Dr. Paul Keown, a former Executive Director of BC Transplant, is a key figure in transplantation in British Columbia. He came to Canada to set up the first kidney, liver, lung, and heart transplant programs in London, Ontario in the 1980s. Then, in 1987, he moved to BC to help establish BC Transplant (or Pacific Organ Retrieval for Transplantation - PORT - as it was then known). Dr. Keown's contributions continue to shape the scope of transplant intervention here in BC.
What led you to the field of transplant?
When I was a medical student, transplantation was in its infancy, and I became involved in some of those early procedures. It seemed like the most exciting thing you could do for whole range of different reasons, but especially because of how it restored life and health in patients. There were huge challenges in the early days with preventing rejection and improving immunosuppression, and it sparked an interest that stayed with me my whole career.
What were some of the early challenges you faced as BC Transplant was established?
When I came to BC in 1987, there was very little transplantation taking place. Dr. David Landsberg had just started a small kidney transplant program at St. Paul's Hospital, and there was a kidney program at Vancouver General Hospital (VGH), but there was a need for heart, lung and liver transplant programs. There was also a desire to consolidate all the programs to increase the scope and number of transplants in the province, and also to build an immunology lab that could serve as a reference support lab for transplantation.
What role does the immunology lab play in donation and transplant in BC?
It is the core lab for transplantation, and now many other immune diseases. It does all of the tissue-typing and sophisticated flow cytometry, which is vital for matching organ donors and transplant recipients. It tracks a person's antibodies, which we all develop as we get sensitized over time for a variety of reasons. The lab also provides follow up advice on immunosuppression post-transplant if a recipient is reacting against the donor organ.
What are the biggest changes that you have seen over the past 50 years?
When I first started in transplantation, immunosuppressant drugs were weak and limited. So there were many early organ rejections – 50 per cent of all grafts were lost within the first eight months, and recipients had profound infections and sepsis which were difficult to treat. We often wondered if we should discontinue the programs because of how challenging it was for patients and their care teams.
But we've advanced into a completely different era now. Modern drugs are very effective, and now only 10 per cent of people have a rejection episode and it's often very mild.
What are you most proud of in all years you've dedicated to this field?
Probably to see the growth and success of the transplant program in this province, and seeing BC rise to the top as a leading transplant program in North America. It is arguably among the top in the world for our successes in the number of transplants that happen here and some of the research that has come out of the province.
What do the next 50 years hold in store?
I think the program in BC will continue to grow; it's built on a very solid foundation, with wonderful teams in all its areas. One of the big challenges is working toward avoiding the need for immunosuppressant drugs—we've started to see the very first steps towards this goal. Another huge challenge is increasing the number of organs available for transplant. I believe that the techniques that are just in their infancy now of growing organs outside of the human body, are going to be huge steps that will carry us forward. And a third key component will be a focus on finding ways to avoid transplantation by preventing the diseases that make it necessary.
What has kept you motivated in all this time?
The pursuit of improvement and change in medicine has kept me motivated. Also, the people involved in transplantation in BC are just outstanding! They are some of the sharpest, most dedicated, and committed individuals you could imagine. They are so hard-working because of how important the program is, how exciting it can be, and most importantly because of the benefit it yields to the patients.