In Their Own Words
I am so very proud that I was involved in the organizing and the getting together of the American Society of Transplant Surgeons. It, I think, is a wonderful venue to interact with other fine surgeons around the world and to gain great knowledge that you may yourself not have, or actually give knowledge that others may not have. And the camaraderie of the organization is worth a ton of gold.
It’s been interesting being in a field where genetics is very important in terms of success or failure of a graft, and to be working with my identical twin brother. Of course I have always let him know that he is going to be the donor to me, not vice-versa. But it has been a wonderful pleasure working with him, because we do pretty well know what the other fellow is thinking about.
Robert Mendez is Emeritus Professor of Surgery and Urology at the University of Southern California School of Medicine. After earning a Bachelor’s degree from Stanford, he went on to receive his MD from the University of California, San Francisco. Thereafter, Dr. Mendez trained in medicine, general surgery, and ultimately urology, the specialty which led him to kidney transplantation. With his twin brother, Dr. Raphael Mendez, also a urologist, he established and led kidney transplantation at USC University Hospital and St. Vincent Medical Center in Los Angeles. Together, the twin brothers founded the Mendez National Institute of Transplantation, an internationally recognized non-profit transplant research organization. Dr. Mendez was President and Board Chairman of One Legacy, which serves the greater Los Angeles area and is the largest organ procurement agency in the United States. He served as President of United Network for Organ Sharing (UNOS), the Los Angeles Urological Society, the Southern California Transplant Society, and the Western Association of Transplant Surgeons. He received a Presidential appointment to the National Institutes of Health Committee Overseeing Xenotransplantation and has consulted regarding transplantation regulatory and governmental matters in Italy, Saudi Arabia, Dubai, and Japan. Dr. Mendez is the author of more than 100 peer-reviewed journal articles and 15 book chapters.
Dr. Mendez: Hello, I’m Dr. Robert Mendez, MD. I am a professor emeritus of surgery and urology at the USC School of Medicine in Los Angeles and also President and Chairman of the Board of One Legacy, our organ procurement agency for California.
Interviewer: How and when did you get interested in transplantation?
Dr. Mendez: I believe my first interest in it came when I was in medical school, and my professor of surgery at that time, at Cal, was John Najarian. And I was a third-year student and I scrubbed with him on one of his cases. And after the case, he called me into his office. He said, “Bob, I want you to come into my office.”
And so I went into his office; I didn’t know what he was about to tell me or anything. And he said, “Bob, you have just remarkably beautiful hands of a surgeon and your concentration and finesse in an operating room as a third-year medical student is phenomenal. I really want you to go into surgery. I noticed that you have put down that you were going to go into internal medicine, but I’d like you to really think about it. We want you in surgery here.”
Interviewer: Let’s weave Rafael in now.
Dr. Mendez: Okay. Well I also had a twin brother; I have a twin brother, who of course thinks he’s a lot more intelligent than I, and better looking than I. These things we argue all through our lives. He, too, was interested in medicine, actually before I was, and he decided to go to medical school about a year before I did. And interestingly most medical schools in the United States, if they accept one twin, they will accept the other twin. And so we happened to end up at Cal.
Interviewer: Where did you do your urology training?
Dr. Mendez: My urology training, I had a kind of circuitous route. I had a rotating internship and then I did a year of internal medicine residency. And then I did three months of general surgery residency and then switched over to urology, mainly because my brother was already two years ahead of me in training and the Chairman in Urology would make me a second- or third-year resident, then I would have caught up with my brother.
Interviewer: Tell us about the first transplant experience for you and Rafael, if you wish to include him in that, aside from Najarian, was that attending or resident level?
Dr. Mendez: Well my first experience in transplantation was really with Dr. Najarian at Cal Medical School. And he was just such a wonderful professor and teacher and mentor that it was just a very interesting field. I was also interested in it because as an identical twin, I pretty well knew that if my brother died, I would have a lot of organs available to me.
Dr. Mendez: That I would not need to take any medications. And so the differences in man, the genetic differences in all of us human beings, became very interesting to me and so I studied genetics for a while.
Interviewer: Rafael can’t be with us. And so I want you to talk a little bit about your brother.
Dr. Mendez: My brother is an outstanding surgeon. He’s not as good as I am, but he is a very outstanding surgeon. And as we started to work together in transplants, he would generally do the removal of the organ and then bring it over to my room, and I would then put it in. Every once in a while, we’d flip-flop and do the opposite, but he enjoyed doing the donor nephrectomy much more so and so that’s how it came to pass, basically, that we worked together.
Interviewer: Let’s go on to the general urology question. You’re one of, I think, only five or ten percent of us kidney guys.
Dr. Mendez: Yes.
Interviewer: Talk a little bit about urologists and transplantation.
Dr. Mendez: Urologists in transplantation are an interesting group of people. In the West Coast, urologists were the ones that basically did the transplants. Up in Oregon it was Don Palmer, I believe, over in UCI, it was Don Martin. At UCLA it was Joe Kauffman and Willy Goodman and Don Martin. And out in the Loma Linda University, it was also a urologist. So in the West Coast, urologists generally did all of the transplants; it was rather rare for a general surgeon to be doing kidney transplants.
Interviewer: How has that grown or how has that evolved?
Dr. Mendez: Then as we got into multiple organ transplantation in the nation, then the general surgeons tended to be the ones that were more adept at doing all different kinds of organs than urologists, who were very simply fixed on kidney transplants.
Interviewer: Let’s go to the UNOS years. I think at that time you and Rafael were directing the early years of your institute, as I would guess, at St. Vincent’s, I think?
Dr. Mendez: Yes.
Interviewer: So how did you get involved in UNOS? What were the steps up to the leadership and so forth?
Dr. Mendez: In the mid ’80s, many of us transplant surgeons were in Chicago at the Drake Hotel at a particular meeting that was being sponsored by joint companies, I believe. And at one casual break in the meeting, we started to talk about the transplantation as a possible organization in itself, not just part of surgery or part of urology or part of internal medicine.
And at that particular meeting was Gene Pierce, who at the time, ran SEOPF, the Southern East Organ Procurement organization. And it was with his kind of leadership that we surgeons started to think, “Well maybe we should have an organ procurement organization of our own.” And so with that, Gene got many of us together a few months later and we decided to try to form UNOS, United Network of Organ Sharing. And in the early years were Monaco from Boston, Jim Burdick and Mel Williams from Hopkins, and several of the surgeons from the Midwest and we decided to get together and form the organization, UNOS. And there was some questions as to where should it be based, should it be in Washington, D.C., should it be in the Midwest? And Gene Pierce offered to have it at his offices just south of Washington, D.C.
Interviewer: Okay, so that was the early time with UNOS with you personally. But then you grew and ultimately became President, so what roles do you recall?
Dr. Mendez: I thought it was very interesting to try to create an organization in which we could all share organs nationally. We did this in the west, in Los Angeles, where we had fourteen transplant centers and we were more-or-less forced to develop a methodology of interacting with each of us. And that was a good format to use nationally, to have all of the various transplant centers interact with each other and to benefit from that sort of interaction.
Interviewer: Once again, let’s get on to your own growth. This is, in part, about you.
Dr. Mendez: Oh, okay.
Interviewer: So you don’t have to be modest about how you began to take the reins in UNOS.
Dr. Mendez: I see. Well I enjoyed very much having visiting guest professors such as Mel Williams and Tony Monaco and the fellows from the East Coast come to the West Coast and give lectures.
And with that, we started to think about how we could share many of our organs that were not necessarily being used. Many places had a plethora of potential organ donors and a minimal amount of potential recipients and vice versa, mainly in the East Coast, and so we thought of a methodology by which we might or an organization might help in the sharing of these organs throughout the United States. Also at that time more and more emphasis was being placed on tissue typing and on matching and that the results were incredibly better if you had a very good match, and so that was also an impetus on trying to match kidneys up.
Interviewer: Tell us about your UNOS Presidency.
Dr. Mendez: Well my UNOS Presidency was very interesting and very enjoyable. First of all, working with Gene Pierce and all of the faculty and staff of UNOS was delightful. Also it was nice to have a representative of the various different transplant centers and organ procurement agencies throughout the United States to get together at one time and on a quarterly basis and to try to ferret out what problems there were and how we might be able to solve them with regards to organ sharing.
Interviewer: You did mention the Drake Hotel a couple of times, but we didn’t talk about your early involvement with the ASTS and your early memories of the ASTS, so if you could just say a few words about that?
Dr. Mendez: Well we started meeting as transplanters, based in Chicago, and logically took the Drake Hotel, which was a meeting place for most every large organization. And as we did so, we found that it was a very important aspect of gaining knowledge and education from listening to your peers talk about different aspects of transplantation that we did not necessarily maybe focus on as much as other centers did.
Interviewer: Yeah and just go on with whatever relationship you’ve had in the ASTS as the years went by, any papers presented.
Dr. Mendez: Yes.
Interviewer: I’ll tell you, I remember like yesterday.
Dr. Mendez: Uh hum.
Interviewer: The day that you took the podium and apologized to the audience because there were two cassettes on your dining room table, one for your daughter to give a talk and one for you to give a talk and you were both leaving the house that morning. She picked up yours….
Dr. Mendez: (Laughs)
Interviewer: You picked up hers. You remember that?
Dr. Mendez: No.
Interviewer: That wasn’t your brother, I know.
Dr. Mendez: I tried to forget that as fast as I could.
Dr. Mendez: I was always interested in transplantation because of the scientific aspect of it and the genetics of it. At Stanford in my undergraduate years, I took a fair number of courses in genetics. We had the Nobel Prize winner of genetics as a professor, and he was a very thrilling professor to have. And as an identical twin, I found that also very interesting as to how other different individuals who had the same genetic markers, basically.
Part of getting together as a group of individuals with common interests, such as in transplantation, is the knowledge, the bulk of knowledge that you learn from others in such a rapid and wonderful way. The American Society of Transplant Surgeons, we had at the beginning just a wonderful relationship, with just a very few surgeons, probably less than fifty, I would say.
But we got together and everyone would speak and there would always be, “Well I know something about this aspect that this should have done this. Why didn’t you do this?” So it was a very learning experience to be able to get together at the camaraderie of other surgeons and to hear about how they would approach things, especially in a couple of instances in the techniques of surgery and how one places a kidney in an organ or what do you do with an individual who has had one previous one that failed? And where do you put the next one? And do you take the old one out? A lot of questions that were answered very much by our colleagues.
Interviewer: You come from a melting pot and your name is Mendez, would you want to talk a little bit about any Latin American or Mexican or Hispanic in California-type link to transplantation?
Dr. Mendez: Yes, it’s possible. First of all, I’m very proud of my heritage. My father was Mexican, born in Mexico of an Irish mother and a Mestizo father, who was part Spanish and part Indian. My mother’s family came from Spain, from Asturias in the northern part of Spain, and then came over during the Franco years to the United States. And so I have a nice genetic mix there.
I would recommend to all the audience to get Spencer Wells’ book, The Journey of Man, which is the study of the genetics on how we are all related. It’s a beautiful book and basically what was interesting to me was how the Latinos or the Hispanics in the United States, whose blood types were mainly “A” blood types, had genetic similarities. And which ones would be best suitable for others.
Interviewer: How about on the professional side, have you trained, you’ve had residents and fellows?
Dr. Mendez: Yes, as mentioned, I am the professor at USC, University of California, and we were one of the first thirty-nine licensed fellowship training programs for transplantation, and I did accept always two fellows each year. One I would always take from Africa and the Near East and then one I would take from the United States or Latin America. So at the end of it all, I had trained thirty-four American Society of Transplant Surgeons and was very proud of them all. They were extraordinarily fine doctors and surgeons.
Now that I’m an emeritus professor, which means, of course, that now I am still working (laughs), but I am of the emeritus status. I am so very proud that I was involved in the organizing and the getting together of the American Society of Transplant Surgeons. It, I think, is a wonderful venue to interact with other fine surgeons around the world and to gain great knowledge that you may yourself not have, or actually give knowledge that others may not have. And the camaraderie of the organization is worth a ton of gold.
It’s been interesting being in a field where genetics is very important in terms of success or failure of a graft, and to be working with my identical twin brother. Of course I have always let him know that he is going to be the donor to me, not vice-versa. (Laughs) And I tried to state that to him at least once a month, for him to get it in through his mind. But it has been a wonderful pleasure working with him, because we do pretty well know what the other fellow is thinking about.
And it is interesting that we have been in studies with the University of Minnesota; they do twin studies on 400 twins throughout the nation. And we have been actively involved in that study for the last ten years.
Interviewer: Talk a little bit about your own family and his family and how transplantation has impacted both families.
Dr. Mendez: Well I was very fortunate to meet an absolutely wonderful woman named Valerie Eastway Nelson. Upon meeting her, I knew that she was going to be “the one” and we were married about two years later and had the most delightful forty years of my life with her. Tragically she passed away unexpectedly about six months ago, and it has been a devastation for me, but fortunately I have three wonderful, wonderful children, adult children, who “take care of their father now” and who are always with me.
My eldest daughter, Danielle, is a beautiful young lady who has been very involved in many different walks of life, but presently is a Cordon Bleu chef and enjoys very much making superb dishes. My son, Rob Jr., besides being an outstanding surfer and athlete and father of three of my grandchildren, is involved in commercial real estate and is working with his wife’s family who are very well known in the field in the western United States.
And my youngest daughter, Alexandra, is presently six months pregnant with her first child, and it is going to be a boy. And so I am starting to try to train that child while he is still in utero, but it’s been a tough drag all along.
Interviewer: (Laughter) And Rafael’s family?
Dr. Mendez: Rafael, my twin brother, due to an unfortunate accident with his wife, he was unable to have children. They were unable to have their own children, but they adopted two wonderful, wonderful twins, a pair of twins, one was a girl, one was a boy, and they are absolutely wonderful people. And we interact with them very much, every day, on a weekly basis.
Interviewer: Okay, is there anything else you want to say?
Dr. Mendez: I’d just like to say what an incredible organization American Society of Transplant Surgeons has become and what an integral part it has played in my life.
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