Barbara Murphy, MD 2009 Presidential Address


What does it mean to be president of this transplant society?

I was somewhat nervous when I was chosen for the position.

I wanted to start off with a list of firsts that I could achieve as your president. Unfortunately it turns out that, on all of the easy ones, I’m second. I’m the second woman to be president. I’m the second youngest. I’m even the second Irish president of the AST.

In my optimism I decided this wasn’t a negative but instead a positive. I’m here by my own efforts and merit. Then I realized that we are all here through our own efforts and merit. This is certainly a positive and it is what makes this society great.

Our jobs are not about circumstances of birth. We are all here because of what we ourselves have done. You don’t become part of transplantation because your ancestors made some earth-shattering discovery. You are here because of your drive to achieve, your desire to help and your efforts to learn.

This drive to achieve is what moves the AST forward every year. When I joined in 1994 I think everyone knew nearly everyone else.

While this had some benefits it wasn’t optimal for strength. We need a large society of people working together to gain the strength required to generate ideas, influence government, and to do the research necessary to advance our field. In fifteen years I have witnessed that important change.

It is ten years since we dropped the “P” and became the AST. We have become a society that truly represents the entire transplant community. We’re now over three thousand members and we are expanding our society to include as many of our allied health professionals as possible. This year we’ve added the transplant pharmacists to our community of practice. And this year we will have our first allied health professional on the board and the first allied health professional to receive an AST grant. The more we unite as a team the better we become at research, the louder our voice in government, and the more able we are to provide the services needed by people who depend upon us to save their lives.

It is important to note that while we are expanding, we are also slowly aging.

In 1995 45% of our members were under 44 years old. In 2008 only 30% of our members can make that claim with a straight face. I am happy to say that I can still tick off that box for a little while longer!! As our society is getting older, so too is our profession.

Yet fewer trainees are getting exposed to the specialty of transplantation. Most of us remember the patient or teacher that sparked our interest in transplantation. I believe it is now our job to become that spark. We must generate the enthusiasm or desire amongst trainees to join the field of transplantation. We, as a specialty, need to make incorporation of transplantation into the curriculum in medical school and residencies a major focus.

How else can we engage trainees and the younger members of our profession? First, I’ll say that we’re not taking advantage of some of the technologies we could be using. Gen X and Gen Z are highly connected and that is something we should learn from them.

As a group we’re not blogging and using social networking tools like Facebook enough. We now have our AST facebook page up and going. We can use these tools to get our message out there and to keep us connected and up to date. We need to let the medical world know about the excitement we feel, and we need to let our colleagues know about the advances we make and these tools are ways to do it.

Another way we have attracted youth in the past is through our support of trainee research. Last year we were able to offer 17 research grants. Some of the recipients of these are now on advisory groups and committees and are active members of our society. The world’s financial troubles are going to slow down the available grants somewhat this year but this will always be a priority. We are working to pick up the slack through new funding sources.

This year will be the first of what we hope will become a regular event; The Annual Scientific Exchange. I always love it we when show such optimism as to name a brand new event “Annual.”

This Annual Scientific Exchange will include senior investigators working with junior investigators and transplant fellows. It’s being spearheaded by our president elect Joren Madsen and Mohamed Sayegh. And, while in some scientific meetings the reviewers can be difficult…

We are encouraging young investigators to present their science in what we hope will be a less intimidating atmosphere. Well, maybe not that much less intimidating.

We do hope to offer constructive and encouraging feedback on their research with the intent to keep this next generation of researchers interested and committed to transplantation.

Another part of the AST that I’m pretty excited about this year are our many collaborations. We have really pushed this issue this year.

Our 2009 Winter Symposium was held in Banff, Canada and was very successful. This was our second symposium with the Canadian Society of Transplantation and it won’t be our last.

For the first time ever we’re having meetings outside of North America. In November of 2008 we held a meeting in Madrid with the four main Transplant Societies from Spain. We also held a joint session at the Catalonian Transplant Meeting in Barcelona and in 2010 we will have a joint conference with the European Society for Organ Transplantation. We hope to work closely with this important group.

Some may say that these collaborations represent true Transplant Tourism – Besides sharing scientific data these meetings strengthen relationships between our societies and may lead to future scientific collaboration.

In addition, we continue to collaborate with ASTS on our Joint projects AJT and this meeting. I would like to thank their president John Roberts who has been great to work with this year.

This year, as part of our efforts to gain influence, we’ve expanded our society to include media insiders…Nicholas Mulcahy and Nan Meyers. They’ve been extremely helpful in increasing our media exposure and in directing us in how to garner more media attention. The more our voice is heard the more effective we become.

We’ve also added links to our web site to make it really easy for people in the media to get information and to talk to us in person. And we have created an AST newsfeed for daily updates.

This has paid off as well as we could possibly have hoped. We’ve gone from 1 or 2 calls from the media per month to 27 in the last 4 months. To meet this increase in demand we’ve created a Media Rapid Response Team.

Let me introduce our specialists:

Mark Barr, Emily Blumberg David Briscoe, Jeff Crippin, Robert Gaston, Bill Harmon, Alan Kirk, Michael Lucey, Maryl Johnson, Joren Madsen, Roslyn Mannon, Flavio Vincenti, Steven Webber, Lori West, and myself.

On a personal note the down side of the “rapid” response team was the untimely request for me to appear on ABC TV a couple of hours after getting of a plane from Madrid. Going forward we may need an extremely talented rapid response make up artist.

With this team we have become the “go to” information source on transplantation. We’ve been featured in many of the world’s biggest and best media outlets. The equivalent cost for us to purchase the amount of attention we’ve received in this same time would be huge.

Through this media exposure we have reached 12.2 million people. Not only would the expense to reach these people be great, but that money would only cover us purchasing the equivalent amount of column space or on-air time. The fact that our information is appearing in news articles and stories lends it weight that can’t be measured in terms of dollars.

Due to regulation changes in the pharmaceutical industry we’re making changes in how we fundraise. No amount of talk seems to persuade lawmakers that “one bad apple doesn’t spoil the whole bunch” and so we must work within the confines of these new regulations. This has motivated us to seek out alternative sources of revenue.

The AST has ventured in to new territory and become involved in concert promotion. Admittedly, there have been a couple of musicians in our group…such as board members Rob Fairchild…and Alan Kirk…but nothing like what we experienced last Saturday night.

How did this come to be? Eleven years ago Robert Redford’s son James put out a film called “The Kindness of Strangers.”

Some of us will remember its premier at our annual meeting in 1999. Mr. Redford’s life had been saved by a liver transplant and he wanted to use the skills he had in film making to raise awareness of the issues involved in transplantation. He wanted to put a human face on the anonymous act of kindness that is organ donation. The film did a wonderful job of promoting what we in the transplant business see every day, real people receiving real life benefits from transplantation.

To capitalize on the success of the film Mr. Redford started the James Redford Institute…and began several programs designed to raise transplant awareness. His success has been phenomenal.

Last year we approached the James Redford Institute to discuss collaboration with their society. Call it the luck of the Irish if you will but the JRI has generously asked us to take over their programs. And we’re going to do it. This collaboration will further enhance our organ donation awareness goals and it will benefit all aspects of the AST mission.

Half of the money raised through this the Share the Beat program will go directly to the AST to support transplantation. With the other half…

…we will continue the JRI’s education program to teach young people about transplantation. When kids learn about transplantation they tell their families. When families learn about transplantation they usually agree it is a good idea. That leads to the increase in the organ donations we need and directly to saving lives. The James Redford Institute has had great success in doing this and we will now continue and expand that program.

I believe organ donation is set to “take off” and education of young people is the way to achieve this. By many predictions Generation “Z”, because of the structure and scheduling their parents have exposed them to, will be tech savvy, socially aware, and more altruistic than any generation ever. Thanks to the James Redford Institute we are now poised to educate this generation about the benefits of transplantation.

In addition to their “Share the Beat” concert series, the James Redford Institute came up with a great way to get kids talking about transplantation. They have created a program called AnimAction in which a group of professional animators visit a school and, in two days, help the students there to create their own thirty-second animated commercials to promote transplant awareness. These commercials have had great success running on many local channels and news programs. Here is one of those commercials.

If any of you have access to a school that might want to participate in this program, arranging a session like this for your area is easy. Contact the AST staff and they’ll get you started.

It has been a very successful year for the AST in Washington DC. In case you ever wondered why a person should be a member of our society, here are a few of the things we accomplished.

This year we conducted the first ever AST Board of Directors Capitol Hill Fly-in. Ten members of our public policy committee descended en mass on Capitol Hill and attended more than a dozen meetings with members of congress.

In early March this year the AST was personally invited by President Obama to attend a White House health care reform conference. The AST helped to secure $10 million dollars in federal budget resolution for the HHS-HRSA-DoT.

The AST secured the reintroduction of the Immunosuppressive Drug Coverage Expansion Act in the House and the Senate and secured more than a dozen new Congressional supporters and co-sponsors to the Tranplant Immunosuppression- bill, and we continue to work to increase that number.

And to further our cause through education of our representatives, the AST testified and presented data at many Congressional Organ Donation staff educational briefings.

The AST has been working hard towards the advancement of the Everson Walls and Ron Springs Gift for Life Act. We have been testifying in support of this bill and have worked to craft and include provisions addressing the study of living donors. As recently as this past April, Dr. Madsen and I joined the society's Public Policy Committee for dozens of meetings on Capitol Hill seeking the removal of disincentives and barriers to organ donation and the enhancement of capabilities within HRSA's Division on Transplantation (DoT)."

And it was the AST who were asked to work closely with the Congressional Black Caucus, Minority Caucuses and Diabetes Caucuses to further garner support on Capitol Hill for organ donation and transplantation.

In July 2008 Dr Bob Gaston and myself represented the AST at meetings with FDA leadership regarding the agency’s policies for scientific review and approval of new novel immunosuppressive drugs.

The AST has been in constant communication with the FDA to work toward changing the currently approved Control Immunosuppression Regimen to be in keeping with current standard of care practices within the US. And we are happy to say that this has now been achieved.

During this year we’ve also been heavily promoting the AST’s Employee Leave and Organ Donation Program.

During the fall of 2008, the AST made presentations about the program to members of the Society for Human Resource Managers during their regional meetings. Thanks to our efforts this program is becoming more widely available to those who are considering live donation.

I believe it is important to protect the rights of the donor and avoid any exploitation of those who are vulnerable. In a perfect world donating an organ would not be a burden or a disadvantage. The AST, and I personally, are strongly in favor of the Employee Leave and Organ Donation Program. The opportunity to donate and have your job secure and your salary paid during your leave seems only appropriate for those who have committed to this selfless act. This program, legislation to extend FMLA, and appropriation of legislation aimed at providing greater subsistence support for donors brings us closer to a perfect world where people can make this type of donation without the fear of financial complications.

This has been an incredible busy year and I have many people to thank for their support. Fellow members of the Executive committee – Flavio, Joren and Maryl Thank you for your support, understanding, advice, attention, time, work, and help.

The Board of Directors, Committees, Communities of Practice and Advisory Councils, thank you for all the hard work that you do, your commitment to the society and its mission. It is you that keeps the society moving forward.

I also need to thank Susan Nelson and her staff. They make the job of AST president survivable, without them there might not be an AST. To my colleagues at Mount Sinai: Thank you for covering for me during my many absences this year.

On a personal note I want to take some time now to thank my mentor and friend Dr. Mohamed Sayegh. While I am a little annoyed that he beat me in the youngest president of the AST category I am grateful to him for his friendship and guidance. There is no one more truly committed to mentoring those who work with him, and to the advancement of the field of transplantation.

I also need to thank my family for their support and for the time they’ve given up that I might fill the shoes of AST president. My parents who always put their children first and gave us every opportunity. My husband Peter, for always being there, keeping things in perspective and making life fun

Henry David Thoreau said:

“I know of no more encouraging fact than the unquestionable ability of man to elevate his life by conscious endeavor.”

It is my hope that the AST continues to grow and influence the direction of transplantation throughout the world. We have become THE major voice in transplantation. That is a great and amazing thing we have achieved.

Now that we have this opportunity, it is our responsibility to treat it with care and compassion. We must listen as well as we speak. We must be honest and true to our science, and we must follow our consciences and our oaths to help our fellow man.

Thank you for allowing me to serve as president of this amazing society.

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