Founder of UCLA Health's liver-transplant program reflects on 40 years of saving lives
Ronald W. Busuttil, MD, PhD, remembers the day he performed his first liver transplant at UCLA Health as if it were yesterday. It was mid-afternoon, and he was at his accountant’s office doing his taxes when he received a phone call that a donor organ was available at St. Joseph Medical Center in Burbank.
In the early days of liver transplantation, there was a short window to recover an organ and transplant it successfully into the patient. He needed to be at St. Joseph’s no later than 6 p.m.
Dr. Busuttil set out with two of his colleagues for the 17-mile drive to Burbank. But first, they had an errand to run.
“In those days, liver transplants were done very infrequently, and the way we transported the donor organ was in an Igloo cooler filled with ice,“ Dr. Busuttil, founding chief of the Division of Liver and Pancreas Transplantation, recalls. “We would procure the organ, profuse the organ during the procurement with preservative, pack it in ice and bring it back.”
After a quick stop at a nearby convenience store to pick up a cooler and four bags of ice, the team was on its way to procure the donor organ.
That was Feb. 1, 1984 — the day UCLA Health launched what was to become an enormously successful liver-transplant program. Today, the hospital system has one of the largest and most prestigious liver-transplant centers in the nation. As the program’s founder and chief surgeon, Dr. Busuttil served as director of the Pfleger Liver Institute, which includes the Dumont UCLA Transplant Center and the Dumont UCLA Liver Cancer Center. He held UCLA’s William P. Longmire Jr. Chair in Surgery for more than 17 years.
During a nearly 40-year span, Dr. Busuttil and his team have performed an estimated 8,000 liver transplants, including over 1,000 on children. Under his guidance, UCLA Health also ran liver-transplantation programs at Cedars-Sinai Medical Center during the late 1990s and at UC Irvine.
Dr. Busuttil will be honored by his peers for his many contributions to UCLA at the Luskin Conference Center on Friday, July 29.
“It couldn’t have been a better three-and-a-half-decades of saving lives,” Dr. Busuttil reflects. “We have such a wonderful team that made this possible. It was an incredible span and an incredible career. I couldn’t be happier.”
Jonathan Hiatt, MD, former vice dean for faculty of the David Geffen School of Medicine at UCLA, calls Dr. Busuttil “one of the greatest living surgeons.”
“While it was not built on his back alone, UCLA’s liver-transplant program succeeded because of his singular determination,” Dr. Hiatt says.
Early role model
Dr. Busuttil knew since his teens that he wanted to become a doctor. His paternal great-grandfather had served as the private dentist to the king of Egypt, and the family lived there until the start of the Arab-Israeli War of 1948.
Dr. Busuttil was four when his family immigrated to the U.S., settling in Tampa, Fla. He graduated magna cum laude from Loyola University in New Orleans and earned his medical degree from Tulane University School of Medicine in 1971 and a PhD in pharmacology from Tulane in 1975. He came to UCLA in 1971 to do his surgical residency under William P. Longmire, MD, the first chairman of the Department of Surgery.
Among his significant role models, Dr. Busuttil counts the late Elmo J. Cerise, MD, a well-known surgeon in New Orleans.
“I had the honor to assist him in surgeries three days a week when I was at Tulane, getting my PhD, from 1973-1975,” Dr. Busuttil recalls. Joking about his rigorous study schedule, he adds: “I told him I couldn’t stay out later than 10:30 or 11 p.m.
“It was a wonderful experience. I must have participated and assisted him in 300 to 400 surgeries over that two-year period. He was an outstanding surgeon and a phenomenal individual.”
Career path cemented
Dr. Busuttil began his career at UCLA as a vascular surgeon. He became passionate about treating patients with liver failure after losing a patient soon after performing a distal splenorenal shunt to control the patient’s bleeding.
Despite his efforts, the patient developed hepatic encephalopathy, a decline in brain function that occurs as a result of severe liver disease. Though an attempt was made to get the patient transferred to Dr. Thomas Starzl — widely considered the father of liver transplantation — at the University of Pittsburgh, the patient succumbed to liver failure before the transfer could happen.
”That was really, really devastating,” Dr. Busuttil recalls. Distraught but determined, he went to Dr. Longmire.
“I said, ‘Dr. Longmire, I’d like to get your approval to start a liver-transplant program here at UCLA,’” Dr. Busuttil recalls. “He was very supportive, as was the chairman of the department, Dr. James Maloney.”
In 1984, liver transplantation was in its infancy. Only the University of Pittsburgh had established a significant program. A few smaller centers were doing transplants on an experimental basis; however, one was shuttered after a surgery during which so much blood product was used that the hospital was forced to shut down its blood bank for three days.
Needless to say, it wasn’t the climate in which to start a new transplant program. Drs. Longmire and Maloney gave their consent, with a caveat. “They said we had to be careful. They would let us start a program, but we had to be very careful and very cautious,” Dr. Busuttil relates.
After first performing liver transplants on about 50 pigs (“Their anatomy is similar to humans,” Dr. Busuttil explains), he went to Pittsburgh to train under Dr. Starzl.
“I spent 10 days with him, worked with him and observed on seven cases,” Dr. Busuttil says.
Then he returned to UCLA to await an appropriate patient and donor liver.
Committed to saving lives
Dr. Busuttil describes the first liver transplant he performed on a human as both “intimidating” and “encouraging.” He calls it the “case of 17” because It took 17 hours from the start of the donor operation to the completion of the transplant; the patient required 17 units of blood — “Which was very, very good,” he says — and the patient went home in 17 days.
“The fact that he went home in 17 days in 1984 after a liver transplant was quite encouraging for us,” Dr. Busuttil says.
The program went on to save thousands of lives that would otherwise have been lost without a transplant.
He says he is continually heartened by the commitment of liver-transplantation patients to maintaining their post-operative health.
“They are so strong, and they are so committed to doing what they can to advance the field and to be advocates for other patients,” he says. “That is so important, and that motivates me.”
Throughout his career, Dr. Busuttil has strived to embody the guiding principles that led him to become a physician. Those are: “A commitment to be a caring, thoughtful and compassionate physician and surgeon; to be a physician who is committed to his patients and to those he is training; and to be a physician whose ultimate goal is to save lives. That is what liver transplantation can do, and that commitment is something I could not do without.”
A lasting legacy
How does Dr. Busuttil explain the sustained success of UCLA’s liver-transplantation program? There are two essential factors — the department’s commitment to advancing the field in both basic and clinical scientific research and its commitment to training fellows — he says.
He notes that more than 80 fellows have graduated from the UCLA Health transplantation fellowship, considered one of the world’s best. About one-third of them are now leading liver-transplantation programs in the U.S. and abroad.
“It's inspiring to see just how far and wide the reach of his impact has been in terms of the fellows he has trained who have gone on to run their own program,” says his daughter, Ashley Busuttil, MD, chief medical officer at Ronald Reagan UCLA Medical Center. “You can see that exponential impact, and that’s really, really nice.”
Dr. Ashley Busuttil credits her father’s passion for his work for inspiring her own career in medicine.
“A lot of his work, and all the stories around his work, are interwoven with my childhood,” she recalls. “I remember going to the houses of his friends and colleagues; it was very much a tight-knit group. I would make rounds with him at the hospital. I felt like I grew up with the program as it grew.”
Dr. Busuttil receives high praise from his peers, as well.
“One of the many lasting legacies of Dr. Busuttil’s career is his extensive impact on the department faculty, trainees and staff,” says Joe Hines, MD, FACS, professor of surgery and interim chair of the Department of Surgery. “He embodies a level of clinical, technical and academic talent that is rare and exceptional. His efforts will support countless department members for decades to come.”
In addition to his pioneering work as a surgeon, Dr. Busuttil has written more than 840 peer-reviewed scientific manuscripts, 86 book chapters and 550 abstracts. He is co-author of Transplantation of the Liver, considered the definitive text on the subject, and is currently working on a fourth edition.
His awards are numerous and include the American Surgical Association’s Medallion for Scientific Achievement — the organization’s highest honor.
Additional honors include Tulane University Outstanding Alumnus Award; Marquis Who's Who in Medicine and Healthcare; United Liver Association’s Man of the Year Award; Loyola University Integritas Vitae Award; Sherman M. Mellinkoff Faculty Award, David Geffen School of Medicine at UCLA; and Society of University Surgeons Lifetime Achievement Award.
Humbled by the awards, Dr. Busuttil says his success has been a team effort.
“What has been most gratifying is the wonderful people I’ve had the opportunity to work with here at UCLA,” Dr. Busuttil says. “They have been tremendously collegial, they’re professional, they’ve been experts, and their goal is to save lives and to advance the field. It’s been such an honor to be working with this great multidisciplinary team for the past 44 years or so.”
He also praises the work being done in basic and clinical science at UCLA that has contributed “tremendously” in many areas of transplantation. Among the advances that stemmed from the laboratory are better preservation fluids and techniques that allow a longer time period — up to 12 hours — in which to transplant the organ.
UCLA Health also took part in an early trial comparing FK506 (Tacrolimus) to another drug, cyclosporine. Both are used to prevent organ rejection in individuals who have received a liver, kidney or heart transplant.
“Results were improved with FK506, and that is basically the standard now for immunosuppression in liver transplantation and many other organs,” Dr. Busuttil says.
While Dr. Busuttil’s contributions to the field of liver transplantation speak for themselves, Dr. Ashley Busuttil notes that her father’s impact goes far beyond the operating room — and indeed, beyond the field of medicine.
“You can tell when speaking with anybody he has been in contact with that he touches and instills confidence in them,” she says. “He has saved many, many lives, but he also has touched many more beyond those he has saved.”
As Executive Chairman Emeritus of the Department of Surgery, Dr. Busuttil says he is looking forward to mentoring residents and fellows and continuing to participate in the program he helped build in “whatever way is appropriate for a retiree.”
He’s also excited to explore his other passions, namely sports cars, traveling and playing tennis and golf with his wife, JoAnn, and spending time with daughters Amber and Ashley and his four grandsons.
“I feel very blessed and very honored for this wonderful family, who have been so supportive of me and my profession their entire lives,” he says.
Learn more about the UCLA Liver Transplant Program.
Jennifer Karmarkar is the author of this article.