Presidential Address to The Transplantation Society, 2004: Accomplishments, Ethics, and Scientific Perspectives

Thank you, Dr. Groth, for the kind introduction. Our long-standing friendship made it special for me to succeed you as president of this great society. The Transplantation Society (TTS) was the first organization devoted to the specialty of organ replacement therapy. I gave a brief history of TTS in my welcome address to open the XX International Congress held in Vienna in September 2004 (1). TTS was an international society from the beginning: being so fostered an intellectual exchange on a large scale, facilitating scientific progress and clinical application. For me, personally, 32 years of membership has broadened my cultural horizons and brought friends in every port. It is a privilege to join the list of my distinguished predecessors and to stand as president before you, all of us partners in and contributors to the advancements in the field of transplantation. In my presidential address, I will give you a personal view of the past, present, and future of TTS, including attention to the ethical issues in transplantation that TTS has formally addressed. TTS was founded in 1966 with the purpose of holding scientific meetings encompassing the entire field. The first International Congress of TTS was held in 1967, and international congresses have been held every two years since the second in 1968. In the decades since its founding, national and regional transplantation societies have been organized, as well as specialty societies devoted to individual organs (such as liver, heart, pancreas, and intestine), complications (such as infections), activities (such as procurement), or challenges (such as xenotransplantation). The opportunity for scientific exchange has become almost overwhelming. The role of TTS has correspondingly expanded progressively, not only to address the ethical issues that are universal to the clinical application of transplantation, but also to provide cohesiveness to a field that touches every branch of medicine. In addition, there is a business component to TTS, and many changes have occurred in our operations during the last several two-year cycles of councils and officers. The 1994–96 Council (with John S. Najarian as president) redefined the original boundaries of the two hemispheres (East and West), in order to facilitate equitable regional representation in TTS governance (2); Najarian reviewed the historical aspects of this division in his presidential address (3). The 1996–98 Council (with Pekka Häyry as president) established a business office in Montreal (4), greatly facilitating governance and record-keeping by subsequent councils. Furthermore, the 1996–98 Council recognized the desirability of having TTS as an umbrella for specialty transplant societies. Thus, the 1998–00 Council (with Oscar Salvatierra as president) incorporated into TTS the International Xenotransplant Association, which had been founded at the time of the VII International Congress of TTS in Montreal in 1998 (5). The 2000–02 Council (with Carl Groth as president) incorporated several more specialty societies as sections. The 2000–02 Council also initiated a strategic plan (6 goals, 12 strategies, 47 projects) designed by our Eastern Hemisphere treasurer, Jeremy Chapman, including a partnership with industry that was essential to establish a stable financial base for TTS (6). Groth, noting the uneven application of transplantation throughout the world (7), also formulated the concept of a Global Alliance in Transplantation (GAT) with these goals: establishment of a world registry for all organ transplants, including a database on all living donors; enhancement of the education of transplant personnel through fellowships and establishment of liaisons of sister institutions between developed and developing countries; and development of standards and guidelines for transplantation that would be applicable and adopted globally. More details about GAT are described in the article by Groth and Chapman in this issue of Transplantation (8). One of the strategic plan’s goals endorsed by the 2000–02 Council was to hire a full-time executive director for TTS; during the next council cycle (2002–04), Philip Dombrowski was appointed, assuming that position in October 2003. And the 2002–04 Council endorsed the most extensive revision ever undertaken of TTS bylaws (6). The division of TTS into two hemispheres was abolished. Instead, six regions (I: U.S.A. and Canada; II: Europe; III: Latin America; IV: Asia; V: Middle East and Africa; and VI: Oceania) were created (Fig. 1), each of which is guaranteed at least one council representative.FIGURE 1.: The world is divided into six regions for election of councilors to The Transplantation Society (TTS), as mandated by bylaw changes ratified by the membership in 2004.Even our logo has been revised into two versions, depending on the reason and format for display (Fig. 2). The basic symbol—two clasped hands encircled by The Transplantation Society’s name above in English and below in French (Société De Transplantation), reflecting the founding and first meeting sites (New York and Paris)—has been retained. But our acronym (TTS) has been added in bold to the side of one of the logos. Our singularity (unity) is emphasized by the word “The.” We need no other adjective. We are THE Transplantation Society, the first and the only one that encompasses every country and every aspect of transplantation.FIGURE 2.: The new logos of The Transplantation Society approved by the 2002-04 Council. The first is preferred when it is the only logo displayed, the second when the logo will be displayed with the acronyms of other societies.When founded, TTS had as its main purpose the organization of the best possible scientific congresses—covering every relevant topic in research and clinical application, with a combination of didactic state-of-the-art lectures and competitive peer-reviewed abstracts for presentation. Collegiality and a multicultural flavor were maintained by altering the site of each congress. The 20 congresses from 1967 through 2004 have been held in 16 cities and 12 countries, in some of the most fascinating and cosmopolitan sites in the world (1). Ethical issues were topics of debates at each congress and of discussion for each council. Since 1985, various councils have published statements about, or defined the position of TTS on, selected issues. In particular, TTS condemned (1) vending (as opposed to living donation) of organs and (2) the use of executed criminals as a source of organs from deceased individuals (9–15). Although TTS is open to allowing debate at all meetings, individual members must not engage in either of the above practices and are required to sign a declaration to that effect on the membership application. Arguments for allowing (16) or not allowing (17) vending have been made quite strongly by various authors. Personally, I do not see how even a government-regulated or government-brokered system could ever coexist with donation—it will have to be one or the other; otherwise, some people who might have donated will instead sell their organs. In any event, as a member, I am bound to uphold the position of TTS, a position I personally agree with while recognizing the validity of debate. An agenda item for the next council is to reexamine the vending issue within the context of our multicultural constituency and to then restate the position of TTS, an effort that will be coordinated by our ethics committee. Another goal of TTS is to continuously educate personnel engaged in transplantation, above and beyond what can be accomplished by the congresses. Developed programs that meet that standard of excellence should help deficient or fledgling programs that are just beginning to do so, through mentoring and exchanging personnel—a process that TTS should formally foster. Accomplishments of 2002–04 Council The accomplishments of TTS through the efforts of the 2002–04 Council are many. First, the strategic plan initiated by the previous council has resulted in formal agreements to receive financial support for TTS infrastructure and administration. Currently, our specific partners are the pharmaceutical companies that manufacture and sell the immunosuppressive drugs that are necessary to prevent rejection of organ allografts. Second, the number of specialty transplant societies affiliated as sections of TTS has expanded to six: the Cell Transplantation Society, the International Society for Organ Distribution and Procurement, the International Xenotransplant Association, the International Pancreas and Islet Transplantation Association, the Intestinal Transplantation Association, and the Transplant Infectious Disease Society. Negotiations are in progress with other transplant specialty societies to become sections. Third, the 2002–04 Council redefined the journal publication policy for the XX International Congress of TTS. Transplantation Proceedings published submitted papers presented at the first 18 congresses. For the XIX Congress, the 2000–02 Council invited only the authors of the 200 abstracts that received the highest grades to submit papers to Transplantation for peer review; those papers that were accepted were published in a single volume representing the cream of the crop (18). The 2002–04 Council responded to a grassroots initiative by TTS members who wanted all congress papers to have the opportunity to be submitted for publication. As a result, the authors of the top-ranked 200 abstracts are now invited to submit a paper to Transplantation for peer review; the others, to Transplantation Proceedings. Thus, our historical relationship with Transplantation Proceedings is preserved, while we continue the distinctive arrangement with Transplantation, the official journal of TTS. Fourth, as mentioned, TTS hired a full-time executive director. This has greatly the of TTS and the by which the of TTS their the revision of the bylaws that was endorsed by the 2002–04 Council has now been ratified by the with the the council will have a and executive one and one the one the But the council will two and East and West), to provide in the of The most was the division of the membership into six regions (Fig. 1), each of which is guaranteed at least one council on the council of any to the of will be (6). the 2002–04 Council to as above and (8). the 2002–04 Council the ethical of TTS (1) in the context of individuals their organs or the vending of organs and (2) the use of executed as of organs for transplantation. councils had about the of from condemned and about the of organ being an for a to the six each more one of the regions have in the application of transplantation and in the of TTS For a large country that has only one most of the members are in in more the members are from one country regions are I and and and The on the number of organ by regions from in I and to in East and the number is in in in and in The number of TTS members organ by from in to in The number is in in in and and in East and One to membership in TTS is to the number of transplants, in regions the number is then the membership will The in transplant and membership can within For in is that of as many with deceased and with living TTS membership in is in reflecting the and between the as well as the on membership from it executed as its main source of most of its transplant One of GAT is to help clinical organ replacement in the regions and application has been recognizing the context of any and We also need on application and from the regions that most need the of a world registry (8). GAT will TTS with the the 2002–04 several of TTS with of TTS is also the regional transplant societies Latin Middle and to join this with The pharmaceutical are also in this TTS is the and of but GAT will not just through TTS but also through a GAT The GAT will of from TTS and the regional transplant other national and international (such as the International Society of as the and that on of various organs. of and our partners will be on the but their will be no in the of the GAT Thus, GAT and will be by the GAT and TTS councils. will be by a One of the first to be will be the world to the of TTS members who are in regional and international will be to living that will will be to standards for the not only of but also of living The GAT will also for which will be for the between sister institutions of developed and developing and for the application of standards of a on standards of of living was by the 2002–04 Council through an international by our ethics that was held in in More from more countries, including and from developing the We were to agree on standards of applicable in every were adopted on on to to including for the on the need to provide a to an of the of the and the to and on and The from the was published in Transplantation just before the XX International Congress The scientific that was to the development of the will be published in a issue of Transplantation The the invited TTS to provide for on organ and transplantation Carl Groth and Jeremy Chapman from the 2002–04 with from our ethics with including at a the by several This resulted in that were more those published by The new and transplantation, were published in the issue of Transplantation as the by the of organs for transplantation, to (1) and practices to the and ethical use of living and deceased and (2) transplantation only when have in to prevent the should be by with an in the application and ethics of transplantation. on Ethical As ethical issues in transplantation are for TTS to TTS has published six statements since 1985, the last in all of which have been by the 2000–02 and 2002–04 councils (9–15). the six on the as opposed to donation) of organs from living and members to be One on the of organs from executed the and members to be issues. Arguments the use of organs from executed the of in the this the what are as the that the organ to the of and to six statements stand as TTS council and are official with or the of councils. The first was published in in and in Transplantation in when was president and was ethics It six guidelines on deceased organ all to and to special guidelines on of by with to that for but with for and to the by the not for is and one that no transplant or be in or organs or in at with any a for from TTS. The article in organ or in and the Since the TTS most with transplant have made vending a have not the and only one has the The Council (with as president and as ethics was the first to an to the use of organs from executed The were that it is to the a aspect to the of transplantation, and with The also the to individuals for their vending and the for vending with including the to had recognized the ethical and cultural between societies and had an education of fellowships for it was might to cultural and in has been The Council (with as president and as ethics published a of all six of the guidelines on deceased organ The one was to the that organs between should only to The guidelines on living were no to the can be for of The 1994–96 Council (with Najarian as president and as ethics published a policy in It that all (1) and that in (2) transplantation through of by the and through by that the were at the time of organ and that their organs were to by a formal through of and in a and through of standards and for and organ The the previous that organs should be that in the of deceased for is and that should not be with transplantation of organs from executed In addition, the 1994–96 Council published ethics in that the use of organs from executed as in was with The that some TTS members had been with executed organ that or to in of TTS The recognized that at least some and accepted the as but that the Transplantation Society had that organs from executed should not be TTS its to the use of organs from executed support for this and to to the use of organs from executed through open at meetings and through and to transplant to establish programs or allowing the use of living and deceased organs are with The was to the Transplantation Society. TTS to the use of executed for organ was to be of individual TTS on and specific to the in But the was formulated with the that the use of organs from executed might the application of in any country is The strongly the policy that transplant not be with organs from executed that TTS not as an society any society that not the use of organs from executed that TTS only for membership who by no with executed and that TTS any members who are the 1998–00 Council (with Salvatierra as president and as ethics in a the guidelines and the Transplantation Society statements that transplant will be in the or of organs at to or The of this policy in the U.S.A. in was The publication also this and should be or financial to the organ Personally, I has our discussion of ethical issues are organ and there are organ but there are no The in the context of is by not an there be or but a not an organ be a a but a organs are for transplantation into this of deceased organ are also of living individuals being to provide organs as a that is and of organs from deceased individuals who to has been as one to the between the need for and the of organs for transplantation this would be a beyond for and to in about is but the stand of TTS on organ has been for two only is and is (9–15). Although the of TTS in business and ethical are the scientific progress in the field also I will a in clinical application of transplantation that I just as as the of ever more immunosuppressive drugs to our even more I have every international congress of TTS since the was held at The in I meeting with John Najarian in the at the of from The and what was new in transplantation. and enhancement were to be the The enhancement has been of for but at that a topic was of the of an to a specific or of an from by the or papers were presented on the at the congress and gave an of enhancement But in an of in a of that is not a of an but an with all or many of the of in the (as opposed to enhancement also that the division into two was or that I was my into the role of to be in rejection in an the Najarian brought from The our of the But I the discussion as a to for a in some of transplantation during each subsequent congress of TTS. Although we do not have clinical we do have a rejection when TTS with a has become the most of goal would we to be the of but with a papers have been presented on the for the in rejection a to the new I it is just as that the in rejection is to the development and use of drugs that give as or This now us to give to prevent rejection with and new drugs In his at the of our 2004 that we just have to how to use the drugs we have immunosuppressive drugs being developed and then brought to on the of at least in with the But so all have been from their side their is the of the to Transplant to the side of by a combination of drugs that are in their immunosuppressive for in clinical even the is drugs with side side that are be in combination an effect for Thus, drugs the or of side the of to prevent the is not by the immunosuppressive to side while the of with the best in order to rejection and all the abstracts on immunosuppressive the rejection it is that almost all transplant programs at the in of the in In a all of the drugs are at a drugs but that have to be defined by and not just by the In my the that resulted in the of rejection the years was not the new so as the application of the the new drugs could have been at the necessary to prevent rejection in a of all the of the possible with an As by in his in the some programs gave the or its to transplant it that on the developed or its use is not when are even it is of every more was the development of to the of first and then and of the have been as and and the of clinical application as the main of in the was the of transplant the and the use of these drugs The application of and as more as the in rejection I it that the use of is what made our had been in the we might have had The side effect would have been but was then and could have been to a not possible in organ by are with the at any one could the by the as and we must the pharmaceutical industry for the development of a of immunosuppressive drugs that has the in But of not to the in has been the of our pharmaceutical in developing and I am that the progress will We need to prevent a of transplant We need to the that have been as being for and have been a source of for transplantation from before the founding of TTS, and a source of other organs pancreas, liver, since the But the of the use of living has the is the use of and the development of exchange programs to and for who would have only an living and have also expanded with to the use of living from to the that were to those of at least to the of was the registry by and published in We now that it is not just a that a that is to rejection one from a deceased of The of living to in the U.S.A. in to the of it is the exchange programs that I see as the most with for application on a large I to TTS members who have exchange and his in beginning in were one of the first to the on a large This not only individual who would have to for a deceased but also time for a deceased by the number of The the the more a exchange is to and the the on the number of that can be or international coordinated by as or the for Organ have been in deceased organs. But the to the number of organ transplants, transplants, is from the living I that living will in the next and that vending will not no what are made in its In the the volume of living has in two decades in the in the first years of the I that the of living will and in a vending system might also the number of transplants, I do not a vending system and a system can and vending would have to just as is the for and But we are not to have in the organ vending is and TTS opposed to its it is us progress with and not to for the future are that living will greatly that the pharmaceutical industry will drugs that are all side that that are to in (such as will be to the that can be for and that the need for by only the will as the of transplantation for years to organs could the need for but no have been to the for organ allografts. are now only of the organ I have being TTS president and that being to be of to is a the I am to the to and on my clinical and research activities in replacement therapy. is my and my I am or organs. Thank you for the opportunity to the of TTS with the 2002–04 a and so of the and that our great

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.