"I just think that transplantation is such a wonderful field because it covers so many different areas, and mentorship is important, teaching is important, we need to continue this. We need to be able to help people."
Frederick Merkel, MD received his medical degree from the Johns Hopkins University and, following training in general surgery, ultimately established his practice of transplantation surgery at Rush-Presbyterian-St. Luke’s Medical Center in Chicago. A founding member of the ASTS, Dr. Merkel was known for his attention to the organization of early Society meetings. Dr. Merkel served as the 5th ASTS President in 1978 - 1979. At that time he called for improvements in organ sharing and expansion of the Society into fields other than kidney transplantation.
Frederick Merkel: I’m Frederick Merkel. I’m a transplant surgeon in Chicago and I got involved in transplantation very early in my medical school career. I went to the University of Cincinnati for my undergraduate training and then I managed to get a scholarship to Hopkins. But I needed some extra money and so I was looking for a job and they told me that they were giving some grants to students who would work in the animal research lab and actually, during the summer, and not too many students were interested in doing that, but I took the job because I needed the money and I really enjoyed working in the animal lab. The director of the lab was Vivian Thomas a black man that had been brought to Johns Hopkins by Dr. Alfred Blalock who was the head of surgery there and Vivian was actually the one who had done the research on the Blalock Taussing Shunt for tetrology of fallot, which had made Dr. Blalock America’s surgeon. So he taught me how to operate and apparently I did quite well because he told Dr. Blalock about me and so Dr. Blalock called me in and said, “Dr. Merckel, how would you like to do some experiments in transplantation?” And being young and not knowing too much I said, “sure why not.” And so he said, “all right, I think I’d like to have you and Vivian transplant lobes of liver in dogs.” And that’s how I got started.
By the time I was a senior I was transplanting lobes of liver in dogs by myself with another assistant and so I was deeply involved in transplantation. And additional impetus was the fact that Roy Com, who was doing some work in Boston came down and gave us a talk and said he had done 60 or so kidney transplants in dogs and about four of his dogs had survived for long periods of time so we were very excited about that and that impelled us to continue our experiments.
Randall Sung: And how did you wind up in Denver?
Frederick Merkel: Oh, that’s a long story, but I’ll try to make it short. Dr. Blalock was going to retire in two or three years after I would graduate, so when I went to see him about an internship he said he thought it would be better if I went and interned with his favorite protégé, Dr. William Longmire in Los Angeles. And so I went there and Dr. Longmire eventually turned over his lab and let me continue the liver, the lobe of liver transplant experiments and when various notables would come by to visit he would sort of trot me out and have me explain what I was doing. I might tell you a funny incident, two days after I arrived at UCLA, I think it was about July 2nd or 3rd. I was an intern and as you probably know, interns in those days just stayed on the floor, they did everything to help the professor, they did all the scut work. In those days we did the labs ourselves, we did our CBC’s, that is, and we quickly got the chemistry results and we had everything ready when the professor would come and he was, he was really the emperor or king.
I was, interns never went to the operating room, and I was paged to the operating room. And the operating room doors at UCLA were like the bar room doors of old, they went back and forth and you could back your way through with your hands all scrubbed and not contaminate them. Well as I got down to the operating room, I saw Dr. Longmire, the enraged Dr. Longmire who was apoplectic, throwing a blond resident through the doors and screaming “don’t you ever come back,” and he never did. That was the end of his career at UCLA.
And so Dr. Longmire looked at me and said, “and who are you?” And so I meekly said, “well, I’m Fred Merckel.” He said, “where are you from?” I said, “Johns Hopkins.” So he softened a little bit and I added that I was a medical student two or three days ago, I’ve just started my internship. He said, “well you’re all I’ve got, scrub in.” So I scrubbed in and we, I managed to help him without too much trouble and so at the end of the operation he said, “well you are going to help me with my next operation.” And that was going to be a hernia. And so he said, “Merckel, what do you think this hernia is, what kind of a hernia is it?” And not knowing anything I said, “it’s an indirect inguinal hernia,” because I did know that those were the most frequent hernias. He said, “you’re wrong, it’s a direct hernia and I’ll show you why.” So I said fine and we scrubbed and he made the incision and then he said, damn and a few other things and said, “you’re right, it’s an indirect hernia.” And so he threw the knife, the scalpel down at me, turned around and walked out the door saying, “you fix it if you are so smart.” I, I had no experience whatsoever, other than having scrubbed, you know, as a student at Hopkins.
So I asked the nurse to call for the chief resident who was a fellow named Randy Blakely. And Randy was quite an advisor to me, helped me finish the residency with this fairly volatile chief. And, Randy said, “well I can’t do the operation, you’ve got to do the operation because the chief told you and he gets very angry if we don’t follow his instructions.” So he said, “I’ll help you.” So we did the surgery and the patient did well. Dr. Longmire then took a shine to me. My life after that at UCLA was much better.
Randall Sung: And then you wound up at Colorado?
Frederick Merkel: Oh, well, how did I get from there to Minnesota, or to Denver? Well, then Dr. Longmire actually let me do a lot of surgery on his private patients very early on. By the time I was a second year resident I was doing some of his hepaticojejunostomies and some of his pancreatectomies which was somehow unheard of, but he, I guess he had trouble finding somebody he could relate to and I did manage do things technically well and as my mentor Randy said, you know, never go to the operating room with Dr. Blalock not knowing how to do the operation yourself, study up, ask questions, see me, but don’t go in and expect him to like it if you don’t know the answers. At any rate, he did trot me out to show the visiting firemen what we were doing and one was from Minnesota and the next thing I knew Dr. Wogenstein asked me to come there and be their first transplant fellow. I went there. The first year I was supposed to be a transplant fellow, but there were four doctors on four different services, Richard Liliha, Bill Kelly, Richard Varco, and Joe Aust and each one was doing transplants, each one in their own way, with their own protocol and they were each doing about four or five a year. And no one wanted to give ground. So for a year I had to do general surgery until they made an accommodation and Bill Kelly became the head of the Transplant Program. On the clinical, so I started helping Dr. Kelly and I soon learned how to do transplants and I was doing some of the transplants and Dr. Kelly was doing some of them, and Rich Liliha and I did transplants together as well. I saw that the diabetic patients with renal failure were being excluded from pancreatic or from kidney transplant because everyone thought they would get the same disease back in their kidneys if they didn’t have a new pancreas and at that time there was no way of doing pancreas transplants in animals that were successful in all the experimental studies that were being done the grafts thrombosed and in a very short order. In
fact, we had two people, Felix Largidae and then Yosu Itazuki who were fellows and they each did several hundred pancreas transplants with a success rate of about 4 or 5%. So the professors were unwilling to start pancreas transplant in man. My idea was rather than anastomose the pancreatic vessels why don’t we intersperse the pancreas into the blood supply going to and from the leg so that we would have blood supply to and from the leg keeping the anastomosis open rather than the very little blood supply that goes to the pancreas. That worked very well. I did, my colleagues and I did 27 straight pancreatic transplants in dogs with no thromboses, and all the dogs, all the pancreas transplants worked and worked for significant periods of time.
So one day Bill Kelly called me and said, “we are going to do a human pancreas transplant, would you come and show us how to do it?” And so I went up to the operating room and Bill and I put the pancreas in and we did a body and tail of the pancreas transplant and unfortunately the donor wasn’t very good and it failed. And then the next transplant was done by Rich Liliha and me and I did the donor and then Rich and I did the recipient and it was a pancreaticoduodenal transplant and that worked very well. It was the first, we did that in addition to the kidney transplant, so it was a kidney pancreaticoduodenal transplant, and we brought the duodenum out onto the skin in an ostomy fashion. At about two weeks after that the patient developed a rejection and the rejection involved the kidney, the pancreas and the duodenum. So this was the first time anybody had seen duodenum reject. It was the first time we had seen a pancreas reject and so we treated the dog, I mean the patient with prednisone in large doses just like we had done the animals in the lab and we reversed the rejection of all three organs.
So Bill and Rich decided that I would present this case in Paris at the first meeting of the Transplant Society and Tom Starzl was a friend of Bill Kelly’s and he had come and seen what we were doing and had invited me to come to Denver. Now one thing that Dr. Blalock said to me which I’ve told all my students and residents was that never stick to one particular research project. If you are going to do research pick three, at least three different projects to work on because one may work and another may not. And so in addition to the pancreas transplant project I was working on an ALG and so I had been out to see Tom Starzl’s ALG program. So when I went to Paris to give my talk Tom was there and he introduced me to some of the people he knew and then I had to give my talk. And I got up and I couldn’t speak, I was absolutely, I had never given a talk before a large group and I just could not talk at all. And the moderator was Sir Peter Medawar and on the stage was Tom Starzl and Woodruff and Armriga from Paris, all these people who had started transplantation and I, I just couldn’t say a word.
And so Peter Medawar said, “drink this glass.” He gave me a glass of water. He said, “Drink this and then tell, give us your talk.” So I gave the talk and then, and then that was it. After that, I had been talking ever since. But after the meeting Tom said, “When you finish your residency why don’t you come and spend some time with me.” And during my training at UCLA one of my other mentors there also told me about Tom and his work. So when I finished I went to Denver and I was a young attending, I was made head of transplant at Denver General Hospital which was Ben Eisman who was quite a character and then at Colorado General with Tom Starzl and he was quite a character too.
Randall Sung: Dr. Kleinbaum wouldn’t forgive me if I didn’t ask you to tell the story about the chimp.
Frederick Merkel: Oh, well there are, there are a million stories about Tom Starzl and all the things that happened. But this one was, I was with him for about 14 months before I moved to Chicago to be a coordinator and assistant professor in transplantation at Northwestern. And, and I had, one of the things that did happen with Tom. Tom, at that time, was doing most of the surgery, but he and I did a pancreas, kidney transplant and shortly after that he called me one night and he said, “Fred come in, we are going to do a real interesting transplant and I said, “well what is that.” And he said, “Well, it’s a liver.” The third liver transplant on a kid that he had transplanted two times before and was losing the second liver. So I said fine and I came in and he sent everybody into the recipient room and said, “You guys get started and get the liver out and I’m going to do the donor.” Well, that was totally unlike Tom. He normally would do the operation on the recipient and so we went ahead and of course it was an easy job because the second liver had only been done a couple months before and so it didn’t take us very long to get everything freed up and so I said, “I’m going to go across and see what’s going on with Tom.” And I walk in the room and Tom is operating and I don’t recognize his assistant and I look at the patient and the abdomen looks just a little funny. So I walk to the head of the table, it was a chimpanzee, and that was the first chimp to human liver transplant that was done. Unfortunately, it didn’t go well. The patient bled out on the table and died on the table. So, there was some humor there, but of course, it was a sad outcome.
Randall Sung: Can you describe other memorable moments in your career?
Frederick Merkel: Oh yes, well, there are a lot of, some of the memorable moments involve doing transplants, some of them involve teaching, mentorship, I think thinking about problems, important problems and somehow balancing my career with a love of music that I have. And so, I don’t know exactly what you’d like, but I can tell you an interesting experience. I was born in Greece and we had to leave because of the Nazi’s, but when I got into transplant I went over to Athens and helped them start a transplant program in Athens. The surgeon was a fellow named John Homatas who had done some work with us in Denver. He had come over, as had probably hundreds or maybe thousands of fellows who could come through the operating room. Some of the operations in Denver went 20, 30 hours and Tom needed a lot of fellows to do the retraction for all that time. So, I had developed a good relationship with them and we decided that we would try and help them. Now in those days tissue typing was thought to be quite important in transplantation and it probably was, but with that in mind, often there were kidneys that couldn’t be used and we tried to place them all over the country. I was one of the first to have a coordinator and we would have the coordinator call all the programs and sometimes these kidneys just didn’t get transplants. So I arranged with John Homatas to give, to bring kidneys to him that we couldn’t use. In fact, my wife went off and would fly over with these kidneys. One time I had a donor that had a left renal vein that was retroaortic and as you probably know a retroaortic renal vein sometimes gets very thinned and flattened out because of the compression of the aorta. And so it can be just like tissue paper and very difficult to work with. We couldn’t place it in the states and I called John and he said he would take it only if I would fly over. They would pay my way, but I had to come and help them do the operation. So I said fine, so I flew to Frankfurt and then Frankfurt to Athens with a kidney. We were met by an ambulance which drove at 110 miles per hour through the narrow streets of Greece. I told them stop, go slowly, it’s not that emergent and finally we arrived at the hospital. We went up and John said, “A terrible thing has happened, they have
changed the rules, Fred, and you can’t operate.” And I had operated with them a number of times when we were getting the program started. So I said, “all right, can I come and watch,” and he said yes. Well, John was a bit heavy handed and when he sewed the kidney in and took the clamps off it bled like crazy and so he shouted, “Fred scrub in, I need help.” And I said, “but John I don’t have a license.” And he said, “it doesn’t matter anymore.” And so I scrubbed in and that patient is alive today. Now my wife June and I were, my wife gave me a birthday trip for my 70th birthday to Athens and so I gave a lecture at the University and Alkis Costacas who is the one who started the work with Cyclosporine in Roy Calne’s lab was now the head of transplant. So after my lecture we went up to Alkis’ office and we were sitting there and in came two patients. One was a patient from Athens that I had transplanted in Chicago about, it must have been 20 years ago and the other was a girl that Alkis had transplanted 20 years ago and they had found each other and gotten married and they brought us gifts. So it was really wonderful. So we’ve had a lot of wonderful, fun times in transplantation.
In terms of mentorship, one of my protégés is a liver transplant surgeon now and I was going to go to give a lecture in Spain in Pamplona and he had been a student there and so I called him up to find out a little bit about things and he said, “Fred,” he said, “I was just now looking up two pictures, the only two pictures I have in my office, one is my professor from Pamplona,” and he said, “guess who the other one is?” And so, you know, seeing, seeing your protégés do well and enjoying a repertoire with them is always a wonderful experience.
Randall Sung: That’s really wonderful. You were the driving, I have to ask this, you were the driving force behind the creation of the ASTS.
Frederick Merkel: Well, I, I had a lot of help. First of all…so your question is I was the driving force in forming the ASTS and I would say certainly that was the case, but I had a lot of help. There were four of us that really got together and divided up the task of getting the transplant surgeons in America to come. And one of them who did a lot was Aaron Bannett who was the head at Einstein in Philadelphia, a very intelligent and mature fellow. He was much older than the rest of us. Another was Russ Lawson who was the one that started the transplant program in Milwaukee and then, and then there was my, my mind is, my brain is failing me here, but the transplant surgeon from Wayne State, Jerry Rosenberg and we each divided up tasks. Jerry Rosenberg wrote up some rules and bi-laws for the organization. Russ Lawson got it incorporated and he also developed the insignia of the Chimera and then Aaron Bennett was assigned persuading Tom Starzl to be our first president. And that was quite a task because Tom wasn’t really sure that we should have a society at first, but Aaron was very persuasive and so then the society got started. And we did have the first three dinners at my house and there were a lot of funny stories that were attacked to that.
Randall Sung: Is there anything else that you’d like to talk about?
Frederick Merkel: Well I just think that transplantation is such a wonderful field because it covers so many different areas and, and mentorship is important, teaching is important, we need to continue this. We need to be able to help people. I would say that, that the joys that I got from transplantation were great and I did maintain a strong interest in music. I play cello and for many years I had a chamber music group. We actually, for the third meeting, which we had a big tent for the dinner out in the backyard and I had a full orchestra and soloist, a well known soloist who had soloed for President Kennedy come and solo for our organization and a wonderful dinner by Chicago’s most famous chef and we had 320 people at that dinner and the year after there were too many people, so we had to have the dinners downtown. But life has been wonderful. As others have said, it’s hard on the family, it took, I’m so happy my wife worked with me because she understood what I was doing, she knew I wasn’t going out to the bar with the boys when I was working, I was working at two in the morning, you know that, I’m sure you do the same thing, but you do have to find a balance so that you can have family life and some interests, I think, in the arts and transplantation.
Randall Sung: Terrific, thank you so much.
Frederick Merkel: Thank you.
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