why did Starzl take 5 times that long?

GBGK: For hundreds of different reasons. First of all, the technical developments in instruments we use now have come a long way. In the 1960s they didn't have atraumatic needles. We had a needle that created a bigger hole than the needle we now use. We never used the Bowie then. The technique and the ability of the anesthesia team to control bleeding and blood pressure have developed light years since then. Tom is the most virtuoso surgeon I know. There is nothing he can't do. He is technically a superior surgeon. Since that time we have come so far in our understanding and ability to control the field and the events surrounding the surgery that surgery times have decreased dramatically.

WCR: Is he technically superb?

GBGK: Yes. He's also extremely fast. We just didn't have today's technology back then.

WCR: It was not personal slowness; it was inadequate equipment slowness.

GBGK: Yes. The world of transplantation changed in December 1978. Lancet had an article by Roy Calne about the immunosuppressant effects of cyclosporine. I remembered that Carl Groth talked about cyclosporine. The original work was done by one of Calne's associates who had heard about its effectiveness in an immunology conference in 1976. I'd read the article and didn't think that a nephrotoxic drug could be used for kidney transplant patients. In April 1979, there was a second article in Lancet describing results of cyclosporine in 32 transplant patients: 28 who received kidneys, 2 who received pancreases, and 2 who received livers. The surprising thing was that most were successful. It was a hallmark article.

In December 1979, Tom started using cyclosporine. Sandoz Pharmaceutical, which developed the drug, sent it to us in Denver. The drug had been available only in Cambridge and in Paris (for the bone marrow transplant unit), but Sandoz then sent it to Boston, Seattle, Stanford, and Denver. The chief medical director at Sandoz was a physician named David Winter. When he came to Denver he took us to the Rodeo Restaurant. He had brought with him a tin coffee can. In it was a plastic bag full of some sort of white powder. We later learned that it was crystallized cyclosporine. He placed it on the table and said, “This you can have for your dogs.” This was the first week of December, and we performed the first human kidney transplant using cyclosporine later in December, the day before Christmas Eve. By New Year's Day, we had done a total of 6 kidney transplants. The protocol was very specific: of the 32 patients who received cyclosporine from Calne, 2 (who had also received cyclophosphamide and steroids) developed cancers. Thus, it was determined that the patients should not receive anything else but cyclosporine.

By New Year's, we had already realized that cyclosporine patients had a rejection episode within a week and, therefore, we broke the protocol. This was perhaps the most important period in my professional career. I was truly Tom's sidekick. I was working side-by-side with him. We would write papers together. In the midst of one of our research discussions, he'd stop and say, “Let's go take a look.” We'd leave his office, go up the stairs to the floor, and palpate every patient's kidney. We checked the catheter with the urine coming out. We would do this 5 or 6 times a day, each time talking about the patients and what was happening to them. We quickly realized that every patient was experiencing rejection, and then one day while rounding at the VA Hospital, as Tom and I were riding the elevator from the fifth floor to the first floor, we decided on a different protocol for our patients. We would place our patients on a steroid regimen that had become standard throughout the USA at the time. Since Tom was the one who discovered that steroids could actually reverse rejection, he was a high-dose steroid man, and steroids in those days were highly toxic. After 1 month the patients were taken down to 40 mg.

WCR: This was prednisone?

GBGK: Prednisone. Tom started the protocol in those days with 200 mg for 2 days, 190 mg for 2 days, 180 mg for 2 days, etc., until patients had been taken down to 40 mg. They stayed on 40 mg for 1 or 2 months and then were taken down to 25 mg. It was a very slow process. Patients on steroids were easily recognized because they had a moon face and buffalo humps and all the side effects that we know of—striae, cataracts, hips falling apart, etc. Starzl went from this megadose protocol to what we today consider normal steroids. He said, “If we give steroids from the beginning, maybe we can avoid rejection.”

WCR: Combined with cyclosporine?

GBGK: Yes. We started the dose at 200 mg with a goal of taking the dose to 20 mg fairly quickly. Our discussion about the protocol while in the elevator was literally like a ping-pong match between Tom and me. I'd say, “Let's take it down by 40mg intervals—200 mg, 160 mg, 120 mg, 80 mg, 40 mg, 20 mg.” By the time the elevator door had opened up on the first floor, we had agreed on a protocol that would take the dose down to 20 mg by day 6. The schedule we designed in that elevator ride has now become a nationwide and worldwide standard.

WCR: That's a great start!

GBGK: We designed the schedule based on clinical experience and intuition. In March 1980, we did the first liver transplant with cyclosporine. Between December and March, we had performed a large number of kidney transplants, and we were quite comfortable using the drug. Almost all of the kidneys worked, and we were extremely encouraged. You have to realize that at this time no one in the world, and I mean no one, knew the pharmacokinetics of cyclosporine. No one had a clue. We couldn't even measure the drug level. The only lab that could measure blood levels was in Cambridge, UK. We started testing and sending off the samples to Cambridge every once in a while and got an answer back after 2 weeks. Yet, no one knew what the target level should be. We weren't taking trough or peak samples; we were just randomly taking samples. No intravenous form of cyclosporine was available, and that's probably why the patients survived the toxicity of the drug to begin with. We had an intramuscular form and an oral form. The intramuscular form was poorly absorbed. We later realized that this was what was saving the lives of the patients as well because we couldn't overdose them. Between March and August 1980, we performed 14 liver transplants. Of those, 12 patients survived the surgery. You have to remember that prior to that time, liver transplant survival was only 27%.

WCR: That was out of those 170 before cyclosporine?

GBGK: You can't even fathom how the change affected us. The surgery took as long as before, but suddenly the post-transplant recovery period changed. The patients were able to survive the trauma of surgery. The rejections were controlled well enough so that when they occurred we could treat them successfully. We did 14 liver transplants in 6 months, and that was an enormous number for those days. The average production up to that time was about 10 per year. We also transplanted 56 kidneys from December 1979 to August 1980.

In the summer of 1980 the International Transplantation Society had its semiannual meeting in Boston. Naturally, we went to it; everybody did. Tom had written a paper about cyclosporine, and they rejected the manuscript. I don't know why they turned it down. Didn't they believe the numbers we submitted? They asked Tom to give an update on liver transplantation at the meeting. We were experiencing a 27% survival rate and Roy Calne had a 22% survival rate prior to cyclosporine. Tom wrote a paper, “Liver transplantation in 1980 with particular emphasis on cyclosporine.” He presented our experience with cyclosporine despite what the reviewers said. Everyone knew about the toxicity of cyclosporine, the difficulty that Roy Calne had with toxicity, and also the kidney experience from Harvard. Harvard closed down its program after a few patients because of all the problems. In the bone marrow program in Paris, almost all of the patients ended up on dialysis, with most of them dying. We told our story, and it sounded like a fairy tale. I guess that's what the problem was. Our story was too good, but we had the data to support it. We had 12 liver transplant patients and the kidney transplant patients who were alive at the time.

WCR: This was cyclosporine plus prednisone?

GBGK: Yes. We wrote the story on it.

WCR: What was the reaction at the meeting?

GBGK: Had Tom not been there to tell this story, it's very likely that the drug would have been permanently shut down. It was a crisis at that time. Here we rolled in, showed the patients' charts, and gave the head count of survivors. It was incredible, but it was also clear that something had been done right. It was an enormous breakthrough. It was the biggest breakthrough ever in transplantation. It was at that point that transplantation changed from human experimentation to health care service. Suddenly there was an outcome that was statistically favorable. It changed the face of medicine. There's no question about that. Tom wrote the papers and I plugged in the numbers. I wrote papers as well. We had an enormously exciting story to tell.

WCR: He was unmarried at the time, and he didn't leave the hospital or he wasn't home much.

GBGK: Nope.

WCR: And you didn't leave the hospital.

GBGK: Not much.

WCR: You obviously weren't married then.

GBGK: No, I was not. I met my wife, Tina, when she was a nurse in the emergency room in Sweden. I met her in one of the corridors of the emergency room and thought, “Oh! I want to date her.”

WCR: That was when?

GBGK: In 1976, shortly after I came to the Huddinge Hospital.

WCR: That was during the residency.

GBGK: It was love at first sight, and we have been together ever since. A few weeks after our chance encounter we moved in together. She is the best thing that ever happened to me.

WCR: That was back in Stockholm?

GBGK: Yes. When Starzl's phone call came to me in Stockholm, we had just moved into a beautiful apartment in downtown Stockholm with 9-foot ceilings. It was an old house from the turn of the century that had just been renovated. I came home and said, “Tina, sit down. I need to ask you something.” She sat down and I said, “Guess what happened.” I don't know how, but she said, “We are going to go to the United States.” How she figured that out, to this day, I still don't understand.

WCR: Before you opened your mouth she said that.

GBGK: Yes. We sublet the apartment, and she came to Denver a month after my arrival. We lived together in Denver. We were engaged.

WCR: But you never saw her?

GBGK: Not much. Tina worked as a research technician for Tom. She had an income, which helped us greatly. When we moved to Denver, Tom was studying something called thoracic duct drainage. That means you can cannulate the thoracic duct known to be full of lymph-containing B cells, which are important in rejection. His thought was to remove the lymphocytes and give back the serum. It was a very messy process. You could do it with kidney transplants but not with liver transplants. Pretransplant liver patients were dropping like flies because we couldn't manage the fluids and electrolytes. He wanted to get a lymphapheresis machine. Tina, being an intensive care unit nurse, ran the machine for Tom. She was home at night but I was working. We took off on vacations together and spent some weekends skiing in Colorado (Figure 7). We borrowed a house from an internist who worked for Tom Starzl in Vail. We'd go up there, stay for the night, and come back the next day.

Figure 7.

Tina and Göran skiing at Telluride, 1995.

In August 1979, everything stopped in Denver. Tom had decided to leave and resigned as chairman of surgery. He had been offered a job at the University of California–Los Angeles (UCLA) by Dr. Longmire. Everything was arranged. We had turned in our keys to the department and actually were packing up the boxes to go to UCLA. Two days before leaving, Tom called me up and said, “Stop packing. We're not leaving.” No more explanation. Tom had decided that the UCLA setup was not viable. He decided not to go. Dr. Hank Bahnson of Pittsburgh, his friend from his residency days at Hopkins, had heard about Tom's potential move to UCLA and called Tom. “Why didn't you let me know? I want you here. Anytime you want to come, I'll make a spot for you.” So now Tom called Hank and said, “Hank, it didn't work out.” Hank said, “You're coming to Pittsburgh.” All this happened in no time. Within a week it was decided that we should go to Pittsburgh instead on January 1, 1980. Tom said, “I'm not going to work here any more. I resign. I'll take vacation leave. I want to go on a worldwide trip. I've been invited everywhere. I'm disappearing.” He took off with his fiancée (he was engaged to Joyce at that time) saying, “Göran, take care of the patients. Don't let anyone else tamper with the cyclosporine patients.”

On January 1, 1980, Tina and I packed the U-Haul and took off for Pittsburgh. We arrived in Pittsburgh and were very disappointed. It was –10°F with snow and ice. Pittsburgh was at the depth of its depression. All but one steel mill had closed. The unemployment rate was very high. The city was dirty and unkempt. Some of the bridges were dangerous to walk on. The town of Pittsburgh was not easy to adjust to. However, the departments of surgery and pathology received Tom with open arms. Dr. David Van Thiel, chief of the gastrointestinal division, realized the potential and was very supportive. The office we were given was an unused lab in the pathology department. We sat there and wrote all the research protocols to get the program started. Literally, we did that day and night. We wrote 13 major protocols in a couple of weeks. We submitted them to the institutional review board, the National Institutes of Health, etc., to set up the program to allow the use of cyclosporine. Tom brought cyclosporine with him, previously not obtainable in Pittsburgh.

We started the kidney transplant program first. In February 1980, we got the liver program started. Pittsburgh was a different environment, and in July 1981, Tina and I left and went back to Stockholm. Tom wanted me to stay but I felt that I needed to have a breather. I had not seen my family since leaving Stockholm. Upon my return to Sweden, I started my general surgery residency again. At the same time we were doing a lot of transplants. I was the only one in Scandinavia who knew how to use cyclosporine. Thus, I was the principal investigator for all transplant trials in Scandinavia. I organized the trials and traveled around, teaching people how to use it.

WCR: This was while you were doing your general surgery residency?

GBGK: Yes. I did all that at the same time. I took trips to Helsinki and Oslo to teach them how to use the drug. I set up the monitoring system and made sure that the data were collected properly. I set up additional trials for Stockholm. We had patients flocking to us for transplants. There were so many transplants that numerous beds were placed in the corridors after the transplant. I wrote manuscripts at the same time. In the spring of 1984, I took a research leave for 6 months to finish up my PhD thesis, which had switched from the study of blood flow to the histology and pharmacology of cyclosporine. I defended the thesis in September 1984 and was awarded a PhD.

I never finished the residency. In February 1984, one evening at 11:00, we had a phone call. The instant I put the phone to my ear I knew who was calling—Tom Starzl. Tom never introduces himself on the phone. He starts talking as though you were sitting right next to him and were in the midst of a conversation. He began by saying, “Göran, have you heard about Baylor? Do you know about Baylor?” I said, “I've heard the name.” Tom said, “They want to start a transplant program. Are you interested?” That's how everything came about. I visited BUMC in April 1984. We stayed at the Baylor Plaza Hotel. We were given a suite with the windows to the courtyard. I was taken on a whirlwind tour with Shields Livingston, Boone Powell, Jr., Jesse Thompson (then chairman of surgery), John Fordtran, Marvin Stone, Dan Polter, Martin White, and Herbert Steinbach, all the senior people. Tina (we were married by then) was taken on a whirlwind tour by their wives.

WCR: When did you get married?

GBGK: When we returned to Stockholm from Pittsburgh. Our oldest son, Marcus, was born in 1982. The offer from Baylor was very attractive. What attracted us the most were the people and the level of ambition. Their vision was clear: there should be a program here, second to none, and it should be academically based. There were high expectations by all, which was exactly what I wanted. It was very interesting. I was only 34 years old and had completed all the general surgical training. I'd had an enormous exposure to transplantation, and I was given an offer that was literally a blank sheet of paper. It was an irresistible challenge. Was I good enough to do what I had trained for? We didn't have a contract, only an understanding and a 1-page letter of agreement where BUMC had committed to several very basic things. It was a commitment from them, and I believed them. It was based on a handshake between Boone Powell, Jr., and myself. Tina and I packed up and came to Baylor. In spite of not finishing my residency in Sweden, I was made a fellow of the American College of Surgeons in 1991 in recognition of my surgical achievements. I was granted membership in the American Surgical Association in 1993, the highest distinction for a surgeon.

I defended my thesis in September and received my PhD, and on December 2, 1984, I left Sweden, leaving Tina and Marcus behind. Tina was carrying our second child and was unable to travel. I began at BUMC in December 1984. I stopped in Pittsburgh first to see what had developed in transplantation since I left. I traveled to Dallas a couple of times to rent a house. On March 9, 1985, I permanently moved to Dallas. When I was down on one of the visits in December 1984, we did the first liver transplant at BUMC.

WCR: You weren't even here full-time then?

GBGK: No. I was employed, but I was not full-time.

WCR: That was shortly after you left Sweden?

GBGK: In Sweden we couldn't do livers because we didn't have the brain death law. We did the first liver transplant in Sweden in November 1984. I was part of the first liver transplant done in Sweden. On Christmas 1984, we did the first liver transplant at BUMC on Amie Garrison. She was 4 years old at the time, and we transplanted her on an emergency basis. Amie had lit the Christmas tree at the White House a couple of weeks earlier. A month earlier Amie had been admitted for a spontaneous bacterial peritonitis. Starzl was afraid that Amie would die at her home. Tom had a donor with an appropriately sized liver for her in Canada, and she and her family were waiting in an airplane on the tarmac in Iowa to see if she would be transplanted. I was at BUMC at the time organizing the operating rooms and the intensive care units to begin the transplant program. I was in Boone's office when Tom called from Pittsburgh saying, “Göran, we have a darling little child, and we have no place for her in Pittsburgh. We can't do the transplant here. Can you do it at Baylor?” I told Tom, “I don't know. I need to check things out first.” “Okay,” he said, “I'll call you back.” I was in Boone's office and he was out. I called John Fordtran and Jesse Thompson. We all realized that this was kind of dicey. We called in a lot of the senior staff at that time (Shields Livingston, Marvin Stone, Dan Polter, and several others) and were discussing capabilities, obligations, and if we could do it. Suddenly, Boone came in happy, smiling, whistling, and carrying shopping bags with Christmas presents. In the meantime, I had a couple of conversations with Tom to get more details. It sounded like this little girl's only chance was an emergency liver transplant. But at the same time, we were not yet set up at BUMC. We were not ready, and if she died it would be bad public relations. The pros and cons were discussed back and forth and finally they all, including Boone, turned to me and said, “This must be your decision. Should we do it or not?” I paused for a moment and said, “Yes. Let's go.”

WCR: Although by that time you had scrubbed on a lot of liver transplants, how many had you actually done yourself?

GBGK: As a surgeon, I truthfully cannot recall, but it was not many—less than 10.

WCR: What liver disease did this child have?

GBGK: Congenital biliary atresia.

WCR: What happened?

GBGK: I called Tom and said, “Tom, we can go.” He told me that he would bring an anesthesia team and a perfusionist. He called the Garrison family, and they flew into Love Field. Tom flew with his team to get the donor and then flew to Dallas. On the way to Dallas the pilot told Tom that they had to go to the Dallas–Fort Worth Airport for customs. They had come from Canada and would therefore have to go through customs. Tom placed a call to the White House because at that time the maximum liver ischemia time was 6 to 8 hours from the cross-clamping in the donor. Therefore, we were talking about a tight schedule. To fly to DFW and drive to Baylor from there would take too much time. The White House called either Customs or the tower in Dallas and told them, “This is an emergency. Keep your hands off. This is authorized by the president of the United States.”

They were allowed to land at Love Field, where they were met by an army of police to clear the road. Bob Hille, a former senior vice president, picked them up. They left for BUMC with red lights flashing and at full speed. Tom and Bob Hille reported to us where they were on the road. Suddenly we heard Bob's voice begin to rise on the radio. “They're slowing up. They're stopping at a donut shop!” There were all these police cars with the lights and sirens going, and Tom tells the driver to stop the van. He gets out to get a cup of coffee and donuts for the entire crew in the cab. He returns to the van and they continue the ride to BUMC.

Tom had been doing transplants for some time, and he knew it would be a long operation. Mike Ramsay and Tom Swygert were anesthesiologists for BUMC, and Andreas DeWolf was there for anesthesia from Pittsburgh. Jesse Thompson was there. We had the largest operating room in Truett Hospital. I think they opened every vascular set in the entire hospital. There were more instruments in that room than I had ever seen in my life.

When we entered Amie's abdominal cavity, we found that she did indeed have a perihepatic abscess. She would have died had she not had the transplant. When we clamped the suprahepatic vena cava, suddenly we saw blood leak through the clamp. We were surprised to see that the jaw of this clamp had broken. The clamp happened to be one of Jesse Thompson's vascular clamps, and he was mortified, as though he had done it on purpose. We got another clamp and completed the transplant. Following the surgery, Tom and his team left for Pittsburgh, leaving Amie in my care in the intensive care unit. She recovered quickly. I had used muromonab-CD3 in Pittsburgh, and if she would need it, we had to take her to Pittsburgh to get the drug. I thought we'd better get her to Pittsburgh before she had time to reject. About a week after transplant, I flew with Amie and her parents to Pittsburgh in a private jet. Indeed, she did have a rejection 1 or 2 days after we hit Pittsburgh and received muromonab-CD3. Amie is still alive today! She is married and has 2 children. Five years ago she stopped taking the immunosuppression on her own. Nevertheless, she did fine. Thus, I spent that Christmas in Dallas at BUMC. Susan and Judy, Boone Powell's secretaries, bought me clean shirts and underwear because I didn't have any clothes with me. John Carver, another of the vice presidents who later went to Methodist, and John Anderson and John Preskitt took care of me. I went to a Christmas church service. It was a very special Christmas, and I'll never forget it.

WCR: When you went back to Stockholm in 1981 to complete your general surgery residency, did you plan to stay there?

GBGK: Yes. At the same time, I had grown to love the United States. We'd had no plans to return to the USA at that time, however.

WCR: When you went to Denver, that was the first time you'd been in the States, right?

GBGK: I'd come as a tourist in 1976. I traveled around the USA for 6 weeks with my youngest brother and a friend.

WCR: That was vacation during your internship?

GBGK: Yes.

WCR: There really weren't any surprises then when you went to Denver?

GBGK: No. I fit in very quickly in Denver. I had more difficulty fitting into Pittsburgh.

WCR: When you moved to Dallas, how did you and Tina adjust to this environment? Did you have any surprises in Dallas?

GBGK: Nothing surprised me. Denver is very similar in atmosphere to Dallas.

WCR: You mean the friendliness?

GBGK: Yes, in both the friendliness of the people and the personality of the city.

WCR: Your transplantation background before coming to BUMC was absolutely fantastic.

GBGK: Absolutely. Also, I had been through the experience of the cyclosporine trials, the biggest of its kind in those days. I was left to my devices to figure out how I wanted to set up the transplant service. No one came to me and said, “This is the way it has to be.” Instead they asked me, “How should we do this?”

People here were eager to work with me to make it happen. They gave me the means to do it. I cannot to this day understand how they dared to give me so much confidence and free range. I was very young. I spoke with a heavy accent. I certainly made a number of faux pas on the way. They didn't know what to expect from me. I had no preconceived ideas except that I knew what I wanted the transplantation service to be. Being from abroad allowed me to be different. At the end of March, Tina arrived in Dallas with Marcus and my second son, Eric, who was born in February. He was 6 weeks old when they arrived. Actually, I flew to Stockholm for his birth. I was in Pittsburgh and Tina called and said, “You need to come. We're going to have the child now.” I took the Friday morning flight, arrived in Stockholm on Saturday morning, and Eric was born on Sunday morning.

WCR: You did the first liver transplant at BUMC in December 1984. When did you do the second one?

GBGK: April 22, 1985.

WCR: How many liver transplants have you done at BUMC now?

GBGK: Over 2000 (Figures 8 and 9).

Figure 8.

Performing the 2000th liver transplant. Left to right: Göran Klintmalm, MD, PhD, Michael Ramsay, MD, Nicholas Onaca, MD, and Philip Halloran, MD, February 2002.

Figure 9.

With Amie Garrison (left), BUMC's first liver transplant recipient, and Bradley Bower (right), BUMC's 2000th liver transplant recipient, February 2002.

WCR: Are you doing more each year?

GBGK: We have leveled off at between 120 and 150 liver transplants yearly at BUMC. Kidney transplants have increased substantially. Last year we did 171 kidney transplants.

WCR: What about the pancreas and intestines?

GBGK: Ten to 12 pancreas transplants a year.

WCR: How is the liver transplantation process now working at BUMC?

GBGK: Superbly. We started quickly with liver transplants at BUMC, and the program has developed ever since. Our survival rate at 5 years is about 70%. The manpower demands for such a program are huge. You have to have a team for the donor and another team for the recipient. So, at the outset, we set up the operation so that there would be people to work with me. With the help of Jesse Thompson and John Preskitt, we organized 2 teams that we called “surgical support teams.” Each consisted of 7 to 10 surgeons who assisted. The leaders of the teams were John Anderson and Butch Derrick. When we had a donor I called on Anderson and Derrick. Each team supplied one surgeon, one for the donor and one for the recipient. I also sent the fellow to be with the donor team. I had one of the team surgeons to assist me plus a resident. Thanks to this organization, from the beginning we had the manpower to do any number of transplants.

For the first couple of transplants, Tom came down from Pittsburgh to be an assistant. Tom understood that I knew that if he was in the room he would take over. Therefore, after a couple of cases, he said, “Do you want me to come in anymore?” I said, “No, you don't need to.” Tom Starzl was the driving force behind the transplant program being started. Without Tom, nothing would have ever happened. He left and I was on my own, and nothing helps you develop quicker than being on your own. I had very skilled and highly selected surgeons working with me, yet they still looked to me for leadership. Those were pretty big shoes to step into at that age.

WCR: You had been here how long when you got your first fellow?

GBGK: Arthur Moore came with me from Pittsburgh.

WCR: You started the fellowship program right away then?

GBGK: Yes, we started it from the beginning. In July, the second fellow from Pittsburgh came down, Andy Tzakis. He's currently chief at the University of Miami. He did his first 3 liver transplants here.

WCR: How many people on your staff now do liver transplants?

GBGK: We have 5 surgeons doing liver transplants.

WCR: And all of them do kidney transplants also?

GBGK: Yes. Also, all do pancreatic transplants. Early on, I recruited another surgeon, Dr. Bo Husberg, to come. I knew him from the cyclosporine trials. He came in the fall of 1985. The 2 of us developed the program. Dr. Robert Goldstein came here as a fellow, and he remained on the staff after he completed his fellowship in 1988.

WCR: How many centers in the USA now do liver transplants?

GBGK: About 125.

WCR: How many liver transplants are done in the USA now in a year?

GBGK: Close to 5000.

WCR: How many worldwide?

GBGK: I would guess about twice that number.

WCR: It's my understanding that you can take a liver out of somebody and essentially let it sit for about 18 hours and then put it in somebody else and that it still works pretty well.

GBGK: Not quite. Many things have happened since the early days in transplantation. One of these is that we have better preservation. We allow the hepatic ischemia time, the time between cross-clamp of the donor up to releasing the clamps in the recipient, to be up to 15 hours. Our average ischemia time is about 9 hours, which allows us to send the team out in the evening and then do the transplant in the morning. That, of course, makes for a huge difference in logistics, the drain on the institution, the strain on personnel, and how we use personnel. It's a well-oiled machine now. When Goldstein was here as a fellow, I did 5 livers in 2 days. Today, with the manpower we have, there are no limits. We have never turned down a donor because of a lack of manpower. We have never turned down a donor because of a lack of surgeons or hospital resources. The intensive care unit and operating rooms have always been made available at any time necessary. We have also done a transplant even when we have not had blood available in the town. In transplants we don't use much blood today.

WCR: What's the average number of blood units used in an adult man for a liver transplant?

GBGK: Four units.

WCR: You are not only head of transplantation here at Baylor, but you've set up the whole department of transplantation. You do a lot of operating. You have other responsibilities at Baylor, serving on a good number of committees. You publish a lot. You've got a lot of research projects. You are on the national and international scenes. This requires a good number of trips a year. I'm sure you go back to Sweden periodically. You still have family over there. How do you mesh the traveling into your daily activities?

GBGK: First of all, you don't have a successful man if you don't have a supportive family. My life was intense when I met Tina. She hasn't ever known any different. I've been like this from the beginning, and she accepted me for what I was. I spend less time with my family than probably most physicians, but the time I have, I spend with my wife and boys. When they were younger, they had usually eaten dinner by the time I got home. I usually came home after 8:00 or 9:00 pm and read them fairy tales. We always vacation together (Figures 10 and 11). We prefer to travel by car like I did when I was a child. We have traveled extensively around the USA and Canada. We have seen many of the national parks. We have traveled by car in Europe also (Italy, France, and Scandinavia). The time we spend together is very important to me. It's something we really enjoy. Some of the best times we have are when we are on the road.

Figure 10.

Göran, Marcus, Erik, Philip, and Tina in Venice, August 2000.

Figure 11.

Göran, Tina, Erik, Philip, and Marcus at Disney World, March 2002.

Something my family enjoys doing, in addition to traveling, is snow skiing. We do that every year. The boys and I also hunt a lot. We hunt upland birds and big game. That has been a true joy for me. It's an escape from the everyday, knowing no one can reach you. We go hunting whenever we can.

WCR: Where do you do it?

GBGK: All over the USA and also in Scotland (Figure 12) and Romania. For my oldest son Marcus's high school graduation, I took him to Scotland for Red Stag hunting. We were there a week on our own, just the 2 of us, which was wonderful. I'm immensely proud of my boys. Marcus is now a presidential scholar at Southern Methodist University. That's an academic scholarship. Marcus is going into engineering and business. Eric has his mind set on premed. He's a junior in high school now. He's stroke oar on the varsity crew team. Philip is an eighth grader. He hasn't figured out yet what he wants to be, but he is enormously interested in biology and anything to do with science. We all have fun together.

Figure 12.

Red stag hunting at Borrobol in Scotland, October 2000.

WCR: How much time do you take off a year?

GBGK: I'm pretty radical on that compared with many of my colleagues. From the very beginning, I've taken 6 weeks a year, realizing at least in the beginning that I was on call literally 24/7 except for the weeks I was off. My vacations were the time I gave back to my family. I have always been adamant about taking that time. Now, I'm only on call for half of the weekends and half the nights, which is better than I had it a few years ago.

WCR: Your oldest was born in 1982?

GBGK: Yes, in Stockholm, and Eric was born in 1985. Leaving Sweden to move to the USA was a big step. I knew by doing so that I would rob them of growing up with our extended families in Stockholm. My youngest son, Philip, was born in 1987 at BUMC. For many years we went back to Sweden every year. The family stayed for 6 weeks and I usually stayed for 2 weeks. We try to maintain Swedish customs and at the same time adopt American customs. It's a mix.

WCR: Do your boys speak Swedish?

GBGK: Yes. We've brought back Swedish children's videos and books and have libraries of them at home.

WCR: What do you speak at home?

GBGK: English. We try to speak Swedish more because the boys now want to practice it. Their first language, however, is English.

WCR: It sounds like you have quite a few interests outside of medicine. You mentioned hunting, skiing, music.

GBGK: Polo (Figure 13). I played polo for a while here, but I don't have time for it anymore.

Figure 13.

Playing polo, 1996.

WCR: You don't play golf or tennis?

GBGK: No. I never played golf. I quickly figured out that I didn't have the time to spend to become any good.

WCR: Do you have time to read much?

GBGK: Yes. I always read, mostly biographies and history. I find that to be extremely stimulating.

WCR: Tell me about Tina.

GBGK: She is as intense as I am. She is extremely focused. She was a nurse anesthetist preparing to go to medical school when the BUMC opportunity came along for me. The BUMC opportunity has allowed her to be at home with our children. She is actually very grateful for that. That's her life. She has taken charge of the home front: the house, the family, the whole works. She certainly is the one for the job. I try to pitch in when I am available to do so.

Tina is the youngest of 3 children. Her sister and brother live in Sweden. Tina has centered her life on our boys, making sure they get their schoolwork done, as well as their extracurricular activities, including scouting. She was a scout troop leader. She's been involved in helping at the boys' school, i.e., helping in the library. The kids went to Armstrong.

WCR: They don't go to Highland Park schools?

GBGK: No. For elementary school, they attended a school in the Highland Park Independent School District, which we were very happy with. We didn't like the prospect of a middle school there, however, so they now attend the Episcopal School of Dallas.

WCR: Göran, I know that you have no days that are alike, but what would be more or less a typical day for you, particularly when you didn't have as many other surgeons in your department? What time would you usually get up in the morning? What time do you get to the hospital? What time do you leave the hospital? What time do you get home? What time do you go to bed?

GBGK: The transplant service really is different from most. It requires a lot of night work. General surgeons are usually up early and get home in time for dinner every day. That is not the case for me. I get up at 6:00 am and am in the office by 8:00 am. I quickly do rounds to make sure the patients are okay. We usually have formal rounds at 10:00 am, when the results of chemical tests are back. The earlier rounds are to look at wounds and do some of the smaller procedures, like putting in lines. We expect the fellows to provide the routine care. Every round is a teaching round. We spend time discussing cases. Our rounding group includes fellows, dietitians, social workers, nurses, coordinators, and research nurses. We used to always make rounds with a transplant physician, which in those days was a nephrologist, Tom Gonwa.

Then I go to the clinic, see consults, and work in the office. At 3:00 pm, the physician making rounds sees all the x-rays, stops at pathology to see all the biopsies, and then makes the patient tour again with just the surgeons and the fellow. During the first few years, I never left BUMC before 8:00 or 9:00 pm. I made rounds 7 days a week. There are also committee meetings for patient selection each week. In addition, I have research meetings biweekly where research projects are discussed. There are several staff meetings weekly, as well as strategy planning meetings. For many years we had informal meetings (Boone Powell, Jr., John Fordtran, and myself) in Boone Powell's office to brainstorm where we wanted to take this program and where it should go. Now the strategic planning group is quite large, and we meet in a more formal setting to set the course for the transplant program. In many ways my life is like that of an emergency room physician in that few things are planned.

WCR: There's no elective surgery?

GBGK: Elective surgeries are primarily living-donor kidney transplants, reoperations, and reconstructions. Otherwise, everything is done on a semi-emergency basis. The donor calls can come any time, day or night, usually in the late afternoons and evenings.

WCR: Where do you get most of your livers?

GBGK: Few livers and kidneys come from outside Texas. In the past we flew around the entire 48 contiguous states. One time, Goldstein flew to Maine to pick up a liver and also brought back an entire cooler of lobsters. You have to be flexible! Today the organ donor territory is more restricted.

In academia, it's not my role to be the first author of the manuscripts. My tenure does not depend on my own publishing. My role now is to develop the young attending surgeons and the fellows and give them the opportunity to establish themselves. I'm totally dependent on our clinical nurses, coordinators, managers, and administrators. I empower those people to do things on their own. Actually, I expect them to think things through and then to come to me with proposals and solutions to problems that come up. I want their suggestions. I often say, “That's fine. Do it.” I involve myself in space planning, the hiring of coordinators, and in most things that affect the performance of the transplant service.

WCR: How many people are involved in your kidney, liver, and pancreas transplant program?

GBGK: Including coordinators, secretaries, research coordinators, nurses, fellows, and database personnel, probably 60 people.

WCR: How long is the hospital stay for an adult patient having a liver transplant?

GBGK: Today, our mean length of stay for a liver transplant is 11 days; our median is 7 days. The normal length of stay for a kidney transplant today is between 4 and 5 days. That length of stay was inconceivable when I started out. Honestly, if someone had suggested these time frames 20 years ago, he would have been considered a cheat, a liar, or a drunk. We developed manuals of operation extremely early on. Now they are called care plans. The routine for communicating with our referring physicians was put in place almost immediately. We constantly look for things that could make us better. We look at quality assurance and quality improvement continuously. Every treatment protocol is based on the study of something we have done. We continuously study outcomes. We are continually tweaking protocols.

WCR: Hepatitis C appears to be increasing considerably in frequency.

GBGK: Hepatitis C is the epidemic of our time. Fifty percent of liver transplants occur because of consequences of hepatitis C. This disease is one of the driving reasons that we intend to multiply the size of the hepatology service at BUMC and make it an independent division. We just hired a new director, Gary Davis, to head up that program. We've had to increase that service by several hundred percent. The hepatologists along with the nephrologists are now able to keep end-stage liver disease patients alive for weeks, which of course allows more time to obtain a donor liver.

WCR: Are you training enough transplant surgeons? Are there too many right now? I guess you can't really predict how big this hepatitis C epidemic is going to be.

GBGK: We train enough surgeons in the USA. The limiting factor is the amount of donors. Any time I make a decision on a recipient, I have to know that the patient has a reasonable chance of survival with a good quality of life; otherwise, this donated organ could be better used in another recipient with better chances. This conflict is inherent in what I do.

WCR: How many patients do you keep in the hospital or very close to the hospital because they need a liver transplant as soon as the donor organ becomes available?

GBGK: Because of logistical tweaking, we don't keep many patients close by because we can get them here quickly from far away. We usually have about 20 patients from far away living close to the hospital. These patients do not make their home in the Dallas–Fort Worth area. We set up and organized the Twice-Blessed House, which is for pre- and posttransplant patients, in 1986.

WCR: Göran, you're still a young man. You are 52 now. These past 20 years have been pretty vigorous. They've been not only mentally challenging but certainly physically challenging. Few people who have gone through life doing just emergency operations for practical purposes.

GBGK: I hope not.

WCR: Good athletes retire sometimes. What are your desires and goals and objectives for the next 20 years?

GBGK: My ultimate goal is to be able to gracefully age with Tina and enjoy our time together. Right now we are in the throes of an enormously exciting development. We are opening up a whole new unit in Fort Worth at Baylor All Saints Hospital. That is the most important development since the start of the transplant program at BUMC.

WCR: You are going to do liver, kidney, and pancreas transplants there?

GBGK: Yes, and I hope to eventually get heart and lungs done there as well. This will virtually be an extension of BUMC. We will have full-time surgeons and physicians there. We will move the Grapevine kidney transplant program over to All Saints Hospital.

WCR: Grapevine now transplants only kidneys?

GBGK: Yes. All Saints will have a full-service program, and Dr. Marlon Levy will supervise it. Dr. Natalie Murray will be the lead hepatologist. She will also move there full time. We expect to get that program started within a few months. This will be an enormous development. We will have all the same protocols; we'll just have more patients. In 1995 we combined with Children's Medical Center and The University of Texas Southwestern Medical Center to form the Dallas Liver Transplant Program performing both pediatric and adult liver transplants. That was an extremely important development for me personally. It is essential that we have a strong pediatric transplant program in Dallas.

WCR: The pediatric liver and kidney transplants will be done at Children's Hospital?

GBGK: They are done there now. We are not involved in their kidney transplants, only livers. The individuals in charge of the pediatric program are Dr. Jay Roden and Dr. Robert Squires. All Saints is the latest expansion for Baylor Health Care System.

Transplant has been one of the most important things to happen at Baylor in the past 20 years. I believe it will continue to be so. Another step is to set up the pancreas islet cell transplant program here at BUMC. We are finishing the building of our good manufacturing practice lab. We now have the funding for the transplant immunology research chair to work together in the immunology and oncology research area with Jacques Banchereau. The impact of this cannot be overestimated.

One of the biggest challenges I've had in the 17 years that I've been here is the fact that we are in a playing field that is thought to be exclusively for medical schools. Acceptance by the academic institutions has been a major priority for me. Developing a reputation for a private institution, albeit with a postgraduate teaching program, is difficult for those in academia to accept. Some people don't accept it to this day. When submitting manuscripts for publication, we sometimes get negative comments from reviewers with only a fraction of the insight and experience that we have here at BUMC; they let us know they view us as inferior because we aren't a medical school. The real leaders of the transplant world (be they in France, Germany, England, or in the USA), however, see us as peers. It is the smaller and less successful programs that don't want to admit that we are their peers.

We have come a long way on our quest to becoming accepted. Our results are second to virtually none. Our scientific output in clinical sciences is among the very highest in the business. We publish more than most “academic transplant programs.” We have a very high profile. We had an attending surgeon here, Dr. Ernesto Molmenti, who interned at Washington University and did a transplant fellowship at Pittsburgh. He was at Baylor for only about 2½ years. Last July he was hired as an associate professor of surgery at Johns Hopkins University. This proves that our program is becoming acceptable to major academic institutions.

WCR: You do liver, kidney, and pancreatic transplants. You run very successful research programs. Of the things you do, what do you enjoy the most professionally?

GBGK: That's a difficult question. I enjoy performing surgeries. I really enjoy the liver transplant that seems impossible, just for the challenge. I enjoy making rounds and taking care of patients. I enjoy the science. To me the euphoria, the high, is not when you find the answer, but when you find the appropriate question to be asked.

WCR: You enjoy the variety?

GBGK: Yes. I enjoy it all.

WCR: How much sleep do you need to feel good the next day?

GBGK: It has changed. Early on, I could be here literally for 3 days and nights and then I needed a full night's rest to be alert. Routinely, if I got 4 hours of sleep, I did well. Nowadays, if I work through the night, it takes me 2 nights to recover. That's a big difference. Now I normally require 7 hours of sleep. I go to bed between 10:00 and 11:00 pm. We eat kind of late as a family. We eat at home between 7:00 and 8:00 pm. I'm rarely home before 6:00. I'm usually home about 7:00 pm.

WCR: Is there anything else you'd like to discuss?

GBGK: When you asked me how long I saw myself going on as I have, the answer is that I don't know. It depends on what kind of help I have, help I can trust in every aspect: clinically, surgically, and administratively. I hope I can pull back some in about 10 years. I have had inadequate time for Tina and for the boys. I want more time to enjoy the finer things in life.

You asked me of what I am most proud. I'm immensely proud of my family, what Tina has accomplished in spite of all my absences. Professionally, there's nothing I'm more proud of than the transplant program at BUMC. That's the fruition of all that I've worked for. It involves the science, the clinical services, etc., as well as developing a vision of what's to come. That's an important part.

WCR: Göran, I want to thank you not only for myself, of course, but for the readers of BUMC Proceedings for pouring your soul out here.

GBGK: You are welcome.