Michael R. Lucey, M.D. 2004 Presidential Address
Thank you for your generosity. Some years ago my youngest daughter Emer came up to me and said, “Dad, I was born in the USA.” And I said, “Correct.” And she said, “You were born in Ireland?” I said, “Right again.” Then she came up with her punchline: “I can become president and you can’t.” Thanks to the AST, that’s all changed. Thanks to the AST, any child, no matter where they were born, can grow up to be president.
It has been a great honor and privilege to have been your president. And it’s a big job. When I took over from Bill Harmon last year, I decided to study the great presidents for guidance.
Abraham Lincoln said: “It is better to remain silent and be thought a fool than to open one's mouth and remove all doubt.”
Well, I thought…“It’s too late for that now.”
As Gerald Ford said: “If Lincoln were alive today, he'd be turning over in his grave.”
I figured there are two kinds of leaders. One is dynamic, like George Washington. Then again, on the same day George Washington signed the Declaration of Independence it is reported that another George, George the 3rd, wrote in his diary, “Nothing of consequence happened today.” I wasn’t sure which George would be my role model. Would I be the iconic man of action who leads by example? Or would I be the bumbler, unaware of what is happening on his watch?
Don’t answer that.
A good leader, like Washington, knows all about the activities of his supporters. My year as president has taught me all about the AST. This is a great organization and it is achieving great things. I would like to use these few minutes to share with you my excitement in the achievements and the potential of the AST.
“Improving human life by advancing the field of Transplantation” It is not just a phrase we use to fill space on the Web site, it’s our guiding principle. The AST is fullycommitted to this motto. We are dedicated to improving human life by advancing the field of transplantation.
We are 2,100 strong. The work of our society is conducted by 26 committees, involving 298 members. Fully 14 percent of the membership participates in the fundamental work of the society.
That is commitment. We could not be what we are without this commitment of time and effort from so many of you.
This year we have seen continued growth in the membership of the society. Our membership has tripled in less than 10 years. What an endorsement of the AST by the transplant community!
I would like to welcome our international members.
I’m proud to say that we have members from every one of these countries. We are truly an international organization.
We all know that transplantation is a team effort. Nurses, transplant coordinators, research technicians, pharmacists, we’re all part of the team. In this spirit I’m happy to welcome our associate AST members. You are essential to our team and to the care of our patients. Thank you for your contribution to the transplantation and thanks for coming to the ATC.
It has been a great year for the AST. If I were to list all we’ve achieved this year, this address would be slightly longer than “Lord of the Rings.” Mercifully, I will highlight only a few of our more spectacular achievements. And spectacular they are.
On April 4, 2004, President Bush signed into law the “Organ Donation and Recovery Improvement Act.” It was a great day for the AST, but more important than that it was a great day for everyone in transplantation.
This legislation has been the number one public policy agenda item for our society during the last four years. We hope this bill will facilitate a leap in organ donation by reducing the financial difficulties involved, by expanding public education about donating, and by giving grants to hospitals and donor organ procurement organizations. We must now work to make it a reality by ensuring that it receives appropriate funding.
I would also like to highlight the ‘organ donation breakthrough collaborative’, the innovative program by which Secretary Tommy Thompson and his team at the Department of Health and Human Services have built on the best practices of the most successful organ donation organization to improve donation across the nation. The AST has given and will continue to give its enthusiastic support to this noble effort.
On April 16th our Public Policy Committee sponsored the first ever National Conference on the Economics of Transplantation.We brought together experts fromthe fields of transplantation, economics, industry, and government to present and discuss the economic issues of solid organ transplantation.
The goal of the Fellows Symposium is to nurture an interest in transplantation in young fellows and residents in training. This year we had our most successful Fellow’s Symposium ever.
Everyone I spoke with had great things to say. To our faculty, I say thank you for giving your time and knowledge. To the fellows, I say build on what you gained, and look to transplantation for your career. And to everyone else, consider sending one of your fellows or residents to next year’s fellow’s conference. You won’t be disappointed.
In December our Liver Committee under the leadership of Kim Olthoff helped organize a conference on the MELD and PELD allocation systems for donor livers. This meeting was a model of how the AST works with other societies and groups for the benefit of patients. As you can see this was a cooperative effort between AST and the ASTS, AASLD, ILTS, UNOS.
And speaking of cooperative efforts, 2004 was a great year for cooperative conferences. What are the two common threads in all of these? The AST and education. The AST has always been at the forefront of ongoing education. It is a big part of why we exist and why we continue to be a success.
We had a hugely successful Winter Symposium this year held in Phoenix, Arizona.
And next year we will embark on an exciting new venture by holding our winter symposium in co-operation with the Canadian Society of Transplantation. Do take a look at this program. I think that it will be great.
There is another common thread in all of the things I’ve spoken about today. It is the constant and expert help of Susan Nelson and her ace team at Association Headquarters, and Bill Applegate in Washington.
They have been a constant source of sage advice throughout the year, and I could not have done the job without them. Like all presidents facing the loss of the office, I can assure them that anything they have said to me will stay with me. As that master of presidential protocol said: “Unless a president can protect the privacy of the advice he gets, he cannot get the advice he needs.” He also said, “When the President does it, that means that it's not illegal. We know where that led...
I want to thank all of you. You made my role of President an easy one. Working with you was a source of satisfaction and joy.
I am happy to report that this year we have had greater than ever cooperation with our sister society, The American Society of Transplant Surgeons.
We have built on the successes of the past with our joint projects, most notably this wonderful conference: the ATC. I want to thank everyone in the organizing committee, and especially Stuart, Hugo, Don and Mark for their tireless efforts. Thanks to them, the organizing committee, and especially Pam Ballinger and her staff, this has become the best transplant conference in the world.
Our joint journal, the AJT, continues to exceed our highest expectations. Thanks to Phil Halloran and his board of editors for creating and sustaining this success. You have enhanced the field of transplantation science and we are in your debt.
No commentary on the relationship between the AST and ASTS would be complete without recognizing the President of ASTS, Avi Shaked.
As many of you may know, Avi and I worked side by side in the same transplant program at Penn for six years. Working with Avi is always fun and exciting, and sharing our joint presidential flights of fancy has been just as rewarding. Avi has unique vision.
Thanks Avi. It will soon be time for us to fade away. We’re like Rick and Capt Renaud in “Casablanca.” Continuing what Humphrey Bogart calls “a beautiful friendship.”
We living presidents have done what we can to further our societies, but to be truly successful the AST needs the help of many dead presidents.
We could not achieve all we do without the commitment and sacrifice of the Development Committee, led this year by Jay Fishman, and of course the generosity of our patrons.
Every year there is a group of companies that continue to actively support the AST and transplantation in general. We could not continue to be successful if it weren’t for their support and generosity, and I thank them. However, we do not rely on the pharmaceutical industry alone. This year we began a members’ giving campaign and I want to thank all of you who contributed.
And how do we spend our income? First and foremost, we tried to stay true to our principals of education, research and advocacy to enhance the lives of patients and professionals involved in transplantation. Our grants and awards program distributed $1.5 million in awards and two-year grants.
The grants are targeted to encourage young investigators at the senior fellow or junior faculty level.
I look forward to seeing each winner return to ATC in future years presenting the products of these grants and awards as new and exciting data. You are the pioneers of the future.
Today we are fortunate to have with us one of the greatest pioneers of transplantation.
We are honored by the presence of Dr. Murray. After Avi and I have spoken we will have a small ceremony to recognize the achievements of Dr. Murray and his team when successfully transplanting a kidney between twin brothers in December 1954. While I cannot remember back that far, I am reminded of the first transplant recipient I encountered. I was a medical student in the Meath Hospital, Dublin, in the early 1970s. She was a young woman of 15 or 16 years who presented with an unexplained acute abdomen. She had a laparotomy and was found to have acute Budd-Chiari Syndrome. She was then sent to the King’s/Cambridge liver transplant program of Professors Calne and Roger Williams. She underwent a transplant, and unfortunately died some time after. Nearly 15 years later, a friend and colleague at University of Michigan, Skip Campbell, went to Cambridge to spend a sabbatical with Professor Calne. One of his projects was to analyze the patients with BC who were transplanted.
One of the patients he included in his important series was the schoolgirl I had seen for a few days many years before. It occurs to me now, that while her death was a tragedy for her and her family, she is one of the many unsung pioneers of transplantation. It is experiences like hers, collated and analyzed by careful clinical scientists, epitomized by Dr. Murray, that form the essential body of information which is the foundation of the successful transplantation of others. In honoring Dr. Murray and his team, we take time to honor all the patients who have put their trust in us.
We should also look to the future.
Indeed, predicting the future is fraught with traps and hazards. The great statesman Edmund Burke said: “You can never plan the future by the past.”
I suspect the future is going to be different from today. I know, not much of a risk in saying that, but I don’t want to entertain a foolish speculation on, say, transplantation in 50 years. Most predictions necessarily turn out to be wrong. That’s good news because we’ve often heard predictions of a bleak, unpleasant future.
That’s not what you’ll hear from me. I’m an optimist as are most of us in this room, or we wouldn’t be in transplantation. But what would a presidential address be without some thoughts on our dream of ‘improving human life by advancing the field of Transplantation.’ I’ve asked the past presidents of the AST to make some predictions. I asked where they thought the AST and the field of transplantation might be in 10 years.
You will not be surprised to learn that I heard a wide range of often-contradictory predictions that mixed hope and expectation. I was told …
All solid organ transplantation will have high success rates with significantly fewer adverse events, and they will be achieved with monotherapy, but still no true tolerance, nor xenotransplantation.
Transplantation tolerance will become a clinical reality and clinical trials with xenografts will commence.
Emphasis on organ replacement will recede as efforts, based on the use of stem cells, for cell transplantbased regenerative medicine will occupy front stage.
The AST will have a wellendowed grants program that will be an important source of funding for young investigators.
The Red Sox will win the World Series.
The Red Sox will not win the World Series.
These last two predictions came from the same president!
So you can see that despite the advances since Dr. Murray’s success in December 1954, there is no shortage of challenges for the future.
And what are my hopes and dreams for the AST? I hope that we will grow as diverse and vigorous society.
We can thank our past presidents, Roy First, Jack Lake and Larry Turka, for making the
selection of the Board more democratic. Of course it is for naught unless you participate by making nominations for board positions, and by voting every year. The more the leadership is a reflection of the membership, the more likely will the AST serve the interests of all its members.
I want the AST to continue to promote careers in transplantation. There is a crisis in biomedical research. Many young talented men and women are selecting less demanding professions, or giving up early. I hope we at AST can help reverse this trend. I have mentioned our grants and awards and the Fellows Symposium. Each grant or award recipient, and every fellow attendee, represents an investment by you in the future of transplantation. The efforts of our Public Policy Committee to secure NIH funding works to this goal. There will be few advances without research, fresh recruits and financial support.
Finally I urge you the membership to use the AST to enter the fray in the many controversial aspects of transplantation. Through the AST, you can give leadership to the wider community. These controversies stretch from the cellular and sub cellular to the greatest political challenges of the day such as how shall we provide health care for all our kin, and how shall we pay for it. These issues reach from the most parochial to the international affecting the place of transplantation in the global world. The AST has established its voice. We must work to use that voice wisely, reflecting the views of our members.
If we can adhere to these principals of democracy and constructive participation, research and education, and thoughtful advocacy, while eschewing introspection and narrow self-interest, we can ensure that the AST WILL CONTINUE AS a vehicle for the growth of transplantation, and the betterment of our patients.
Those at any rate are my hopes and dreams.
As Yeats said: “I have spread my dreams at your feet: Tread softly because you tread on my dreams.”
I ask you to give your support to Jay our new president and to work for the benefit of transplant patients one day at a time, and I assure you will make history.