Dr. Bill Wall performed 1,885 liver transplants during career that helped put London on world medical map

This is a repost from the London Free Press.

To think that 14 years ago I happened to move to within walking distance of one of the world’s leading centres of organ transplant surgery…

Dr. Bill Wall performed 1,885 liver transplants during career that helped put London on world medical map

By Hank Daniszewski, The London Free Press

The transplant team at London Health Sciences Centre, University Hospital, lead by Dr. Bill Wall, left.

The transplant team at London Health Sciences Centre, University Hospital, lead by Dr. Bill Wall, left.

A jangling phone in the middle of a night.

A liver is available in Edmonton, Baltimore or Baton Rouge for transplant in London.

The clock is ticking down.

Dash to the private jet.

Try to grab a nap on the flight.

Remove the organ from the brain-dead donor.

Bring it back in a picnic cooler full of ice.

Spend hours implanting the organ in the recipient.

Thread the needle between organ rejection and infection by suppressing the immune system.

Life saved.

Repeat.

That was Dr. Bill Wall’s routine for decades.

He was part of a team that performed medical miracles in London and gave it the unassailable reputation as the transplant capital of Canada.

The former director of the Multi-Organ Transplant Program at London Health Sciences Centre (LHSC), Wall retired this year after a 40-year medical career that included performing

Canada’s first successful liver transplant in 1982.

Ronnie Gavsie, chief executive of the Trillium Gift of Life Network, the provincial agency promoting organ donation, said London’s reputation as a transplant capital is well-deserved because of leaders such as Wall.

“He is a renowned statesman in the transplant medical community.”

LONDON’S MEDICAL MIRACLE

Early attempts at organ transplants were fraught with failure in the late 1960s and 1970s. Rejection of the donated organ was a constant problem and some hospitals simply gave up.

So how did London’s University Hospital (now part of LHSC) shoot to the top as a Canadian and world leader in transplant surgery?

Opened in 1972, University Hospital was designed to be a ground-breaking research hospital.

Dr. Calvin Stiller was recruited to spearhead the transplant team, and within six months the first kidney transplant was performed there.

“He was the visionary, the leader, without question. He knew transplantation would someday be a successful treatment for organ failure. He knew it would happen,” Wall said.

For his part, Stiller said the London transplant team refused to think small. He remembers hospital officials in Toronto shocked that University Hospital was drawing referrals from all over Canada.

“We didn’t measure ourselves against anything in Canada, but against Stanford, Harvard and Pittsburgh. It never crossed our mind that we were ‘little London’ and we shouldn’t aspire.”

A NOT SO GENTLE PUSH

Wall grew up in Tecumseh, near Windsor, and went to medical school at Western University. He joined the department of surgery at University Hospital in 1977.

Along with Stiller, Wall gives credit to Angus McLachlin, Charles Drake and John Duff, all chiefs of surgery at University Hospital, for establishing London as a transplant leader.

Wall wanted to be a vascular surgeon but Drake and Duff had other ideas,

“They said I should do transplant. It was chosen for me.”

Wall was sent to Cambridge, England, to study with Dr. Roy Calne, who performed Europe’s first successful liver transplant in 1968.

Wall could have stayed in England and succeeded Calne but was persuaded to come back to Canada, Stiller said.

“I can’t think of anyone who benefited the work we are doing more than Bill Wall,” Stiller said.

When Wall retired, Stiller gave him a wood carving with the number 1,885 inscribed — the number of liver transplants Wall performed over his career.

“I told him he could show that to his grandson — that’s the number of lives that Bill resurrected,” Stiller said.

THE MAGIC POTION

One cold winter day in 1978, Wall went to Pearson Airport in Toronto to pick up Dr. David White, an associate of Calne.

White had flown in from England with a precious vial of powder in his vest pocket.

It was cyclosporine, the drug that would revolutionize transplant surgery. It was a huge coup for University Hospital.

“It was a magic potion. Everyone was trying to get it, but we got it here — the first here in North America,” Wall said.

Stiller and Wall heard about cyclosporine at a conference in England and seized the opportunity to conduct clinical studies.

Kidney, liver or heart failure was once a death sentence and transplanting a new, healthy organ into a patient seemed the obvious answer.

But in most early transplants the patients survived only a short time because their bodies rejected the new organ.

The only solution was to suppress the patient’s immune system so their body wouldn’t reject the transplant. But that made them vulnerable to a wide variety of bacterial, viral and fungal infections that could be fatal.

Wall said cyclosporine was different because it targeted specific cells responsible for rejecting transplanted organs without suppressing the whole immune system. The London team held the first clinical trials with kidney patients, experimenting with different dosages.

“We were flying by the seat of our pants. We didn’t know how it worked, but it worked.”

The early work with cyclosporine vaulted “little old London” into the lead of transplant surgeries among Canadian medical centres, Wall said.

Cyclosporine wasn’t perfect, but combined with improved methods to preserve organs and new antibiotics, it dramatically raised the transplant survival rate. Today it’s more than 90%.

THE PROCEDURE

It usually starts with a tragedy. A car crash or some other calamity. After the donor’s family gives consent, the donor is matched with a recipient based on compatibility, the urgency of their condition and how long they’ve been on the waiting list.

The transplant team has to work out the logistics of getting the donor organ and bringing it back to London, based on unforgiving deadlines. Hearts can last outside the body for about six hours, livers 10 to 12 hours, kidneys up to 24 hours.

The organ is cooled, washed out in a special solution and put into a cooler.

In the early days, the equipment was startlingly simple. The organ was put into a kitchen pot with a special solution, wrapped in sterile bags and put in a picnic cooler surrounded by ice.

Organs were retrieved from as far away as Vancouver, Wall said.

“If you timed it just right, you could cool an organ, and get it back to University Hospital but you were racing against time.”

In the early days, Wall went to retrieve the donor organs himself but he later trained special retrieval teams, made up of future transplant surgeons. With the prep time, flight time, several hours of donor surgery and six to seven hours of recipient surgery it made for long day. Wall learned to sleep on planes and in lounges.

“Fortunately, I can sleep anywhere.”

THE BOTTLENECK

Wall said safety measures such as seatbelts, motorcycle helmets and air bags have reduced crashes and the number of potential donors.

Half of kidney transplants are from living donors.

“The results of transplantation have never been better . . . but there’s never been a worse time to be on a transplant waiting list. The waiting list has never been so long and the risk of dying has never been so great,” Wall said. “We have this wonderful treatment that saves lives and we can’t offer it to everyone who deserves to get it.”

Dr. Patrick Luke, a co-director of the Multi-Organ Transplant Program, said 5,000 Canadians are waiting for an organ donation. A couple of people on the waiting list die every week.

GIVING AND RECEIVING

Heather Fisher was 29 in 1983 when she received a new liver in an operation performed by Wall.

She had less than a year to live because her liver was failing. But Fisher was an operating room nurse and acutely aware of the risk of transplant surgery.

Only one of the four previous liver transplants had been successful. But Fisher survived.

She went on to work with Wall in the operating room on liver transplants.

“It was pretty surreal — working with the physician that saved your life.”

Fisher made the best of her new lease on life. She climbed Mount Kilimanjaro and was co-chairperson of the World Transplant Games in 2005.

She’s still active in the transplant cause, donating felt bracelets to a fundraising art show and auction called New Canvas of Life: the Art of Transplantation. Artwork donated by transplant recipients, staff, living donors and celebrities is being sold in an online auction ending April 29.

Sports photographer Dave Sandford was also at the show displaying two striking sports photos he donated.

In 2004, when he was 30, he donated a kidney to save the life of his sister Linda, who had fallen ill the day after her wedding. Only six weeks after the surgery he went on a month-long trip to Europe to cover the World Cup of Hockey. Sandford is nonchalant about donating his kidney, considering himself lucky he could help his sister.

“I’ve always thought of it as a no-brainer.”

SPREADING THE WORD

Canada has a mediocre rate for organ donors but the London area has always been higher.

Wall believes one reason is an organ donation program piloted at Central secondary school in 2000 that spread across the province.

Visits by high school students to the transplant unit morphed into school assemblies that prompted intense interest by students, Wall said.

“They had practical, piercing questions that we never had time to answer. So we put a course together.”

Those students brought the issue back to families where organ donation could be discussed in a calm environment, Wall said.

“That’s so much better than a waiting room outside an ICU when the family is presented with the concept at the worst time of their lives.”

But there are still myths, suspicion and misinformation holding back organ donations, Wall said. Some people think it violates their religious beliefs, even though all major religions have consented to organ donations, he said.

Some people suspect donors will not get the best care if they’ve signed a organ donor card.

But much of the resistance to organ donation is just an aversion to face the inevitable, Wall said.

“We don’t want to think about death and dying.”

THE PAYOFF

It was exhausting, always stressful and often frustrating because of the lack of organ donors.

But looking back, Wall said it was great to work with a dedicated team for 40 years on a medical practice that gave him great rewards and gratification helping patients with organ failure who had perhaps just days to live.

“A week later they’re having Cheerios for breakfast, talking about going back to school or their daughter’s birthday. In a month they look normal.

“Nothing compares to that . . . It’s been a privilege to be part of that.”

hank.daniszewski@sunmedia.ca

— — —

Organ Donation rate

(annual donations per million people)

  • Southwestern Ontario 28
  • Canada 15
  • Britain 18
  • United States 25
  • Spain 35 (world leader)

Source: Blackburn-Stiller Multi-OrganTransplant Centre

— — —

Registered organ donors

  • Ontario: 27%
  • London: 35%
  • Sarnia: 44%
  • Chatham: 39%
  • Stratford: 38%
  • Woodstock: 35%

Source: beadonor.ca

— — —

Transplants at LHSC

  • Kidney 2,409
  • Liver 1,883
  • Heart 639
  • Heart-lung/lung 95
  • Heart-liver/kidney-liver 41
  • Pancreas/islets 6
  • Bowel 11
  • Total 5,151

Source: Blackburn-Stiller Multi-Organ Transplant Centre

— — —

Check your organ donor status

— — —

TIMELINE

1972

University Hospital (UH) opens; Dr. Cal Stiller launches transplant program.

1973

First kidney transplant at UH.

1980

London leads trials for cyclosporine, which prevents organ rejection.

1981

First heart transplant at UH, also first in Ontario.

1982

First successful liver transplant at UH, also first in Canada.

1983

First heart-lung transplant at UH, also first in Canada.

1987

Dedicated multi-organ transplant unit established at UH.

1988

First successful liver-bowel transplant in the world performed at UH.

1997

Dr. Bill Wall take over from Stiller as program leader.

2001

High school organ donor course developed (first in Canada).

2005

First transplant games.

2012

600th heart transplant

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