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3 top surgeons on short list for UPMC transplant chief

| Sunday, Oct. 5, 2008

At least three leading surgeons have emerged as candidates for transplant chief at the University of Pittsburgh Medical Center, the Tribune-Review has learned.

Administrators should pick a tough manager and an innovator, someone who, above all, could carry on the legacy created by pioneer Thomas E. Starzl, transplant experts said.

"Once upon a time, it was Pittsburgh," said Dr. Jeffrey Punch, transplant director at the University of Michigan Health System and a regional councillor for the United Network for Organ Sharing.

"They sort of owned the market. In a lot of places in the world, if you needed a liver transplant, you had to go to Pittsburgh for it 20 years ago. Now you can get a liver transplant in lots of places."

Candidates for the job include Dr. Pierre-Alain Clavien, a top Swiss surgeon who developed a widely used scale to measure organ transplant complications; Dr. Abhinav Humar, head of the live-donor transplant program at the University of Minnesota Medical Center; and Dr. J. Wallis Marsh Jr., a longtime UPMC surgeon who has been interim chief for seven months.

Each has ties to live-donor liver transplants, the controversial field espoused by UPMC's recently departed transplant chief. Clavien and Marsh have been involved in what UPMC officials called a broad-based, independent study of complications in those surgeries at the center. The study results are expected to be submitted soon to the New England Journal of Medicine.

UPMC officials declined to comment on the search.

"When we have something to report, we will do so," said spokeswoman Maureen McGaffin.

Dr. George Mazariegos, chief of pediatric transplantation at Children's Hospital of Pittsburgh, believes UPMC has an opportunity to move the program forward.

The person who wins the job of running the Thomas E. Starzl Transplant Institute will take over the program following the abrupt departure of former chief Dr. Amadeo Marcos in March, as the Tribune-Review prepared to publish an investigation into UPMC and other hospitals performing unnecessary liver transplants.

Marcos, who headed the transplant center since 2004, said he stepped down for personal reasons.

At the time, UPMC announced the review of complication rates in its live-donor liver transplants.

"Repairing your image is not something you do overnight," said Dr. Goran Klintmalm, past-president of the American Society of Transplant Surgeons. "There is no easy fix."

For UPMC, selecting the right leader will be crucial, said Klintmalm, who studied under Starzl and is chief of the Baylor Regional Transplant Institute in Dallas.

"It's going to take someone who can make clear that everybody knows internally what the rules of the game are from now on," he said. "Will they put a liver in a patient (at the bottom of the waiting list) just because they have a liver floating around• This is about internal medical policy."

UPMC, whose transplant program has expanded to a hospital in Sicily, could benefit from someone with an international standing, Klintmalm said.

Clavien interviewed here in August with top UPMC administrators.

Clavien, surgical chair at Switzerland's University Hospital of Zurich, declined to talk about UPMC's selection process.

"This is rather an honor for me to have been contacted by UPMC, as I am sure they can attract many top national and international people," Clavien said in an e-mail.

Clavien is a well-respected surgeon, as well as a researcher whose team has focused on how to improve the liver's condition after it is removed from a donor's body. He served as transplant director at Duke University in Durham, N.C., in the late 1990s.

"His name offers credibility so he can attract good faculty," Punch said. "If he brings stability, maturity and a high-level management style to the program, his name would mean something to people looking for jobs."

Humar, with less management experience and fewer clinical research credentials, could bring a fresh perspective to UPMC. He avows a transplant philosophy based on innovation, clinical research and successful outcomes -- rather than quantity.

"If you can maintain a very high quality, the volume comes as a part of the high quality," Humar said.

Humar has been medical director of the University of Minnesota's living donor transplant program since 2000. The center performed 24 live-donor liver transplants last year, the nation's second-highest total and five more than UPMC.

Humar said he generally advocates not performing liver transplants on patients ranked at the bottom of the waiting list according to a score known as MELD, for Model End-stage Liver Disease.

Low-MELD transplants should be performed only in cases in which the patient has cancer or some other severe symptom that is not reflected in their score, he said.

Humar had not been to Pittsburgh before his interviews. With its "incredible infrastructure" and ancillary services for transplant patients, UPMC "is a powerhouse and certainly would continue to be a powerhouse for many years to come as far as I could see," Humar said.

"My take on the program is that it certainly has a well-established reputation," Humar said. "The program has taken on some problems, but nothing that's not fixable."

Humar had his first sit-down conversation with Starzl last month. Humar said it was an "enjoyable chat" and described Starzl as "very warm, almost fatherly."

UPMC's next transplant chief will need the authority to take over, said Dr. John Lake, director for liver transplants at the University of Minnesota Medical Center. Starzl, 82, continues to exert influence even though he has not performed surgery since 1991 and in February announced his retirement.

"They probably need to have somebody come in who's going to be a strong leader to tie together the components of a transplant center to take over from Starzl," Lake said.

He described Humar as an "absolutely outstanding surgeon" whose "patients adore him." The University of Minnesota is seeking a surgical transplant director, and Lake said Humar is the leading internal candidate.

Marsh, who was appointed interim chief March 20, completed a fellowship under Starzl in 1985. He joined the faculty of the Washington University School of Medicine in 1989, and returned to Pittsburgh four years later.

Marsh worked alongside Marcos as UPMC established its hospital in Sicily, where 136 transplants were performed last year. He continues to be a critical part of that hospital's living-related liver transplant team.

Marsh has performed more than 500 liver transplants. His area of research focuses on improving transplant outcomes among patients with early liver cancer.

Marsh is quiet and soft-spoken, the opposite qualities typically associated with surgeons, said Dr. Sydney Finkelstein, a former UPMC surgical pathologist who co-authored several papers with Marsh. He described Marsh as moral, ethical and religious.

"He's extremely smart and knows the field very well," he said. "He is a very stable kind of person, a person who will follow through. He would be a leader who wouldn't be rushing in and out but someone who would take the time to understand problems."

Marsh did not return calls or e-mails.

"It's a difficult place to lead," said Dr. Cosme Manzarbeitia, Pennsylvania's regional councillor for the United Network for Organ Sharing. "It's extremely complicated, and Starzl is still in the background. You need someone who knows how to navigate those waters."

Pierre-Alain Clavien, M.D., Ph.D.

Current job : Professor and chairman, Department of Visceral and Transplant Surgery, University Hospital of Zurich

Education : Medical degree from Geneva Medical School, Switzerland, 1982; Ph.D., Toronto University, 1992

Work experience : Several appointments at Duke University in North Carolina dating to 1994, including director of Transplant Program from 1998 to 2000

Research : Developed the Clavien Scale, used to measure complications in live-donor liver transplants; 140 peer-reviewed articles

Recognitions : Recipient of the Otto Naegeli Prize, awarded to a scientist in Switzerland, for contributions to biomedical and clinical research

Source: Swiss Medical Weekly

Abhinav Humar, M.D.

Current job : Surgical director for liver transplant, medical director for the Living Donor Transplant Program, professor of surgery at University of Minnesota Medical Center, Minneapolis

Education : Medical degree from University of Ottawa, 1988; residency, University of Ottawa, 1988-1996; fellowships, University of Western Ontario, 1996, University of Minnesota, 1996-1998

Work experience : Staff physician, Fairview University Medical Center, since 1997

Research : 119 peer-reviewed articles, 298 abstract presentations

Recognitions : Selected as a Top Doctor in Minneapolis-St. Paul Magazine

Source: University of Minnesota

J. Wallis Marsh Jr., M.D.

Current job : Interim chief, division of transplantation at UPMC Thomas E. Starzl Transplantation Institute

Education : Medical degree from University of Arkansas, 1979; general surgical residency at St. Paul Hospital, Dallas, 1984; surgical fellowship in kidney transplantation at Mayo Clinic in Rochester, Minn.; master's in business administration from University of Pittsburgh, 2001

Work experience : Joined faculty of Washington University School of Medicine in St. Louis in 1989; joined University of Pittsburgh School of Medicine in 1993

Research : Areas of interest include improving outcomes of transplantation in patients with liver cancer; more than 100 peer-reviewed articles

Source: UPMC

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