​Prof Elmi Muller, Dean of the Faculty of Medicine and Health Sciences at Stellenbosch University, delivered her inaugural lecture on Tuesday 29 August 2023. The title of her lecture was “Fugitive reflections on pain, death, and surgery".

Muller spoke to the Corporate Communication and Marketing Division about how her ground-breaking work as a transplant surgeon has saved many lives and continues to impact legal and healthcare policy globally.

Prior to becoming Dean, you worked as a transplant surgeon. Tell us more about your research and why you became interested in this specific field.

Upon completing medical school, I pursued a career in surgery due to my affinity for the immediate gratification and practical engagement it provided. My preference leaned away from becoming a general practitioner or physician, as I discovered that my inherent impatience clashed with waiting long for clinical results and improvement of patients. With surgery you get your results the same day – you can almost immediately see what difference you made to the patient.

My desire for a more creative outlet found resonance in the realm of surgery, which has a more practical side than most other fields in medicine.

The path to transplantation unfolded for me in 2005, following the completion of my surgical exams. Venturing into transplantation was a compelling choice, presenting a captivating arena with a multitude of deserving patients and an intricate need for teamwork. Transplantation encompasses various facets: the surgical aspect, meticulous and gratifying; as well as intricate political dimensions, in which I've engaged by raising public awareness, formulating ethical organ allocation policies, and curbing organ trafficking. These issues captivated my attention.

The scientific realm of transplantation immunology, its intersection with medicine and infectious diseases, adds another layer to this field. My research focus revolves around the clinical outcomes of transplanted patients, the nuanced dynamics of HIV within transplantation, and broader matters such as organ trafficking and equitable access to transplantation care.

My contribution stands out because of the world's first kidney transplants from HIV-positive donors to HIV-positive recipients, which I performed in 2008.

Additionally, my role within the Declaration of Istanbul Group underscored my involvement as a clinician-researcher, addressing matters of organ trafficking, ethical regulations, and education on these matters in many parts of the world. I have played a pivotal role as an African-based clinician-scholar, aligning with global efforts to tackle the intricate landscape of organ regulation.

Looking back on your journey as a transplant surgeon, how would you describe the relevance of your research on transplantation?

When I started working as a transplant surgeon, individuals living with HIV faced ineligibility for dialysis or transplantation. Frequently, patients discovered their HIV status only when presenting with symptoms of renal failure. In 2008 I pioneered the use of HIV-positive donors for transplantation into HIV-positive recipients.

The ground-breaking nature of these research-driven HIV-positive-to-positive transplantation procedures reverberated nationally and internationally. Locally, it brought about transformative changes in dialysis and transplantation policies for HIV-positive patients. Prior to this initiative, such patients in South Africa were excluded from these interventions. Internationally, this work found a platform at many conferences including the American Transplant Conference, the Transplant and Infectious Disease Conference, and the Transplantation Society Conference. 

As time went by and the project expanded, my multidisciplinary role as a clinician-researcher extended to various specialised gatherings including technical surgical meetings, infectious disease symposia, immunology-focused events, virological conferences, and ethics-centric assemblies.

My contributions played a decisive role in informing policy and legislation globally. Of significant note, the outcomes of my clinical research directly influenced the Hope Act, signed into law by President Barack Obama, which permitted transplantation from HIV-positive donors in the USA.

I served as the Chair of the Declaration of Istanbul Custodian Group from 2016 to 2018. This role underscored my involvement in updating the Declaration of Istanbul (DOI), a pivotal document shaping global healthcare policy pertaining to ethical living and deceased donation. My co-chairmanship and the direction of the taskforce led to the 2018 revision of the DOI, a transformative initiative discussed in publications such as Transplantation and Kidney International.

This effort continues to impact legal and healthcare policy on an international scale.

My engagement within the global transplantation landscape is further underscored by my decade-long membership in the Executive Council of the Transplantation Society, culminating in my current role as its President. This position has enabled me to steer numerous educational and research-focused gatherings worldwide.

Being the Dean of a faculty can be challenging at the best of times. What keeps you going when things get tough?

I am fortunate to have an incredibly supportive husband who has been instrumental in shaping my career trajectory. Alongside him, there are my two sons, who've mastered the art of keeping my ego in check with their razor-sharp wit and eye-rolling expertise. Home is my sanctuary, where I enjoy doing experiments in the kitchen and try to coax my plants into growing without giving them motivational speeches.

Our family's outdoor escapades are like episodes of a reality show: us versus the wild, with walking, swimming, and beach bumming as our main events. There's also Addie, our bull terrier, who has a lot of charisma … And lastly, there's our cat, named after my husband, who insists on sharing a piece of buttered toast for breakfast.

What aspects of your work as Dean do you enjoy most?

I find immense satisfaction in the knowledge that I can enact positive change and enhance and optimise systems and operations within the Faculty. I like interacting with my colleagues, engaging in stimulating conversations, and embracing the diversity of tasks that come my way.

My interactions with students are not as frequent as I'd like them to be. I hold a deep appreciation for these interactions, as they bring me joy and a sense of fulfilment. My aspiration is to proactively seek more opportunities to connect with students. I try to effectively address challenges and make well-informed decisions. Knowing that my decisions can pave the way for progress in various workplaces, aiding individuals in their professional journeys, is truly rewarding.

You've made your mark as a leader in healthcare and academia. What would your message be to young aspiring females?  

I frequently employ the term “compartmentalize" in my conversations. Especially when speaking with young women, I counsel them on the significance of maintaining a distinct boundary between their professional and personal spheres. During work hours, the focus should be singularly on the tasks at hand. Similarly, when at home, it becomes crucial to detach from work-related influences that are beyond one's control.

This fluidly led to practical discussions about setting up effective systems, such as reliable childcare arrangements.

Another piece of advice that I often share is the paramount importance of selecting the right life partner. To me, this entailed discovering an individual who not only offered love and support but also played a constructive role in my demanding career, which frequently extended into after-hours and involved substantial responsibilities. I acknowledge that there were many instances when my expectations were very high ... The essence lies in striking a harmonious balance and staying connected with each other.

Essentially, it boils down to whether two individuals can function seamlessly as a team. Naturally, not everyone finds themselves in a partnership or raising children, but we all seek some form of a support network – individuals who can act as sounding boards and wellsprings of encouragement, people who embrace us for our authentic selves and applaud our navigation through life.

Ultimately, my core advice is to remain true to yourself. Life gains meaning when it's fulfilling across all dimensions, reinforcing the need to never compromise your identity and essence.

Tell us something exciting about yourself that people would not expect.

I used to play the piano and the organ. I like to plan outdoor activities such as walks, but I must admit that when it comes to doing the walk and the sun beats down, my mood can turn a bit grumpy and irritable. Heat is not my friend, and I'm not particularly fond of sweltering conditions.

During a family holiday in Livigno in 2018, I could manage a blue slope while skiing – something I had never thought possible. Given my woeful balance, it wasn't a straightforward feat to achieve. So, while I might not have a repertoire of extraordinary tales, conquering that ski slope stands out as a testament to leave my comfort zones and embrace moments of exhilaration.

How do you spend your free time?

I take pleasure in the comforts of home, relishing moments spent crafting interesting and new dishes, tending to my garden, orchestrating Christmas feasts and birthday gatherings, or simply spending a simple weekend in nature or at the beach.

Engaging in activities with my loved ones brings me immense joy, whether it's with my family or my friends.

Exploring novel recipes is a passion, and I find delight in experimenting with an array of kitchen gadgets and garden tools. ​

​