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Obituaries

Oscar Salvatierra: helped draft the US National Organ Transplant Act of 1984 and fought for its passage

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1768 (Published 25 April 2019) Cite this as: BMJ 2019;365:l1768
  1. Ned Stafford
  1. Hamburg, Germany
  1. ns{at}europefn.de
Lucile Packard Foundation for Children’s Health

Oscar Salvatierra Jr was widely acknowledged as an outstanding paediatric kidney transplantation surgeon. He approached each patient with one goal in mind: to make sure that the surgery was “perfect.” A deeply compassionate man, Salvatierra had an ability to connect with his young patients and to calm the fears of their parents.

One of those parents was Carlos Esquivel, a colleague of his at Stanford University. Esquivel, chief of abdominal transplantation at Stanford, had learnt that one of his sons needed surgery for a kidney problem. “I chose Oscar to do his surgery,” Esquivel said. “For a surgeon, to pick someone to do an operation on your own child means you think that surgeon is the best person in the world. And I did.”

In addition to his masterful surgical skills, Salvatierra also was a leading clinical researcher and the author of more than 300 papers. In the late 1970s and early 1980s he pioneered the use of donor specific blood transfusions in living donor kidney transplantation, a forerunner of bone marrow and kidney transplantation to induce tolerance.1

Salvatierra also made several important contributions to paediatric kidney transplantation, including developing methods that enabled small children successfully to receive adult kidneys.23 He helped pioneer an immune suppression protocol for paediatric kidney transplant recipients that avoided steroid drugs, which have harmful side effects in children.456

“So many of the techniques we now use in paediatric kidney transplantation are because of him,” said Waldo Concepcion, who succeeded Salvatierra as chief of paediatric kidney transplantation at Stanford’s Lucile Packard Children’s Hospital.

Transplant law

Late in his life, Salvatierra was asked what he was most proud of during his long medical career. He cited his participation in a political battle that raged in the US Congress and the White House, occupied at the time by President Ronald Reagan during the early 1980s.7 Provisions of the law—the National Organ Transplant Act—included establishing a nationwide network to ensure fair and equitable allocation of donor organs and banning their sale.

During the nearly two year long battle, Salvatierra, at the time president of the American Society of Transplant Surgeons, worked closely with then congressman Al Gore to help draft the law. Gore, who was later vice president under Bill Clinton, described Salvatierra as “the driving force” behind the law, adding that Salvatierra “stands above all others as the person most responsible for bringing groups together” to support the law.

In a 2013 interview, Salvatierra recalled: “We had to fight the American Medical Association and the Reagan administration.”7

Salvatierra, at the time chief of the transplantation service at the University of California-San Francisco, made more than a dozen trips to Washington to collaborate with Gore and to educate members of the Senate. “I ended up personally going and visiting about two thirds of the senators to try to develop some understanding of our problems.”

In September 1984, with Congress to adjourn within weeks for national elections, Salvatierra wrote a heartfelt letter to President Reagan, expressing his dismay about political delaying tactics used by opponents to keep the law stuck in a Senate committee rather than allowing a full Senate vote. “There is tremendous urgency to our request,” Salvatierra wrote to the president, “for you to exert your influence and leadership in obtaining an earlier meeting of this committee.”8

Salvatierra’s hard work paid off. The law was approved in October and went on to become a model for other countries to enact their own transplantation laws.

Early life and career

Salvatierra was born on 15 April 1935 in Phoenix, Arizona, one of six children of Josefina Garcia from Santa Ana, Mexico, and Oscar Salvatierra from Tucson, Arizona. He graduated cum laude in 1957 from Georgetown University in Washington, DC, with a bachelor’s degree in biology. After receiving his medical degree in 1961 from the University of Southern California in Los Angeles, he trained in urology and paediatric urology.

During the Vietnam war he served in the US Army Medical Corps as surgeon and chief urologist at the 8th Field Hospital in Nha Trang. He was awarded the army commendation medal. “I held many soldiers in my arms as they were leaving this life,” he later recalled. “They’d cry out, ‘Hold me. I feel so alone. I don’t want to die.’ Here were these young men with their dreams and futures completely snuffed out. It was there that I received the inspiration for the rest of my life. I committed myself to help young people realise their hopes.”7 During his tour of duty, Salvatierra also served as a volunteer surgeon at a Vietnamese hospital treating civilian war victims, primarily children.

“I’m hoping many doctors will model their behaviour after Oscar,” said Thomas G Plante, psychology professor at Santa Clara University and adjunct clinical professor of psychiatry at Stanford. Plante added: ”Oscar frequently used to say —and emphatically, almost like a mantra or motto—‘life is about people.’ He meant that we need to treat people with kindness, compassion, respect, and care.”

Agent Orange

While serving in Vietnam, Salvatierra, according to his family, was exposed to Agent Orange, a herbicide and defoliant chemical used by the US military that later caused health problems for millions, including US soldiers.

After discharge from the army, Salvatierra spent two years in private urology practice before returning to academia at the University of Southern California. In 1972 he made the defining move of his career, accepting a postdoctoral fellowship in transplantation surgery at the University of California-San Francisco (UCSF), training under Samuel L Kountz and Folkert Belzer. Salvatierra later described Kountz and Belzer as two of his three most important mentors.9 The third mentor was pioneering transplantation giant Thomas Starzl.10

Ron Shapiro, who trained under Starzl and is now surgical director of the kidney and pancreas transplantation programme at Mount Sinai Hospital, told The BMJ: “Starzl was an inspiration for a great many people in the field, and Oscar was one of them. Starzl was also a big fan of Oscar’s, so it was mutual.”

Salvatierra remained affiliated with UCSF until 1991, when he was appointed head of transplantation at the California Pacific Medical Center in San Francisco. In 1994 he moved to Stanford, an affiliation he kept for the rest of his life. He retired from clinical responsibilities in 2006 to become associate dean for medical students at the school of medicine, a position he held until 2015.

Salvatierra was a leader in the transplant community, serving as president of the American Society of Transplant Surgeons (ASTS), the Transplantation Society, and the United Network of Organ Sharing. His many honours include the Franklin Ebaugh Award for outstanding medical student advising at Stanford, the Knighthood by the Republic of Italy, the Presidential Medal from the president of Argentina, Stanford’s Rambar-Mark Award as Clinician of the Year, and the Albion Walter Hewlett Award. In 2016 he received the Pioneer Award, the highest honour bestowed by the ASTS.

Salvatierra died at home surrounded by family and close friends after a long struggle with Parkinson’s disease. He leaves behind his wife of 25 years, Pam; a son and daughter; four grandchildren; and his five siblings.

“Oscar told me,” Shapiro told The BMJ, “that his Parkinson’s disease was a result of his exposure to Agent Orange.” Shapiro, noting that “Oscar was a good friend,” said he wanted to make a “final point.”

“Oscar is to receive the Lifetime Achievement Award from the International Pediatric Transplantation Association in early May,” Shapiro explained, “and in this case will receive it posthumously. He was aware, however, of this upcoming award, and was really thrilled. As much as I miss him, I am happy that he knew about the award and was excited about it, and I am also happy that he is at peace. He had had Parkinson’s for 14 years, and to go from being a master surgeon to being wheelchair bound is a terrible thing.”

Oscar Salvatierra (b 1935, q University of Southern California, Los Angeles, USA, 1961), died from complications of Parkinson’s disease on 16 March 2019

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