John Najarian, a celebrated transplant surgeon who, by dint of his skill on the operating table and with an anti-rejection drug that landed him on trial in federal court, expanded the lifesaving potential of organ transplants beyond what was once thought to be possible, died Aug. 31 at a nursing home in Stillwater, Minn. He was 92.
He had heart ailments, said his son David Najarian.
Historians of medicine place Dr. Najarian in the pantheon of surgeons who developed organ transplantation in the 1950s, ’60s and ’70s, in the process overcoming the skepticism of critics who regarded the procedure as an impossibility, something drawn from science fiction.
Advertisement
“This was the thing that drove me the most,” Dr. Najarian once said, according to the St. Paul Pioneer Press, “to find a way that we could in fact transplant organs from one individual to another. Wouldn’t this be wonderful if we could do it?”
The most noted early pioneers in the field include the Nobel laureate Joseph Murray, who in 1954 performed the first successful human organ transplant — a kidney transplant between identical twins at Peter Bent Brigham Hospital; Thomas Starzl, who in 1967 performed the first successful human liver transplant; and Christiaan Barnard, who performed the first human heart transplant, also in 1967.
Collectively, these surgeons and others of their generation transformed organ transplants from “experimental treatment into reality,” said Joshua Mezrich, a professor of surgery at the University of Wisconsin School of Medicine and Public Health and the author of the book “When Death Becomes Life: Notes From a Transplant Surgeon.”
Dr. Najarian spent most of his career at the University of Minnesota’s medical school, where he built an internationally known transplant program — and cut an unusual profile in hospital corridors.
He stood 6 foot 3, weighed 250 pounds and wore size 15 shoes, according to his son. A former college football star, he was a tackle for the California Golden Bears, played in the 1949 Rose Bowl and declined a chance to join the Chicago Bears in favor of studying medicine.
Advertisement
But in the operating room, he performed devilishly complex surgeries with the precision of a miniaturist. In 1970, Dr. Najarian stitched a new kidney into a 6-week-old baby, using magnification to view the child’s minuscule veins. At a time when few other surgeons would perform transplants on children so young, Dr. Najarian would review their cases and declare: “I can do it.”
Perhaps his most famous patient was 11-month-old Jamie Fiske, who was born with biliary atresia, a rare condition of the liver and bile ducts.
In 1982, after her father, Charlie, made national news with his plea before a meeting of the American Academy of Pediatrics for a new liver for his daughter, Dr. Najarian transplanted the liver of a boy killed in an automobile accident.
The surgery, three weeks shy of Jamie’s first birthday, and after she was given just a week to live, was performed at the University of Minnesota Hospital.
The infant, from Bridgewater, Mass., infant recovered and her case was credited with spurring the National Organ Transplant Act of 1984, which formalized a national organ matching network.
Dr. Najarian specialized in the transplantation of abdominal organs — kidneys, livers and pancreases. Beyond his pediatric cases, he took on patients many other physicians would have considered too old or sick to be considered for transplants, given the techniques and drugs available at the time. In 1968, according to the University of Minnesota, Dr. Najarian and his team performed the first kidney transplant in a patient with diabetes.
Advertisement
The same year he operated on a 6-week-old baby, he operated on a woman of 62, at the time an advanced age for a transplant patient.
“I think we have shown that almost no one is either too young or too old for a kidney transplant,” he said at the time, according to the Minneapolis Star Tribune.
One of the most confounding complications of transplant procedures was organ rejection, in which the recipient’s immune system identifies the new organ as an invader and attacks it. The condition was often fatal, and Dr. Najarian “was working in an era when there wasn’t much to give patients to prevent rejection,” Mezrich said.
Dr. Najarian distinguished himself in the laboratory as well as in the operating room, refining an anti-rejection drug known as anti-lymphocyte globulin (ALG). His purification and application of the drug “revolutionized outcomes in transplants,” Mezrich said, but also sparked a high-profile legal battle that threatened to derail Dr. Najarian’s career.
Over more than 20 years, the University of Minnesota distributed ALG to medical facilities around the world, reaching a reported $79 million in sales. But in 1992, the Food and Drug Administration ordered an end to the program, saying that official approval for mass production had never been granted.
Advertisement
The next year, Dr. Najarian stepped down as chairman of surgery, and in 1995 he resigned from the medical school, although he continued seeing patients. He was later indicted on 21 charges including flouting drug safety regulations, obstructing a federal investigation, embezzling $75,000 from the University of Minnesota by double billing for travel expenses and falsifying income tax forms to conceal income.
At trial in 1996, a judge dismissed six of the charges, and a jury acquitted him on the other 15. In an unusual statement from the bench, the judge credited the drug with saving lives and said that prosecuting Dr. Najarian for the manner in which ALG was produced and marketed crossed “the bounds of common sense.”
In 1998, the University of Minnesota agreed to pay the federal government $32 million in a settlement resolving a lawsuit over sales of ALG. Nine years later, around the time that Dr. Najarian retired from performing surgery, the school announced the establishment of an endowed chair in his honor.
ALG is no longer in use, according to Mezrich, but it was replaced by other drugs similar in concept.
John Sarkis Najarian was born in Oakland, Calif., on Dec. 22, 1927. His father, a rug salesman who was born in Armenia, died when Dr. Najarian was 12 of complications of pneumonia resulting from the flu. After his death, Dr. Najarian’s mother, who was from Turkey, supported her three sons with savvy investments.
In his youth, Dr. Najarian nearly died of a ruptured appendix, an experience that helped fuel his interest in medicine.
Advertisement
“During that period of time, the people that I admired the most were the doctors and the nurses who took care of me,” he said in an oral history for the University of Minnesota. “I was going to do everything I could, if I made it through this, to find out how I could become one of them.”
After graduating from the University of California, Berkeley in 1948, he received a medical degree from the University of California, San Francisco in 1952 and was an Air Force surgeon before joining the UCSF faculty in 1963.
Dr. Najarian established a transplantation service at UCSF and embarked on his research on tissue rejection before moving to the University of Minnesota, where he was recruited to lead the surgery department, in 1967.
At the time, according to Thomas Schlich, a historian of medicine at McGill University in Montreal, the school was a “hotbed of innovative surgery” under the leadership chief of surgery Owen Wangensteen. Dr. Najarian built a noted transplant program at the university, where he “institutionalized this whole principle of transplants,” Schlich said.
Dr. Najarian’s wife of 67 years, the former Mignette Anderson, died in 2019, and their son Paul Najarian died in 2014. He leaves their three other sons, Peter Najarian of Mahtomedi, Minn.; Jon Najarian of Chicago, and David Najarian of Stillwater; 12 grandchildren; and four great-grandchildren.
The parents of children Dr. Najarian treated regarded him with veneration.
Jamie Fiske today is 38 and lives in a nursing facility in Raleigh, N.C., after suffering a brain aneurysm last year unrelated to her liver condition.
Her father, Charlie Fiske, recalled in an interview that when Dr. Najarian emerged from the operating room after the liver transplant, he said that without the procedure Jamie was unlikely to have lived more than another day or two.
“You know, Doctor, you probably shouldn’t have operated on her,” Fiske recalled saying. Dr. Najarian replied by asking, “What other option did I have?”
“We brought to him a dying patient, and he could have easily said, ‘Oh, my God, this is too much risk,’ ” Fiske said. “He gambled on his ability, along with his great medical team there, to give Jamie a second chance at living. There was no place else we could have gone.”