A Life's Work

Dr Barbara Murphy, MD, MB, BAO, BCh, FRCPI (1964-2021)

Alumna Dr Barbara T Murphy (Class of 1989) was the Murray M Rosenberg Professor of Medicine, Chair of the Department of Medicine and Dean for Clinical Integration and Population Health at Mount Sinai in New York, and a world leader in treating and researching kidney disease and transplant immunology

Dr Barbara Murphy, world-renowned transplant nephrologist, scientist and trailblazer, passed away on June 30, 2021, at the age of 56.

Barbara’s professional achievements in her too-short life were remarkable. Outside of work, she shared a rich life with her husband, New Yorker Peter Fogarty, and was a devoted mother to her young son, Gavin. Her charm, wit, sense of fun and direct approach disarmed everyone she met.

Her extraordinary career and vital work had a deep and lasting impact on patients, colleagues, friends and mentees throughout the Mount Sinai

Health System, the wider medical community in the US and globally in the nephrology community.

Barbara was inspired to pursue a career when as an undergraduate at RCSI, she met a young patient, just a few years younger than she was at the time, who was su ering from kidney failure. As she explained in an interview in 2016 with Irish America magazine: “I saw her on dialysis when I was a medical student, then I saw her when she got her kidney transplant, and then I saw her as a renal registrar – I saw her all the way through.” e young woman went on to become a teacher. Witnessing the life-changing impact of that transplant, Barbara set her course: a fellowship in clinical nephrology at Beaumont Hospital in Dublin, then postdoctoral training with a fellowship in nephrology at Harvard Medical School’s Brigham and Women’s Hospital. Years earlier, Barbara had set her heart on Harvard when, on a J-1 summer visa to Boston, she took the wrong bus and wound up taking a detour through

the Harvard Medical School campus, buying her rst stethoscope in the medical supply shop there.

At Brigham and Women’s Hospital, Barbara trained in transplant immunology at the Laboratory of Immunogenetics and Transplantation. She was recruited to Mount Sinai Medical Center in New York as Director of Transplant Nephrology in 1997 and in 2003, was named Chief of the Division of Nephrology, one of the youngest division chiefs in the US. In 2012, Barbara was named Chair of the Samuel Bronfman Department of Medicine at the Icahn School of Medicine and just one year later, a er Mount Sinai merged with another hospital system to form the Mount Sinai Health System, an amalgam of seven hospitals and more than 2,000 faculty, Barbara served as Chair of Medicine and also Dean for Clinical Integration and Population Health.

Due to Barbara’s signi cant administrative roles and her international leadership in research in the eld of genomics in transplantation, she was unable to maintain her clinical work, something she said she missed terribly. However, everything she did outside of her clinical work was patient-focused. She placed great emphasis on a coordinated approach to patient care, thus making it easier for patients to navigate the medical system and facilitating clinical and translational research. HER WORK ON Her research was to bene t patients directly. Using high-throughput genomic technologies to understand GENE EXPRESSION the immune mechanisms leading to gra injury and loss, PROFILING TO HELP she followed transplant patients for two years, doing PREDICT PATIENTS’ serial biopsies, drawing blood, tracking their progress to identify a set of genes that predicted which patients RISK FOR REJECTION would develop disease and su er a decline in function AND DISEASE so their immunosuppression could be managed in a HAD SIGNIFICANT more personalised way. Her work on gene expression pro ling to help predict patients’ risk for rejection and IMPLICATIONS, NOT disease had signi cant implications, not only for kidney ONLY FOR KIDNEY transplantation but for all organ transplantation. TRANSPLANTATION Since they met in Harvard in 1994, Professor Catherine Godson PhD MRIA, of the Diabetes BUT FOR ALL ORGAN Complications Research Centre at University College TRANSPLANTATION. Dublin, and Barbara were lifelong friends. ey were introduced to each other at Harvard by fellow Dubliner, Professor Hugh Brady, President of Imperial College London. e three would gather for anksgiving and celebrate Christmas together in Boston. When Catherine returned to Ireland, both she and Barbara maintained regular contact and went on to collaborate in developing some of the analytical tools to predict progression of kidney disease. Before her death, Barbara had asked if Catherine would speak at her memorial. is took place in Westchester County, New York in April. Catherine remembers Barbara’s immense enthusiasm and energy: “Barbara took everything in her big long stride, her scarf swinging. She knew everybody, was super-e cient, superpositive. She was fantastically supportive of all her colleagues, and particularly so of her Irish colleagues. We are all devastated by her loss.”

In addition to her roles within the health system, Barbara was appointed Chair of the Scienti c Advisory Board for RenalytixAI, an arti cial intelligenceenabled in vitro diagnostics company that seeks to improve chronic kidney disease detection, management and treatment. In 2020, she co-founded Verici Dx, a pioneering company focused on advanced clinical diagnostics

Inside the Murphy laboratory at the Icahn School of Medicine, New York. in organ transplantation. Catherine says: “As well as being a wonderful clinician and a great researcher and administrator, Barbara was also a gi ed businesswoman.” Much of Barbara’s career was spent advocating for those disadvantaged with no access to kidney transplantation, such as HIV patients. Her groundbreaking discoveries led to transplantation in HIV-positive patients becoming standard of care. No stranger to the corridors of power in Washington DC, she lobbied for extended drug coverage for transplant recipients. More recently, while New York City was the epicentre of the COVID-19 pandemic in early 2020, her leadership in developing a workforce redeployment strategy allowed Mount Sinai to treat more patients. She was also integral to the establishment of the Centre for Post-COVID Care at Mount Sinai. Among many honours, she was named one of the Crain’s New York “Notable Women in Health Care” in 2018. She received the distinguished Jacobi Medallion in 2014. In 2011, she was named Nephrologist of the Year by the American Kidney Fund. In 2005, Barbara was awarded the Irene and Dr Arthur M Fishberg Professorship of Medicine at the Mount Sinai Hospital. She received honorary doctoral degrees from a number of universities and medical schools including her alma mater, RCSI. roughout her career, Barbara was a champion of diversity and inclusion. As an immigrant to the US, receiving her Green Card through the Diversity Immigrant Visa Lottery programme, she was an avid supporter of immigrant rights and worked to improve access to care for immigrants with kidney disease as well as training and employment opportunities for immigrant trainees.

BACK TO THE BEGINNING

Some clue to Barbara’s success may lie in the incredible work ethic instilled by her parents at an early age. Barbara’s brother Professor Kieran Murphy, Professor of Interventional Neuroradiology, University Health Network, Ontario, Canada recalls their empowering upbringing in Knocklyon, on Dublin’s southside, with their sister, occupational medicine clinician Dr Céline Murphy. “Our dad, John had an airfreight company and our mother, Anne designed

bridal wear. Dad was very quiet but quite brilliant, one of the most widely read people I’ve met; Mum’s attitude was that while there may not have been many female role models in medicine at the time, it was as important for her daughters to have a career as it was for her son to cook! Barbara said she was her role model. We would watch current a airs programmes on RTÉ, then sit at the dinner table and discuss stu . Our aunts and uncles and grandfathers were politically engaged, and we were inspired by people like Noel Browne, Jonathan Miller and Anthony Clare. We were encouraged to use the public library system, to pursue knowledge and to believe that if we set our minds to it, we could achieve anything.”

Kieran believes that Barbara displayed the trait that so many Irish people share, the inability to tolerate unreasonable authority: “She would just say, ‘But, that’s not right’ and go and do something about it.” He also attributes her ability as a researcher to another Irish characteristic: “We Irish are only concerned with what we do badly, not what we do well – this is something that makes you a good researcher.”

Barbara recognised no boundaries to her work life, according to Kieran. Work and weekends were a continuum, and airplane ights were academic time. “She would go on a twelve-hour ight and work all the way, she would

Dr Barbara T Murphy and Peter Fogarty “BARBARA get a lot done and still be fresh. Barbara DISPLAYED found the joy of discovery very powerful THE INABILITY and energising.” In 2020, prior to her illness, Barbara was TO TOLERATE appointed President Elect of the American UNREASONABLE Society of Nephrology (ASN). At Barbara’s AUTHORITY: “SHE behest, Catherine Godson will chair the ASN conference in Orlando in October. In WOULD JUST 2021, Barbara was named posthumously as SAY, ‘BUT, THAT’S the recipient of the ASN Trailblazer Award, NOT RIGHT’ AND a lifetime achievement award for her work on advocacy, mentorship, and breaking GO AND DO barriers in nephrology and medicine. SOMETHING “It is so not the way it’s meant to be,” ABOUT IT.” says Catherine. Barbara was the last of the three Murphy siblings to start at RCSI, though at one point all three were simultaneously in medical school. It was at RCSI where GP Dr Katrina McCrory Costello (Class of 1989) rst met Barbara in pre-med. “She

Barbara, her son Gavin and brother Kieran Barbara and Kieran

was strong and independent and had a rm values system,” says Katrina. “We went on our J-1 summer trip to Boston together, and Greek island-hopping a er our nal exams and on a trip to Egypt while we were both training in Beaumont.” ey continued to see a lot of each other when they both moved to the US, Barbara visiting Katrina in Baltimore and Katrina visiting Barbara and Peter’s Westchester home or their vacation place in New Hampshire. Barbara was a bridesmaid at Katrina’s wedding to Professor Richard Costello, also a great friend of Barbara. “We really valued the times we could meet, she knew my sons, I got to know her son, Gavin. No matter how important the work she did, Barbara always said Gavin was the biggest achievement in her life, and she was so appreciative of how Peter supported her so she could be a devoted mother and remain committed to her work.”

“ e beauty of RCSI is that we are all still in contact with our peers and the wider RCSI family,” says Kieran. “It was RCSI that opened our eyes to global health. Barbara worked in a refugee camp on the border between ailand and Cambodia. She and her colleagues had to leave the camp at night because of the danger of attacks by the Khmer Rouge. Barbara’s belief that we are on this earth for a reason and here for a purpose inspired a lot of people,” explains Kieran. “ is is how Barbara lived her life.” ■