SLIDE 1: WELCOME TO WTC

I am delighted to be here as President of the American Society of Transplantation on this momentous occasion of the World Transplant Congress. On behalf of the membership of American Society of Transplantation, I want to commend the local organizing and scientific committees of the World Transplant Congress for a tremendous effort at utilizing the talents of the three professional transplant societies to stage this successful Congress.

SLIDE 2: EXEC. COMMITTEE

I would also like to thank the members of the Executive Committee for their invaluable leadership support during the past year. The chairs, co-chairs and members of the 30 committees who have contributed their time and effort to achieve the mission of AST and the AST staff at Association Headquarters have been amazing. I must especially thank Susan Nelson. Her managerial and administrative skills facilitate the almost seamless functioning of AST. Your efforts have made the fulfillment of duties as President of AST possible.

SLIDE 3: AST Logo

My clinical and academic career as a pediatric nephrologist and transplant physician was determined by a chance encounter as a young faculty member at Children's Hospital of Los Angeles in 1966 with this young boy.

SLIDE 4: Young boy

At 6 years of age he presented with end-stage renal disease. I was confronted with the lack of facilities at our institution and the paucity of experience worldwide in providing care to pediatric patients with ESRD. In exchange for my commitment to develop the clinical therapeutic modalities of dialysis and transplantation at our institution, I was permitted to undertake the first transplant at CHLA with the assistance of physicians and surgeons from a nearby institution. This event launched my career in organ transplantation which culminated in the Presidency of AST 40 years later.

This recipient...

SLIDE 5: Transplant recipient and father as adults

...shown here with his father who was the donor, is now 40 years post transplant with a serum creatinine level of 1.5 mg/dl when I last communicated with him.

SLIDE 6: AST Logo

During the past 7 years, at which time I have had the privilege of serving on the board of the AST, there have been substantive changes in the Society.

I am rather compulsive. Fourteen months ago, about a week after assuming the Presidency of the American Society of Transplantation I outlined the skeleton of my Presidential address. I thought I would delineate the accomplishments of my predecessors and identified challenges for the future.

It has not been the year I imagined.

SLIDE 7: "Diseases desperate grown by desperate appliance are relieved, or not at all" --Hamlet

During the first 6 months of my Presidency there was a recurrent theme that confronted me: ³Desperate recipients seeking an organ for transplantation². This theme was punctuated by a physician in need of a liver transplant whose friends/relations may have trespassed accepted standards by soliciting relatives of a potential deceased donor. Another physician acquired a kidney through matching donors.com. A man who successfully solicited a kidney from an individual in another state with a billboard advertisement and 2 couples interviewed on national television who swapped organs to facilitate kidney transplantation of spouses.

SLIDE 8: OPTN report

The recent OPTN report on organ donation indicated that the waiting list for organ transplant has grown from 16,026 in 1988 to > 92,000 in May 2006 of which almost 67,000 are waiting for a kidney transplant. The gap between the number of transplants performed annually and the number of patients on the waiting list continues to grow despite prodigious efforts of transplant professionals.

I firmly believe that every time we invade the body of a healthy individual to save the life of another that we must admit failure at our inability to stimulate sufficient generosity of the population to provide adequate numbers of deceased donor organs.

Certainly, the assiduous efforts of the Collaborative...

SLIDE 9: "Number of Organ Donors by Month"

...have proven effective in increasing the availability of deceased donor organs. Yet the increasing need far outweighs these prodigious results and individuals with end organ disease in need of a solid organ transplant are dying daily.

Is it time to challenge prior prohibitions and enhance approaches that have heretofore been taboo to the transplant professional?

SLIDE 10: "He who saves one life is as if he saved the whole world." --The Talmud

"and if anyone saved a life, it would be as if he saved the life of all mankind." --The Quran; Sura: 5, The Table; Verse 32

Both the Talmud and Koran extol us to save lives without limitations. At present, transplant professionals are not enthralled with solicitation of a donor for individual specific recipients. Such solicitation, whether on the Internet or billboards or by utilization of the media is an anathema to the transplant professional. The primary reason that such methodologies are offensive is because they circumvent "equity". The playing field is not level because individuals with means or brashness have a potential distinct advantage. However, no one is actually harmed by such events and everyone potentially benefits because the waiting list shrinks as more individuals receive the gift of life.

It is time that we cease to be pious about "equity" in the acquisition of solid organs for transplantation? Equity is in the eyes of the beholder: Is it equitable that a child with AIDS living in the United States is provided drugs that can sustain life whereas a similar child born in Africa or parts of Asia will die because the world economies to not deem provision of such drugs a priority; Is it equitable that children in many areas of the world go to bed hungry every night yet the silos in the Midwest of the United States are overflowing and the harvest is stockpiled in the open fields; Is it equitable that a child born in Ethiopia or Sierra Leone has a life expectancy of fewer than 33 years whereas one born in the U.S. can expect to live an average of 78?

It is time that we enhance all approaches to increase the availability of solid organs without the prejudice of the taboos of the past. We should not arbitrarily dismiss such extraordinary solicitations but should strive to incorporate any legitimate methodology that results in a "life" being saved.

Since 1984, it has been a felony in the United States to pay for an organ for transplantation. Why is paying for a body part so repugnant? I believe the major impetus for such prohibition is fear. Fear that impoverished individuals will be exploited and/or coerced to donate part of their body. Fear that unscrupulous individuals will monopolize the donation efforts for financial gain. Fear that potential donors will not be appropriately evaluated and that follow-up care will not be provided thereby jeopardizing their health.

Parenthetically, in the United States there is no statute that mandates lifelong follow-up and medical care for live donors and no registry that categorizes the long-term potential adverse consequences of solid organ donation.

Is it wrong for an individual, who because of the fate of circumstances is impoverished and relegated to a life of poverty and who wishes to utilize part of his/her body for the benefit of another and in return will be provided with financial compensation that could obliterate a life of destitution for the individual and his/her family? If we can put a man on the moon we can surely devise a system that guarantees the short and long-term safety of potential donors, guarantees that the financial reward is not subverted and assures that availability is not limited to the wealthy. I realize that there are substantive risks to financially incentizing organ donation. In addition to potential exploitation and coercion of potential donors and manipulation of the process by unscrupulous individuals, a deleterious impact on altruistic donation could result.

I realize that this approach is iconoclastic; however, our current efforts have fallen far short of providing an adequate number of solid organs. If we, as Transplant Professionals, do not seize the opportunity of exerting a leadership role in expanding potential sources of organs we risk that less dedicated and committed individuals will potentially control the process. I also realize that the recent IOM report on organ donation was unenthusiastic about the concept of incentivization.

Therefore, I challenge the Transplant Community to reassess attitudes that potentially limit availability of organs for transplantation and suggest pursuing the following:

(1) SLIDE 11: Support the Collaborative to ensure that an increasing number of centers are involved in this innovative approach to increasing availability of deceased donor solid organs. Lobby the Federal Government to increase rather than decrease funding for the Department of Transplantation to enhance this effective effort.

(2) SLIDE 12: Partner with alternative approaches to solicit organ donation --Internet, billboards, media--to assure that potential donors receive optimal information and counseling and that the maximal number of potential recipients have access to these approaches.

(3) SLIDE 13: Re-evaluate the prohibition of financial incentives for both live and deceased donor organ donation. Initiate serious discussions to develop a system that assures optimal surveillance of the entire process and prevents exploitation and coercion of both donor and recipient.

(4) SLIDE 14: Actively advocate for a long-term live-donor registry and pursue the assurance that all live donors receive lifetime insurance coverage for any medical issue linked to the donation of a solid organ.

Finally, I would like to provide two vignettes which exemplify the kind of extraordinary courage that is required to address vexing issues such as those related to solid organ donation and that we must "Build Bridges" to concepts heretofore not actively embraced.

SLIDE 15: Building Bridges

In 1942, a mother and her two-year-old son were smuggled out of the Cracow ghetto in Poland.

SLIDE 16: The Cracow Ghetto

The mother sensed the impending liquidation of the ghetto and feared for the life of her child. It was her hope that her son would be kept safe and cared for by a childless Polish couple. The mother gave the couple her son along with two letters addressed to relatives in North America. She urged that if she did not return after the war would the couple please contact the relatives in America. It was her wish that the child be raised in the tradition of his ancestors.

The parents did not return. Naturally the bond between the adoptive parents and the boy grew. The adoptive mother wanted to have the boy baptized and sought advice from a priest in the nearby town who was known for his sagacity. The priest counseled her that she must make all efforts to contact the relatives so that the child could be raised in the tradition of his ancestors. The adoptive mother did. The boy grew up in North America, became a lawyer, married, had two sons, and became observant in his birth parents tradition. He communicated and visited his Polish adoptive parents frequently over the years; however, it was not until 1978...

SLIDE 17: Pope John Paul II in Papal robes

when Cardinal Karol Wytowa became Pope John Paul II, that his adoptive parents indicated that the priest who saved the spiritual life of one survivor of the Cracow ghetto was indeed Karol Wytowa.

As we are confronted with the challenges of our professional activities, remember that each one of us involved in cellular and organ transplantation has the potential to save a life and mankind.

SLIDE 18: Zygmund Kalicinski

Zygmund Kalicinski was a pediatric surgeon from Warsaw, Poland. I met ZK in 1979 when he asked me to travel to Poland to introduce the concept of renal transplantation in children. Dr. Kalicinski initiated the first scientific contact between the then West German Government and Communist Poland in the early 1970s. In recognition of his accomplishments, the West German government awarded him a medal and invited him to Bonn to receive it.

Because of financial constraints, he took an overnight train from Warsaw to Bonn. During the long night, he had an imaginary conversation with his father who had been a Professor of Political Science and who had died in Buchenwald.

ZK asked his father if it was appropriate that he accept the medal because of the short temporal relationship between the current events and the atrocities that had afflicted the Polish people during WWII. These atrocities had even resulted in his father's death. His father urged him to continue his journey because he said it is important to "build bridges" in order to prevent calamities such as occurred in the recent past.

When ZK stood before the entire Bundestag in Bonn to deliver his acceptance speech, he discarded his prepared comments and related the imaginary conversation he had had with his father the previous night. At the conclusion of his presentation, there was total silence. And then, one by one, each member of the Bundestag rose and gave Zygmund a standing ovation.

If we are to succeed in overcoming our current unresolved challenges we must have a vision that is unencumbered by the prejudices of the past.

I urge that all members of the American Society of Transplantation remember the example of ZK and participate in building bridges to facilitate pursuing innovative approaches to resolve the shortage of organs for solid organ transplantation; these include between the leadership of American Society of Transplantation and the membership, between the members of the American Society of Transplantation themselves, and between the American Society of Transplantation and all organizations with an interest in cellular or solid organ transplantation.

SLIDE 19: Mrs. Fine.

Lastly, I want to thank my wife Shawney.

SLIDE 20: Moshe and his family

My son Moshe (and his wife Rochel and six of my grandchildren Eliana, Aliza Hava, Shmuel Yosef, Yaccov Mordechi, Tamar, and Ariel

Slide 21: and my daughter Joanne and my granddaughter Hannah Ray, my daughter Rachel, her husband Hugh and my grandsons Noam and Ezra and son Jeff and finally Shawney¹s mother, Betty Wagner Kramer for the support and understanding of my frequent physical and emotional absences during the last 14 months when my attention was focused on the American Society of Transplantation.

Thank you all for your attention and for participating in this momentous event of the first World Transplant Congress.

SLIDE 22: WTC logo.