Sir Roy Calne, our leading liver transplant surgeon, is locked in the paradox of which his painting is an emblem. Thirty-five years ago he was one of the pioneers of the international quest for an anti- rejection drug that would make the grafting of human organs possible. As a consequence, the gift of prolonged active life has been bestowed on thousands of people suffering from fatal diseases.
Yet life-preserving medical discoveries have brought about apopulation explosion that is already unleashing war, famine, pestilence and death on a scale that threatens civilisation itself. His book Too Many People, published next week, proposes radical governmental intervention to reduce childbirth and warns, chillingly, that there is not much time left.
He is a compact man of 63, 5ft 7in tall and weighing 12 stone, with black bushy eyebrows, crisp blackhair and an open, roundish, good- humoured face unstamped by professional arrogance. The walls of his office at Addenbrooke's Hospital in Cambridge, and of his suburban house, are cluttered with his portraits of his transplant patients. These pictures capture their suffering - but something else as well: the essence of his extraordinary partnership with them. He needs their stamina, their bravery and their trust. They need his knowledge, his candour and his humanity. Their haunted faces bring to mind those in paintings in the Imperial War Museum of soldiers coming out of the trenches.
ROY CALNE and his brother Donald, now Professor of Neurology at the University of British Columbia, grew up in a comfortable home in Surrey. His father, who had been an engineer with Rover in its pioneering days, owned a garage. As a boy, learning to take cars apart and put them together again, Roy acquired an interest in how things work that translated itself into an ambition to become a surgeon.
He was educated at Dulwich College prep school and Lancing, and entered Guy's Hospital medical school at the precocious age of 16. During his National Service he was medical officer of the 2nd Ghurka Rifles in Hong Kong. Back in England, he became an anatomy demonstrator at Oxford, an even humbler and worse-paid job than houseman. At Guy's he had met his wife, Patsy, still a strikingly slim and elegant woman and in those days as lean as a compass needle. One day the head of his department sent for him. 'I saw your wife last night, Calne,' he said. 'She's dreadfully thin. I don't think she's getting enough to eat. I'm raising your salary.'
Not only did transplant surgery not exist in the Fifties, its possibility was derided by many medical scientists. Calne's interest was first engaged at Guy's when treating a patient of his own age who was dying of renal failure.
'The consultant on his rounds said: 'We must make him comfortable while he dies in the next two weeks'. I was fond of this lad. I knew his family. I asked if he couldn't be treated with a kidney graft. There were gasps from everybody. The consultant replied: 'It just can't be done.' I was going to pursue my questioning when someone nudged me and whispered: 'You do want a job at Guy's, don't you?' So I shut up. That was the first time I had thought
Transplant medicine has always required strong nerves and persistence. In the early days there was continual professional discouragement, and the literature was sparse. The relationship between surgeon and patient was often close. Surgeons knew that the first patients for any new procedure would endure great trauma with odds against prolonged survival, which posed legitimate moral questions. And with success came the knowledge that almost all transplant operations are tragically associated with the death of the donor and the grief of relatives asked for their permission.
Calne was given his chance after he moved to the Royal Free in 1958. 'I wanted to work in this subjectthat everybody said was hopeless and couldn't be done. I found that human kidney transplants had been attempted but had all failed except for an identical-twin kidney graft carried out by Joe Murray at the Peter Bent Brigham Hospital in Boston.'
The hitherto immovable obstacle was rejection of the transplanted organ. Various researchers were trying radiation. The Brigham team had used an anti-cancer drug, Theotepa, without prolonged success. In 1959 Nature published a paper by two researchers who had successfully used another anti-cancer drug, 6-Mercaptopurine. Calne tried it in his work on dogs and found it significantly delayed rejection.
He applied for a job at the Brigham, where he achieved successful kidney grafts on dogs with Azathiopurine, a derivative of 6- MP. When Lollipop, who had survived for six months, tail-waggingly bowed to applause in a crowded auditorium, Calne knew the immovable obstacle was starting to shift. Shortly afterwards, the use of thiopurines allowed the first moderately successful human organ transplants from unrelated donors.
At Cambridge from 1965 he was one of the small band of British and French surgeons who were learning to transplant livers in pigs. In 1968, in the week that Christiaan Barnard performed the first human heart transplant in South Africa, he had to decide whether to attempt a liver transplant in a terminally ill patient.
'I was being subjected to the usual enthusiastic support one's colleagues give on these occasions: 'Don't do it] It can't be done] It shouldn't be done]' Murray's chief, Francis Moore, happened to be visiting Cambridge. I said: 'This is Dr Moore of the Brigham. Let's hear his views.' He just said: 'Gee, Roy, you've got to do it]' ' It was the first human liver transplant outside America.
Calne's department now performs 100 liver transplants (annual budget pounds 4m- pounds 5m) and 80-90 kidney transplants a year. Survival periods are lengthening. One patient who had a liver transplant in America 24 years ago has taken no anti-rejection drugs for 14 years. The department has done 21 liver- and-kidney grafts (without rejection), and in the past seven years five heart-lung-and-liver grafts (four patients still alive). Recently, he performed a 12-hour six-organ transplant.
He keeps fit by playing squash or tennis four or five times a week, and relaxes by painting. The Scottish artist John Bellany, a liver transplant patient six years ago, introduced him to a richer palette. He and Patsy (they have two sons and four daughters) have a cottage in Spain.
'People criticise transplant surgery,' he says. 'As a doctor this doesn't worry me. If you come to me in pain and frightened, it's my duty to help you. But as a citizen of the world I regard transplant surgery as irrelevant. There are about a billion people living in the streets of mega-cities on the verge of starvation. In Bombay two years ago I visited the children's hospital. The professor of pediatrics told me that every day children were brought in dead and dying from diseases that could easily be treated like cholera, typhoid and tuberculosis. That's when I started writing the book.
'The Royal Society had published a short document giving some stark facts: we were 2 billion a few years ago, we're 5 billion now, we'll be 10 billion in 50 years. This simply isn't sustainable, yet I didn't see any political notice of it taken by anybody.'
The remedies he proposes include tax-breaks for people who accept aminimum age for child- bearing, approved birth-control methods and a two-child limit. Contrary to newspaper reports, he says, he does not support coercive measures, though the language of the book ('there is a strong case for rules limiting the number of births') does not always make this clear. He also suggests an international laboratory for population studies to unify fragmented knowledge of the subject.
His answer to the question ofwhat moral right we have to use these behavioural controls to dictate other people's reproductive habits is grimly persuasive. Environmental breakdown is now a greater threat to an open society than are the Fascist look-alikes east of the Elbe, in the Middle East and elsewhere. If we don't sacrifice some freedoms we may be left with none. That a great British surgeon whose humanitarian and liberal credentials are unassailable should be forcing himself to accept this is what makes Too Many
People so absorbing - and so alarming.
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