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John Webster Kirklin

A.J. Wright, University of Alabama at Birmingham
John Webster Kirklin (1917-2004) was an important figure in American medical history. His distinguished career as a cardiac surgeon began at the Mayo Clinic in Rochester, Minnesota, where he refined an experimental heart-lung machine and performed the first open-heart surgeries with such a device. His innovations continued during his many years at the University of Alabama at Birmingham (UAB) School of Medicine in Birmingham, Jefferson County. There, he developed one of the foremost cardiovascular surgery programs for patients and surgical residents. By the time of his death in 2004, nearly one million cardiac operations had been performed around the world using the heart-lung machine. The mortality rate had declined to very low levels in many types of these surgeries after decades of research and clinical experience. Additionally, the willingness of this Mayo Clinic medical star to come to Birmingham began a sequence of events that decades later has made UAB the state's largest employer and a world leader in medical practice, education, and research.
Kirklin was born on August 5, 1917, in Muncie, Indiana. His father Byrl R. Kirklin, was a radiologist recruited as the first director of radiology at the Mayo Clinic. His mother, Gladys M. Webster Kirklin, was a homemaker; he had one sister. Kirklin received a bachelor's degree from the University of Minnesota in 1938. During his four years there, he served as student manager for the varsity football team.
He then attended Harvard Medical School, where his interest in cardiac surgery developed. He graduated in 1942 and spent July 1942 through April 1943 as an intern at the University of Pennsylvania Hospital. In 1943, he married Margaret Hair, with whom he would have two children. Kirklin was next a surgical resident at the Mayo Clinic. He served at the rank of captain in a U.S. Army neurosurgical unit from July 1944 until August 1946, during World War II, and then worked at Children's Hospital in Boston, Massachusetts, where he trained under Robert E. Gross, a pioneer in pediatric heart surgery who had sparked Kirklin's interest in cardiac surgery while at Harvard. He returned to Mayo in 1950 to finish his residency, rising from surgical assistant to chair the Surgery Department by 1966.
Kirklin and a group of collaborators began working with the heart-lung machine first developed by John Gibbon. They were able to make refinements and complete a series of successful open-heart surgeries for congenital defects. Much of Kirklin's subsequent career was spent improving the repair techniques for such defects, dealing with a variety of complications that could develop in the surgeries, and training residents in his techniques.
On October 24, 1965, the UAB School of Medicine's chair of surgery, Champ Lyons, died of a brain tumor. The school began a national search, but no major figure wanted to come to the city during this period of nationally televised racial turmoil. Harvard surgeon Francis D. Moore, a consultant for the search committee, learned that Kirklin was very interested in the post, despite an offer for chief of surgery from Boston Children's Hospital, the leading pediatric hospital in the United States.
Kirklin was attracted to UAB for several reasons. Most significantly, Vice-President for Health Affairs Joseph F. Volker was known for hiring good people and staying out of their way. Thus Kirklin would have a chance to develop a surgery department in a less established environment than at Mayo or Children's and implement some of his own ideas about administration and surgical training of residents. Additionally, Kirklin and his wife would also be able to stable their several horses close to where they lived.
Kirklin began work at the School of Medicine on September 1, 1966, as Director of the Division of Cardiothoracic Surgery. He surrounded himself with accomplished individuals willing to work as hard as he did. Albert D. Pacifico, one of his residents at Mayo, came with Kirklin and followed his mentor as a brilliant cardiac surgeon. Arnold Diethelm arrived in 1967; he performed the state's first kidney transplant after the 1968 opening of the Alabama Transplant Center.
The School of Medicine's reputation quickly began to change in the perceptions of both the general public and academic medicine. The February 1967 Ladies Home Journal named University Hospital as among the country's best. Later that year, a survey of southern medical school deans named it the most rapidly progressing such school in the South. Kirklin's arrival helped University Hospital evolve from a facility primarily for indigent patients to one supporting world-class clinical care, research, and teaching. By the early 1970s, the school was receiving more cardiovascular research funds from the National Institutes of Health than any other medical school in the country.
A few years after Kirklin's arrival, conflict developed in the medical center over financial pressures. The conflict became so bad that several prominent medical school faculty threatened to resign. This group included Kirklin, who had other offers from Harvard and elsewhere. Dean S. Richardson Hill, a physician himself, negotiated a settlement that avoided this potential disaster, however. The dispute ended with the creation of the Health Services Foundation at the medical school to manage patient revenue funds. Kirklin, who was instrumental in the settlement, served as the foundation's president from 1975 until 1982.
In 1981, Kirklin became the director of the newly established Alabama Congenital Heart Disease Diagnosis and Treatment Center. In 1982, Kirklin stepped down as the chair of surgery but remained as director of the Division of Cardiothoracic Surgery. The school also created an endowed professorship named for Kirklin. The first recipient was his colleague, Albert Pacifico, who also replaced Kirklin as director in 1984.
Among his many accomplishments during his tenure were the development of computerized monitoring in the intensive care unit and a non-M.D. surgical assistant program to help with staffing shortages. Both were widely adopted in other medical centers. His wife Margaret K. Kirklin was also a physician and during her career directed the surgeon's assistant program at UAB. Son James Kirklin, who had trained as a cardiac surgeon, became head of the heart transplant program. In 1988, James Kirklin and George L. Zorn Jr. led the team that performed the first heart-lung transplant in Alabama. In 1997, James Kirklin led a team in the 500th heart transplant at UAB.
John Kirklin died on April 21, 2004. His medical legacy is visible on the UAB campus and beyond. On June 5, 1992, UAB opened the Kirklin Clinic. This facility, designed by renowned architect I. M. Pei, consolidated the outpatient activities at the medical center. Over his career, Kirklin published more than 700 articles, many of them related to congenital heart defects, and wrote a landmark textbook, Cardiac Surgery, that is in its fourth edition. He also served as the editor of The Journal of Thoracic and Cardiovascular Surgery for many years. Kirklin's many publications and cardiac surgery textbook, as well as the faculty and residents who worked and trained with him, have spread his medical achievements worldwide.

Additional Resources

McWilliams, Tennant S. New Lights in the Valley: The Emergence of UAB. Tuscaloosa: University of Alabama Press, 2007.
Weisse, Allen B. "John W. Kirklin (1917-2004)." Clinical Cardiology 28 (December 2005): 585-86.
Published:  February 6, 2018   |   Last updated:  February 6, 2018