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Huge liver library faces ‘imminent extinction’ in San Francisco, lawsuit alleges

Dr. Stewart Cooper opens a case of liver samples with Dr. Adil Ed Wakil; both are founders of the Ibrahim El-Hefni Liver Biorepository in San Francisco. | Liz Lindqwister/The Standard

Every year, liver disease kills some 50,000 Americans. From processing your booze intake to bolstering your immune system, the liver is one of the most consequential organs in the human body—and San Francisco happens to house one of the largest liver biobanks in the world. 

The Ibrahim El-Hefni Liver Biorepository, based at a Sutter Health hospital in Pacific Heights, has collected, annotated and stored hundreds of thousands of tissue and blood samples for research. It’s like a library, but for liver samples—over 250,000 of them, to be exact—collected from nearly 5,000 donors across a 14-year period. 

“My mandate was to build a hepatology program and expand on it to increase its depth. A part of that was actually to develop a scientific anchor to the program,” said Dr. Ed Wakil, an immunologist who founded the lab alongside Dr. Stewart Cooper. 

Dr. Ed Wakil, left, and Dr. Stewart Cooper, right, pose outside the Ibrahim El-Hefni Liver Biorepository in San Francisco. | Liz Lindqwister/The Standard

Now, Wakil and Cooper say their lab is “threatened with imminent extinction” and allege that Sutter Health and California Pacific Medical Center—the medical system and host hospital for their lab—are to blame. 

“We’ve made hardly any [liver sample] collection at all in the past 18 months, even post-pandemic. We've been able to do very little except keep things afloat,” said Cooper, a liver doctor and researcher. “From an independent reference frame, the only inference could be that the biorepository has been sabotaged.”

Sutter Health faces a $250 million lawsuit from the two researchers and their team, who say the hospital system has gutted their research lab and blocked their ability to continue the biorepository work elsewhere. 

Shunted to a Dusty Basement

Many researchers have used the San Francisco-based liver biorepository for basic research, making it a crucial living library for the medical field. Wakil says their biorepository has allowed liver researchers to make major advancements against diseases like hepatitis B, which claims nearly one million lives annually. 

“It's an academic institution; it's run by philanthropy—that's the whole core of it—which means they're making [livers] accessible for people like me or others that can use them and then hopefully produce important research,” said Dr. Melanie Ott, an immunologist who has collaborated with the El-Hefni researchers.

“If you have a great biorepository but it's behind walls or it's incredibly expensive, then it's not useful,” Ott added.

Dr. Adil Ed Wakil surveys a list of philanthropists and donors to the Liver Immunology Lab, including the El-Hefni family. | Liz Lindqwister/The Standard

Despite the scientific value of the space, the lab sits in a dimly lit basement of a near-empty former hospital building. There is no air conditioning in the building, the basement has few windows and the two researchers have equipped the lab with extra fans and power generators—resources that they say Sutter Health failed to provide. 

“[Sutter Health and California Pacific Medical Center] have engaged in a concerted effort to abuse their control over the Biorepository in an intentional, systematic campaign to starve it of funding, staff, and other essential support,” the lawsuit alleges.

The lawsuit claims the hospital quietly deleted the biorepository’s website, refused to allow the hiring of new staff after 2018 and slashed its budget. The suit further claims the hospital system failed to honor a core financial promise in the lab’s original contract: to raise an additional $6 million endowment for the El-Hefni biorepository. 

Lab equipment sits under a fume hood reflecting an image of Dr. Ed Wakil. The lab was empty on May 9, 2023. | Liz Lindqwister/The Standard

In response to these conditions, the two researchers secured a new spot at a University of California San Francisco campus to continue their research and move their repository—this time to an 11th floor research lab that Cooper and Wakil already committed $1 million to renovate. 

But in the lawsuit’s biggest allegation, El-Hefni researchers say that Sutter Health has effectively blocked it from moving to UCSF, even though the biorepository completely self-funded their work since opening and they arranged for the transfer of their lab without support from Sutter Health. 

“Those two things—taking down our interface with the world, not allowing us to replace staff who've left—of course, this has a big impact on staff who remain,” Cooper said. “So is their intent to try to monetize this repository, given the culture? We don't know. But it would certainly be consistent with [Sutter Health’s] culture.” 

The UCSF Helen Diller Medical Center is at the Parnassus Heights campus in San Francisco. | Justin Katigbak for The Standard

In effect, Wakil and Cooper claim Sutter Health gutted the liver library and then blocked them from carrying their samples to a research hospital more suited for their kind of clinical biorepository research.  

Sutter Health denied many of these claims, saying that they had invested "millions of dollars" towards the repository's operations.

"Plaintiffs’ allegations, though inaccurate in many respects, show a deep commitment to the biorepository," a Sutter spokesperson said. "CPMC looks forward to ensuring that the biorepository continues to receive the highest quality stewardship, whether at CPMC or another deserving institution.”

UCSF did not respond to our request for comment by publication time. 

Trust Broken

It’s hard to explain why a collection of frozen liver samples is such a big deal, but when you look at the medical and bioethics research that’s come out of the lab and its samplings, it’s not hard to see why Wakil and Cooper are concerned. 

“This is a national treasure that has already enabled [National Institutes of Health] grant funding,” Cooper added. “It isn't just a bank of tissues—we also do biorepository science. We established cell lines, we have established organoids and we've published.” 

What it all boils down to is trust—something that Cooper and Wakil prioritized when they first opened the biorepository, named and funded in honor of Ibrahim El-Hefni, one of Wakil’s former patients who died of hepatitis C. 

The El-Hefni Biorepository helps solve the very disease that claimed Ibrahim’s life—a mission that both Wakil and Cooper, as well as the El-Hefni family, fear will be lost if the biorepository is shuttered or kept at Sutter Health. 

A magazine article highlights the researchers and family behind the El-Hefni biorepository. Suzanne Wright, far left, runs the nonprofit that funds the lab. The repository's donor consent form sits behind it. | Liz Lindqwister/The Standard

“I really wanted to make sure that this was a resource that was available to doctors all over the world,” said Suzanne Wright, El-Hefni’s daughter and head of the nonprofit that funds the biorepository. “Now, the head of CPMC is not willing to let [the lab] move, and they have never given us a reason for that. 

“They're clearly trying to kill it, or take all of the liver samples and sell them, which they can't do based on the consent forms,” Wright continued. 

If the biorepository remains under Sutter Health’s care, Cooper and Wakil say they aren’t sure who would even tend for the 250,000+ samples, which require storage in specific freezers that can reach as low as -80 degrees Celsius. 

The two researchers also worry that it would constitute a serious breach of trust and contract agreements for the biorepository’s 4,800 donors, who all signed a contract that explicitly pledged their organ samples to the El-Hefni Biorepository—not Sutter Health. 

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Dr. Stewart Cooper holds a liver sample at the Ibrahim El-Hefni Liver Biorepository at a Sutter Health hospital in San Francisco. | Liz Lindqwister/The Standard

“We were specific on several things: One is that [the repository work] would not be done for profit, that we would not generate a business,” Cooper said. “The second thing is that we wanted the biorepository to be institutionally agnostic so that it wasn't just for samples to accrue from patients who had Sutter Health, or for Sutter Health research. 

“My trust in this organization has been betrayed,” Cooper added.