Nazih Zuhdi, M.D.

ABOUT NZTI

The years 1984-2000

In founding this program, Dr. Zuhdi believed that Oklahomans had the right to have transplant procedures performed here and should not have to leave the state.  The transplantation institute brought life-saving medicine to the Sooner State and has continued to pave the way with cutting-edge procedures.

Stanley Hupfeld

INTEGRIS Health

PRESIDENT AND CEO

1987-PRESENT

We are 25 years old and we grew through progressive phases. NZTI’s entire foundation concept—hearts, piggyback hearts, kidneys, live-donor kidneys, heart-lungs, lungs, double-lungs, livers, live-donor livers, in-situ split livers, pancreases, and small intestines—for transplantation, medical components, research, and artificial circulatory support occurred during this period of its formation.

THE NAZIH ZUHDI TRANSPLANT INSTITUTE (NZTI) at INTEGRIS Baptist Hospital Medical Center, in Oklahoma City is the nation’s first, and as far as we know, still the only “comprehensive transplant center.”  Nazih Zuhdi, MD had a vision when he founded the transplant center in November of 1984—a vision of unification “bringing together into an integrated whole” (Thesaurus) all phases of transplantation.  In contrast to the separate, defined and distinct programs and organizations for different solid organ transplants that prevailed in other institutions, Zuhdi organized his institute into one cohesive unit for all solid organ transplants—and he labeled it a “comprehensive transplant center.” The value of this kind of integration is exemplified in the multi-disciplinary approach of two of the units under the NZTI umbrella.  Zuhdi explains:

THE NZTI ORGAN RETRIEVAL TEAM was trained at NZTI in all types of organ retrievals. Starting in 1989, it has grown at present into three full-time surgeons for that mission: Dr. Ye Yong, Dr. Shi-Feng Li, and Dr. Yi Hwang.  They are versed in all transplant modalities, and Dr. Zuhdi considered them as the beacon to light the way for others to copy.  THE NZTI INTENSIVE CARE UNIT is a multi-organ unit with a full-time medical corps trained to take care of all different organ transplants and allied medical conditions.

 

Dr. Zuhdi believed this integrating atmosphere widened the scope of thought, knowledge, and experience.  NZTI has ranked from its inception among the top programs in the nation for survival rates—a remarkable achievement, particularly when based in a community hospital—albeit, a citadel of a medical center.

An analysis of the 1997 center-specific survival report of results up to 1994 by the U.S. Department of Health and Human Services reveals that NZTI ranks, in one-year patient survival, second for hearts, second for livers, and first for lungs among centers performing comparable or more transplants for those organs. When the rankings of each organ are added to give an overall ranking for the center, we ranked on top of the seven centers analyzed above. These numbers also include both actual survival rate and percentage-above-expected survival rate, assigned by the national governing body adjusting for the overall illness severity of the transplanted patients.

 

ABOUT NZTI

The years 2000-2008

Into the Twenty-first Century

1999-2004

This tradition continued with Bakr Nour, M.D. as director, and Anthony Sebastian, M.D., chief of abdominal transplant, as shown by the latest Center Specific Report: “1 Year Survival, Adult, For Patients Transplanted between 01/01/2003-06/30/2005 — Organ: Liver. (Single-Organ Transplants Only; Retransplants-transplants excluded).”

There were only 5 centers in the entire nation among the 107 centers for liver transplantation, that were distinguished by having statistically highest survival rates than the national average—only 5 centers.  And we were listed as the second highest survival rate ahead of the Mayo Clinic in Rochester, Minnesota (our own minimally-invasive hepato-biliary surgeon and abdominal transplant surgeon Dr. Vivec Kholi had his fellowship in transplantation at Mayo Clinic in Rochester, Minnesota and hence, he felt at home at NZTI), Mayo Clinic-St. Luke’s Hospital, Jacksonville, Florida, and Mt. Sinai Medical Center, New York, New York.  Loma Linda University Medical Center, Loma Linda, California, was ahead of NZTI.  High ranking was our forté from the inception of the first heart transplant by Nazih Zuhdi on March 3, 1985.

 

In contrast, exemplary institutions such as Ohio State University Hospital, Columbus, Ohio; University of Southern California, Los Angeles, California; and Johns Hopkins Hospital, Baltimore, Maryland, had the highest mortality of patients in the nation.

 

Research was very prominent at NZTI.  The combined output of its members in its 23 years of existence was significant in number of scientific presentations, scientific publications, patents, and books.

 

2004-July, 2006

Johnny Griggs, M.D., chief pediatric transplant intensivist, was interim director from 2004-July, 2006.

 

2006-

Dr. Nicolas Jabbour was solely recruited by INTEGRIS administration from the University of Southern California, Los Angeles, California, in July of 2006 as the medical director. Our already in existence superior and successful teams of NZTI will continue its legacy.

 

January, 2008-

INTEGRIS Baptist Medical Center announced the formation of Oklahoma Advanced Heart Failure Program at NZTI with the leadership of James Long, M.D., PhD. Zuhdi considers him as his natural replacement to continue the legacy of NZTI.  This section to be elaborated by Dr. James Long.

NZTI History

 

“It was a spur-of-the-moment decision.  I consulted no one,” Dr. Nazih Zuhdi explained, “I was sickened by the placidity surrounding me.  I leaned across my desk and told my executive secretary Sue Lowe, ‘Sue, I am going to start a transplant center. I am calling it The Oklahoma Transplantation Institute.’  ‘OK,’ she said, and a few minutes later, she came into my office, ‘What did you call it? What’s a transplant center?’  It was that simple.”  As a heart surgeon, of course, Zuhdi wanted to start with a heart transplant. March 3, 1985, Dr. Zuhdi performed Nancy Rogers’ heart transplant at Baptist Hospital, an historic first for Oklahoma. He had just raised Baptist Hospital to national prominence in a burgeoning field, and made it one of the 12 or so hospitals in the nation that had performed heart transplants, and it was the only community hospital to do so.  Dr. David Vanhooser retrieved the heart from Georgia, and James Grim was the anesthesiologist.

 

After her discharge, Tim O’Herin in Friday, reported, “Nancy spent the first few days just walking around her house, getting reacquainted with it.  She spent a lot of time beside the beloved creek that ran through her family property.”  Less than three weeks after she left the hospital in triumph, Nancy was readmitted with a virus infection for which there was no medication at that time. She passed away to the Kingdom of Heaven, 54 days after receiving her new heart. But a woman, Nancy Rogers, led the way to our comprehensive transplant center.

 

At the time of the transplant, Jay Henry was the President of Baptist Hospital Medical Center and he retired early in 1987.  Kenneth Bonds was Chairman of the Board at Baptist; he crystallized in 1986 the Oklahoma Transplant Institute by his singular agreement with Dr. Zuhdi and secured Zuhdi’s continued presence and his creative momentum. Stanley Hupfeld became the President of the Baptist Hospital Medical Center in April of 1987.  When he was asked by the Journal Record reporter Max Nichols why he left All Saints Episcopal Hospital to take over Baptist, Hupfeld gave a reply that revealed not only a clear understanding of the work at the center, but also his vision for it.

 

Baptist Hospital is on the cutting edge in several areas, said Hupfeld, including heart transplants, heart-lung transplants, and the work of Dr. J.V.D. Hough (who headed a team that helped develop the first bioelectronic ear). I like being a part of that.

Also, Baptist is recognized as the market leader, and there is a special challenge to being in that position.  We are expected to be the best.  We have to be competitive, and I still like being competitive.

 

 

The administrative talents of Stanley Hupfeld were demonstrated in his forward to The Life of Nazih Zuhdi—Uncharted Voyage of a Heart by Brooks Barr, PhD,

 

I asked Nazih to do the first five-minute introduction, and I stressed that while I would like to give him more time, in order to fully present the financials, equipment, etc., that would go into the development of such a program, I had to limit his time to five minutes.  He swore to me on several occasions that he understood the need for brevity.  Of Nazih’s many wonderful virtues, brevity is not one.  Nevertheless, I took him at his word and planned for the meeting.  I invited Dr. Zuhdi in the room and asked him to introduce the subject. The first words out of his mouth were… “I am Nazih Zuhdi—son of Abraham.”  Nazih then spent ten minutes talking about the relationship of the Muslim, Christian, and Jewish religions.  And another ten minutes talking about the early life and times of Nazih Zuhdi.  Another full five to ten minutes talking about his early training.  We were now almost 45 minutes into an agenda item slated for five, and the story of Nazih Zuhdi still had not made it to the United States.

At this point, I interrupted and told the assembled board members that because of the time constraints we had one of two choices, either we could ask Dr. Zuhdi to come back next month and finish the discussion, or we could approve the program, sight unseen.  I got a motion to approve the program, and Baptist Hospital Medical Center launched into liver transplantation without ever reviewing the details of the program.

I have had the opportunity to tell that story many times.  It captures Nazih’s well-known proclivity for speaking at length.  It also is very clearly a measure of the prestige and reputation that he carries throughout our community.  The board clearly was very comfortable with embarking on something this serious if they were  convinced that Nazih Zuhdi was committed to the program.

 

The role of Stanley Hupfeld was best expressed with a remembrance presented by Dr. Zuhdi to him the Christmas of 2006 for the years 1987-1999. It was an 86 1/2 pound natural copper rock that had been found in a Michigan mountain.  Zuhdi wrote the words that were inscribed by artist Gary Hamby:

 

                                    Stanley Hupfeld

                                    For doing the impossible together

 

                                    Nazih Zuhdi

 

The transplant institute grew into its present dimensions.  NZTI has expanded from a staff of only three to more than 250 clinicians, surgeons, researchers, and support personnel.  And it emerged in the year 2008 as the only center in the state of Oklahoma performing all solid organ transplants—hearts, lungs, and livers—only the kidneys and pancreases being shared by other hospitals.

 

The Growth of NZTI

     Transplant Firsts at NZTI

     Mechanical Circulatory Support

            Substitute for a Heart Transplant

 

November, 1984 Nazih Zuhdi conceived, founded, started, and charted the course of what is now known as the Nazih Zuhdi Transplant Institute (NZTI). During the formulation of NZTI in 1984, Jay Henry was president and CEO of Baptist Medical Center.

 

March 3, 1985, Nazih Zuhdi, M.D. performed Oklahoma’s first human heart transplant at Baptist Hospital, one of the 12 or so hospitals in the nation and as far as we know, the first in a community-based hospital.

March and April 1985, Zuhdi performed four heart transplants. Together they are the panes of the window and the four cornerstones of a foundation in the “House that Zuhdi builtthe Oklahoma Transplant Institute (OTI), renamed the Nazih Zuhdi Transplant Institute (NZTI).

End of April 1985, After his initial visit in May 1984, as the guest of Zuhdi, for the dedication of the Oklahoma Heart Center that Zuhdi co-founded and was its chairman, Christian Barnard returned to Oklahoma City by the end of April 1985, after Zuhdi completed his four heart transplants.

May 31, 1985, Nazih Zuhdi performed, at Baptist Hospital, Oklahoma’s first piggyback heart transplant—two hearts in one chest—the sixth piggyback heart transplant in the nation.

May — June 1985, Nazih Zuhdi performed two successful piggyback hearts. 

 

 

During the above four months, Nazih Zuhdi performed six heart transplants and five were dismissed to home.

 

 

1985, Christiaan Barnard described his modus operandi at NZTI in his 1993 book, The Second Life:

I discussed my duties with Nazih and we agreed that I should act only in an advisory capacity, supervise the research programme and be a public relations officer for the transplant programme and the heart centre. 

 

July 11, 1986, Zuhdi performed a heart transplant with the new crew of Dimitri Novitzky, M.D. as first assistant and John Chaffin, M.D. as second assistant.  Zuhdi considers John Chaffin as a product of NZTI.   

 

January 24, 1987, Scott Samara, M.D. performed NZTI’s first kidney transplant.

April 1987, Stanley Hupfeld started his tenure as President and CEO of Baptist Medical Center.B

June 6, 1987, Nazih Zuhdi, M.D. performed, with David K.C. Cooper, M.D., and Dimitri Novitzky, M.D., Oklahoma’s first heart-lung transplant at Baptist Hospital.

 

May 5, 1988, Nazih Zuhdi, M.D. with Dimitri Novitzky, M.D. implanted at Baptist Hospital in the same patient Oklahoma’s first successful right ventricular assist device (Thoratec) and Oklahoma’s first successful left ventricular assist device (Thoratec) as a bridge to transplantation.  They maintained the patient alive and well for five months until a heart became available.  Patient was transplanted, post-operative course was smooth, and patient was dismissed to home; she later passed away due to rejection.  

May 19, 1988, The Food and Drug Administration approved the use of left and right ventricular assist devices to prolong life for patients awaiting transplant surgery at Baptist Hospital-the first hospital in the state to be recognized and one of 20 in the nation.

 

January 1989, The heart transplant program at Baptist Hospital received Oklahoma’s first Medicare certification, and the first awarded to a non-teaching hospital.

 

 

 

June 23, 1990, Nazih Zuhdi, M.D. performed Oklahoma’s first single lung transplant at Baptist Hospitalone then of a handful of such centers worldwide.

Norman Imes, M.D. was medical director of lung transplant medicine.

 

 

November 8, 1992, Luis Mieles, M.D. performed NZTI’s first liver transplant.

 

1994, Nathan Lidsky, M.D. and Barbara Kerwin, D.O. initiated a full time medical corps for a unified intensive care of transplants of different organs and related diseases at Baptist Hospital.

1994, David Nelson, M.D. initiated the heart transplant medicine unit at NZTI. 

April 15, 1994, Nazih Zuhdi, M.D. performed Oklahoma’s first double lung transplant at Baptist Hospital Medical Center.

August 2, 1994, Bakr Nour, M.D. performed Oklahoma’s first pediatric liver transplant at Baptist Hospital. By the end of 2002, about 11 percent of the liver transplant patients were pediatric—only 26 centers in the nation have performed more pediatric liver transplants than NZTI.  Perhaps most memorable was Jacob Mills who was 7 weeks old when he was transplanted September 11, 1999. Jacob was the youngest Oklahoman ever to receive a transplant and one of the youngest in the nation.  The donor organ itself was larger than the patient and had to be carefully reduced to fit.  Dr. Nour was the pediatric liver surgeon.

 

1995, Robert McFadden, hepatologist, and David Van Thiel, M.D. founded with Harlan Wright, M.D. Oklahoma’s first specialized hepatology service at Baptist Hospital Medical Center.

March 17, 1995, Eliezer Katz, M.D. performed Oklahoma’s first living-donor liver transplant. Katz as well performed the other four living-donor liver transplants at Baptist Hospital.

November 7, 1995, Anthony Sebastian, M.D. performed Oklahoma’s first pancreas transplant in a patient with Type I Diabetes Mellitus and end-stage renal disease.  Scott Samara, M.D. performed the accompanying kidney transplant.

January 19, 1996, Eliezer Katz, M.D. initiated and led the team for the USA’s first beating heart in-situ split liver transplant where the liver was divided into two parts—the larger right portion sent to an adult in New York and the smaller part given to a child at NZTI.

October 22, 1996, Bakr Nour, M.D. performed Oklahoma’s first small bowel transplant at Baptist Hospital.

 

October 31, 1998 It was fortuitous that the 1000th transplant happened to be a heart.  The heart transplant surgery was performed in the course of three hours from 11:00 P.M. to 2:00 A.M. by John Chaffin, M.D. and David Vanhooser, M.D. The heart was retrieved from a local hospital by Ye Yong, M.D., and Shi-Feng Le, M.D. The patient, 47-year-old Margaret Sue Craig suffered from cardiomyopathy. Vanhooser and perfusionist Jerry Jenison, C.C.P., were also participants in Oklahoma’s first heart transplant surgery performed by Nazih Zuhdi, M.D. in 1985.

 

2000—2005, Bakr Nour, M.D. was the medical director of NZTI.

 

2002, NZTI Heart Transplant Program achieves 100% one year survival rate.

 

November 16, 2003, Bakr Nour, M.D. performed Oklahoma’s first multi-visceral abdominal transplant at Baptist Hospital.

 

2005—2006,  Johnny Griggs, M.D. became the medical director of NZTI.

 

2006—present, Nicholas Jabbour, M.D. is the medical director of NZTI.

 

2007,  NZTI’s 400th heart transplant is performed.

 

January 2008, Formation of Oklahoma Advanced Heart Failure Program under the leadership of James Long, MD, PhD.  To be elaborated by Dr. James Long.

 

As of February 2008, there were more than 2259 patients who received the various organs cited above.  About 11,000 patients were treated for end stage liver disease in the hepatology division. There were 54 patients who received left-ventricular-assist devices (most of the assist devices were performed by James Long, MD, and PhD) in the last decade.

 

A PIONEER TO BOLD NEW FRONTIERS

NAZIH ZUHDI, MD

 

Dr. Zuhdi is internationally recognized as the “Father of Total Intentional Hemodilution.” Clif Warren summarizes its impact:

During 1959-1960, in Oklahoma City, Dr. Nazih Zuhdi laid the foundation and opened the gateway for bloodless surgery for all patients.  This had been a major goal of all surgeons since surgery began.  Zuhdi’s “Total Intentional Hemodilution,’ for which he has been accorded incontestable status worldwide, solved the worry of the proper management for procedures requiring cardiopulmonary bypass and paved the way for this application to be used globally for all forms of surgery when possible.

The principles he used allowed for a more flexible understanding of blood hemacrit (the level of red blood cells), thereby making all variations, including transfusion-free surgeries, not possibilities but immediate realities.

At first Zuhdi’s basic principles of Total Intentional Hemodilution astounded the medical profession, but in time they were globally accepted, and in turn, benefited all patients of all colors, races, philosophies, and religions—of course, including Catholics, Protestants, Muslims, Jews, Hindus, Jehovah Witnesses, and all mankind.  As soon as Zuhdi’s success became known, physicians from throughout the world began to beat a pathway to Oklahoma City. And across the world millions of patients annually are served through Zuhdi’s Total Intentional Hemodilution….

 

Zuhdi co-founded with Allen Greer M.D. and John Carey, M.D. the Mercy Heart and Research Institute in Oklahoma City, Oklahoma (1958). In its research laboratories with the experimental kennels on the campus of Mercy Hospital, Zuhdi originated and completed his experimental (1959) use of non-hemic, no-blood and no-blood components primes of heart-lung machines, producing his Total Intentional Hemodilution.  Zuhdi also studied and inaugurated the use of banked citrated blood instead of the specially prepared fresh blood for surgical field blood loss replacement if needed beyond the cell saver. This led the following year (February 25, 1960) to his clinical implementation with Greer and Carey of Total Intentional Hemodilution—the universally accepted principle of cardiopulmonary bypass for partial and total body perfusion during open-heart surgery, heart transplantation, and lung transplantation-a benefit for millions of people around the world.  

John Carey, M.D. and Nazih Zuhdi, M.D. performed the first successful cardio-pulmonary bypass operation ever on a pregnant woman—using, of course, Total Intentional Hemodilution. By  1961, the team reported the clinical experience with 127 patients. The response worldwide became the talk of all surgeons at all meetings.  Nazih Zuhdi realized that once the principle has been established and accepted, variations would happen and its expansion would be forthcoming. Zuhdi published his famous paper in 1964 with the title, “Blood, Mannitol, Dextran, sugar water and confusion”.  Several of Zuhdi’s papers on the subject were condensed in Yearbook of General Surgery, editor Michael DeBakey in the years 1962-1963, 1963-1964, and also, condensed in the series Cardiovascular and Renal Diseases, editor John W. Kirklin and others, 1962-1963. As Zuhdi predicted, the robust vitality of the basic principles of hemodilution has been proved by the flexibility of their application by countless other surgeons worldwide.

 

At the Mercy Heart and Research Institute, he conceived, designed, and implanted into a dog the Zuhdi-Ritchie ventricular artificial bypass heart (1963-1964).

He was the first surgeon in the United States to implant a pig’s heart valve ála Carpentier (1970) into a human at Baptist Hospital in Oklahoma City, Oklahoma. He was the first in the world to implant a stabilized glutaraldehyde porcine valve into a human (1970) at Baptist Hospital in Oklahoma. He founded Oklahoma Transplantation Institute (OTI) late November, 1984 at Baptist Hospital—it was renamed the Nazih Zuhdi Transplantation Institute (NZTI) in 1999. He was inducted into the Oklahoma Hall of Fame, 1994.  The etched portrait of Zuhdi is one of 60 honorees in 20 monoliths forever preserved as a part of Oklahoma’s incredible history on the Oklahoma State Fairgrounds in Oklahoma City.  The replica of his 1959-1960 double helical reservoir heart-lung machine that brought about non-hemic total intentional hemodilution and the original 1963-1964 Zuhdi-Ritchie ventricular bypass artificial heart are on permanent exhibit at the Oklahoma History Center, an affiliate of the Smithsonian Institution.  Nazih Zuhdi and James Gilbert obtained on September 10, 2006, the provisional patent for their Zuhdi-Gilbert Symbionic Heart Assist Device (MFCP).  This provisional patent has been extended to December 17, 2008.  Zuhdi has discussed it briefly with Long in the last two years.  Long has proposed to Zuhdi that he will complete the work on it as a legacy to Zuhdi.  Zuhdi, with his advancing age, is prone to agree.

The Life of Nazih Zuhdi—Uncharted Voyage of a Heart by Brooks Barr, PhD, has descriptive insights and formative details into his life, his accomplishments and NZTI.

 

A PIONEER CONTINUES THE WAY TO NEW FRONTIERS
JAMES LONG, MD, PhD 

Partnership with Dr. James Long for Heart Assist Devices, 1996

Dr. James Long from Latter Day Saints Hospital in Salt Lake City had a major, very active, leading surgical role with NZTI in assisted heart devices starting in 1996, for 12 years.  He joined NZTI in 2008.