Review: 'Burden of Genius'

Cinequest documentary profiles the first doctor to transplant a liver
Dr. Thomas Starzl pioneered the liver transplant. So why isn't he better known?

There's no poetry to a liver, even if the ancients thought it was the seat of a man's courage ("white-livered" or "lily-livered" meant cowardly). Yet this particularly slimy piece of viscera—"a big crimson slug," one of its admirers calls it—may be the second-most complicated organ after our brains.

And as for the transplanting of this homely thing, that's an unappetizing story in itself, fascinatingly told by Tjardus Greidanus in the documentary Burden of Genius. Under those conditions, as described by journalist Andrew Corsello: the liver is "a blood bomb" suffused with blood under pressure; the act of having a liver ripped and replaced is "a violent, violating thing." One witness recalls the time 300 units of blood were used in one surgery, leaving the floors looking like the aftermath of combat medicine. In the 1980s at peak operation, the University of Pittsburgh hospital had four different transplant teams working simultaneously, and surgical nurses dropping from the length of shifts. It's far more complicated than heart transplantation—the liver is a tricky fellow, with its ins and outs and whathaveyous. Implicitly, Burden of Genius asks hy Dr. Thomas Starzl isn't as well known as Dr. Christiaan Barnard—indeed Starzl's first successful liver switch occurred some six months before the first heart transplantation.

Starzl was in his 50s when he did the most important work of his career. Burden argues that he forced this brutally complicated operation to succeed, through unending tries and retries. His nervelessness can be exemplified by one story. Starzl's team were of the custom of retrieving the organs from legally dead people, zipping back in a plane to the Iron City with the necessary piece resting in a Playmate Plus ice chest. Urgency was essential—four hours is about as long as a liver can last on ice, but the task was slowed by the necessary dealing and comforting of the bereaved donor's family. It's the kind of unimaginable horror parodied in Monty Python's The Meaning of Life ("Listen! I can't give it to you now. It says, 'In the event of death'" "No one who has ever had their liver taken out by us has survived.") Starzl was aboard a Learjet with no brakes and no stabilizers heading at a 180 mph toward a runway in Halifax—whiler he tryied to shut up the praying around him so he could study his case notes as the plane dropped. He walked away from the crash, they got the liver and the recipient lived. There was nothing pale about Starzl's liver.

There were far more serious problems facing the operation—first of all, overcoming immunological rejection. In the 1970s, liver transplants were a faint hope for doomed patients, and survival rates were anywhere from 20 to 30 percent. The staff at a Colorado hospital where Starzl worked voted to shut him down because of the way his patients died. Later, when the doctor and his team became more successful back East, there were other rumblings. What was a 53-year-old rock star like David Crosby doing with a new liver when his lifestyle should have killed him?

Crosby is still around at age 76, and quite lively in interviews here. Burden of Genius makes its point: aside from the matter of age, who is qualified to judge who gets to live or die? As interesting as the medical ethics are, Starzl's own persistence deserves respect—this sleepless, dogged pioneer astonishes his son Tim, who describes his father's progress as "the Oregon Trail, with all these white crosses along the way." Starzl is human and not bigger than life in this profile—his work and life inseparable, his monument, the lives that he and his team have saved.

Burden of Genius
Mar 2, 6:45pm & Mar 3, 10:30
Redwood City
Mar 7, 1pm
Mar 8, Hammer Theatre Center

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