News Review
19 SEPTEMBER 2025 ausdoc. com. au
‘ I was told I’ d create stunted dwarfs’
Carmel Sparke 6minutes news editor
Liver transplantation in the dark days of the early 1980s.
“
I
WAS abused and told that what I was going to do was a new cannibalism,” surgeon Professor Russell Strong recalls.
“ I was told it was bordering on obscenity, that it would produce stunted dwarfs and that they would never live a normal life.”
Professor Strong is talking about liver transplantation back in what would now be considered the dark days of the early 1980s.
The procedure had only just lost its status as an experimental treatment— when only 25 % of recipients lived for more than 12 months.
But the introduction of new immunosuppressants— notably cyclosporin— was going to change that.
Ethical concerns
The problem for Professor Strong— and it perhaps takes an imaginative leap to understand now— was that ethical concerns around transplantation and what it involved ran very deep, even within medicine.
Before he travelled to Pittsburgh, Pennsylvania, to train under the procedure’ s pioneer, Dr Thomas Starzl, there had been media coverage about the plight of a baby in Queensland called Paul McKee.
Deteriorating with liver disease secondary to biliary atresia, the only curative option was a transplant overseas at a cost that would run to hundreds of thousands of dollars.
It was this which led to a concerted push for liver transplantation in Australia. But with it, in the words of Professor Strong, came a medical political war, one led by The Medical Journal of Australia.
Under the headline Surgeons Run Amok, the journal’ s editor at the time, Dr Alister Brass, fired off a scathing editorial, including a reference to notorious Nazi physician and medical experimenter Dr Josef Mengele.
“ These operations are experimental by any definition of the word, and promises made to parents and the public about any outcome other than death painfully postponed are specious,” the editorial said.
The medical profession must act to curb“ the extravagant behaviour of its super technologists whose manual dexterity has far outgrown their vestigial sense of judgement, proportion and compassion”, it added.
“ No doubt the surgeons are really nice people, kind to dogs, cats and their own children— once they take off their masks and leave the supercharged atmosphere of the operating room.
“ But then away from the laboratory, probably Dr Mengele was kind to children too
( as long as they were Aryan), and he surely had spotless hands.”
Ethicist and lawyer Paul Gerber, who was also a legal adviser to the MJA, described liver transplants in children as“ too controversial, too experimental”.
“ I am against it under any circumstances. Technically, you are dealing with dwarfs. This is one of the problems that parents are not told about. A normal life is absolutely impossible; the quality of life poor.”
His argument was that the immunosuppressants resulted in stunted growth.
Professor Strong, now 87, tells Australian Doctor that he had never set out to fuel such a vitriolic debate. In fact, he never set out to become a liver surgeon.
‘ Mark Twain said a crank is a man with a new idea— until it catches on.’
Early beginnings
Raised in a small northern NSW community, Alstonville, he originally trained as a dentist in Sydney. He then went to medical school in the UK, where he held a series of surgical training positions.
On his return, he took up a post as the director of surgery at the Princess Alexandra Hospital in Brisbane.
There, with the appalling road carnage of the 1970s, he found himself spending a substantial amount of time repairing ruptured livers.
It is worth stressing that when Professor Strong began thinking about opening a liver transplant unit in Australia, there were only three such programs in the world— the one in Pittsburgh, another in Cambridge in the UK, and one in Hanover in Germany.
He remembers many of his colleagues at Princess Alexandra Hospital were highly sceptical about what he was doing— in part it was rooted in concerns about scarce health resources which would be going into the unit.
But the advocacy worked. The pollies, it seemed, were worried about the taxpayers’ money used for transplants for
Australian patients being spent overseas.
By 1984, Queensland Premier Sir Joh Bjelke-Petersen had announced a plan to set up a liver transplant unit in the state, along with a new jet aircraft that would be used to fly members of the transplant service to collect donor organs.
In January the following year, in the midst of the media storm, Professor Strong performed the first Australian orthotopic liver transplant in an adult at Princess Alexandra Hospital, then in March, a transplant on two-year-old Rhonda Natera.
Further innovations were to follow.
Formulating the idea
“ In Pittsburgh, I realised very quickly that there would never be enough children dying of brain death to meet the needs of those awaiting a liver transplant,” Professor Strong said.
“ Therefore, I started to formulate my idea of taking part of the deceased adult donor liver … and reducing it in the segmental in what’ s called [ a ] reduced-size graft.
“ This is related to the liver’ s segmental anatomy, which I got to know very well and was using in the liver resections I was performing on cancer patients.“ At the time, I was told I was mad to do it.” He performed his first reduced-size graft in 1987. It would become known as the Brisbane technique and was taught around the world. Its impact has been revolutionary.
“ I remember putting it to the parents of a girl, she was around six months old, and I said,
Australia’ s first child liver transplant patient, Rhonda
Natera( left), 40 years later with Professor
Russell Strong.
‘ Look, I don’ t know whether this will work, but your child is possibly going to die before a suitable paediatric organ is available.’“ They agreed. And so we did it, and it worked.”
Further refinements of the technique made headlines when he and colleagues performed the world’ s first living donor transplant, between a mother and her 17-month-old son.
Professor Strong took part of the mother’ s liver, cut it down, and transplanted it into her baby.
The Brisbane technique is still used in around 75 % of paediatric liver transplants.
An indication of the progress that has been made is that the five-year survival rate over the past decade is now 93 % for children.
His breakthrough has saved thousands of lives.
Reflections
Professor Strong is philosophical about the opposition he faced in the early days.“ It was a new therapy at that time,” he says.“ And it’ s like a lot of things. Mark Twain said a crank is a man with a new idea— until it catches on.”
In a 2009 article published in the Journal of Gastroenterology and Hepatology, he wrote:“ The controversies in the early 1980s propagated by many in the medical fraternity and propelled by the media and politicians could in retrospect be regarded as unwarranted, self-serving or really stupid.
“ However, it is always easy to look back when the answers are known, in that history allows for the wisdom of hindsight.”
Following the MJA editorial, lawyers got in contact to see if he wanted any kind of financial compensation for being compared with Dr Mengele.
“ I said,‘ I’ m not after money. I just want an apology for being referred to like that,’” he tells Australian Doctor.“ And I did get that. But that’ s all in the past now. It’ s history.”