Dr. Mikel Prieto is a kidney, pancreas, and pediatric transplant surgeon at Mayo Clinic in Rochester, Minnesota. He has special interests in kidney paired donation and transplantation for polycystic kidney disease as well as pancreas transplantation for type 1 diabetics and transplantation in children. I sat down with Dr. Prieto recently to ask him about his career, hobbies, and interests. I learned what he thinks will happen in the field of kidney transplant in the future.
Where did you grow up and how did you decide to become a surgeon?
I grew up San Sabastian, a town in the Basque Region of Spain. My city is known for its beautiful beaches, outdoor activities, and has a claim to fame for being one of the best places to eat in the world. We have many award winning restaurants and San Sabastian is one of the few cities in the world with more than one restaurant with a 3-Star rating in the Michelin guide. My wife is also from the Basque region, and we both met at a ceremony were we were both receiving the “Basques of the World” award. She is a concert pianist who specializes in coaching and accompanying opera singers.
At age 9, I already knew I wanted to be a transplant surgeon. It was the year that Dr. Christiaan Barnard from South Africa, after training in Minnesota, performed the first heart transplant. He wrote a book about his experience. I read the book and found the possibility of organ transplantation in humans fascinating. My other interest was to be an astronaut, because Armstrong landed on the moon around that time. I figured it would be easier to get into transplant surgery than go to space, so after attending medical school in Spain and spending 3 years in England, I came to the United States for training in surgery and organ transplantation. Interestingly, the locker that was assigned to me during my training at the University of Minnesota had the inscription “C. Barnard”. The surgeon that had inspired me to become a transplant surgeon in my youth had shared with me the same operating room locker decades later. After 12 years of training and research in surgery and transplantation, I came to Mayo Clinic, where I have been a transplant surgeon for the last 20 years.
Describe your role on the care team and what brought you to Mayo Clinic.
The first thing I noticed when coming to Mayo Clinic was our strong philosophy of teamwork. In transplant, we need the expertise of many different disciplines, and the surgeon is an integral part of that team. I was drawn to Mayo because this area of medicine, transplantation, is a very fertile ground for teamwork, and Mayo Clinic practices this concept better than any other institution. In my job, I get to change peoples’ lives every day by performing life changing transplants. But that’s not all we do. We also get the privilege of being able to advance the science and art of transplantation medicine and surgery. One of the great aspects of Mayo Clinic is that our teamwork makes it possible for us to make changes in processes and advance the science of transplant through these changes. After two month at Mayo Clinic, I was able to change our practice from open surgeries for kidney donors to laparoscopic (small incisions, fast recovery) surgeries for those patients. We also pioneered the removal of very large polycystic kidneys with a laparoscopic technique. Today we are one of the few centers that perform this procedure at the same time as a kidney transplant. As Mayo Clinic doctors, it is part of our job to innovate and improve care for our patients every day through research and surgical advancements.
Apart from the daily care of transplant patients, I have had several administrative responsibilities. These included Surgical Director of the Kidney and Pancreas Transplant Program, Director of the Pediatric Kidney Transplant Program, and Director of International Practice Operations for Mayo Clinic.
If you weren’t doing this job, what would you be doing?
If I had to retire from medicine tomorrow, I think I would like to be at least a part-time cowboy or wrangler somewhere in Wyoming, Montana or Colorado. I love the American West, the open plains and mountains. However, my number one love today still is medicine. Sometimes people in Minnesota take for granted the incredible health care quality that we have. We benefit from the best health care in the world right here in our hometown hospital. This is the birth place of many great innovations in medicine that date back to the Mayo brothers. Many people don’t realize how amazing this is, and they accept it as normal. But other places don’t have this great health care experience. I am very proud to be here as part of the Mayo Clinic miracle.
I also have a personal interest in understanding the factors that lead to high quality healthcare. With 20 years of experience at Mayo, I see up close every day what good health care looks like. I travel often and see how health care looks in other areas of the world, and as the medical director for international activities I had innumerable opportunities to discuss these issues with other healthcare leaders. If I wasn’t a surgeon, I would be interested in consulting with hospitals, healthcare organizations and government agencies on how to improve the quality of healthcare.
What is the best part of your work?
My best days at work are taking a young child to the operating room who typically has spent a good part of their short life sick and on dialysis and being able to change their life for the better. Seeing how that child, after a successful transplant, flourishes and is given a new full life is the most rewarding part of what I do. In fact, I can’t think of another job that could provide me with this kind of satisfaction and sense of accomplishment.
Describe one of your favorite or most rewarding work experiences.
My favorite experience is being able to transplant a patient that no one else thought was possible. A few years ago, we transplanted a child who nobody thought could ever be transplanted. He got the H1N1 flu after only a month in kindergarten and spent the next 2+ years in the hospital. He had more than 70 surgeries before he came to Mayo Clinic, and he was very weak and sick with multi-organ failure. We were able, through some preparatory surgery, to get him well enough to undergo a kidney transplant from his mother. If he hadn’t come to Mayo Clinic, and our team hadn’t agreed to think outside the box, he would not be with us today. He is now a happy, healthy teenager leading a normal life.
If you could change something about the kidney transplant field today, what would you change?
I wish we had enough organs to get everybody transplanted through tissue engineering and other techniques. I also would like us to make a greater effort to minimize the wait time for patients on the waiting list by promoting living and deceased organ donation.
Another great advancement would be to conquer “tolerance” so patients no longer need immunosuppression medications after a transplant. Research work is being done in all these areas, and I am very hopeful for the future.
What is the most challenging part of your job?
The biggest challenge for me is the frustration that we can’t help everyone. Sometimes people are too weak and frail to benefit from these techniques. We do our best to help as many people as we can, but sometime we are just too late.
What are your interests or passions outside of work?
I love the outdoors. As far as I am concerned, an evening trail ride through the countryside around Rochester on horseback is the perfect way to end a day. I try to get out of town and camp with my family on most weekends in the summer. For my travel vacations, I choose the American West or a trip through Europe. In the winter, I like to go skiing to the Rockies or to the Alps.
I am also a classical music and opera lover. My favorite memory was to watch my wife, a concert pianist and a coach for opera singers, perform at Carnegie Hall. I did that twice!
What is your hope for kidney transplant in the coming years?
I hope we are successful at conquering immunological tolerance, so we don’t need to use long-term immunosuppression to prevent rejection in our patients. I also hope we can figure out, one way or another, how to solve the organ shortage problem. In the short term, I want to see Mayo Clinic continue to be a leader in preemptive kidney transplantation and kidney paired donation. These are the things that will help make transplantation an option for everyone who needs a lifesaving organ.
Join us in congratulating Dr. Prieto on his 20 years at Mayo Clinic, and we hope to have his skill and expertise for many more!