It would be the first liver transplant ever performed at Baylor. Dr. Fordtran had 1 hour to decide whether to go ahead with it. The stakes were high either way. “If we declined,” he says, “I think Tom would have concluded we didn't have the guts to be in the transplant business.”

Dr. Starzl was an old friend of Baylor. He has also been seen as one of the greatest technical surgeons, scientists, and teachers of our time. Dr. Starzl performed the world's first human liver transplant in 1963 and the first successful liver transplant in 1967.

What Dr. Starzl proposed to do at Baylor that December evening was no small undertaking. Amie Garrison and her parents were coming from Indiana, 731 miles away. The donor liver was in Canada, 1169 miles away. Dr. Starzl was planning on bringing 5 associates, and they were all 1070 miles away. Dr. Klintmalm, who was to initiate Baylor's transplant program in February 1985, was from Sweden, 5086 miles away. (Fortunately, he was in Dallas, making plans for the new program.) Doing the transplant at Baylor, then, would involve moving a total of 14,000 man-miles (one way).

“A large number of doctors began to accumulate in Boone's office,” Dr. Fordtran says. Boone Powell, Jr., president and CEO of Baylor Health Care System, was away from his office and not expected back until 5 pm—the deadline for the decision. The assembled doctors debated the urgent questions: “Could the people involved really get here in time to do a transplant at Baylor? Could Baylor handle a complicated case, a desperately ill 5-year-old child?”

Compelling arguments were advanced on both sides. The debate was going full steam when Boone Powell arrived. He had no idea what was going on. Dr. Starzl was on the line, awaiting the decision. Dr. Fordtran recalls, “Boone listened to both sides of the argument for about 5 minutes and said, `Well, I think we should do it.' At that point there was 100% agreement. In the end, we thought this little girl would miss a vital chance if we didn't take the risk on the downside that we might suffer if things didn't go well.”

The operation started at 6 am the next day and ended at 2:30 pm. Dr. Starzl was assisted by Dr. Klintmalm and teams of physicians from Pittsburgh and Baylor (Figure 1), including anesthesiologist Dr. Michael Ramsay. “It was actually a very hard case,” comments Dr. Starzl. “Amie had originally had a biliary atresia, but we didn't understand why her condition had deteriorated so rapidly until she was opened up at Baylor. She had a very large abscess. . . . We had to resect the abscess along with the liver.”

“At a news conference the next day,” recalls Dr. Fordtran, “Tom was asked how things went, and he said they went all right, in a typical understatement. The Baylor transplant program had been launched, and the whole world saw it.”

Amie Garrison benefited greatly from the operation (Figure 2). But she suffered side effects from the immunosuppressive drugs. In 1994, in what was apparently a teenage rebellion, Amie stopped taking her antirejection drugs.

When Dr. Fordtran followed up with Amie Garrison's family, he feared the worst, since most people who stop their immunosuppressive drugs reject the donated organ and die. He was happy to hear that despite the fact that Amie has taken no medicine for 5 years, she is doing well. She now has a healthy 2-year-old son (Figure 3).

The organ transplant program at Baylor, started by Dr. Starzl, has developed into one of Baylor's hallmarks and flagships. Twenty-one transplant fellows have trained under Dr. Klintmalm, and the 1000th liver transplant was performed in 1995.