Photograph by Matthew Worden.
He went to Duke on an academic scholarship and wanted to study pediatrics, but he didn’t have the patience for it. His professors gave students keys to the anatomy lab, so he’d go back after class and dissect cadavers. He realized surgery would be a better fit.
Johnson was intrigued by all that the liver could do: make proteins and energy, store glucose, break down fats, detoxify. There wasn’t any other organ like it.
When he was in medical school, many patients weren’t surviving liver surgery—the three-pound organ is intertwined with blood vessels and bile ducts, making it complicated to operate on. Kidney patients can go on dialysis; there’s no end-stage therapy for people with liver disease.
Johnson was shadowing a surgeon on rounds when he met a patient who was dying from liver failure. He saw her again a few days later, after her transplant, and she was eating and talking to him.
Liver transplantation was a new field when Johnson finished training in the early 1990s at Boston’s Massachusetts General Hospital. The University of Maryland was doing kidneys, pancreases, and some lungs and hearts; Johnson was hired to build a liver program.
If an organ was available for one of his patients, it was his job to get it. If the donor hospital was nearby, he’d drive there, store it on ice, and bring it back. Then he’d perform the transplant, often in the middle of the night.
His first transplant patient, a woman in her fifties, didn’t survive surgery. The patient’s mother was in the waiting room. He’d never had to do this before. He was expecting her to yell at him.
“I told her the surgery didn’t go well and there were some problems and her daughter had died,” Johnson says.
“Come here—I want to give you a hug,” the woman said, “because I know you did the best you could for my daughter.”
No, he thought: I didn’t do the best I could. I should’ve done better.
That first transplant stuck with him. Johnson had never operated with the team he was working with that night. He knew he probably couldn’t have prevented what happened, but he decided he should be in charge of every detail of an operation—from how the room was cleaned to how anesthesia was delivered.
Assume nothing, trust no one, check everything, he’d say.
Johnson and his wife, Gloria, lived in Ellicott City with their two small children. Gloria had decided as a medical student that life would be too complicated if both she and her husband were surgeons, so she’d specialized in obstetrics and gynecology.
The two had met when Gloria was an undergrad at Georgetown and Johnson was giving a talk about how to get into med school. He invited her to see The Woman in Red; they spent a year dating long distance before marrying in 1987.
Johnson was consumed by the lifesaving potential of transplants, often sleeping on the couch in his office. Gloria was an attending physician at Bethesda Naval Hospital, pregnant with their second child. They tried to coordinate their on-call schedules. They would have nine nannies by the time their oldest daughter turned nine. (They now have four children.)
After five years at Maryland, Johnson wanted a change. His program was competing for patients with Johns Hopkins.
“Washington was the only big city in the country that didn’t have a major multi-abdominal-transplant program,” he says.
He came to Georgetown with a Rolodex and started making calls. He brought one surgeon with him and recruited others; some of his patients followed him to DC. Georgetown had only a small kidney program when Johnson was hired in 1998, so he trained staff in caring for transplant patients.
“The operating room, the blood bank, the lab—all those places need to have a special way of doing things,” says Johnson, who also treats patients with liver and pancreatic cancer.
He wanted a team approach to transplants. All of his doctors would know about all the cases. Surgeons, critical-care physicians, anesthesiologists, and nurses would work under one umbrella.
Johnson and his colleagues did 14 liver transplants their first year. Johnson operated on the hospital’s first live liver donor—a mother donating to her 17-year-old daughter.
In 2005, Dr. Thomas Fishbein, whom Johnson had recruited to head the hospital’s new small-bowel transplant program, led a surgical team in a rare six-organ transplant: A 43-year-old man received a liver, kidney, pancreas, small bowel, colon, and stomach. Two years ago, the hospital performed its first split-liver transplant, in which a young woman who needed a liver agreed to sacrifice a portion of her new organ to give it to a baby girl. The deceased-donor liver was a match for both patients; they’re both doing well.
In September 2007, a 35-year-old Alexandria man became the hospital’s 500th liver-transplant patient. The same day, Johnson’s team performed a small-bowel-and-pancreas transplant and helped save a three-month-old.
The phone rings at the Washington Regional Transplant Community (WRTC) in Annandale whenever someone dies at a local hospital—about 15,000 times a year. Hospitals report every death; WRTC works with a patient’s medical team to determine whether that person is a potential donor.