Driven by the Desire to Make a Difference

Professor Hakim is a man in a hurry, often working 18 hour days. He is Surgical Director of the West London Transplant Unit at Hammersmith Hospital and divides his time between running private practices in London, fulfilling his duties as World President of the International College of Surgeons and giving numerous lectures around the globe.

Nadey Hakim is also a man of many talents. Apart from being one of the world’s leading transplant surgeons, he speaks nine languages, including Russian, Hebrew and recently-acquired Japanese. He’s also an accomplished clarinetist, having released a classical recording on CD, and a skilled sculptor.

With great charm and modesty, he points to a letter on the mantelpiece at his consulting rooms in Harley Street, London. It is from Buckingham Palace, thanking him for the gift of a bronze bust of the Queen he sculpted. “She must have really liked it,” he says with obvious excitement. “I’m told it’s very unusual for her to accept gifts from members of the public.”

In a fast-moving world, he regards time as a precious commodity, and is not one to waste time by watching TV or simply pottering about at home. Indulging his artistic and linguistic hobbies is what Nadey Hakim regards as rest and relaxation. It was the desire to achieve quick results that first attracted him to surgery. “I could never have become a physician, administering tablets and medicines that may or may not work over a period of time,“ he says. “Being able to improve the life of someone who has been suffering for years with an operation taking only a few hours gives me great pleasure,” he explains. “With transplant surgery, you get an instant result that changes a patient’s life literally overnight.”

Born in the Lebanon 50 years ago last April, Prof. Hakim says he had always wanted to be a doctor. As a young boy, he liked to dissect things, even the odd insect or two. “I remember taking toys apart and putting them back together,” he says. “I was always fascinated to see how things worked. In the Lebanon, the word ‘Hakim’ actually means wise man or doctor, so I suppose that was an omen, although none of my family were doctors.” He trained as a surgeon in Paris, London and the United Sates, before being appointed as a consultant at St Mary’s Hospital, London, at just 35 years of age.

Within two years, he had performed the UK’s first pancreas transplant. Three years later, the young surgeon’s skills achieved worldwide recognition when he was part of a team which carried out the world’s first arm transplant in Lyons, France. That was followed in 2001 by the world’s first double arm transplant
again in Lyon.

In almost 20 years of practice, he has performed more than 1,500 transplant operations, specializing in kidney and pancreas transplantation. “We have made tremendous progress in dealing with rejection and developing surgical techniques that help us carry out successful operations a lot more quickly,” he says. “For example, when I first started with kidney transplants we had a success rate of about 80 %. Now it’s 97.8 % and the operation has become almost routine.”

Pancreas transplantation as a cure of diabetes is less well-known and Prof. Hakim admits that some family doctors are not even aware of it. “We have now performed over 150 pancreas transplants and we have had fantastic success. When I first started the operation was very long, about 10 hours. Now it only takes about two or three hours. Apart from cost, reducing the patient’s time under anesthesia for any operation makes a big difference to recovery rates and the relief of pain.

“I was recently invited to a party by one of my patients who had a kidney and pancreas transplant. She was celebrating the 10th anniversary of the operation and had invited other patients as well. It was very nice to see them all healthy and able to enjoy life.”

The prevention of rejection has been a common challenge for all transplants and advances in what Prof. Hakim calls ‘intelligent immune suppression’ have been key to overcoming it. “We now have drugs that specifically target only the cells that will cause rejection, rather than affecting the whole body. In the old days we used corticosteroids which hit everything and caused unwanted side-effects, often making people look fat. For that reason alone, many patients, particularly women, would stop taking their medication.” However, there is one abiding problem that has not been solved: a shortage of organs.

In the UK alone, Prof. Hakim says there are currently 6,000 people awaiting a kidney transplant and only 1,500 operations being performed each year. “The waiting list is growing all the time and without organs we can’t do transplants,” he says. “The only way to solve this is to adopt an ‘opt out’ system, such as they have in France, Italy and Spain, where organs can be used unless the individual has previously stated otherwise. Instead of carrying a donor card, people could carry a card if they don’t want their organs used.”

Infection control and maintaining aseptic practice is another challenge that remains in many hospitals, despite all the advances in medical technology. For Prof. Hakim and his colleagues it is particularly important. “Many of our patients have infections like hepatitis B, sometimes C and even HIV. It is not the patient who is at risk but the doctors and nurses. Getting infected can be an absolute disaster. This is why I have always supported double gloving and strongly recommend it to all my assistants. “There are still many surgeons who do not take this precaution because they are concerned about losing sensitivity. With the modern gloves made from very soft material this is no longer an issue. I have to say it’s a bit like people who don’t want to use a condom. If you are not properly protected, you get infected. These days, I even triple glove sometimes, it’s not a problem.”


Prof. Hakim regards the use of single-use gowns as another essential requirement in preventing the spread of infection. “They are vital and I have been wearing them for many years,” he says. “I remember when I was a junior 25 years ago we even had reusable gloves, which seems laughable these days. There were lines of gloves being hung up to dry in the operating theatre. It was like a laundry. “In the long run single-use products are cheaper, you don’t have to wash and sterilize them, and they are certainly safer, which is probably the most important consideration.”Out on the hospital wards, Prof. Hakim suggest that consultants – senior doctors who lead and help train teams of juniors – could set an example by wearing disposable white coats over the suits they wear every day on their rounds. “Consultants all over the world used to wear white coats which ended up looking pretty grubby and had to be
laundered all the time,” he says. “Maybe we should now wear disposable ones.”


Looking ahead, he believes the pace of medical progress will eventually make transplant surgeons such as himself redundant. Over the next few decades, he expects to see a greater use of artificial organs. He also foresees huge potential in regenerative medicine, which could ultimately lead to the use of stem cells, administered by injection, to repair faulty organs. “It will become a radiological procedure, with the X-ray people doing it, not a surgeon,” he says. “Medical science is moving at such a fantastic pace, we will have new treatments available that make surgery unnecessary. It’s happening already. I’m sure the time will come, though probably not in my lifetime, when the role of the surgeon will be restricted to trauma cases, dealing with the results of accidents, repairing broken bones and the like. “Even today, surgery is becoming much more specialized. With restrictions on working hours and the need for efficiency, you now have surgeons who just do one or two specific operations. Hour after hour, week in week out, the same operation. I have to say I would find that very boring.


“I’m happy doing what I do. Over the last few years, I’ve branched into bariatric surgery for the treatment of obesity. We insert a balloon in the patient’s stomach, or put a lap band around it. Their appetite is greatly reduced, they eat less and lose weight permanently. You get a rapid result, which is what the patient wants, and I find that very rewarding.” With a smile, he adds, “As a surgeon, I like to think my work will not disappear and the benefits will, hopefully, last a lifetime. That’s probably why I enjoy doing sculpture so much. I hope this does not sound selfish, but I like to have something to show for my efforts.” Those efforts are appreciated by thousands of patients all over the world who owe their lives to Prof. Hakim’s surgical skills – and he also has a very special admirer of his abilities as a sculptor.