"We introduced such things as, monitoring education programs, keeping track of what was going on in terms of results…and we always had a very good time."
Jeremiah Turcotte, MD, was Professor Emeritus in the Department of Surgery at the University of Michigan Medical School. Dr. Turcotte received his medical degree from Michigan and trained there in surgery as well. With a career entirely devoted to that University, Dr. Turcotte rose to Chair its Department of Surgery after starting its transplantation service. A founding member of the ASTS, Dr. Turcotte served as the 6th Society President in 1979-80. During his presidency he sought to refine requirements for graduate medical education in transplant surgery, and he expanded the number of committees and committee members to reflect the increased needs of work by our Society. Dr. Turcotte also served numerous other organizations in a leadership capacity, including the United Network for Organ Sharing which he led as President. He passed away in February 2020.
Jeremiah Turcotte: I’m Jeremiah Trucotte from the University of Michigan where I have been my whole career and I have much enjoyed my association with the American Society of Transplant Surgeons since its beginning.
Goran Klintmalm: What was it that pulled you into transplant? What made you go that route?
Jeremiah Turcotte: Well, it wasn’t any great career decision. It was circumstantial. The chairman at Michigan at the time I was in my surgery residency was Gardner Child and he decided to introduce a research year into the residency program and a good friend of mine and I were the first two chosen. We really didn’t know whether we were being promoted or demoted or what, but my friend, Bob O’Neil, graduated from Harvard where they had done a few kidney transplants so he was familiar with transplantation and he decided his project was going to be in transplantation. Mine was going to be in portal hypertension working with Dr. Child and we worked together of course and we were good friends and we lived next door to each other and we helped each other with the experiments. So as that went on through the year I got more and more interested in transplant and about the time I finished my surgery residency Dr. Child decided we should do our first kidney transplant and low and behold there wasn’t anybody else around that any experience with transplants so he and I did the first kidney transplant after six months after I finished my residency. So it was not a grand plan, it was just the way things worked out.
Goran Klintmalm: Can you tell us when this happened?
Jeremiah Turcotte: It happened in March of ’64. I finished my residency in July of
’64, or July of ’63, July of ’63. March 30, 1964 was an identical twins, their names were Ottenbacher, and they were 15 years old. We had a surprise in the operating room. In those days angiography of the renal vessels was considered too risky so we did not have an angiogram on the donor and of course when we got the donor kidney it had two renal arteries which made things a little more complicated but we had done quite a number of those in the lab so I suggested to Dr. Child, well just sew them together and we’ll sew them. Everything went well and those two twins are still alive. They both got married, they both had four children and they both became nurses. So we have them back with some frequency when we have a large event at the University. So from there, of course, transplant grew, interest in operating on patients with portal hypertension diminished and that’s also the way my career went. So that’s the way it all worked out. I think Gardner Child may have had some thoughts about it because he fairly routinely sent me to the meetings put on the New York Academy of Sciences and the Ceba drug company in New York City which I think were very important in simply setting the whole tone of transplantation because they weren’t large, they were like 150 people from all over the world and they are a mix of scientists and clinicians and they had people like Peter Medawar and other world famous immunologists and the same on the surgical side.
So right from the start the scientists and the surgeons and the internists were working together. And that’s kind of the way that transplant has matured and that was a major attraction for me that people got along and they introduced a lot of science into the whole practice. So that’s a long answer, but they sort of fit together and demonstrates that not everything is a grand plan.
Goran Klintmalm: Can you tell me a little bit about your day as a transplant surgeon at that time, in the late ‘60s, early ‘70s? How was it? How was, did you, was it just you at that time or did you have help, what about calls, what about donors, how did you organize it? Anything that you feel can help paint the picture.
Jeremiah Turcotte: Well, we had a transplant service. It wasn’t just me there was a team of a nephrologists and an urologist, immunologist and myself and usually, there was usually a surgical resident that was helping or sometimes somebody else. And I can’t remember exactly when, but after two or three years we added or one of the other staff people actually got interested, Tom Herman, and he joined us as an assistant. And we sent him out to spend a year with Tom Starzl when he was in Colorado and he was actually the first outside resident by outside, I mean, not somebody from the training program at Colorado that Tom worked with in Colorado. So we had a team and we had, you know, we got together and we were the operating team, I don’t mean surgical operation, but there was a policy group which was the chairs of the involved departments and then there was us down in the trenches and one somewhat humorous thing I remember, so we drew up, of course, the professors at that time they didn’t know anything about transplant because they had never really seen one, but, so, we drew up the policies and one of the criteria we set up was they couldn’t be older than 35 to receive it, and we got this little note back from Gardner Child that said, “don’t you think that’s a little young.” So we extended it up. So that’s the way we functioned and that’s the way it was set up administratively.
Goran Klintmalm: Any, what, what do you think is your biggest triumph as a transplant surgeon?
Jeremiah Turcotte: My biggest triumph, you know, I don’t think I’ve had any earth shaking triumphs, I’ve had some things that I’m proud of, the way we set up our program has been copied by a lot of people and we always kept a close affiliation with general surgery and you’ll notice that today we have six or eight young transplant surgeons now, all who received their first exposure as general surgery residents as they rotated through our service and the transplant rotation is probably the most popular rotation among our general surgery group now. So, that wasn’t the way a lot of our programs were set up and I know a lot are not set up that way now, but I think that was good for many reasons. The, the, some of the things I did with ethics persisted and I was the first chair for two terms actually of the ASTS ethics committee and also the first chair of the UNOS committee and at that time there really were no ethical guidelines about allocation of organs and so on. So we came up with concept that should be as far as ethical terms, beneficence should be half of the equation and the other half should be fairness, in other words, justice and benefit rather than the other autonomy and the other and that was published in Transplantation Proceedings and has been pretty much followed since then. So, I was, I thought that was something significant and as everybody is aware, there are still many discussions about the ethics not only of allocation of organs and should there be incentives and I think that will continue to be important. And I think we set up a good training program which many, many people have adopted. So, and there are a lot of technical things, but I don’t think they were necessarily earth shaking.
Goran Klintmalm: As a transplant surgeon, and it was a very small community in the ‘60s and ‘70s and even later on, how did you interact between you and the other driven individuals in Philadelphia or in Boston or in Virginia and Denver and Oxford and other places?
Jeremiah Turcotte: Well, our main interaction with other programs in the United States and around the world was through going to meetings together and the ASTS became an important function. But there were other international meetings that weren’t necessarily primarily concerned with transplant and then by having them visit we were the first program to have Christian Bernard visit. I could tell you a little anecdote about that, so there is a medical school honorary society in Michigan called Nigerian Society and at that time one of their major functions was to sponsor a lectureship. And one of the medical students whose name was Art Fleming had worked with me in the lab so I knew him pretty well and they read this little article in the paper, it was about an inch long, this article and it said, “South African surgeon transplants heart into human.” And they said, that sounds interesting why don’t we call up this Dr. Bernard, Mr. Bernard and see if he’ll come and give our talk. So they called him up and he said, yeah, sure, you know. Well, a week later, this was international news, you know, top of the news. But he kept his commitment. If the attendance at this lecture was 150, we thought that was a great success. Well this thing grew and grew and in the end, we had to set up a press table of about 50 to 75 old fashion typewriters and a phone, a long table. We had to move to the largest auditorium at the University, 1500 people and people actually came and they were pounding on the glass doors to get in. We over filled and this was a medical talk. I mean, it was not a public relations talk.
Somewhat ironic, if you recall that was sort of the peak of the apartheid situation in South Africa. Well, Art Fleming was African American and they got along fine. Art went into general surgery trained at Walter Reed and became chief of surgery at a hospital in Watts in Los Angeles, Martin Luther King Hospital, which you have to be a dedicated person to be chief of surgery there. And he made some contributions in that role. So that was one way of communicating with people around the world. We were friends with Bernard ever since that time, but even at the early stage it was clear that Christian Bernard’s role was going to be as a good will ambassador for South Africa and he would get a telephone call about every 10 or 15 minutes for the three days about that.
Goran Klintmalm: That’s fascinating.
Jeremiah Turcotte: We introduced such things as, you know, monitoring education programs, keeping track of what was going on in terms of results and so on and we always had a very good time. So one of the most humorous things, I mean, we were all sort of amateur meeting people and we decided well we would have our executive council meeting in the evening at dinner with a few glasses of wine and we’d have the formal executive council meeting after dinner. This would be about 10 o’clock at night after having had this dinner. The year that Dr. Cerilli was the president as we walked into the lobby coming from the dinner they always had a harpist playing in the lobby, so Jim was a good friend, another president, and he invited the cellist to our meeting so she played during the whole meeting and then we invited a German guest we invited to the meeting to come up, but there were two people in the hotel with the same name and the wrong person came. He couldn’t understand this meeting. So that’s how we did things. But we got quite a bit done really, believe it or not. And then it got more formal which was fine. So, we basically set the structure that persists today.
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