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Dr. David Landsberg, BC Transplant's provincial medical director for transplant services, originally came to BC from Quebec to start the kidney transplant program at St. Paul's Hospital in 1984. He has been one of the driving forces behind making BC's kidney transplant program one of the leading ones in Canada.
What led you to the field of transplant?
During my medical residency in 1978, I had the opportunity to do a rotation in the kidney transplant service in Toronto. It was during this rotation that I realized how fascinating the science of transplant was and how well it fit my strengths.
What about the field of transplant did you find so captivating?
I love helping people and there are very few interventions in medicine where you are able to help people so dramatically, effectively, and quickly! It's a combination of things that keeps me so engaged in this field: the relationships with patients, the acuteness of the challenge, and the fact that you can make such a difference. You get to look after someone on a continual basis, and that's not something you see in many other areas of medicine.
Why did you decide to come to BC? And what were some of your early challenges in setting up transplant programs in this region?
In the early 1980s, there wasn't a transplant program at St. Paul's Hospital. There was a growing need for one, and I realized that there was a once-in-a-lifetime opportunity to start something from the ground up.
A big challenge for me in the early days was gaining the confidence and trust of my colleagues and associates because I was really new and young. I didn't have a lot of expert medical support in this province yet, and so I often found myself having to consult with those I trained with back in Ontario for a second opinion on cases. Over time, I was able to build a team of strong medical experts, who were instrumental in setting up the foundation for what we were aiming to achieve in the field of transplantation here in BC.
What are some of your fond memories from the inception of BC Transplant and the transplant program at St. Paul's Hospital?
When I think back to the early days, I'm reminded of the friendships I was able to create, and how much we all supported and trusted each other in getting this endeavour off the ground. What made it worthwhile was seeing good patient outcomes, which have improved tremendously today in comparison to what we were dealing with in the early years.
How important is BC Transplant's role in the Canadian transplantation context?
There is no other provincial organization like BC Transplant; it is unique in that it has been able to build partnerships across the province for both donation and transplant. We have been able to establish a provincial infrastructure that wouldn't have been possible if individual hospitals focused solely on developing their own programs.
The organ donation rate here at one point was the lowest in the country and last year in 2017 we had the highest rate in the country, surpassing national averages for deceased donor and living kidney donor rates. None of this would have been possible without BC Transplant.
What changes have you noticed over the past years in donation and transplant here in BC?
Early on transplant was considered risky and experimental, especially for older patients. The way we have been able to offer transplantation to older patients has changed, and for the most part their outcomes have kept getting better. Donation rates have steadily increased partly because advances in medical techniques have allowed our criteria for donation to broaden, enabling donation from people who at one point would not have been considered.
What developments do you see coming in the next 50 years of donation and transplantation?
I think one of the big changes will be some basic changes in anti-rejection medication and manipulation techniques at the time of transplant, so that a transplant recipient's immune system will not view the transplanted organ as a foreign body. This could pave the way to no longer needing anti-rejection and immunosuppressant drugs for transplant.
How has the experience of being involved in the past 50 years of transplant in BC been for you?
Transplant is a career I've always wanted, and it has surpassed my expectation in so many ways. It has been truly rewarding to have been personally able to help many people; form a strong team at St. Paul's and within the provincial program; and strategize ways to grow and improve our programs to help more people.