A modern Cosmas and Damian: Sir Roy Calne and Thomas Starzl receive the 2012 Lasker~Debakey Clinical Medical Research Award

Abstract

Cosmas and Damian, the patron saints of surgeons, were twin brothers who dedicated their lives to healing the sick (Figure ​(Figure1).1). They are most revered for performing the first transplant operation, when they replaced the gangrenous leg of the sacristan Justinian with one from a recently deceased soldier. In the 1940s and 1950s, when Thomas Starzl and Sir Roy Calne (Figure ​(Figure2)2) were training to be surgeons, successful transplantation was still in the domain of the miraculous; in fact, both Calne and Starzl had been told that the procedure was impossible. However, within a period of 30 years, they were able to overcome surgical and biological obstacles to develop liver transplantation procedures that have saved the lives of thousands of patients and made the transplantation of multiple organs a reality. Figure 1 The healing of Justinian by Saint Cosmas and Saint Damian, Fra Angelico, 1438–1440. Figure 2 Thomas Starzl (left) and Sir Roy Calne (right), winners of the 2012 Lasker∼Debakey Clinical Medical Research Award. In the late 1950s, the inability to perform a liver transplant meant that liver diseases were often fatal. The liver is critical to a wide variety of physiological processes. It removes and breaks down toxins in the blood, generates biochemicals necessary for digestion, stores glycogen and vitamins, and produces plasma proteins (such as clotting factors) and hormones (such as angiotensin and cholesterol). Diseases or damage that interfere with liver function can lead to a multitude of abnormal physiological processes. Liver damage can be inflicted in various ways, including infections such as hepatitis, exposure to alcohol or drugs, cirrhosis, and cancer. Inherited disorders can cause pediatric liver diseases such as biliary atresia, Wilson’s disease, Alagille syndrome, progressive familial intrahepatic cholestasis, Langerhans cell histiocytosis, and α1-antitrypsin deficiency. Once the liver has sustained severe and permanent damage, a patient’s only option may be the transplantation techniques pioneered by Calne and Starzl.