Bill Harmon's 2003 Presidential Address

Of that versatile man, O Muse, tell me the story,
How he wandered both long and far after sacking
the city of holy Troy.
Isn’t that beautiful? It’s ancient Greek. Those are the opening words of The Odyssey. I believe we can all find a message in them.

I could say that the Odyssey is an important work that set the stage for all poetry and prose that would follow. And that would be true.

I could say that the Odyssey offers analogies of the struggle of man against forces of Nature he can barely understand. And I could say that this parallels the struggles of transplantation. And that would be true.

Perhaps the simple answer is that the Jesuits forced me to memorize these words in school and I finally found a captive audience.

The Odyssey opens “en medias res” or “in the middle of things.” That is where I find myself as president of the AST, “in the middle of things.” Great achievements have been made and yet great achievements still lie ahead before we can rest.

Many things contributed to Odysseus’ success. His crew, his wit, luck, the gods, all pushed and pulled him along. These same factors have contributed to our success at the AST this year. It has been a wonderful year for me as president.

I feel fortunate to have been the guy banging the drum. This has been the year of the crew. The vitality of our society has always been its members. When the Society was growing rapidly, the leadership of the AST chose its agenda. I felt that this limited the scope of the committees and didn’t allow them to use the power and vitality that I knew they had. This year the committees themselves have decided where they want to go. They meet and make decisions. They are doing research and conferences and they are bringing their ideas and energy back to the Society.

There are 27 committees this year. It’s a huge number. It’s a record number and it’s a number that makes it impossible to give each group the attention it deserves. All have done incredible work.

I put out the call for committee independence and the response was overwhelming.

As the committee names run behind me I would like to mention a few of the highlights:

First I want to thank the ATC Planning committee for completing the huge task of getting us all here. David Briscoe and Donald Hricik, represented AST and their crew have done a fine job of organizing this outstanding event. Thank you.

The infectious diseases community of practice has almost completed their over 300-page manuscript detailing ID practice guidelines. The guidelines will become something that we all refer to frequently.

The ad hoc clinical trials committee met during the 2003 Winter Symposium and developed its mission statement: To enhance AST members’ clinical trial capabilities; to optimize the work among the FDA, payers, and investigators for improved clinical trials; to enhance the education of patients about clinical trials. The committee is working on a clinical trials registry that will be a valuable resource for all of you.

I appointed another committee this year: The ad hoc Consensus Conference Committee. Under the extraordinary leadership of Frank Delmonico it has perfected the technique of calling together the experts in an area, leading them to reach a contemporary consensus and publishing the resulting information on time and under budget.

Under the leadership of Sharon Bartosh, the Pediatric Committee has been developing guidelines for the care of the pediatric transplant recipient. Importantly, the committee has been working very hard with NIAID, ASTS and NAPRTCS to hold a consensus conference in Washington in September about research in pediatric organ transplantation.

The women’s health committee’s conference “Reproductive Issues in Transplant Recipients” was a huge success. Dr. Michelle Josephson and her crew brought together experts to help develop practice guidelines for the pregnant transplant patient, discuss reproductive concerns of living donors, and consider effects of immunosuppression on the fetus. She presented the results of that conference yesterday.

The training and workforce committee recently presented data to us from a work force survey. The data Dr. Connie Davis and her crew revealed to us predicts a need to double the number of practicing transplant nephrologists within the next five years. The committee also chose 50 worthy residents and fellows to receive AST’s 2003 trainee travel awards and brought them to this gathering. It sure will make me happy if all of them show up again next year.

Dr. Fuad Shihab’s crew has partnered with the ASN to accredited 28 adult renal transplant physician training programs. Our first pediatric renal transplant physician training program was approved this year and hopefully more will follow soon.

The nominating committee has recommended an excellent slate of candidates for officer and councilor positions. If you haven’t cast your vote yet, you still have five hours to do so before the Business Meeting this evening.

The AST board and the membership have identified the awards and grants program as core to the mission of the society. Dr. Larry Turka and his crew have finished the task of selecting 13 grant recipients. Congratulations to the committee and to the recipients of these important awards. You are the reason we formed this society. Thank you.

Over the past three years, the patient care and education committee has produced, with the help of the organ specific committees, eight patient education brochures. The brochures are in English and Spanish and are downloadable from the AST website. They were just recognized by the NLM as an authoritative source of patient information on transplantation. Tom McCune’s crew is developing an additional four brochures.

Dr. Charles Orosz and his crew at the Basic Science Committee have somehow held two conferences in a week. I don’t know how they did it. They’ve completed their annual update of the transplant funding research database for the AST website.

The education committee has the monumental task of reviewing and approving all AST educational programs for compliance with mission, scientific excellence criteria and CME requirements. Dr. Jeff Platt and his crew have completed planning for one of AST’s core programs, the 2003 Fellows Symposium, scheduled for July in Ft. Worth.

Dr. Ginny Bumgardner and her crew on the kidney-pancreas committee are preparing for their AST symposium, “Patient Access to Replacement Therapy for Diabetes” that will be held at the 2003 ADA annual meeting. They have completed updates to the pre and post kidney transplant patient education brochures.

The liver and intestine committee also completed their pre and post transplant patient education brochures. Dr. Bob Brown and his able crew were also successful in negotiating a co-sponsored research grant for 2004 with the American Liver Foundation.

When I talk about Odysseus’ crew I have to hope you don’t remember the actual story. His crew was indeed strong and brave. They were also terribly unlucky. Some were turned into pigs, some killed by the Cyclops, some eaten by the six headed monster Scylla, and those that survived these horrors were struck by lightning and drowned. We’ve had a much better year here. I’m happy to report not one of our crew members were eaten by a monster or turned into a pig.

What is it that drives these committees to such great work? I think it is that we all have a common dream in which we steal back some of the ugliness of death and turn it into a miracle.

When transplantation began there wasn’t really much scientific basis and the clinical teams were small, sometimes limited to a single individual.

A surgeon and physician would go it alone.

If somehow things worked out, they were heroes.

More often though, loss was the norm.

Now we work as better-organized and more efficient teams. As we have grown in specialization, success has become the norm.

The task of transplantation isn’t about a single hero, but a group of heroes. Each of us in this room serves a vital function in this team effort. We each have a task we must complete in order for the team to be a success. And we are better at it each day. When I first became involved in transplantation, almost half of all cadaver kidney transplants were lost to rejection in the first year. Now, virtually none are. An interesting realization for me was that during this huge improvement there were no dramatic “Eurekas.” Improvements happened in tiny steps as parts of our team made new discoveries and advancements. We each do a small part in creating a huge success. Congratulate each other and yourselves for this spectacular accomplishment.

Today we sail onward into the world of the cellular. We’ve moved farther from the early idea of obliterating or suppressing the immune system, from trying to force it into submission. We have done a very good job of overcoming acute rejection and perhaps we should consider it now like these skeletons.

Going forward, we will learn how to modulate the immune response, to work with it. Our methods will be much more subtle and carefully directed. We’ve moved into the molecular level of persuasion.

Odysseus was warned that if he and his crew were to survive they must sail a very exact line between the two monsters Scylla and Charybidis. We now sail an exact line in our use of immunosuppression. We carefully try to sail between rejection on one side and infection and other complications of immunosuppression on the other.

Too much or too little immunosuppression leads us into the danger we know may come but can currently only vaguely chart. We follow in the wake of brave explorers, but the sea, and patients, change constantly.

It is said that ancient Polynesian sailors, who made long voyages between islands, were able to identify various waves and swells coming from far-off islands. So, in addition to using the stars for guidance, they were expert in identifying extremely subtle signs in the vast and complicated ocean. We need to become equally sensitive to subtle changes in our patients' ebb and flow. Stars are our expected results; Subtle changes in immune responses are the waves and swells we must learn to read. Each time we venture into another transplant we learn to better understand the subtle clues that we encounter.

Odysseus had Athena as his sponsor. We have repeatedly tried to contact Athena to solicit her sponsorship. But we have, as yet, received no reply. That said, we haven’t done poorly. Our sponsors are every bit as generous as Athena and they certainly seem less capricious. We’ve listed them here. On behalf of everyone here, we all thank you for your extraordinary support.

While we are on the subject of support I need to thank our Development Committee, Financial Advisory Committee, and the Task Force to Establish Long-term Financial Stability. They have the difficult job of making sure that we’ve got the money we need to keep operating and funding research and that we will be able to do so into the future. Without the efforts of this group and the contribution of our generous supporters many AST programs would not be possible. It has been an unusually tumultuous two-year period for the financial markets and that has further complicated their difficult jobs. I do not envy them their position.

So, you ask, what do we do with the money?

Our single largest outlay is for our grants and awards. We have made 13 fellowship and faculty research grants available. One million, five hundred thousand dollars was divided among the successful applicants. Much of this money is available to young investigators. This society was formed to advance transplantation. If you've got an idea to advance transplantation, come talk to us. As we run into the pleasant problem of having too many highly qualified applications we promise we will do our best to increase the number of grants and expand our partnerships with other organizations. So, I encourage every one of you to become a member and to take advantage of these opportunities. Research is the essence of transplantation and of the AST.

In the past year we’ve been fortunate to become involved in much more international work than in previous years. We’ve been involved in conferences in Canada, the Middle East, Asia, France, Czechoslovakia, and Yugoslavia. I wasn’t going to add the Canadian Transplant Society to the list of international destinations because they are so closely aligned with AST. Then I remembered how much better their scenery is there. They are definitely international.

In the past year, we’ve collaborated with more societies than I can possibly translate for you.

AOPA, ASHI, ASTS, ASN, ASLD, NKF, DHHS, ASPN, AASLD, ISHLT, ALF, ASHI, CAKS, ADA, AAI, DOT, NIAID, NAPRTCS. Oddly, if you scramble those letters around they spell "We’ve been busy." Well, not really. They actually spell


Next year, the ATC will be held in Boston. Two years later, in 2006 we will return to Boston to have a combined meeting of the AST, ASTS and the Transplantation Society, which will be called the “World Transplant Congress”. This will be the first time all three of the societies have held a joint meeting.

There are a lot of reasons that Boston is a great place for us to have ATC.

Number one, It’s near my home.

Number two. The security will be incredible.

Number three, Boston is where it all began.

Dr. Joseph Murray performed the first successful organ transplant right there in Boston. In fact next year will be an important milestone for the transplantation community. It will be the 50th anniversary of an amazing day. On December 23, 1954, Dr. Murray transplanted one of Ronald Herrick’s kidneys into his identical twin brother Richard. It seems only appropriate that the AST and the ASTS are proud to “spansah” next year’s ATC in Beantown. We’ll hit Faneuil Hall, have a bowl of “chowdah,” root for the Red Sox and talk about transplantation until the wee hours of the morning. We hope to see Dr. Murray there.

Dr. Murray was the first transplant surgeon I ever met. Let me tell you about him and a couple of other people who have characterized what it takes to be successful in transplantation. I hope you can learn from their example as I have. When I met him during my internship, Dr. Murray was already in his second career, leading a joint Brigham-Children’s Hospital program in reconstructive plastic surgery. I was amazed at the skill he had, at the ability to draw together a multi-talented team to deal with the most difficult facial anomalies of very unfortunate children, at the infectious optimism that even the most difficult obstacle could be overcome.

It was only years later, just before he was awarded the Nobel Prize which is shown in this picture, that I learned about his earlier career in transplantation. Dr. Murray taught me about persistence and the courage to attempt the impossible.

Terry Strom introduced me to the science of transplantation. The first scientific transplant article of which I was a co-author came from Terry’s lab. Terry knows how to “Think Different”. Terry has as many new ideas as there are fish in the Sea. Terry taught me about persistence in the pursuit of creativity.

Amir Tejani was persistent in overcoming seemingly insurmountable obstacles. Amir taught me you never get discouraged if you have a good idea. Amir’s lasting tribute will be the success of NAPRTCS whose guidance has been passed on to me and to those shown here. Children thank Amir for making transplantation successful for them.

Steve Rose was persistent in guiding the NIH to focus its substantial resources on the problems of organ transplantation. Over a decade ago, Steve and Andrea Zachary showed up at a UNOS pediatric committee meeting, enquiring about the advisability of developing a pediatric transplant initiative. When the Cooperative Clinical Trials in Pediatric Transplantation of NIAID was formed, young children had the worst outcomes of all kidney transplant recipients. Over the past decade, CCTPT has become a model collaboration among NIAID, the pharmaceutical companies and the academic medical centers As you heard yesterday, young children now have the best outcomes of all kidney transplant recipients. Draw your own conclusions. Steve has passed the oars to Shiv Prasad and Nancy Bridges of NIAID and, under the leadership of Dan Rotrosen and Anthony Fauci, we can expect persistence from them to assure continued support for scientific investigation of important transplant problems.

Mo Sayegh defines the word “persistence.” Three years ago I appointed Mo research director of our division and our support has tripled in just that interval. This month, Mo was named the first director of the joint Brigham and Women’s and Children’s Hospital “Transplant Research Center” and I am positive that the next generation of transplant research scientists will be nurtured there. Mo, thank you for your support and, yes, I will send you that paper, that chapter and that grant that you persistently demand…soon.

While I am thanking individuals, I must thank the staff of the AST.
Susan Nelson, Nikki Zuecca, Pam Ballinger, Tina Squillante and the rest of the staff at Association Headquarters have persisted in making sure I finish all of my duties, even occasionally on time.

And, I can’t stop before thanking my family, who has persisted in assuring me there is life outside of work.

But let’s get back to the AST programs:

Of course we can’t do all of our AST programs in Boston since there is a slight possibility that it might snow there in January. So for our Winter Symposium, we will return to our original site in Arizona and we will be returning to one of our most successful topics: The Future of Immunosuppression for the Next Decade

We have had an amazingly prolific year for the official journal of AST and ASTS, the American Journal of Transplantation.

Under Phil Halloran’s persistent drum beat, we are way ahead of schedule. By this time, we were scheduled to publish six issues annually. We have somehow published ten in 2002 and twelve in 2003. And it isn't just about frequency; we've done a fine job of it. We've been recognized in the National Library of Medicine and you can now access citations through Medline. AJT is now the #1 journal in our field.

The membership of AST continues to increase at a remarkable rate as more and more of you take advantage of the many benefits of membership. The AST recognizes the contributions of the variety of professionals who are involved in the field of transplantation and provides them with the opportunity to work together to share ideas, knowledge and information.

What can I say about the Public Policy Committee. Like the other committees they have done so much we can’t possibly cover it all. Here are some of the highlights:

We have continued to strengthen our connections in Washington through several big events. On March 12, this year we held, The "AST Congressional Transplantation Awards" on Capitol Hill.

We hosted these awards to recognize those Members of Congress and Executive Branch officials that have worked closely with the Society in championing organ donation and transplantation issues.

How successful was it? Let’s check the guest list. New Senate Majority Leader, Bill Frist, the Secretary of the Department of Health and Human Services, Tommy Thompson, medical liability reform champion, Congressman Jim Greenwood, the House Energy & Commerce Health Subcommittee Chair, Congressman Michael Bilirakis, Senators Chris Dodd, Mike DeWine, Dick Durbin, Congressman Jay Inslee, and several other key Members of Congress who have worked closely with the AST to craft and advance initiatives to strengthen our nation's ability to provide the gift-of-life. I think that’s a success.

Under the outstanding leadership of Jeff Crippin and Bill Applegate, our Public Policy Committee crafted an amazing tool with their "AST Public Policy Position Statements & Key Messages." This is now used to educate important federal decision-makers on the latest and most cutting-edge policy issues being faced in the field of organ transplantation. Members of Congress and the Administration have utilized the Society's position in the development of new legislation and regulatory initiatives. That’s great for us and for the future of transplantation.

These events and ideas continue to strengthen our reputation as the “Go-To” organization for members of congress, their staff, and the department of Health and Human Services.

Our Employee Leave and Organ Donation Initiative is moving forward. Five major pharmaceutical firms are now involved in this great program.

And, many of your hospitals are also involved. If yours is not, please stop by our booth to get the materials to bring home to your Human Resources Department so that they can provide this benefit to their employees also.

Our work in implementing this initiative has earned us election to the 2003 Associations Advance America Honor Roll. The American Society of Association Executives recognizes organizations that make significant contributions to the American society through innovation, education, skills training, community service and much more. How's that?

This is an amazing adventure we are all on. Our work is far from finished. Our eventual goals will be reached. Our goal of organ tolerance is just over the horizon. We’ve seen glimpses of it. We’ve achieved it in the laboratory. This is of course, great news if you’re a mouse.

The good and bad news is that we are not mice.

When I say that our struggle with transplantation is an epic one, I mean it. We are a large and diverse group whose skills and talents cannot be measured or matched by anyone. We are in the middle of a great journey. We’ve come a long way but there are still huge obstacles to surmount and huge discoveries to be made by new heroes. Heroes who are sitting in this room today. Thank you all for allowing me to be a part of this adventure.

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