The Clínic Hospital commemorates the 40th anniversary of the first pancreas transplant in Spain, led by Laureano Fernández-Cruz and Josep Maria Gil-Vernet. In 1983, a 32-year-old man, diabetic since childhood, received a double kidney and pancreas transplant. Despite its pioneering nature, the intervention was a success. The patient had a good quality of life, was able to start a family and went back to work. He died ten years later due to a myocardial infarction unrelated to the transplant, recalls the doctor.
He went to train abroad when healthcare in Spain was very poor.
My generation revolutionized the organization of hospitals. In the 70s, many doctors left to train in specific fields and give rise to specialized medicine. Some did not return, others we did because specific cities or hospitals needed to establish certain areas of hospitalization. Today's public medicine is consolidated in that effort of my generation. Before going to a public hospital was laughable, now the best medicine is in public hospitals.
Did you see things very different in the US?
I saw a medical organization that gives meaning to our specialty, which is to diagnose, treat and cure the sick. Here everything was a system with many unknowns regarding early diagnosis or treatments, which with few resources were not adequate. And the clinical control of these patients also left much to be desired.
Why do you decide to come back?
I integrated myself into a kind of medicine that I believed I could develop in our country. Because of the education I had, I was privileged, and my father always reminded me and my two brothers that we should give back to society the privilege of having had a good education and the possibility to train - us in relevant places. The three of us comply.
At that time transplants must have seemed like magic.
In Spain, the Clinic was the first hospital to organize a kidney transplant on a scheduled basis. It began in 1965 with nephrologists, Antoni Queralbs and Jordi Alsina, who had trained in France. Queralbs put me in touch with Dr. Gil Vernet and we talked about the possibility of getting together, because one of the things that interested me in the University of California was a program on the prevention of kidney disease in diabetic patients through pancreas transplant. I was given the Fubright scholarship and I went there to participate in research in this field.
18 years between the first kidney transplant and the pancreas transplant.
The pancreas is a very delicate organ, prone to complications after transplantation. It becomes inflamed, thrombosis occurs... From an anatomical point of view, it is designed in such a way that it suffers when it is manipulated. That's why the transplant took quite a while to consolidate. All the transplants in their beginnings had very poor results, and the pancreas one even more so.
L'impossible
"The physical substrate of the soul is the neurons; I do not see the possibility that the brain can be transplanted"
Did they all have them with them? What did they feel when everything was fine?
In the vast majority of transplant programs the first operations have failed. Our first transplant lasted ten years! We rehabilitated a diabetic patient who had retinopathy, a very important eye disorder, a neuropathy that was causing him disorders... And also some kidney failure. We absolutely rehabilitate it. So, this first transplant went really well and we're on a journey.
What impact did they have?
We cause a revolution in the world of transplantation in our country. We did the first extrarenal organ transplant and that encouraged colleagues. The following year, in Bellvitge, Dr. Carles Margarit and Eduard Jaurrieta began the liver transplant. And a colleague of mine, Dr. Josep Maria Caralps, did the first choir successfully, in Sant Pau. On the other hand, we teach the importance of arming the transplant organization, which today is the Ocatt (Catalan Transplant Organization) and at national level the ONT (National Transplant Organization). It was essential to organize a structure to manage donors. This was an extraordinary success. We spread the enthusiasm we had at the Clinic to other hospitals. This changed the way hospitals collaborate. Before, they all worked in their own way. And we doctors go from hospital subjects to citizens.
How have transplants changed in 40 years?
The surgical technique has been gradually refined. In Barcelona, in 1989, I organized the European Organ Transplantation Meeting, where the American Society of Transplantation presented the first results of an immunosuppressive drug to reduce the risk of rejection, tacrolimus, which has revolutionized the medicine of transplants
The next frontier?
What we need is more organs. As organs are missing, we enter other fields such as the possibility of genetic manipulation. Animal studies have been done in China... The creation of artificial organs is another line of research. They are forwards that are in a nebula. They are not defined. It is not taken a step further due to ethical issues.
Will the brain be transplanted?
We consider an organ donor when there is brain death. It is the central organ of the body, it exerts a direct influence on all the organs, apart from giving you the ability to be and to feel. Existence is for the brain. The physical substrate of the soul is neurons. Therefore, talk of a brain transplant is not in the future.
