Physician at Work: Transplant surgery is lifesaving, emotional

Sanjay Kulkarni, MD, finds a powerful skill can be gratifying

alt textSanjay Kulkarni, MD
Sanjay Kulkarni, MD

Sanjay Kulkarni, MD, has a busy schedule as a kidney, liver and pancreas transplant surgeon, sometimes getting up in the middle of the night to rush into surgery after getting a call that an organ is available.

But the toughest part of the job can be procuring organs from living and deceased donors. Transplant surgeons can’t ask for donations because of potential conflicts of interest. But they do read the medical histories and sometimes traumatic stories of children and adults who have died to consider them as potential donors.

“This can be emotionally exhausting,” said Dr. Kulkarni, who is the director of kidney and pancreas transplantation at Yale. “On the flip side, when you see what the organs do for the people who are in desperate need of them, it’s an extremely gratifying experience. You start off on an emotional low and you end up on an emotional high. It’s also humbling. From a personal perspective, it can keep you focused.”

Attracted by an ‘amazing science’

Dr. Kulkarni was initially attracted by the “amazing science” behind transplant surgery, and because it is a field in its infancy where he thought could make contributions. Since he became director in 2007, Yale’s program has since developed into the largest in New England in numbers of kidney transplants performed and new patients listed for kidney transplantation. Yale is the only center in New England to perform total laparoscopic donor nephrectomies for right and left kidneys, which minimizes pain and results in a much shorter hospital stay, with living donors typically remaining in the hospital for just a day and a half.

He performs kidney, pancreas and liver transplants, all of which are becoming increasingly efficient. Liver transplants, the most complicated of the three, used to take up to 12 hours; now they can be done in about five, with some exceptions.

Understanding organ donation

Dr. Kulkarni thinks organ donations would rise and more patients could be helped if people had a better understanding of the process. They should know that their status as an organ donor won’t make emergency room doctors any less willing to save their lives, he said.

Living donors should know that they can go on to live a completely normal life—and have a good chance of living longer than others their age because of the good health that qualified them to donate in the first place. They also get excellent support. “If somebody is considering being a living organ donor, they should understand there is a very deliberate process with lots of education that can help them make that difficult personal decision,” he said.

Dr. Kulkarni remembers one patient whose unexpected generosity was inspired by a tragedy. A woman whose niece had died in a car accident came forward as an altruistic donor and paid tribute to her niece by donating her own kidney on the same day her niece’s organs were procured. On that day, he said,” Two people had a second chance at life.”

Name: Sanjay Kulkarni, MD

Title: Associate professor of transplant surgery nephrology

Area of expertise: Transplant and immunology (liver/kidney/pancreas)

Place of birth: Asansol, India

Age: 44

College: University of Wisconsin

Med School: Medical College of Wisconsin

Training: Residency in general surgery, University of Chicago Hospitals; fellowships in organ transplantation and clinical research, University of Chicago Hospitals, and organ transplantation, University Hospital Essen, Germany

Family: Married to Yale Radiologist Christine Colton, MD. Children: Nathan, 12, and Nina, 7.

What is the most important thing you’ve learned from your patients? To be very direct and honest, particularly when unfortunate news needs to be delivered.

What was the biggest challenge you ever faced as a physician? Early in my career I took over the kidney and pancreas program, which was challenging.

How have your experiences with patients changed your approach to care? The way we work up our patients for transplantation is a very long and arduous process. What I’ve come to understand is that if you can provide a level of care that’s highly efficient for the patients, it’s very gratifying.

Personal interests or pastimes? Cooking and playing tennis.

Last book read: Steve Jobs, by Walter Isaacson