Chapter 11
DR. BILL FRIST
Set up organ transplant center at Vanderbilt University
Professor of business and medicine, Vanderbilt University
U.S. Senate majority leader, 2003 to 2007
People who undergo a heart transplant to extend their lives probably don’t think about it, but successful organ transplantation is all about learning from mistakes. Dr. Bill Frist (yes, the former Senate majority leader) helped set up the first organ transplant center at Vanderbilt University.
“Every time you cured one problem,” he says, describing the early days of transplantation research, “there was a new problem.”
Already a Harvard-educated cardiac surgeon in the early 1980s, Frist spent a year and a half training under Dr. Norman Shumway, a pioneer in the field of heart transplantation, at Stanford University.
“You do a heart transplant and the patient lives for two weeks, and then they have some rejection, but there’s no way to diagnose the rejection,” Dr. Frist says, touting the scientific approach that Dr. Shumway established at Stanford. “Dr. Shumway would go back to the laboratory and invent an instrument to diagnose rejection—like a biotome, which you would insert into the neck, then into the heart, pull a piece of the heart muscle out, look at it under the microscope, and then you’d get the patient out to six weeks. And then you’d have a problem with infections, so he would go out and invent another combination of immunosuppressant drugs that would make it less likely to get infections.”
The enthusiasm in Frist’s voice as he talks about heart transplantation reveals a passion that has consumed a major portion of his life and career. His firsthand account of going through the process of accomplishing a successful heart transplant is presented in his book, Transplant. It includes getting word of a donor, identifying and choosing which patient on the waiting list will get the heart, traveling in the middle of the night by private jet and waiting helicopter to remove the heart from the donor patient, fighting the traffic from the airport to get back to the hospital with a dying organ, and performing the life-saving surgery itself. It is as riveting as any movie thriller on the big screen.
His passion for treating the heart began in a physiology class in his second year at Harvard Medical School. He describes it as falling under a spell. As he says in Transplant, the heart serves a function in the body, just like other organs. “But most of us feel the heart working in ways that we believe are beyond physiology. Our hearts race, or skip a beat, or break, we say, and we are gripped by fear, heavy with sadness, filled with joy, lost in love. From remote time, mankind has considered the heart the sanctuary of our emotions.”
When Frist set up a heart transplant program at Vanderbilt, he didn’t stop there. He set up a program to transplant other organs as well. “What was unique about our program was that it was under one roof, it was centralized, multidisciplinary, five different organs to be transplanted.
“We established a multidisciplinary team,” he continues, “a team doingheart transplants, kidney transplants, liver transplants, pancreas transplants, and even bone marrow transplants, and we put them in a single center. And that concept was brand-new. Nobody had ever done that, not even out at Stanford.”
And the reason he did that was so they could learn from each other, which they still do today. “They interact with each other,” Frist says proudly, now a professor of business and medicine at Vanderbilt University Medical School. “We have everybody under one roof. They’re able to walk the hallways, talk about new innovations, talk about the research, talk about the clinical application, and do it in a way that you learn from each other instead of taking a silo approach to transplantation.
“My whole approach was this: Rejection is rejection, and infection is infection, and you shouldn’t have five different teams trying to figure out these five different processes when the underlying biological processes are the same. ”
Yes, it turns out the medical field doesn’t dwell on mistakes, but learning from them is built into the scientific process from the get-go. In fact, life-saving procedures owe their advancements to such learning, and Frist has seen it work. He says:
The scientific process is about being active and learning from it. It’s taking data—measurements and metrics—and applying it in a way that makes science and discovery efficient and have value, instead of being serendipitous where things just happen.
But all of Frist’s accomplishments in the field of transplantation occurred only because he had to make a life-affecting decision that some may have considered a mistake—especially at the time. What came later was determined by that decision.
Dr. Bill Frist’s Best Mistake, in His Own Words
Around 1982, after I had left Nashville and gone to Boston because it was considered the mecca for heart surgery and for innovation in the practice of medicine, I vvas surprised and disappointed when all seven hospitals and all the academic medical centers got together, and in a very unusual move said, “Because heart transplantation is a new field, and because it’s a field that has not been proven, and because it’s very expensive, we’re going to put a moratorium on doing heart transplants in Boston.”
I had just spent the last 10 years of my life there in Boston, all with the goal of being on the cutting edge [of heart transplantation], of being in a creative environment that was pioneering, that would capture evolving science, shape the science, and direct it in a way that would have a clinical good.
It was terribly disappointing. My dreams had been shattered by a public policy decision made by a group of individuals collectively in Boston, which really ran in the opposite direction of where research and science and finding cures to fatal problems were going.
The decision was made by group of hospitals and clinicians whom I had always looked up to. And all of a sudden they were saying no to what in my mind was one of the most exciting fields in medicine today.
To be able to take individuals who would be dead in six months, and give them 10, 20, 30, or 40 years of life—the potential for that was a great dream of mine.
And this moratorium occurred despite the fact it was the place that had a history of that sort of thing [innovation in heart surgery], that should have been most interested in it. But they were saying, “No, we’re not going to do it. It costs too much. Let somebody else prove it.”
Karyn and I had one child at the time, and we had to make a big decision: whether to go on the track to full professor at Harvard, which is a pretty certain track if you stay on it, with med school, internship, residency, fellowship, assistant professor, and then professor.
Do we stay with the safety and security of Boston, and professorships and clinical directorships there, or do we follow our dreams and follow our hopes of being able to find cures that heretofore had not been either discovered or applied?
We had to make a decision to leave.
At that time, only one person in the country had been working on heart transplants in a systematic, concerted, focused way, beginning with research and carrying it through to clinical application, and that was a guy by the name of Norman Shumway, and he was at Stanford at the time.
So we picked up and left Boston, and left the opportunity to stay there, to go to Stanford to be a senior fellow in transplant surgery, to learn how to do heart transplants. The first successful human heart transplant was performed by Dr. Christiaan Barnard, but it was really based on all the research by Norman Shumway.
The Shumway approach was relying on science. Shumway was very systematic, he was very focused.
And that sort of systematic approach to science to cure seemingly insurmountable problems is a lesson that I carried with me that I would never have been exposed to had I stayed in Boston.
You had Shumway out there saying, “Believe it can be done, think about how to do it, and just go do it.” In Boston, they basically said, “We’re not sure it can be done, and it’s too expensive, and we should use these resources elsewhere; therefore, let’s not engage in the clinical practice.” They were saying the value in heart transplantation doesn’t exist, so instead of trying to participate in creating that value, they just said, “No, let’s put the money elsewhere.”
The lesson for individuals is that if you run up against a roadblock where people say no, and you really believe in it and have the passion that they should not be saying no, you just need to follow your passion and go do it.
If it means leaving the security of a safe, comfortable 30- or 40-year career—as I did—and taking that chance, and going out with somebody who is an iconoclast in some ways, and not even yet accepted in the mainstream, like Norman Shumway at the time, follow that passion, follow those dreams, and realize what can be done.
About William H. Frist, MD
Doctor and Senator Bill Frist is both a nationally recognized heart and lung transplant surgeon and a former U.S. Senate majority leader. Currently Professor of business and medicine at Vanderbilt University, he is uniquely qualified to discuss the challenges and solutions in health care policy. Senator Frist is consistently recognized among the most influential leaders in American health care and is one of only two individuals to rank in the top 10 of each of the five inaugural Modern Healthcare magazine annual surveys of the most powerful people in health care in the United States.
Senator Frist majored in health policy at Princeton University’s Woodrow Wilson School of Public and International Affairs before graduating with honors from Harvard Medical School and completing surgical training at Massachusetts General Hospital and Stanford University. As the founder and director of the Vanderbilt Multi-Organ Transplant Center, he has performed more than 150 heart and lung transplants and is the author of over 100 peer-reviewed medical articles and chapters, over 400 newspaper articles, and seven books on topics such as bioterrorism, transplantation, and leadership. He is board certified in both general and heart surgery.
Dr. Frist represented Tennessee in the U.S. Senate for 12 years, where he served on both committees responsible for writing health legislation (Health and Finance). He was elected majority leader of the Senate, having served fewer total years in Congress than any person chosen to lead that body in history. His leadership was instrumental in passage of prescription drug legislation and funding to fight HIV at home and globally.
Senator Frist’s latest book, A Heart to Serve: The Passion to Bring Health, Home, and Healing, is an inspirational treatise on channeling one’s passions to serve others through medicine, politics, and global health. In it he discusses how his family shaped his values, his arduous path to leadership and service to others through heart transplantation, his jump to serving a larger community through politics, and his commitment to global health and communities around the world. The reader is treated throughout to a behind-the-scenes, insider’s look at his life-saving emergency surgery on General David Petraeus; his unique health care experiences, including his working almost a year for the socialized British National Health Service; and the never before fully told story of his rise to majority leader.
Today Senator Frist is focused on domestic health reform, K—12 education reform, the basic science of heart transplantation, global health policy, economic development in low-income countries, children’s health around the world, health care disparities, medical mission work in Sudan, the health of the mountain gorilla, and HIV/AIDS.
Frist currently serves on the Robert Wood Johnson Foundation’s Commission to Build a Healthier America, which has directly linked better health to education. This along with other education research led him to create the Tennessee State Collaborative on Reforming Education (SCORE) in 2009, which is a statewide K—12 education initiative working to improve the level of education for Tennessee students.
Dr. Frist regularly leads annual medical mission trips to Africa. He is chair of Save the Children’s Survive to Five Campaign and Nashville-based Hope Through Healing Hands. His current board service includes the Kaiser Family Foundation, Millennium Challenge Corporation, Africare, the U.S. Holocaust Museum’s Committee on Conscience, the Smithsonian Museum of Natural History, the Center for Strategic and International Studies, and the Harvard Medical School Board of Fellows.
Senator Frist was the 2007—2008 Frederick H. Schultz Professor of International Economic Policy at Princeton University’s Woodrow Wilson School of Public and International Affairs. He is a partner in the private equity firm of Cressey and Company. Dr. Frist is married and has three sons, and lives in Nashville.
