Ignazio Marino

Ignazio Marino (Genoa, 10 March 1955) is a transplant surgeon (liver transplantation) and an Italian politician. He is currently the Democratic Party whip in the Standing Committee on Health of the Italian Senate (16th Parliament).

Ignazio Marino is the eldest of three children (he has two sisters). Married, one daughter. He graduated in Medicine and Surgery from the Catholic University in Rome. He trained at the Transplant Center of the University of Cambridge and the Pittsburgh Transplantation Institute. In 1992 he has been appointed Associate Director of the National Liver Transplant Center of the Veterans Affairs Medical Center of Pittsburgh, the only organ transplant department of the Government of the United States. In 1997 he founded Palermo’s ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), the first liver transplant centre in Sicily - thanks to a partnership between the University of Pittsburgh Medical Center and the Italian Government – of which he has been Director and CEO. In 2001 he performed the first transplant ever carried out in Italy on an HIV-positive patient undergoing HAART therapy. In 2002 he left his position as Professor of Surgery at the University of Pittsburgh and became Professor of Surgery at [http://www.jeffersonhospital.org/transplant/article3704.html Thomas Jefferson Medical College] in Philadelphia. Dr. Marino has personally performed over 650 transplants. He has authored 635 scientific publications and 3 scientific books. In 2005 he published a book with Einaudi (“Le Vele” series) entitled “Credere e curare” (Treating and Believing); the book deals with the medical profession and the influence that faith, seen as a religious creed but also as compassion, solidarity and empathy towards all human beings, has upon it. In 2007, his pamphlet entitled "Sistema salute. Analisi e prospettive per il futuro della sanità italiana” (tr. "Analyses and expectations for the future of the Italian healthcare system") was published by the political foundation Italianieuropei. In 2008, the book “Idee per diventare chirurgo dei trapianti. Una corsa fra la vita e la morte” (tr. "Ideas on how to become a transplant surgeon") was published by Zanichelli. In 2005 he founded Imagine onlus, an international non-profit organisation engaged in international solidarity activities with special regard to health issues. He is also a member of the Editorial Board of Transplantation, Liver Transplantation, Clinical Transplantation and 9 other international scientific journals. In March 2006 he ran as an independent candidate in the Left Democrats’ list for the Senate. In April 2006 he was elected to the Senate; he has been the Chairman of the Senate Standing Committee on Health since 6 June 2006.In April 2008 he has been re-elected to the Senate, where he was appointed whip of the Democratic Party in the Standing Committee on Health.

The first baboon-to-human liver transplant in medical history

Ignazio Marino was a member of the surgical team which on 28 June 1992 and 10 January 1993 performed the only two baboon-to-human liver xenotransplants in medical history. The first attempts at xenotransplants were made in Europe in 1906, with a goat, a pig and a macaque as kidney donors. All transplants failed following the almost immediate insurgence of vascular thrombosis. Three more attempts were made - one in Europe and two in the United States – over the following 58 years. The first successful transplant dates back to 1964, when Keith Reemtsma of Tulane University transplanted a chimpanzee’s kidney, which functioned for nine months. In 1984 international media reported the dramatic case of Baby Fae, a 2.2 kg newborn infant who received a baboon heart in the Loma Linda University Medical Center and survived twenty days. No more xenotransplants were performed for nearly ten years, until the first two baboon liver transplants performed in 1992 and 1993 at Pittsburgh University. The clinical trial was coordinated by Prof. Thomas Starzl, the pioneer surgeon who performed the first liver transplant in humans in 1963, with whom Ignazio Marino worked for over fifteen years and who taught him liver transplant techniques. The transplant with baboon liver was envisaged in those years for the treatment of terminal cirrhosis from chronic hepatitis B virus. Baboons were chosen as donors because – in spite of their different size – they share many of the physiological and genetic characteristics of human beings but are resistant to chronic hepatitis B virus. The first recipient was an HIV-positive 35-year-old man, the second a 62-year-old man. Both had terminal liver failure from hepatitis B. The first patient lived 70 days after the transplant. He spent most of the post-surgery time on a regular hospital ward and maintained nearly normal liver functions. The second, much older patient never regained consciousness; he remained icteric and lived for 26 days. There are still a number of problems to be solved before xenotransplantation can become a reality. The main problem is rejection; others include the need to make sure that xenotransplanted organs function properly in the recipient, and the need to minimize the risk of introducing new infective agents in the human population. Furthermore, there are inevitable problems of an ethical and anthropological nature, from the acceptability of human intervention in terms of species manipulation, to the ethical feasibility of using animals to improve human survival capability and wellbeing. Ethical issues also include the concerns and objections raised by animal protection movements. The two above-mentioned transplants did at the time provoke heated controversies in this regard.

The first kidney transplant on an HIV-positive patient in Italy

In 2001 Ignazio Marino received a request for a kidney transplant from an HIV-positive patient. The young man had addressed most Italian transplant centres but his request had consistently been rejected. Ignazio Marino accepted to examine him, subjected him to all appropriate tests and then judged him fit for a kidney transplant. The man’s father would be the organ donor. News about the transplant aroused doubts and disputes in Italy’s academic and institutional world. In particular, the then Minister of Health, Girolamo Sirchia, declared that that type of operation would have “catastrophic results”. A few months later, Italy’s National Transplant Centre (CNT) reprimanded Ignazio Marino and warned him not to perform any further transplants on HIV-positive patients. To this day, the above patient is alive and in good health condition. After that first transplant on an HIV-positive patient, an ad hoc Committee was established at the CNT to determine whether that type of transplant should be carried out, and nearly three years later a final approval was issued. Today transplants are regularly and successfully performed on HIV-positive patients in Italy, too. The controversy which had emerged at the time was probably less the result of scientific evidence than of a general prejudice towards HIV-positive people. That first transplant performed in 2001 made it possible to open the way to a type of surgery which had been regularly performed in other countries for several years.

See also

*Organ donation
*Xenotransplantation
*Immunosuppressive drugs
*Organ transplant
*Transplant rejection
*Liver Transplantation