It is early Friday evening in Toronto and I am speaking with one of the most notable surgeons in Canada, from his office on a sunny Vancouver afternoon. The voice filtering through my phone is gentle and patient. It is completely devoid of arrogance. It has a calming effect on me, the one I imagine the voice of a Zen master has on his students. It is the voice of Dr. Garth Warnock, the head of surgery at the University of British Columbia and Vancouver Hospital and Health Sciences Centre. He is talking to me about a procedure he helped to develop that has revolutionized the treatment of type one diabetes. The procedure is nothing less than miraculous: a 30-minute islet cell transplantation that can reverse years of insulin dependence almost as easily as phone lines connect our disparate time zones.

Performed under local anesthetic, the procedure is the most effective control of type one diabetes to date and involves transplanting only the required insulin-producing cells (called islets) from a donor pancreas organ into the recipient's liver. "It's a very tiny quantity of cells we're talking about here," the soft-spoken doctor says. "About two millilitres - enough to fill the smallest syringe you can imagine." The cells are placed in the patient's liver, because it offers the most hospitable environment for the transplanted cells to thrive, Dr. Warnock explains. And while patients must still monitor their blood sugar and remain on immunosuppressive drugs for life, to prevent rejection of the new cells, the freedom they experience is almost immediate.

But don't be deceived by the procedure's apparent simplicity. The research and development of the islet transplantation program, like any modern technology, took years to evolve. Historically, transplantation for diabetics involved the entire pancreas – a lengthy and invasive surgical procedure. Today, islet cell transplantation is considered an "outpatient" therapy with the recipient often allowed to go home the same afternoon. Even better, this new surgery is available to patients who have not yet developed serious end-stage complications of the disease. Despite this, the procedure is not considered a cure in the purest sense. "It is only a control," Dr. Warnock emphasizes. "A cure would be something that would prevent the disease from affecting people altogether."

As I listen to him speak, I remind myself that this incredibly accomplished surgeon sprang from relatively humble roots. The son of a nurse and a southern Alberta farmer, Warnock always knew that he wanted to be a doctor. And while he cites his mother as having "prompted" him in a medical direction, it was growing up on a farm that really prepared him for life as a doctor. "My father is a farmer and I think that gave me the best skills in making things grow and survive," he says. After graduating from the University of Alberta, he completed a post-doctoral degree at Oxford University. But he began specializing in the treatment of diabetes while training to be a surgeon in Edmonton. Today, Dr. Warnock carries the honour of being the first diabetes researcher in Canada to successfully perform an islet cell transplant.

Since 1999, the islet cell transplantation program in Canada has successfully treated more than 60 patients. The Vancouver-based program can accommodate from 10-12 recipients per year. But those numbers are modest, Dr. Warnock says, given the prevalence of the disease. Diabetes affects more than two million Canadians. And the number is growing each year, with 200,000 diabetics in B.C. alone. While there are several different types of diabetes, islet transplantation is open only to patients with type one or insulin-dependent diabetes (as opposed to obesity or adult-onset). Type one diabetes usually develops before the age of 30 when the pancreas – the organ responsible for producing insulin – is either unable to make insulin or the insulin is not able to work effectively. Without insulin, glucose builds up in the blood leading to high blood-glucose levels causing health problems, such as blindness, and heart and kidney disease.

Although refinements to the program continue to grow, including improved immunosuppressive drugs and better methods of extracting the insulin-producing cells, there are not enough donors to meet the demands of all the patients. This is surprising and unfortunate, especially since the program can accept organ donations from people up to the age of 70. "Organ donation is what makes this program possible," Dr. Warnock says, his voice growing passionate. ?It is such a gift of life for people who have a need for transplantation therapy. It?s very important that people know this is how we are able to offer this type of program.?

Currently, Canadian islet cell transplantation programs are offered only in Vancouver and Edmonton. And while any resident of Canada can apply, understandably, there are more people willing to participate in the programs than there are spaces available. Participants must meet certain criteria to qualify - they are between the ages of 18 and 65, have had type one diabetes for five years, and show certain complications associated with the disease. Participants must also be willing to relocate close to the cities in which the program is offered for a given amount of time (depending on the therapy). Those who wish to learn more about the program can do so at the following addresses:

Islet Transplant Program
2000 College Plaza
8215-112th Street
Edmonton, Alberta, Canada T6G 2C8
phone: 780-407-1501
fax: 780-407-3850
e-mail: isletprogram@med.ualberta.ca

Vancouver Hospital Division of Endocrinology
fax: 604-875-5925
e-mail: support@bcendocrineresearch.com
Web site: www.bcendocrineresearch.com