"I recognized that one of the ways to get into the black communities is going to the church and this is an area I was comfortable with. So we started an effort in the District of Columbia, actually myself and Dr. James Bayton, who was an eminent psychologist. After we got data from the South Eastern Organ Procurement Foundation that indicated that African Americans were rarely donors but in contrarywise were more likely to have hypertension, kidney disease, diabetes, and therefore 60%, 70% of the patients on dialysis in the southeastern part of the United States were African Americans. So this seemed like something that I could be involved with and go and make a difference."
Clive O. Callender, MD, FACS, is Professor of Surgery, Howard University College of Medicine. Following undergraduate studies at Hunter College in New York, he went on to medical school at Meharry Medical College and then an internship at University of Cincinnati. He did his fellowship at Howard University and Freedmen’s Hospital, where he later became director of the transplant service. In 1973, he helped develop the first minority directed dialysis and transplant center and histocompatibility and immunogenetic laboratory in the United States. In 1991, Dr. Callender founded the National Minority Organ Tissue Transplant Education Program (MOTTEP) to increase minority donation rates nationally. He was an early member of ASTS, joining in 1975, and has served on the the ASTS Membership, Standards, and Ethics committees, as well as the Advisory Group of the National Living Donor Assistance Center.
Dr. Peters: I’m Tom Peters, Historian for the American Society of Transplant Surgeons, and speaking with me today is Clive Callender, Professor of Surgery at Howard University. Welcome, Clive.
Dr. Callender: Thanks Tom. Good to see you again.
Dr. Peters: Okay, tell us a little about your early years and your interest in medicine as it grew and what it is you did in those times.
Dr. Callender: Well actually at the age of seven while I was in church, I heard a sermon that suggested that the best thing to do would be a doctor of medicine, dealing with the bodies of mankind, and also the souls of mankind. So, at the age of seven I wanted to become a medical missionary, and so that began my quest to do what I’m doing now. Things emerged differently than I would have planned. For example, I contracted pulmonary tuberculosis at the age of 15 and I was in the hospital for 18 months, and a little of that seemed kind of difficult to deal with. It actually was something that enhanced my life in many ways.
While I was in the hospital, I read the Merck Manual from cover to cover in spite of my ignorance, and I read the American College Dictionary from cover to cover, and so those things kind of enhanced my life. In addition to which, I took exams that indicated that I had the ability to do whatever it is that I wanted to do in my life. And so, when I ran into obstacles along the rest of the course of my life, they paled in significance to what I dealt with. I also had a lobectomy when I was 15, and being in the hospital for 18 months was an interesting way to begin my teenage years, but it was something that prepared me for the rest of my life.
Dr. Peters: Was that in Washington?
Dr. Callender: Actually, I grew up in New York City and in Harlem and I was in Otisville Sanitarium for much of my life. Had my surgery at Metropolitan Hospital and had my lobectomy there.
Dr. Peters: And then your college and medical school.
Dr. Callender: After I finished high school, after I got out of the hospital and went back to high school, finished there, I went to Hunter College and did my undergraduate work there. And in spite of my kind of mediocre beginnings, because my first two years in Hunter College I didn’t do well as a student--I had about a 1.8 out of 4 average, which wasn’t desirable, and few felt that I really would wind up becoming a physician. But I had faith in God, and my belief in God is what kept me through it all. And this then resulted in my getting into medical school at the end of four years of Hunter College in spite of only having a 2.5 out of 4 average. But I was actually one of the first in my class accepted into medical school.
Got into medical school and had in mind becoming a medical missionary and then felt that being an internist was my gift, but as I did my externship in Dayton, Ohio, I encountered a surgeon who operated on his patient who was dying from GI bleeding and the result was that the patient was out of the hospital in five days. That was an epiphany for me which indicated that I really wanted to be a surgeon. And so from that point on I spent the rest of my medical training going into surgery. Did my surgery first at Howard University, the old Freedmen’s Hospital in Washington, DC. I think it was around there that I finished my surgery and decided that I wanted to go into a field of medicine that was challenging, but first I wanted to do my medical missionary work which was my life’s dream.
Because of the fact that I encountered a medical student who identified a problem in Africa and that there was a need for somebody like me there, I was blessed and as soon as I finished my residency at Howard University I got the opportunity to go Africa and have my life’s dream come true. And I worked in Port Harcourt, Nigeria, for 9 months. However, while I was there I lost 40 pounds and so it seemed to me that this was an interesting beginning for the rest of my life but that maybe this wasn’t where I needed to be.
So after 9 months, I came back to the United States and had an interview with people from the National Institutes of Health, and they wanted minorities to go into post-doctoral fellowships. And one of the opportunities was to go into transplant. It was a field that I knew nothing about, but I knew that there were very few minorities in transplantation and that this was an exciting area of surgery. General surgery was a field that I felt didn’t challenge me. I thought I could do more than general surgery, and so this was an opportunity that came along and I thought I would like to try that.
So, when I came back I did find out that I could get a post-doctoral fellowship at the University of Minnesota with John Najarian. But before I did that, I wanted to go back to Africa to give it another try and so I went back for three months and I lost 20 pounds, got malaria, and decided that maybe my life was not to be in Africa. So after that I decided to come back to the United States. I did my transplant fellowship at the University of Minnesota with John Najarian and Richard Simmons, and it was there that I met Sam Kountz, who was the first African American transplant surgeon. He was there to give a lecture and I met him and from that point on we had a friendship that allowed us to interact. While at the University of Minnesota, Eduardo Santiago-Delpin was my mentor along with Luis Toledo-Pereyra. Those are people who played a major role in my life in terms of developing as a transplant surgeon.
After completing my training at the University of Minnesota, I came back to Howard University Hospital, Freedmen’s Hospital, to start a transplant program and I think it was there that I met you. You were at Walter Reed, I believe.
Dr. Peters: That’s right.
Dr. Callender: Because you and Jimmy Light were there. Of course that actually reminds me of the fact that the first African American transplant surgeon was Sam Kountz, but Joe Alexander was at Walter Reed also who was probably the second African American transplant surgeon; I’d followed them into transplant surgery.
I started a program at Howard University there in 1974 and between 1974 and 2010 we developed a transplant program that did liver and kidney transplants.
Dr. Peters: Was LaSalle Leffal the chair when you went back to Howard or did he become the chair afterward?
Dr. Callender: When I went to Howard, Burke Syphax was the chair and Burke Syphax was followed in 1970 by LaSalle Leffal, who was my chair until I took over as chair in 1996. So my mentors at Howard were Burke Syphax, LaSalle Leffal. They were the ones who actually helped me become the surgeon that I became before I went into transplant surgery.
Dr. Peters: Your professorship is named after Dr. Leffal.
Dr. Callender: The first, yes, LaSalle Leffal Professor and Chairman. I was the first LaSalle Leffal Professor and Chairman at Howard University. It was an honor that I will never forget.
Dr. Peters: There were some interesting initiatives that you took, initially in the community of Washington, DC.
Dr. Callender: It was interesting. When I returned to Howard University and Freedmen’s Hospital, it became clear to me as we developed a transplant program that one of the biggest problems was the lack of donors, which remains the biggest problem today. But in particular was the lack of minority donors, especially African American donors. Because of my religious background, it seemed to me that it was a very logical thing for me to become involved and to do something about it. As I talked to people, they thought it was an impossible problem to deal with, that African Americans were reluctant to become donors and so that this was something that was an impossible task. However, I recognized that one of the ways to get into the black communities is going to the church and this is an area I was comfortable with. So we started an effort in the District of Columbia, actually myself and Dr. James Bayton, who was an eminent psychologist. After we got data from the South Eastern Organ Procurement Foundation, which you know about, that indicated that African Americans were rarely donors but in contrarywise were more likely to have hypertension, kidney disease, diabetes, and therefore 60%, 70% of the patients on dialysis in the southeastern part of the United States were African Americans. So this seemed like something that I could be involved with and go and make a difference.
We first talked with the South Eastern Organ Procurement Foundation (SEOPF), but they ran out of funds, so as a consequence Dr. Bayton and I went to Howard University and got a grant for $500, so we could go into the African American community of DC and to find out why it was that blacks were so reluctant to become donors.
With $500 we were able to develop a study. Dr. Bayton was an eminent psychologist, and we paid about $50 to some 40 people from the District of Columbia which included one donor and one recipient, and the rest were people from the community. And we had a survey tool with the psychology students that asked them why it is that they were reluctant to become donors and their take on what was going with transplantation. And the information we got from there was very important because it answered the question why it is that African Americans were reluctant to become donors. We identified the five reasons.
The first was the fact that they were unaware of the problem that African American was more likely to have kidney disease than other ethnic groups. They were unaware of the role they could play in transplantation by becoming donors. They had religious misconceptions, forgetting that it is in giving that Christ came and gave his life, so that it’s in giving that we receive and it’s in pardoning that we are pardoned, it is in dying that we are born to eternal life. So it is the right and proper thing to do. So the religious misgivings were addressed.
Then there was fear that if I give them an organ, or I become a donor, they might be more interested in getting my organs than with saving my life. The premature declaration of death was a concern. Then fourth, it was the fear that if I sign a donor card and I give my organs that they will go to whites rather than to blacks and that I would be used as a guinea pig. Finally, fear about racism that if I leave my organs that they’ll only go to white people. Now this was in spite of the fact that at Howard University, 70% of the donors, at that time, to our black patients were white, and so this then was the opportunity to identify the five reasons why blacks are reluctant to become donors and then to identify a program to do something about it.
And what was key to us was the observation that of the 40 people we analyzed and surveyed, when we started this, only two out of the 40 would sign a donor card. But at the need of our surveys and sessions all 40 signed donor cards. And we realized that this may be the key to making a difference and turning people’s ideas around about transplantation, and with this in mind, we started the DC organ donor program. This program which began in the District of Columbia was successful and doubled the number of African American donors there. And because of that success the Dow Chemical Company, which at that time had developed Agent Orange--that was a publicity nightmare.
So, they needed something to do to turn around that image, and so they decided they would develop a Dow Chemical Company Take Initiative program to go across 25 cities across the United States and this program would heighten the awareness of the need for black donors. Because of the success of the DC organ program, they then got monies to pay for GolinHarris, which was the public affairs corporation that took me across 25 cities in the United States to talk to the mass media about what we could do to have African Americans more involved in donations and transplantations.
The success of both of these programs was such that a Gallup Poll analyzed our efforts and indicated that the number of African Americans who signed donor cards and who were willing to become donors had tripled as a consequence of our efforts. With this in mind, with the success that we had from both of these, the DC organ donor program, the Dow Chemical Take Initiative program, we then conceptualized MOTTEP, the national Minority Organ Tissue Transplant Education Program. And MOTTEP’s goal was to do exactly what we did in the African American communities, which was thought to be impossible, and to do the same thing in all the minority communities.
So in 1991, we then worked with John Ruffin, in the National Institutes of Health, which allowed us then to get grants between 1993 and actually 2010, which gave us some $16 million that allowed us to develop MOTTEP sites in some 15 states across the United States of America. Now what was miraculous about this was the fact that when we started this effort back in the 80’s, African American organ donors per million was in the vicinity of 8 organ donors per million. By the time we accomplished our mission in the 2000’s, that number had gotten up to 30 organ donors per million. As a matter of fact, in a study that we conducted in 2010 that looked at NIH data, we realized that we are going from the bottom to the top and that African Americans in 2010 were the number one ethnic group that donate organs in the United States of America.
So in many ways I have seen many miraculous things happen in my life. I overcame tuberculosis, I was able to become a doctor, became a transplant surgeon, and then the MOTTEP was so successful. I think the only thing that I value even more in my life than what happened in MOTTEP was the efforts I made in terms of addressing the inequities of organ allocation. Because when I first started, I felt that the UNOS and its plans were discriminatory against African Americans. They knew about the HLA antigens in the white group, but they didn’t know about all the antigens in the African American. Yet the allocation schema was based upon the white knowledge of HLA antigens.
Over time, with my work with Dr. Tom Starzl and others, we were able to change that around so that the use of HLA antigens, in matching, became fair across all races. And so I felt the role I played in trying to get equity into allocation for all ethnic groups has played a major role in getting to where we are today. Most recently I think the last bridge to that occurred when we went from allowing waiting time to be used only when you start on dialysis. That’s when your waiting time starts. In the past, waiting time started when the doctor placed you on the transplant list. And many minorities didn’t get on that transplant waiting list until they’d been on dialysis 10 and 20 years. That was an inequity that I think we’ve overcome.
In my lifetime I’ve been blessed to see many things happen positively. We’ve seen the minority donation rate triple, we have seen allocation become almost equitable as it is today, and so I’ve been blessed in many ways. I think that the fact that I’m 81 years of age now and have lived to see these miracles come to pass is something that I can never thank God enough for.
I wore many hats in ASTS. I didn’t talk about them but I wore many hats. I was chairman of the membership committee; I had a number of hats that I wore in the ASTS. I was one of the charter members of ASTS in 1975 and John Najarian and Richard Simmons and Sam Kountz helped me to participate in the running of ASTS in terms of being a member of the committee that dealt with the membership, which was of course one of the most important committees.
Through the years I have been able to participate in just about all of the ASTS meetings. From way back in the days at the Drake, when there were just maybe a couple hundred of us together. I remember those days most wonderfully because we had such a tight-knit group and we worked together as one. In those days there was no concern about race, ethnicity, or anything; we were just transplant surgeons who were working to do our best. Those were the days of Peter Medawar and all the giants that we knew: Tom Starzl, Roy Calne, and the giants at Harvard, Murray and the rest of them. So we grew up and those were the guys we presented papers to and those were the guys we had criticism from and those guys who mentored us and helped us to become who we are today.
And I think all of that is part and parcel of what helped me, because what I did when I went to the meetings at the ASTS and other meetings was to talk about the problems we were encountering: why African Americans needed to become part of donation because the shortage of donors was the number one problem in transplantation. Like it is today.
It seems as though in the future it’s going to be stem cells and editing of genes. Xenotransplantation will help us, along with genetic re-engineering. They will help us overcome the donor shortage in the next 10 years. I hope to see some of the dreams become reality so that we don’t have such a huge waiting list with 20 people dying every day because of the shortage of donors, and this of course is my dream that in the next 10 years or so it is going to come to pass. I think with the groups like ASTS and groups interacting with the community and the rest of the United States, this dream will become a reality.
Dr. Peters: You mentioned your travels and you may recall my partner Ken Jones. At the time I think you and Ken and maybe one or two others were the leading black transplanters in America.
Having a partner who was a highly talented transplanter and a very well-spoken member of the black community was a great advantage to my program, I can tell you.
Dr. Callender: I always wondered about whether or not you missed Walter Reed and the times in DC.
Dr. Peters: After 25 years, I was ready to retire from the Army.
Dr. Callender: Did you have any interactions with Joe Alexander when he was there?
Dr. Peters: No.
Dr. Callender: He was before you. Okay, it was interesting because he went back and took over the chairmanship at Martin Luther King and actually never did any more transplants after he left Walter Reed. And so that Sam was really my predecessor in transplantation who actually ran transplant. I got a chance to work with him at Downstate with Khalid Butt and so we worked together before his untimely death. Interestingly he died from complications of hypertension, with him dying at the age of 50, right at the prime of his career.
Well you know, there are some questions that you asked that jogged my memory. As a transplant surgeon, I don’t know that I think much of my successes, but I remember a couple of my failures. I remember there was a patient I had, who I had a full antigen match. I did a transplant on that patient and I never ever understood why the kidney never worked. That’s something I remember all my life, that’s one patient I’ll never forget and I never understood why a full antigen-match kidney would not work, in spite of everything I did.
Dr. Peters: Those were the days when we only identified four antigens, it was a perfect match.
Dr. Callender: I’ll never forget that case, and you know as I think about the time I spent as a transplant surgeon, you know very well that we take care of our patients from the beginning to end and then again some with the families and everything else. And when I did my first transplants at Howard University the first six weeks--because I was the first transplant surgeon, didn’t really have anybody else who knew about transplant--I spent the first six weeks in the hospital.
I have a wife and three children and so when I was writing my autobiography, I asked my son to write a chapter about me. His chapter was entitled “Where’s Dad?” and so it was sobering to me, but it shows you that in my life my patients came first. If I had to do it over again, I would spend more time with my family. I think that’s the area I sacrificed most. My first thing was my God, my transplant patients, and then my family. One day I said to my wife, she asked me if I’d do anything differently and tragically I said no. I’ve paid for that for the last 10 years. And she reminded me what a lousy husband and dad I was.
And so I dedicated my life to transplantation and to my patients and to my God and so I think that, that’s the only thing I would change in my life. I’d spend much more time with my family than I did.
Dr. Peters: Do you have grandchildren?
Dr. Callender: Two sons, two grandsons who are now teenagers.
Dr. Peters: Are they in DC?
Dr. Callender: They live in Maryland outside of DC, so I see them often. And my twin brother who is a judge and a minister has been kind of my right hand all along and has helped me along the way. In the beginning nobody believed I would ever be a doctor, my family included, because I wasn’t a good student. I had my faith in God and actually I got into medical school because my church sponsored me, so that in those days my twin brother, my sisters, my dad, all felt that I was dreaming, but lo and behold my impossible dream came true.
And I guess we loved what we did, and it was a joy to work. And in many ways I’ve never worked a day in my life because it’s been fun, and I don’t mean that sacrilegiously. I mean I enjoyed operating; I enjoyed everything that I do.
Dr. Peters: Oh, the best two hours in the world is putting a kidney in.
Dr. Callender: Right, and seeing urine produced.
Dr. Peters: Yeah.
Dr. Callender: And we’d see the family the next day, and the weeks thereafter. It was really thrilling and exciting and rewarding.