Published Monday December 21, 2020
In 1969, kidney dialysis and transplantation were considered important emerging parts of the clinical partnership between the fledgling University of Texas Medical School at San Antonio and the brand-new Bexar County Hospital. Founding faculty including surgeon Dr. J. Bradley Aust and renal specialist Dr. Marvin Forland were preparing for the first kidney transplant to be performed in a San Antonio civilian hospital.
Neither dialysis nor transplantation were available outside the San Antonio military community at the time.
Dr. Aust, chief of surgery, had been part of a pioneering clinical and research transplant group at the University of Minnesota. Recruited to San Antonio in 1966, he was assisted by his junior colleagues, Dr. Waid Rogers and Dr. Carlos Pestana. Dr. Forland had come from the University of Chicago.
Dr. Michael J. Sweeney brought dialysis and nephrology expertise in the pediatric area. Dr. Howard M. Radwin, head of urology, had been an active participant in a transplant patient program at the Tulane University School of Medicine. Dr. David Fuller in psychiatry, Dr. Daniel Rosenstein in pathology and Rosemary Joseph in the social services department of Bexar County Hospital contributed their expertise.
Dr. Forland, now professor emeritus of medicine, recounted the story of the first patient, Joan Glicksman (whose married name became Wish), in a 1979 issue of Mission, the magazine of UT Health San Antonio:
“In the fall of 1969, I received a call from my counterpart at the Mayo Clinic in nephrology. He asked if I would accept in transfer a bright and cooperative young woman who would soon require dialysis and hopefully a cadaveric kidney transplant. He explained that Joan Glicksman had resided in Chicago before her illness, but her family now lived in San Antonio, and they thought the possibility of obtaining a compatible cadaveric kidney would be better in our metropolitan area than in rural Rochester, Minn. This was before our extensive national organ sharing network was established.
“I responded that although we had been at the medical school in San Antonio and at Bexar County Hospital for less than a year, we had individually achieved experience in renal transplantation at other centers and were about to initiate our transplant program in San Antonio. He knew of most of us, and we agreed to arrange for this transfer, thus beginning my 30-plus-year patient-physician relationship and friendship with Joan Wish.”
Dr. Forland continued:
“Joan came to us to initiate dialysis in the hope of transplantation, and in reviewing her history, we found that she had a history of childhood rheumatic heart disease and a murmur, indicating residual involvement. Our cardiologist and our transplant surgeon felt that was not a contraindication to transplantation, and we went ahead and put her on our transplant list.”
Months later, Joan was on dialysis. It was January of 1970. Dr. Forland continued:
“I was invited back to the University of Chicago to participate in a weeklong teaching program for the first-year students in kidney disease. As I was walking in the corridors of the hospital going to the lecture hall, I received a call from Dr. Brad Aust saying that we had a cadaver available for kidneys that were blood-type compatible for Joan, and he wanted to check with me. I said terrific, go ahead, that’s wonderful news.
“And some hours later, I received a second call from Dr. Aust saying that we had no other patients who were compatible with the donor. What did I think of giving Joan the second kidney, that is, giving her two kidneys? That was unheard of, but why waste a kidney? After discussion with the rest of the team, Dr. Aust went ahead and did the second kidney transplant, and, you know, the rest was history.
“Joan was the recipient of our first successful renal transplant. She lived for more than 30 years and had normal kidney function. She died of other causes with normal kidney function, and although we did not have tissue typing at the time, she never had any evidence of rejection.
“She was a model patient in regard to cooperation and following her dietary and other medical requirements, and she was a very talented interior decorator. She had graduated from Stanford University, completed postgraduate training in design and so forth, and had a successful career as an interior designer in Chicago before becoming ill. And she later practiced her profession in San Antonio.
“Throughout all the years, we considered her the poster child for transplantation, and she was always available to other individuals who were candidates for dialysis and/or transplantation. She helped guide them, answering concerns about going ahead with this very demanding and serious medical treatment, either dialysis and/or transplantation.”
Joan was honored in March 2001 at a Gift of Life event of the Kidney Foundation of South and Central Texas, where Dr. Forland spoke about her devotion to a successful outcome and willingness to help others. She lived until Nov. 4, 2007, and her life was a testimony to the lifesaving value of transplants.
“We had a gathering on Wednesday, Jan. 16, 2008 as a memorial,” Dr. Forland said. “I spoke, Dr. Aust spoke, Dr. Michael Lichtenstein, who assumed her care after I retired, spoke, and Dr. Glenn Halff spoke about where we were regarding transplantation at that time. It was a very memorable gathering honoring her and the progress of the program.
“And it was really a team effort. All the physicians were part of a team that worked very closely together. Our social worker was very helpful, and we had great cooperation from the hospital getting it started. At first, with dialysis, we could treat two patients a day, and now there are literally hundreds of patients being treated in a variety of centers the hospital has. We’ve made lots of progress.”