September 27, 2016
Dr. Thomas E. Starzl,
Professor of Surgery
Starzl Transplantation Institute
Dear Dr. Starzl,
I have read and re-read your email of January 5, 2016 to me in which you state “it would be difficult, particularly in today’s climate, to justify liver transplantation for the indication of ALS.”
I fully respect your measured opinion and have strived to develop a series of non invasive studies which would support the heretical premise of my Liver-Brain-Theory, i.e. that the "proximate cause of ALS are neurotoxins produced in each patient's own liver."
I initially proposed two simple, inexpensive studies: (10 A & 10 B) that would provide supportive evidence for the Liver-Brain-Theory. I now am proposing a more specific study (10C) which has the potential to provide direct evidence that the proximate cause of ALS are circulating neurotoxins. This study has the potential to establish a dose relationship between the quantity of circulating neurotoxins and the rate of progression of muscle weakness.
The fundamental thesis of this newer proposal is that repetitive plasmapheresis will reduce the quantity of circulating neurotoxins and could be easily quantified by measuring the markedly decreased rate of change in the loss of muscle strength in patients with ALS which I anticipate you will observe.
Even more importantly, repetitive plasmapheresis will facilitate the acquisition of the plasma containing these specific ALS neurotoxins which I postulate to exist. It would only be appropriate that the first liver transplant to permanently arrest the progressive muscle weakness characteristic of ALS be done under the auspices of the Starzl Transplantation Institute.
I trust you might encourage several of your neurologists, or even a team of your transplant surgeons, to perform repetitive plasmapheresis on two or three patients with ALS. I am quite certain they will witness a near total cessation of progressive muscle weakness associated with repetitive plasmapheresis at least on a temporary basis.
These objective findings will provide supportive evidence to justify performing the first liver transplant in a patient otherwise certain to die from ALS.
With respect and admiration,
Next year (2017) will be the 50th anniversary of your first successful liver transplant. It would be quite timely to celebrate this accomplishment by demonstrating that a liver transplant (replacement) will permanently arrest the progressive muscle weakness characteristic of ALS and give afflicted patients a more normal life expectancy.
Dr. Thomas E. Starzl died March 4, 2017, a week shy of his 91st birthday.