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Peter Attia MDPeter Attia MD

#155 - Chris Sonnenday, M.D.: The history, challenges, and gift of organ transplantation

Chris Sonnenday is the Transplant Center Director for Michigan Medicine. As Peter’s senior resident while at Johns Hopkins, Chris made a lasting impression on him with his remarkable leadership and ability to maintain his humanity through the stressors of that challenging environment. In this episode, Chris tells the incredible backstory of the history of transplant medicine, focusing on the kidney and the liver. He discusses the surgical and immunologic developments that launched the field forward, but also lays out the challenges ahead for the field, such as the rising prevalence of chronic kidney and liver failure. Chris also tells many stories of tragedy and triumph that comes with working in organ transplantation, but ultimately explains the rewarding nature of being a witness to the gift of organ donation. We discuss: 00:00:00 - Intro 00:01:15 - What attracted Chris to medicine, and his leadership in residency 00:07:30 - How Chris maintained his empathy and humanity through the stresses of med school and residency 00:25:15 - Why Chris chose a complicated field like transplant medicine 00:31:10 - Explaining kidney transplantation to showcase the challenge of organ transplantation surgery 00:41:15 - Overcoming the immune-based challenges of transplant surgery 00:54:30 - How the discovery of cyclosporine transformed the field of organ transplantation 01:00:10 - Rising chronic kidney failure due to the prevalence of pre-diabetes and metabolic syndrome 01:06:45 - Why living kidney donations are superior, and the possibility of a market for kidney donation 01:26:50 - Designing a fair system of organ distribution 01:31:15 - The debate on what constitutes “death” when deciding when to take organs from a registered organ donor 01:44:20 - Reflections on the gift of organ donation 01:51:15 - The history of liver transplantation and why it’s so complex 01:58:45 - Addressing acute liver failure and the amazing baboon experiment 02:08:25 - The potential for the rising prevalence of NAFLD and NASH to overwhelm the liver transplant infrastructure in the US 02:20:40 - The importance of teamwork in successful organ transplantations, and the most tragic event Chris has ever witnessed Show notes page: https://peterattiamd.com/chrissonnenday/ About: The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 25 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life). Learn more: https://peterattiamd.com/​​​​ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/​​​​ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/​​​​ Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB​​​​ Twitter: http://bit.ly/PeterAttiaMDTW​​​​ Instagram: http://bit.ly/PeterAttiaMDIG​​​​ Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts​​​​ Overcast: http://bit.ly/TheDriveOvercast​​​​ Spotify: http://bit.ly/TheDriveSpotify​​​​ Google Play: http://bit.ly/TheDriveGooglePlay

Peter AttiahostDr. Chris Sonnendayguest
Mar 29, 20212h 30mWatch on YouTube ↗

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At a glance

WHAT IT’S REALLY ABOUT

Transplant surgeon Chris Sonnenday on organ transplantation's history, ethics, and future challenges

  1. Sonnenday describes how a service-oriented upbringing, team sports and mentors at Hopkins shaped him, and says patients and a team mindset kept him grounded through grueling residency.
  2. He traces transplantation from the first twin kidney transplant in 1954 through poor early survival to cyclosporine, which in the 1980s lifted one-year kidney graft survival to roughly 90% and revived liver, heart and lung programs.
  3. The conversation explains why living donor kidneys outperform deceased donor kidneys, how paired exchanges work, why selling organs is banned as coercive, and how allocation has shifted to concentric circles to reduce geographic disparity.
  4. They cover brain death, donation after cardiac death and the strict separation between the care team and the transplant team, with Sonnenday encouraging people to register and tell their families.
  5. On the liver, Sonnenday explains the surgical difficulty, the lack of extracorporeal support, the fall of hepatitis C as a transplant indication and the rise of fatty liver and alcohol-related disease, and he recounts the 2007 plane crash that killed six team members.

IDEAS WORTH REMEMBERING

5 ideas

Patients and team re-centered Sonnenday during residency

He says remembering that patients upstairs had it worse, and being surrounded by a team he relished working with, pulled him back when medicine got hard.

Good M&M culture focuses on system improvement, not blame

Sonnenday says assigning blame has no value and humility is needed because anyone could cause the next complication; he notes M&M conferences have moved toward what is right for the patient.

Cyclosporine was an overnight game changer

He says it selectively interfered with T cell signaling, raising one-year kidney graft survival from about 60 to 70% to about 90% and reinvigorating liver, heart and lung transplant programs.

Living donor kidneys beat deceased donor kidneys even with worse matching

Shorter ischemic time avoids reperfusion injury and immune priming, so living donor grafts last longer, and paired exchanges and algorithmic networks widen access to compatible donors.

The US bans organ sales but may move toward compensating donors' costs

The ban rests on concerns about coercion of disadvantaged people, as in the Afghanistan example he cites, though he expects things like reimbursement for travel and time off, and possibly health benefits, to come gradually.

WORDS WORTH SAVING

5 quotes

being a surgeon provides this really unique opportunity to enter people's lives in their, um, scariest, kinda darkest moments. And to have the privilege to be able to walk that with them and try to help them

— Dr. Chris Sonnenday

there is not value in kind of assigning blame to individuals. There's only, um, value in recognizing opportunity for us as a system, as a team to get better.

— Dr. Chris Sonnenday

the experience of organ donation and knowing that their loved one's organs went on, uh, live on in another individual and saved their life is the only good thing about what was otherwise the worst day of their lives.

— Dr. Chris Sonnenday

the more that you can, you know, register yourself or, and communicate that to your family, the actual easier you make it on your loved ones, God forbid they end up in that situation, having to facilitate that gift.

— Dr. Chris Sonnenday

the liver remains the only major organ with no form of extracorporeal support.

— Peter Attia

Surgical training and leadership at HopkinsMorbidity and Mortality conference cultureHistory of kidney transplant and immunosuppressionCyclosporine breakthroughLiving donation and paired kidney exchangeOrgan allocation and brain deathLiver transplant challenges and NAFLD/alcohol-related disease

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