"I remember when it [ASTS] started. I presume it was 1974. I had been in business for four years by then…most of us were founding members of ASTS and knew each other professionally. It was a great camaraderie in those days. A small group, and of course, it’s grown now. And I think by size, we’ve lost a lot of our personal relationships that we used to have."
Robert McCabe, MD, trained in general surgery as early programs in organ preservation and transplantation were just beginning. Ultimately joining St. Luke’s Hospital in New York City, Dr. McCabe, a charter ASTS member, pioneered both clinical kidney transplantation and the development of kidney preservation through machine perfusion. A groundbreaking innovation, machine preservation allowed for kidneys to be kept viable for several days. In an unusual episode, Dr. McCabe actually transported recovered organs on a preservation machine from New York City to Italy where they were successfully transplanted. His efforts to expand organ preservation ultimately led to the development of more wide-spread organ sharing and technical advances in pump perfusion of kidneys.
Robert McCabe: I am Robert McCabe. I started transplants in 1961 at St. Luke’s Hospital in New York. I got into transplants by my chief …He said, “ I want you to tackle this project.” So that got me started. And I went and visited Dave Hume, and Dave said, “What you’re going to do isn’t going to work,” and I didn’t believe him, but he was right. It didn’t work. But that was the beginning. And that I had an NIH grant, which supported kidney research, more on hypertension than…than transplant immunology or things like that. But I really got involved in clinical transplantation when a member of our board of trustees gave us one of those big, huge, Belzer perfusion machines, and I was assigned to learn how to use it. So, I took it apart, put it back together, learned how to use it, did a half a dozen dogs with success. And then I think it was 1971, we did our first clinical preservation in New York City. I think it was the first machine preservation in the city, although Cornell may have beat me out by a month or two. I can’t remember. But that got me started in clinical transplantation, and I stayed active in it until I retired at age 65.
Randall Sung: What were your biggest challenges back then?
Robert McCabe: Getting enough organs. Also, we had medical-legal problems with the medical examiners, who obviously wouldn’t give us permission to take the organs of a gunshot wound to the head. We I had problems with the nephrologists, not willing to risk their patients to the dangers of a transplant, and in those old days, with Imuran and prednisone only, the mortality and morbidity was much higher than nowadays, of course. So, nephrologists, who have to hang onto their patients, and that’s why we often had kidneys we couldn’t use in New York City, because the patients were sequestered in the nephrologist offices, or in the dialysis units, and our lists weren't accurate enough for us to unders--- to know whether they were transplantable or not or whether they were too sick. And sometimes, we’d call a patient up and they had already died. So, there were lots of problems and those early days which have been corrected now with the organ recovery programs and the transplant units around the country. And of course in those early days, that was SEOPF only, and New York was not a member of SEOPF. So, we weren’t as…nearly as well organized in the New York area as they were in the southeast, with SEOPF in particular. And we always wanted to join SEOPF, but I don’t think they wanted us. I don’t know quite why we didn’t get in it, but that was life in those days.
Randall Sung: So, you had to do it in New York by yourselves?
Robert McCabe: We did it by ourselves in New York. There were six transplant units in New York in those days; still are, I think, and we were competing with each other rather than working together. But luckily, since I had the preservation machine, I could get the kidneys, and then I could do what I wanted to do with them, which was tried to give one to the donor hospital patient and the other go to the community. But of course, those rules were all changed in subsequent years, and I think that was to the disadvantage of the transplant units, because the incentive for donating organs was not as …there was nothing to gain by a hospital giving a kidney or finding a donor for us if one of their patients wasn’t going to benefit from it. And I think many of us in transplant feel the same way. And maybe it’s more acute now with the livers. I’m not sure what’s the status in that is now. But I know the rotation and the distribution of livers is quite different than it was in my days.
Randall Sung: Aside from the opposition that you had from the nephrologists, there a lot of other people that were skeptical of transplantation as you are developing it?
Robert McCabe: Well, I think some of the religious people were. I think brain death was difficult for… a concept that people had difficulty accepting, and that was particularly
true with the country coroners, where automobile accidents occurred or gunshot wounds occurred, and the coroners were very skeptical. And the tort lawyers were equally concerned about whether the surgeons were killing that patient or whether the perpetrator of the accident or the perpetrator of the gunshot had killed that person. Of course, through the years, that’s in all resolved, and now, it’s a foregone conclusion. If it’s a gunshot wound to the head, and the patient is brain dead, we get the organs. We used to have to wait three or four days; now, I think you can get them in 24 to 48 hours easily, and so it’s a whole different ballgame. And of course, what always happened in our days, and we’d hear about a donor on Tuesday or Wednesday, and we couldn’t get the neurologist to declare brain death. They were some of the skeptics too, frankly, and they would not declare brain death until Friday afternoon at a 5:00, when they were tired of caring for the patient and wanted us to take over. So, we would be busy every weekend, and that was …that was our life in those days.
Randall Sung: What was a typical day like for you back then?
Robert McCabe: Busy!
Randall Sung: [laughter]
Robert McCabe: Because we had our regular patients to care for. We had our dialysis patients to care for. We had the transplant recipients to care for. We have emergency room at the hospital, which was always keeping this busy. Of course, it supplied us with organs too. But it was…There was no such thing as an eight-hour day in those days, or no such thing as a five-day week either. And I always told our residents that, “Half your patients get sick with the complications at night or weekends. So if you really want to learn something, you’ve got to be there more than eight hours a day.”
Randall Sung: How was the typical experience for a patient different then compare to now?
Robert McCabe: Well, I think a patient in those days knew who his doctor was. I’m not sure a patient today knows who is doctor is. I think it’s different. They have hospitalists and nocturnists and all those now, caring for patients, and there are so many specialists involved in caring for a patient, they may not know who their primary physician is in the hospital. I don’t know. I had been a patient, a year and a half ago; I don’t know who was caring for me either. But that happens.
Randall Sung: You must have some memorable moments. Do you have any…any particulars that…that stand out in your mind?
Robert McCabe: Well, I think probably, the most exciting moment was when we had a pair of kidneys in New York that we couldn’t use, and so we put them on Alitalia, with Belzer’s machine, and flew them over to Rome, where we transplanted them over there with Professor Cortesini, and then we went flying across the Triborough Bridge in a taxicab. Not in a taxicab; in an NBC or a CBS News car, and the poor guy went flying through the toll…without ever paying his toll, and I was sure the police were going to get after us, but we got to…not… Alitalia, and flew them over, and I got to Rome the next morning about 6:00, and the attack dog wouldn’t let me through the gate because he smelled something suspicious in the kidney machine. But finally, a member of Dr. Professor Cortesini staff showed up and got us through the police dog problem. But then, we had a terrible ride with a police escort through the streets of Rome at commuter time, and that was a horrible experience, and the machine was bouncing up and down, and I wasn’t sure the kidneys were going to survive the cobble streets, cobblestone streets that we were going across. And the perfusate was frothing up,] but they got there safe and sound. And Cortesini used them both. They both functioned immediately. Went and saw the patients the next day, and it was a real pleasure to see those two patients, both urinating, both kidneys functioning immediately, hadn’t been on the preservation machine for 48 hours by that time. Cortesini was familiar with our work in New York; so he know what he was getting in for, and he’s a very astute clinician, and a very wonderful man. And he let me pick the two patients that I thought should get those two kidneys, and one was an older man who had been on the list for several years and was in his late fifties, early sixties. And I said, Professor, if he doesn’t get this kidney, he’s never going to get one. So, he got it, and everything went well, and it was a very gratifying experience.
Randall Sung: Any embarrassing moments that you remember?
Robert McCabe: I guess, getting stuck in a mud hole with the police department.
Randall Sung: [laughter]
Robert McCabe: And I have a copy of The Daily News with my picture on the front page, pushing the police car out of a mudhole. The kidney was in the back seat, and…we’d flown by police helicopter from Brooklyn to New York City, and they had parked the car…in a grassy area in the springtime, and…and they got the thing stuck in the mud, and they couldn’t get it out. So, The Daily News somehow found out about it, and there I was, pushing that police car out of the mudhole. If anything can go wrong, it does.
Randall Sung: That created a big storm.
Robert McCabe: A big storm on the front page. And then there was a big storm on the front page of The New York Times, with my picture on the front page of The New York Times on the Fourth of July. I think that was 1978, when we’d gotten…we’d gotten a couple of kidneys from Moscow, and they were transplanted…I think one went downstate, and one at ups---- at …up in the Bronx, and they both did well, but they’d been on ice for 48 hours before we got them. But we perfused them for time enough to do the transplant, get the cross-match done and then get the transplant done, and that was an exciting time too. Because I knew nothing about this. So I went to work in the morning. There were police, reporters … police cars and reporters all over the place, waiting for those things to come in. And Aeroflot was in business in those days. So we could share with Moscow. Of course, Jimmy Carter put Aeroflot out of business in the States, and that ended that…that relationship, which was a very cordial relationship. But, there was no need for that. We should have been able to use those kidneys at home, but we weren’t organized adequately in New York City to use them all locally, or in the States themselves. We shouldn’t have had to go that far. But, the nice thing about it was, it created publicity for the transplant program and got people interested and the people and backing us and helped us with getting more kidneys for transplantation. And of course in those days, that’s about all we were doing in New York were kidneys. And then, Tom Starzl came to town one day, and he was written up in Life Magazine, taking a pair of kidneys out of my hospital in New York City, and the liver was in one hand, and we had the kidneys in the others, and that was a big, big spread on Life Magazine in the days when Life was still, still around.
Randall Sung: That never stopped anyone in New York from trying to start a program.
Robert McCabe: [laughter]
Randall Sung: I wanted to ask how transplantation has affected your life.
Robert McCabe: Well, it kept me busy. Intellectual stimulation was particularly keen. It kept me in the poorhouse, that’s for sure. I think it was all very challenging in the early days. It was a real pleasure in the early days. Challenging always; intellectually challenging in particular. Innovative in many ways, because all of us were learning how to do things. There were no teachers in those days. We were the…We became the teachers, and it was very satisfying in the first 10 or 15 years, and then, it got to be a…a burden, because the work was always nights and weekends, and there was no family life. But I think … I don’t regret having gotten in it at all. It was something that was very satisfying, to see a patient get off the dialysis machine. Of course, we weren’t doing livers; we weren’t doing hearts. We’re just doing kidneys. And many of my residents were always very impressed to see that kidney pink up when the clamps came off, and that was very satisfying to all of us in the team to…and especially to see a little dribbling coming out of that ureter before we implanted it; very satisfying. And it’s a great career.
Randall Sung: Could you talk a little bit about the…your experiences with the ASTS, particularly when it was starting?
Robert McCabe: Well, I remember when it was started, and I had to look it up. I couldn’t remember the date. So I presume it was 1974. So I had been in the business for four years by then, and Starzl was the moving force behind it, I think, at least as I remember. And I don’t know who else was pushing it, but Starzl in particular wanted it to be a group of surgeons, discussing surgical problems, free of the immunologists, who always wanted to talk about immunological problems. They were too esoteric for surgeons to be involved in, really. And There were a group of us; most of us had some affiliation with SEOPF, either actually members of SEOPF or familiar with SEOPF and working with them or attending their meetings and so on. And I don’t remember…I asked today. And Pat was at the Hyatt Hotel, but I thought it was…I think it was an outgrowth of…of a…of a then College of Surgeons clinical forum perhaps, that it began. I’m not quite sure. But it’s just, most of us who were founding members of ASTS knew each other professionally. So it was a great camaraderie in those days. A small group, and of course, it’s grown now. I was surprised to hear that the transplant conference is 4,000, and of course, it outgrew the Drake Hotel in four or five years, six years. And we had it… had the meeting in Chicago for one reason. It was centrally located, and everybody in the country could get there. And now, it’s all over the place, and people still get to it, but it’s…it’s…it’s such a large organization now that the individual comeraderie that we were so proud of has grown to what? Four thousand now, with …with the surgeons and the immunologists and all of the groups together in one big meeting like we’re having now.
And SEOPF, I think, was…It was a great organization. Everybody knew everybody. Everybody trusted everybody. They had the tissue-typing people, who worked closely with the surgeons. They had the nephrologists, who worked closely with the surgeons. And I think by size, we’ve lost a lot of our personal relationships that we used to have. But then, this filming that we’re doing now, today and tomorrow, I think will help bring us back to where we were 30 years ago, or about 30 years ago; 35 years ago.
Robert McCabe: [laughter] SEOPF was South. The short letters for Southeastern Organ Procurement Foundation. It was based in Richmond, Virginia. And I can’t think of the man’s name who was the founding father of it. But he is called “the gray haired fox.”
Randall Sung: Gene Pearce.
Robert McCabe: Gene Pearce. Thank you. That’s just who it was. And…and…ASTP sort of grew out of SEOPF and sort of grew out of the surgeons who were members of SEOPF but had other affiliations also besides just SEOPF, but SEOPF was the predecessor, really, to UNOS, United Network Organ Sharing, and many of the ideas that SEOPF had were adopted by UNOS.
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