In a 1998 article in the New England Journal of Medicine, Starzl and Swiss immunologist and Nobel Prize winner Rolf Zinkernagel proposed that tolerance for a transplanted organ occurs because certain cells in the recipient's immune system that would have attacked the donated organ instead commit suicide, a process known as apoptosis.
They said the same process permits certain infections, such as Hepatitis C, to linger in the body for decades.
Starzl theorizes that in transplantation, this cellular suicide won't occur unless the patient's body is first allowed to mount an immune response to the foreign organ. If that's true, giving patients high amounts of anti-rejection drugs right after a transplant may doom their chances of ever being weaned off the drugs, he said.
Not everyone agrees with Starzl's model, but no researcher contacted was willing to voice his criticisms openly, which may be a testament to the power Starzl still wields in scientific circles.
Starzl himself is convinced that other scientists have come to accept the theory. "The requests for reprints [of the New England Journal paper] have been overwhelming, more than any other [paper] that I can remember," Starzl said. "A lot of people were threatening to write angry letters and criticism, but [the journal] never received one single line."