Bliss was it in that dawn to be alive, But to be young was very Heaven!
—The Prelude, by William Wordsworth
Twenty-five years ago, with more than a little trepidation, Baylor decided to develop an organ transplantation program. This decision was risky because Medicare did not pay for liver transplants at that time—they were considered experimental—and some thought that such a program would bankrupt our hospital. In spite of the risks, the president of Baylor University Medical Center, Boone Powell, Jr., decided to go forward with this unlikely venture.
As I'm sure you all know, Göran Klintmalm was selected to design, develop, and direct the Baylor transplant program. That was in 1984, when Göran was only 34 years old.
In spite of his youth, Göran was chosen for this position by Dr. Tom Starzl, Baylor's patron saint. Tom had many of his ex-trainees to choose from, most of whom lived in the USA and were more readily available than Göran, who lived in Sweden. I remember exactly the three reasons why Tom said he chose Göran instead.
He was an excellent surgeon and would be highly respected by other Baylor surgeons.
He had outstanding organizational talents, rare in a physician.
His wife, Tina, would be a terrific asset. We would, in essence, be getting a two-for-one deal.
None of us at Baylor had met Göran, but we trusted Tom Starzl's advice, and Göran was hired for the job. The first time I met Göran and Tina, I knew immediately, at the very first glance, that we had made a good selection. Never had I seen a more attractive and charming couple. I knew they would be well liked at Baylor.
There were, of course, hurdles to jump, and much work was needed to get the state of Texas to approve his appointment. We had to prove that there was no one in the USA who could do the job, and it was difficult and time consuming to get the state to appreciate his extensive previous surgical training, since requirements, licenses, etc., are so different in the USA and Sweden. Most of the time it seemed that we were in a Red Queen's race.
Fear of the unknown was by far the major problem. No one at Baylor knew anything about organizing an organ transplant program, and here we were turning everything over to an unknown 34-year-old who was not from Dallas, not even from Texas. There were naysayers, as there always are when you superimpose such an ambitious program into an already very busy hospital. There was a major fear that liver transplant recipients would require so many blood transfusions that there would not be enough blood for open heart surgical procedures. Some complained that Göran was too young and too inexperienced in the ways of being a Texan to succeed at Baylor and that no one could establish a successful transplant program in a hospital that was not owned by a medical school. Göran had a PhD as well as an MD, suggesting to some that he was too much of a researcher to fit in with practicing physicians. Besides, Göran was born and raised in a relatively small country that traversed the Arctic Circle. He wouldn't last through one summer of Dallas heat.
But the naysayers did not know about Göran's heat tolerance, and they totally misjudged the attitude of many of the young surgeons at Baylor, who were eager to be part of both the clinical and research aspects of the transplant program. With enormous support from Jesse Thompson, who was chief of surgery at Baylor, Göran created teams of young surgeons to help him. There was a team for the donor and a separate team for the recipient. Göran and his teams were also embraced by physicians in other departments, and numerous members of a dedicated support staff were brought in. With these people working together, under Göran's strong leadership and close attention to details, a real transplantation center was developed.
There was another problem. Although there were many patients in our region dying of liver failure, very few were referred to Baylor, or to anywhere else, for liver transplantation. This was mainly due to the mindset of most practicing physicians who did not know about the high success rate of liver transplantation since the advent of cyclosporine. Liver failure patients were expected to die, as they always had, and referral for liver transplantation was not even considered.
Since Göran was new to this part of the country, he asked several of us to travel with him and introduce him to various medical societies in other Texas cities and in neighboring states. Göran used these trips to get to know the territory, to make friends, to show the world that Baylor was creating an academic transplantation service, and above all to change the mindset of physicians about the modern treatment of liver failure. These trips were highly successful, and referrals poured in. And from the very outset the results for transplant patients at Baylor were outstanding.
I am certain that Göran does not feel a need for us to emphasize his accomplishments. The real payoff to him is not what others think and say but instead the day-by-day joy that comes from creating something original. A revolution in the treatment of organ failure started in the early 1980s. Any physician who played an active role in the dawn of that revolution was truly blessed by the inner satisfaction that healing the sick and preventing death always bring. But to have been a young physician leader of that revolution must have been heaven, as the opening quote suggests. And there is not much that anyone can say or do to add to that. However, I want to try.
Göran has consistently improved the well-being of patients with organ failure who come to Baylor for their care. He extended the Baylor Dallas transplant program into Fort Worth at All Saints Hospital, with the dedicated help of Marlon Levy. A major and extremely successful and unique offshoot of the transplant program—treatment of liver tumors—has been developed by Bob Goldstein. Dr. Klintmalm has also been responsible for bringing an outstanding group of hepatologists to Baylor, under the direction of Gary Davis. These physicians are part of the transplant program and also part of the internal medicine department at Baylor, and we in internal medicine are very proud of them. And of course there are many outstanding nephrologists, pulmonologists, and cardiologists who help make kidney, lung, and heart transplantation so highly successful at Baylor.
As you all know, Göran and Baylor are now recognized internationally as having one of the finest kidney, liver, and pancreas transplant programs in the world. Baylor was the third US program to do 2000 liver transplants. Göran is a transplantation superstar, both in terms of his surgical skills and in terms of the outstanding research and teaching that he has done and continues to do. Like his mentor Tom Starzl in the 1980s, Göran is now the one who wrote the book on transplantation. His program has trained many fellows, some of whom now head organ transplant programs throughout the USA and in other parts of the world. Honors from outside of Baylor abound. He was elected to the American College of Surgeons, an honor rarely given to those who did not train in the USA. He is the incoming president of the American Society of Transplant Surgeons. He is considered a visionary for his establishment of organ transplantation in a freestanding not-for-profit hospital. He was invited to return to Sweden to head up the transplantation program at the Karolinska Institute, home of the Nobel Prize, but he turned down the offer to remain at Baylor. The very high national ranking that Baylor enjoys in digestive diseases is in a major way due to the reputation of Göran Klintmalm.
I won't attempt to list the many other honors that Göran has received, but rather I want to try to put his accomplishments into the context of today's Transplant Reunion picnic in this lovely park. In this setting, what Göran accomplished reminds me of what a band leader would have to do to create music. Like in a musical band, in a transplant band every person has to play his or her role correctly and stay in step with a highly respected leader (Figure). More specifically I have in mind a marching band, like the one in the play and movie The Music Man. In that movie, Professor Harold Hill, a man of questionable integrity, promises a town in Iowa that he will create a marching band that will uplift the spirits of the townspeople and be the envy of other small cities.
Figure.
Dr. Klintmalm displaying the drum major's baton that Dr. Fordtran (right) presented at the conclusion of his tribute at the 20th Annual Transplant Reunion.
There are several similarities between Professor Hill and Göran Klintmalm. Both were in foreign places and had to learn the territory. Both had to sell their idea and change mindsets. Both had trouble getting their credentials approved. Both had to face and overcome naysayers. Both had incredible style and charisma, although only Göran wears Italian suits. Of course, there are other differences. Harold Hill didn't know a note of music; he was a spellbinder and was able to mesmerize and beguile the town. In contrast, Göran was an honorable man who knew every detail of transplantation. But both of them were highly successful, both were and are larger than life, and both enjoyed every minute of their work. Professor Harold Hill promised a marching band, and Göran Klintmalm promised a transplantation program. Both delivered on their promises.
As a marching band lifts the spirit with rousing music, Göran and his “transplant band” have made music in the form of hope to the parents of sick children, freedom from dialysis and insulin injections, a breath of fresh air for patients with cystic fibrosis or heart failure, and a second chance for sick people to be fully healthy and therefore to have a shot at reaching their potential in life.
As I mentioned earlier, in 1984 we had to prove to the state of Texas that Göran was the only person in the world who could successfully develop an organ transplant center at Baylor Hospital in Dallas. I don't know that we really believed it at the time, but I believe it now.
Göran, it has been an honor to deliver this paean to you, and I am especially pleased to have done it before this particular audience—which I know is more precious to you than any other audience could be. We ask that you now come forward with Tina and with all of the Baylor transplantation physicians in your band to receive one gift from Baylor and another from me on behalf of the internal medicine department at Baylor, which we give to you with great admiration and much affection.