Organ transplanation has become so commonplace that references to it often border on the blasé. But cutting an organ out of one human body and sewing it into another remains fraught business — for recipients, living donors, their families and doctors, too.
Pittsburgh Tribune-Review investigative reporter Luis Fabregas weighs the full cost in his new book, A Transplant for Katy (Fourth River Press). The book traces two intersecting stories. Katy Miller was a vivacious Indiana County college freshman with a degenerative liver disease. In 2005, she became the first patient in a new protocol devised by revered transplantation pioneer Thomas Starzl. The protocol was designed to avoid the use of potentially life-threatening anti-rejection drugs. But Miller's case ended so poorly that it finally called into question the very idea of live-donor transplants.
In a phone interview, Fabregas says he wrote the book "to make sure [Miller] didn't die in vain."
Fabregas, a native of Puerto Rico, is a Duquesne University grad who's reported for the Trib since 1999, mostly on medicine. Transplant emphasizes the trust Miller and her family had in UPMC's physicians: "They came to the best-known transplant center in the world, and she was told this was going to change transplantation."
Starzl, meanwhile, was in Fabregas' words "obsessed" with getting patients off immunosuppression drugs. And the transplantation boom he helped launch drove the demand for liver tissue, leading to increased use of live donors (who can give a portion of their livers).
Live donation was championed by UPMC's then-transplant chief Amadeo Marcos, who did Miller's surgery. In Transplant, Marcos is the most controversial figure: It's unclear whether he's more motivated by helping patients or by the desire to grow UPMC's prestigious and profitable transplant program.
Starzl raised alarms about Miller's case, but Marcos didn't listen, Fabregas says: "That's what's disturbing, that they couldn't work together to solve the problem." (Marcos no longer works at UPMC.)
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Fabregas notes that greed and professional "hubris" played a role in the decision-making. But he is careful about apportioning blame. "I never wanted this book to be anti-transplantation," he says. "You can't paint transplantation with a wide brush ... but this is a cautionary tale."
While he concludes, in hindsight, that Miller's transplant wasn't necessary, her own family still believes in transplantation as well, he says.
"I still believe UPMC has the best doctors in medicine," he says. "The question is what motivates some of those doctors."