The work life of an international transplant specialist, McGowan Institute faculty member Amadeo Marcos, MD, chief of the transplant division at the University of Pittsburgh Medical Center Thomas E. Starzl Transplantation Institute, and professor of surgery at the University of Pittsburgh School of Medicine, was highlighted in the latest issue of Pittsburgh Quarterly. Described was his commute to his ISMETT operating room--ISMETT, an acronym from the Italian for the UPMC-managed Mediterranean Institute for Transplantation and Advanced Specialized Therapies, in Palermo, Italy--and his work performing living-donor liver transplants during his 4-day-long visit which he makes every 6 weeks.
Living-donor transplantation is a growth industry on the rocky island, which is starved for usable cadaver organs to transplant. “Now when we arrive,” Dr. Marcos says, “they are already telling us about the next three or four pairs of patients who are scheduled for the next time we come.”
Pittsburgh Quarterly described that although UPMC administrators had no official strategy for global expansion, interest in the idea of branching out into Europe had been brewing. Hospital physicians, particularly transplant surgeons, were already treating patients from some 30 countries in Oakland. That population would thin following the Sept. 11, 2001, terrorist attacks and bombings in Europe and elsewhere when fewer foreign patients began entering the United States for medical care — a development of no small consequence given the fact that most of them arrive at American hospitals able to pay the full cost of expensive procedures in cash. Also, new rules governing how U.S. donor organs are allocated tightened the supply available to patients coming from abroad.
In Italy, there was a clear demand for transplantation, a UPMC specialty. The Italian and Sicilian governments were solidly behind the UPMC-managed ISMETT venture, willing to commit public funds to cover the cost of renovating a temporary home in an existing public hospital and, a few years later, put up $58 million to build a new 70-bed high-tech facility.
Last year, ISMETT surgeons performed 152 solid organ transplants of all kinds — liver, kidney, heart, lung and pancreas — pushing their 7-year total above 600. More important to patients, the center's survival rates for all organ transplants exceed the national averages. Ninety percent of their liver transplant patients survive at least one year, higher than Italy's average one-year survival rate of 86 percent. Also, fewer transplant candidates die while waiting for their surgeries. Those outcomes have helped make ISMETT the place to go for the seriously ill, so much so that openings are scarce and the waiting list is long.
More than 40 percent of ISMETT's liver transplants are of the living donor variety. By comparison, such procedures account for about 20 percent of the liver transplants done by UPMC's Pittsburgh surgeons. This complex process is made possible by the liver's capacity to regenerate and involves two major operations: one to remove 50 to 60 percent of the donor's healthy liver; the other to transplant that section into the ailing recipient. Unlike the United States, Italy requires that living donors be related to the recipient and they get court approval before going under the scalpel. Despite such legal protocols, doctors say, there is no shortage of donors willing to offer a piece of their liver to a family member, which has helped ISMETT's living-donor liver program to become the busiest in Europe—a transplant program which keeps Dr. Marcos continually crossing the Atlantic.
Illustration: McGowan Institute for Regenerative Medicine.
Pittsburgh Quarterly (Winter 2008)