Transplant Surgery and Global Health with Dr. Tom Pham

In this episode of Scrubcast, host Rachel Baker sits down with Dr. Tom Pham, a clinical associate professor in the Division of Abdominal Transplantation at Stanford University. Dr. Pham discusses his recent work in Lusaka, Zambia, where he has been instrumental in developing the kidney transplant program. He emphasizes the importance of collaboration and training in improving surgical practices in underserved regions.

Dr. Pham also shares his inspiring journey into the world of transplant surgery, highlighting the pivotal role of mentorship in his career. He pays it forward as the Clerkship Director at Stanford.

Rachel Baker: [00:00:00] Welcome to Scrub Cast, where we take a closer look at the research happening at Stanford University's Department of Surgery. I'm your host, Rachel Baker. Today, we're speaking with Dr. Tom Pham. Welcome to the show. 

Dr. Tom Pham: Thank you for having me.

Rachel Baker: Thank YOU for joining us. Dr. Pham, you are a clinical associate professor in our Division of Abdominal Transplantation.

Why did you choose transplant?

Dr. Tom Pham: It all comes down to mentorship. My earliest mentor I met when I was studying immunology, which I thought I was gonna go to graduate school. I thought I would go beyond and just do research. And uh, my mentor ended up being a transplant surgeon who, uh, I have to work in her lab.

And, uh, she was like, oh, graduate school, that's too boring, gotta go do surgery. You know, because she does everything. Her name is Jenny Bumgarner and, uh, we're at, uh, the Ohio State University and, uh, she does surgery. She does basic science [00:01:00] research and she's like, Oh, you got to go do everything. And so I listened to her and, uh, went to medical school and became a transplant surgeon because of her.

Rachel Baker: Great story. Well, so I want to talk about some of the global health work you've been doing. Yeah,

Dr. Tom Pham: I'm going to be honest with you, I really had no experience with global health, global surgery prior to June of 2024. Sherry Wren and Tom Weiser sent an email just asking for volunteers. Because of this relationship we have with the American College of Surgery HOPE Initiative.

And, uh, one of the sites that they have a relationship with was Lusaka Zambia. And, um, I literally went on the internet and googled kidney transplant in Zambia. And saw their Twitter feed which said they had performed some transplants as early as 2018. And from there, I investigated further, Sherry had connected me with a nephrology team out there and we talked more about the transplants [00:02:00] they're doing, and I found that there was a role for me to kind of help them with their transplant program.

Rachel Baker: Awesome. Well, that actually leads right into my next question. Um, so it's the University Teaching Hospital in Lusaka, Zambia. And you said that they, they launched their kidney transplant program in 2018, but all of the surgeries were performed by. Outside surgeons, what sort of skills or equipment does a hospital need to be able to perform these operations on their own?

Because they're, they're quite extensive, aren't they?

Dr. Tom Pham: No, that's, you're absolutely right. And, um, by outside surgeons, it was really a pay for service fee. What had been going on prior to 2018, where citizens that had money, which were very few of them, would actually leave the country to get their transplant.

They would find a donor. They would leave the country and either go to India or South Africa to get their transplant, then they would return two weeks later and then they would receive care for their transplant back in Zambia.

Rachel Baker: Wow.

Dr. Tom Pham: Yeah. In 2018, what they [00:03:00] did was they hired surgeons from India to come over to Lusaka and work at the university teaching hospital just to perform the kidney transplant.

They have actually brought their own team, scrub nurses, their own equipment. Everything. Oh my gosh. And then they would actually do a fee for service where patients would actually pay them to do the transplant. They would do the transplant and then they would leave. That was how their program had been maintained since 2018.

If I remember they had done, between 2018 and until I met them in 2024, they had done probably about 40 transplants altogether during that time period. Obviously this is not sustainable. There's no transfer of skills. And at that time, when I met them in 2024, there were no surgeons who resided in Lusaka, Zambia, or Zambia at all together, who could do the kidney transplants.

Rachel Baker: Oh dear. Yeah, okay. But you're saying that the transplant patients return to Lusaka [00:04:00] after their transplant, so they must have the services or medications to take care of post-transplant patients?

Dr. Tom Pham: That's exactly right. The person I was connected with to learn about their program was a gentleman by the name of Aggrey Mweemba.

Who's their chief nephrologist for the country and he is transplant trained and actually trained in South Africa and he Actually has been managing all of these patients and has developed really a transplant Nephrology program there that oversees these patients and he's been training residents to follow along also nephrologists also help manage the patients and Given his background.

He has actually advocated for the government paying for immunosuppression medications out there, which they do And really taking great care of them.

Rachel Baker: So what did you do on this first trip to Lusaka? Was it just a fact-finding mission?

Dr. Tom Pham: Yes, it was a needs assessment and fact-finding mission. And I tried to temper down the [00:05:00] expectations as, you know, they saw this kidney transplant surgeon coming and they're like, oh, we're going to line up five transplants for you and things like this in a matter of like six days.

You know, and, and so I made it very clear that I was just going to do a needs assessment to see if it's safe to do it there because I wasn't bringing staff with me. I wasn't bringing equipment with me. My plan was to see, is it safe to do kidney transplants in their hospital with their own staff and equipment, et cetera.

And so they were very welcoming. I went there, I got to meet the patients they had in mind, got to review their charts, examine them, talk to them. And also, take tours of their facilities, which included an ICU they have dedicated to just kidney transplant. Look at their resources, look at their OR equipment.

And then I decided to go ahead and give the green light when I was there. Let's go ahead and do this. And, uh, during my first visit we did a kidney transplant, a living donor kidney transplant.

Rachel Baker: Awesome! That's fantastic!

Dr. Tom Pham: Yeah, uh, it was a [00:06:00] son donating to his father.

Rachel Baker: Oh, that's so sweet. Well, so you returned to Zambia earlier this year, um, and you posted on Twitter that you're really excited about the local surgeons performing AV fistulas independently.

One, what is an AV fistula? And two, why is that a big deal?

Dr. Tom Pham: It's a huge deal. And so an AV fistula is arterial venous fistula. And it's an alternative way to get dialysis access. Uh, for hemodialysis specifically, and it's actually the preferred way to get it as it has less complications such as less infections when compared to other ways such as catheters placed in the vein.

Another problem that I found when I was out there was that they didn't have any vascular surgeons to actually do AV fistulas for them. Oh! Although the government does support individuals on dialysis, they only have a limited amount of dialysis, and the only dialysis access they had aside from peritoneal dialysis, was actually [00:07:00] tunneled dialysis catheters.

And so these are catheters that are tunneled into the skin and go into the vein, and they stick out of the chest. area. And they're a higher risk for thrombosis, which is blood clots or infections. And the vast majority of their patients on hemodialysis, like greater than 90%, only had catheters. And because they had no way to give them an AV fistula.

So in addition to doing the transplants, I also showed the same surgeons how to perform just basic AV fistulas and through a simulation lab, through education, teaching, and then we actually did some AV fistula access for some patients when I was out there.

Rachel Baker: Well, so the other thing that you actually seemed really excited about was a picture of a silver box.

Um, you called it a Thompson retractor. Um, what's the story there?

Dr. Tom Pham: Yeah, so as I went down this path and I talked to other surgeons such as like Brendan Visser who does a lot of work in South America. Uh, what I learned was that there are [00:08:00] several foundations out there who are happy to support this.

Foundations based on surgical equipment. So Thompson Retractor is a well-known company that provides retractors for certain, um, operations. And we have several of them for our kidney transplant operations. And what I learned is they have a foundation where if you retire one of your retractors that you're no longer using or no longer want to use, they will take it back, refurbish it, like new, and then donate it to the, uh, country in need.

So, uh, usually a low- or middle-income country, free of charge.

Rachel Baker: How cool. As

Dr. Tom Pham: long as you're willing to, uh, part ways with it. And so I, uh, I asked our group and we had several retractors that we could probably part with one of them. And we all agreed. And so we did it. And, um, what was really great is not only did they refurbish and pretty much gave a brand new retractor, but they personalized it.

They laser engraved. Lusaka University Teaching Hospital.

Rachel Baker: Awww.

Dr. Tom Pham: Things like that.

Rachel Baker: That's so special.

Dr. Tom Pham: The only thing Thompson asked for in [00:09:00] return is some recognition on Twitter.

Rachel Baker: How adorable.

Dr. Tom Pham: I love it.

Rachel Baker: Well, so when's your next trip? What's the plan?

Dr. Tom Pham: Yeah, so I'm not making this a solo effort. This has really become a multi-disciplinary training consortium.

And so not only from other centers other surgeons have gone. In fact, After I went in January, the lead surgeon, the kidney transplant director, Hans Albin Gritsch at UCLA actually went out in February and performed two additional living donor kidney transplants and actually performed the first pediatric kidney transplant in all the country.

Rachel Baker: Wow!

Dr. Tom Pham: Yeah.

Rachel Baker: That's great.

Dr. Tom Pham: And so he did that just, uh, literally two to three weeks ago. In addition to that, I've recruited other surgeons here from Stanford and from other places to also go. And the plan is to have a surgeon out there every two to three months. Throughout the year to help continue training help continue doing transplants and make sure we're helping them build the infrastructure necessary for this So they answer your question.

I'm going back in [00:10:00] August. I've surgeons dedicated going in April and June We also have a nephrologist here at Stanford who is also going as well to kind of help with management and make sure Pretty much everything's up to date and really providing the best care possible for these patients.

Rachel Baker: That's fantastic.

You should be very proud. One of the things I've learned from the residents who travel overseas is that they learn just as much as the people who are in the country, uh, do during these experiences. Can you tell us one thing that you learned while working in Zambia?

Dr. Tom Pham: Oh my God. And so one of the things that was kind of nerve wracking was.

They don't have laparoscopy out there.

Rachel Baker: Ooh!

Dr. Tom Pham: Yes. Well, they do, but it's not regularly used. And so, the surgeons I'm working with are actually urologists who have done nephrectomies before for other reasons, such as cancer or infection, things like that. And so when it came to the live [00:11:00] donor nephrectomy, we did them open.

And I had never actually done an open nephrectomy before, because here in the U. S. we only do laparoscopy. And so after doing a total of five nephrectomies with them, I am now confident and able to do an open nephrectomy, and it took me just as long as doing a laparoscopic nephrectomy. So they really just taught me that operation out there.

Rachel Baker: Fantastic! Yeah. That's, well, so one of the things you, in addition to your global health work and, you know, your work as a transplant surgeon at Stanford—it actually ties into what you were saying earlier about mentorship—You serve as our department's clerkship director and have done so since 2020, which basically means you are in charge of, I'd say many to most of medical students, first foray into surgery and the ORs.

What do you hope our MS3s come out of their rotation knowing?

Dr. Tom Pham: Yeah. One thing I really stress to all our [00:12:00] educators is that the majority of students on the surgery clerkship are not going to go into surgery and that's okay. Only about 10 percent of them actually go into surgery. I'm going to be honest with you.

Those 10 percent are the easy ones to teach because they're invested in surgery, right?

Rachel Baker: Absolutely. But

Dr. Tom Pham: the rest of the students, what we, I want them to know and want them to realize is be comfortable with a surgical problem or a surgical patient. And I learned how to recognize that I learned how to, and when to call for your surgeon.

And then that will just make them much more comfortable in whatever discipline they go into.

Rachel Baker: Awesome. Well, so on each episode of Scrubcast, we ask each of our guests, the same two questions. And the first one is who is a surgeon you admire and why?

Dr. Tom Pham: Well, I have to say my mentor, Jenny Baumgartner from The Ohio State University.

She has really dedicated herself to mentorship. And has trained many, many surgeons, and I'm glad I could [00:13:00] say that. Uh, although I didn't directly train her there because I didn't do my fellowship there, but she really influenced me from the time I met her as an undergraduate. And now she is currently the president of our transplant society.

Rachel Baker: Oh, cool!

Dr. Tom Pham: Which is very well deserving of her, so I'm really happy to see that she's ascended. To these great leadership roles.

Rachel Baker: So the second question is, What is the best advice you have received in 10 words or fewer?

Dr. Tom Pham: Alright, I'm not sure if this is, uh, safe for work, but, uh, Uh oh. Um, don't F it up. Ha ha ha

Rachel Baker: ha ha!

Dr. Tom Pham: Okay. Let me give you some background.

Rachel Baker: Do you say that in, like, every part of your

Dr. Tom Pham: The reason this has really stuck with me is cause As I started my transplant career, multiple transplant surgeons, and these were leaders in the field, told me the same advice. You're going to be just fine. Don't F it up.

And they told it to me, but they [00:14:00] had no relation to each other. So I had like three surgeons say this from three different institutions.

Rachel Baker: Okay.

Dr. Tom Pham: That I had worked with. Those are exact same words. And there was no way they had talked to each other or had known or even known each other in that regard. So I was like, wow.

I can't believe, uh, three different people have said the same thing to me as I've gone through my career.

Rachel Baker: Any advice on how to not F it up?

Dr. Tom Pham: I'm still trying to figure it out, but all my mentees all say the same thing.

Rachel Baker: Awesome. Well, it has been such a pleasure chatting to you, but before we go, I want to ask, what is next for Dr. Pham?

Dr. Tom Pham: Oh, so more to come as far as global health, global surgery. You know, hope to acquire more funding, more surgeons, lots to come in surgical education. I'm excited to work with a new Associate Clerkship Director, Cassie Sontag, and uh, lots of things on the horizon. So, excited to be here. Excited [00:15:00] to be on this too, Rachel, so thank you.

Rachel Baker: Thank you! Um, and, you know, I look forward to seeing everything that comes for you in the future.

Dr. Tom Pham: Thank you.

Rachel Baker: And that brings us to the end of another episode. If you like Scrubcast, we hope you'll tell your friends and subscribe wherever you get your podcasts. Scrubcast is a production of Stanford University's Department of Surgery.

Today's episode was produced by Rachel Baker. The music is by Midnight Rounds. And our chair is Dr. Mary Hawn.