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to join us this evening. >> Thank you all for coming
the executive director of the Wisconsin Academy of Sciences,
Arts and Letters. We're just really pleased
to welcome you all here this
presentation, even"The Gift of Life."er's
Some of you are joining us
so this evening offers you for the first time,
a little bit more about athe Wisconsin Academy.
We're an independent nonprofit
since 1870. orBack then, the organizationnd
felt that there needed to be
to share with people. morToday, that's reversed.ion
We have so much information that the Academy helps
provide some context for that information, and helps us
put our finger on what's really most important.
I'm pleased tonight that we are joined by some of the Academy
Council members and a member
And so I wanted to introduce of our Foundation board.
here in the front, and to you Jesse Ishikawa,
Ann Peckham, and Andy Richards Millard Sussman, and
Howard Marklein, the treasurer from our board, and
So I hope you'll join me of the Wisconsin Academy.
( applause ) in welcoming them as well.
that is here, Gail Kohl, our You'll meet some of the staff
and Kathy Dickerson, who has development director up here,
I would also like to welcome just recently joined us.
the University of Wisconsin theHospitals and Clinics, of
Donna Katen-Bahensky. Donna, would you stand?
( applause )
Clinics are one of our sponsors Tof the event this evening.
We're very grateful for our new sponsors.
The Wisconsin Academy's job is to bring people and ideas
together for a better Wisconsin.
thinkers in our state Wto shed light on the importantt
issues in the sciences, the arts, and letters,
thus our name.
knowledge available in a respectful, agenda-free
environment.
series, we also have In addition to our lecture
third floor of this building, right under the dome.
We call it our
the James Watrous Gallery. home under the dome,
just opened this week, from the Wisconsin Visual Arts
Lifetime Achievement
So I hope you'll have an opportunity to take time
and visit that as well. It will be on display
until June 8. We also have an award-winning
magazine called Wisconsin People and Ideas, devoted to
all those great thinkers, authors, artists from Wisconsin.
And if you join the Wisconsin Academy, this is
a benefit of your membership. We hope you might think about
that, because we appreciate all our members, and especially
we appreciate what they contribute to our thinking, and
the feedback that you give us on thee little cards that you've
received about who else you want
topics you'd like to hear about. to hear from, and what other
to fill those out and pass them in before you leave, so that
we can take full advantage
The last program of the Wisconsin Academy
is a public policy project
We try to bring together that we do every two years.
on certain troubling, difficult issues and try to
reach some consensus and help develop an agenda that is useful
to public policymakers. We did one in 2002 called
"Waters of Wisconsin" that
groundwater legislation. resulted in some groundbreaking
called the Future of Farming, Wwhich we hope will also have
very positive results in
I want to take this opportunity preseto just thank all ofnds.
the sponsors of the Wisconsin Academy evening events.
The Pleasant T. Rowland Foundation, the Wisconsin
Alumni Research Foundation, the University of Wisconsin
Madison, the John and Sally Meilke Family Fund, UW Health,
as I mentioned earlier, Reinhart Law Offices, and
a number of individual donors that I see here
in the audience tonight.
who could not join us For this evening, we thankters
Wisconsin Public Television and City Channel 12 for making
this and other presentations
Wisconsin Eye, also does that availfor us, as well.rnet.
And then it is rebroadcast
We also really appreciate the support of the Madison
Community Foundation through
So thanks to all of you, the Great Performance Fund.
we're able to offer the highest and quality programs.sors,
So if you are interested
programs, please feel free in offering support for future
So with that, what I'd like to do is introduce our director
of special events, Laurie Dies, who will introduce
our speaker.
and have a great evening. I hopThank you.y it
( applause )
And thank you everyone >> Thank you Margaret.
Regarding tonight's program, for joining us tonight.
after the presentation. therProfessor Hans Sollingerions
is internationally recognized as one of the leading transplant
surgeons in the world.
experience and his affiliation His depth of transplant
enable the UW Transplant Program with the University of Wisconsin
in transplant medicine. Dr. Sollinger earned
his MD and PhD from the University of Munich.
And he joined the UW in 1975, where he finished
a post-doctoral fellowship
Research Center. in the Immunobiology
faculty under the leadership In 1980, he joined the UW
transplant surgeon, of Dr. Folkert Belzer.ned
In 1982, Dr. Sollinger
for pancreas transplants, which found worldwide application.
As a result, the survival rates of kidney and pancreas
recipients more than doubled. Dr. Sollinger also pioneered
the development of CellCept,
most frequently used currently the world's
In 1995, Dr. Sollinger immuno-suppressive drug.
of Organ Transplant at the UW was nand the Folkert Belzersion
Professor of Surgery. His current research includes
experimental gene therapy with a goal to cure diabetes.
He was recently awarded an
from the University of Leipzig honorary doctoral degree
He is a member of the American in Leipzig, Germany.
the Transplant Society, and many other organizations.
He's also a past president
Transplant Surgeons, and of the American Society of
for Organ Sharing. the International Society
governmental advisory boards He has served on two
Committee on Organ as the chair of the Advisory
and the chair of the Midwest Transplantation,
During his 27 years on the Regional Advisory Board.
Wisconsin, faculty of the University of
than 3,000 patients to discuss Dr. Sollinger has met with more
renal failure and diabetes. mWe are so pleased that
Dr. Sollinger, who I must add is a Fellow
of the Wisconsin Academy
to present "The Gift of Life." has joined us this evening
Dr. Hans Sollinger. ( applause )lcome
Good evening and thanks much for coming.
I know it's finally a sunny evening, and you could have
gone out to the square
State Street. And you decided to come here
and listen to my lecture
I very much appreciate that. on organ transplantation, and
my honors, but quite clearly, being a member of the Academy
belongs to one of my most cherished honors.
And there's an old friend of
He still cross country skis minevery day, 15 miles,d.
that the best honors are the
from the people you know. onesSo this is one I cherishme,
very much, and I am so happy
Some of them are patients. to see so many faces here.
Some of them are high in politics or administration,
and you all took the time to come here.
What I would like to talk today about is give you a short review
on organ transplantation
But before I start, I have to tell you a story.
And it's not going to be
I was speaking here three weeks ago, when we had
the movie premier, and I had
I will not repeat that one, a joke despite the fact visit.
that it was a great success.
Today's story is about the place ( laughter )
because this place, some of you might remember,
in the '70s and early '80s
( laughter ) was called the Mall Bookstore.
well, let's call it Andpornographic material.ld,
It had aluminum siding, and was just for the wonderful
corner on the street, it was
Now my wife, who had a business just ain the 500 block,sight.
decided that this can't go on this way, and very trickily
using her charm,
( laughter ) bought the building.
she didn't renew the lease. And what became then,
the Radical Rye,
was the building we owned. a sandwich store,
over to the arts. It has this wonderful entrance.d
Mary got the nickname of
( laughter and applause ) MotheSo this is my storytreet.
for the start.
the University Hospital, But let's go back to
transplant centers which is one of the largest
And we are very, very fortunate to have this center
in such a small community.
when I talked to the board, As I the numbers are 550,s ago
almost 600 transplants. That should happen in New York,
Los Angeles, Miami, large cities.
It shouldn't happen in Madison, Wisconsin.
But it's happening
A team, not just doctors, becabut we have wonderfuleam.
nursing staff, coordinators,
everybody who is with us administrators,
So we have this great team is working at the highest level.
When we look at the national scope, you see.
what we are dealing with. We are dealing with a large
number of patients who are
Some of those transplants makes a difference between
life and death, like a heart, a lung, or a liver transplant.
And pretty soon, the number will have reached 100,000, and
there are projections by 2020,
So organ transplantation the number will have tripled.
and we have to place much more is a field which will grow,
Here you can see, just as empan example of a slideon.
that I show my students.
waiting list. And in 2002, it goes like that.
This is the number of transplants we are performing.
We are not closing the gap. In fact, the gap is getting
larger and larger.
to increase organ donation. WThat's why we have thisd
booth here, and that's why
thanks to Senator Risser. wAnd we're doing everything,
to increase organ donation. When we look at our centers,
we call it the three wisemen... ( laughter )
who are in charge of the center.
charge of the cardio-pulmonary Here's Dr. Edwards, who is in
Here's Hans Sollinger. transplant team.
is this one here. And this is Tony D'Alessandro.
I want to highlight his contributions in a very special
way, because he's running the organ procurement organization.
And Tony being, I can say one of my best personal friends
as well, I know how much time and how much effort
he has put in over the years
what it is nowadays. to make the OPO
in the country. And I think without Tony, this
would not have been possible. This is the key person
of our program. I have said it
many times before, if Tony
working, I would stop too. were to decide tomorrow to stop
That's what we have accomplished ( applause )
We were the number one in 2005 and 2004.
in the United States, with over 350 kidneys performed,
so that means at least one a day.
I think it's the same in 2007.
but today, we did four We don't have the final numbers,
I started out with kidney transplants.
in the back, Sidney Cole, onewe started out about 6:30.ing
I think they're just
of the kidneys. fSo that's a normal day for us.
It's not unusual to do four or five kidney transplants
on a single day.
teams, there are more pictures. NoYou can see these teamsual
are large.
specialists and subspecialists They require a lot of
together very well. anWe have special teamsrk
for children, for adults, obviously, for cardiac
and lung teams, which I cannot show here
because otherwise my talk would be too long.
So I cannot talk about heart
Maybe you invite Dr. Edwards and lung transplantation today.
He gives a little bit more one of these days.
And finally, we need not only doctors and nurses,
we need good administration.
I knew you were coming, Aso I put a picture in..
( laughter )
and the understanding Buof the administrationion
what our needs are, we could do very little.
And I haven't worked a lot
she's relatively new. But one of my best friends
and trainees, Alan Reed,
a few months ago, and he told me great stories
about how helpful she was in
program, so I'm looking forward reacto working with Donnalant
to make our program even better.
when we make our rounds, usually Now, medical stories,
so I would put myself stin the role of an intern.on,
And I'm going to sit there
and I'm going to present with my white coat,
And the history goes like that. tA.G. is a 14-year-old girl
who became jaundiced, which means she became yellow,
14 days prior to admission. After admission to the hospital,
she became severely ill.
she would not survive without the liver transplant.
A desperate search
by the UW transplant team. for a liver was initiated
only a few days to live. It was clear that she had
the rest of the story by her mother, Julie.
I'm A.G.'s mother, Julie. Thank you, Dr. Sollinger.
Miracles happen here in Madison.
it was actually this February, As the slide says,
liver failed unexpectedly eas a result of an underlyings
illness.
Children's Hospital We enteron Wednesday.an Family
And on Saturday, we received
she required a liver transplant the devto survive.ws that
She was given a priority position
on the organ donation list
for Organ Sharing, or UNOS. manMy husband also offeredork
to donate part of his liver to her.
I was deemed too petite to share.
Her condition deteriorated
The physicians rapidly that weekend.
pediatric intensive care unit fought through Sunday night
to preserve my daughter as a transplant candidate.
She fought, too.
watching, waiting, and hoping. We stood in the hallway
Although she was on the UNOS Our situation was desperate.
during that very long weekend. list, no organ was offered
and organs are not available. Thankfully, we were here at UW,
the home of the leading organ transplantation program.
Bringing art and science
physicians and their colleagues finalized preparation for
plan B, a live liver donation to our daughter from her father.
My husband entered the hospital Sunday night.
And on Monday morning,
to do amazing work, and, yes, perform a miracle.
Because of the skill and courage
for our daughter, my husband, of evand even me,ared
we have our daughter back.
level of care from everyone We who touched our case, andible
we are grateful beyond words. Not only was
the medical care superior,
caring and kind. that care was compassionate,
at the beginning of March. We left the hospital
has continued in the same vein The post-surgical care
Highly skilled, ascompassionate and kind.e.
We have at least weekly contact with the transplant program
as part of her recovery and adjustment to her new liver.
A.G. and her father have recovered well.
She returned to school
actually on her birthday, a sweet irony I'm not sure
she appreciated.
Because the UW Transplant program was able to perform
the complex, difficult
for a live liver donation, dual surgeries required
her 15th birthday in April. As one of the many cards
she received said,
We couldn't agree more. Our experience has impressed
upon me the importance
I think about the families who and promise of organ donation.
to have a live donor, havor a donor through UNOS.ugh
I ask you to think about
showed us this evening. The vast numbers of patients
who are looking for organs
who probably will not get and the vthose organs. patients
Please think about becoming an organ donor.
It is a gift beyond measure.
we want to thank everyone associated with our case.
The UW Transplant program, the
the pediatric gastroenterology pediatric intensive care unit,
and the nursing staff of the Children's Hospital
and the transplant floor
for their miraculous work. at the main hospital
I see some familiar faces Anhere tonight.ar,
So I am going to indulge. I want to particularly thank
Dr. Anthony D'Alessandro, who is a brilliant surgeon
and a very, very dear man.
Dr. Fernandez is also here, (and I believe you were
on my husband's team. Also a very dear man.
And Dr. Goodman, who we met just at the tail end
of our stay in the hospital.
It was an amazing experience Also very sweet.
have, but to have been here anat a time of huge need,er
unbelievable need,
I want to thank Dr. Sollinger for including me and my family
in tonight's program. We're pleased to have the
opportunity to publicly praise
program for the gift of life. and ( applause ) Transplant
Thanks Julie, making my eyes, actually, a little bit.
And I am used to these stories, but just to give you an example.
This is what's happening at University Hospital.
And we are so proud of you
and look so good. threNow, we talked aboutoday
a young lady who was saved
I wanted to show you by a liver transplant, but
This was a gentleman up north who had the bad luck of picking
the wrong mushrooms,
And you see here the middle andconsole is Med Flight.g.
This bar is the helicopter. He has various lines in
to measure and keep him alive.
24 hours left Anand came to the hospital.ay,
His liver was poisoned
This is just about and had to be taken out.
We have a picture of him 14 days later.
playing with his granddaughter. And he looked about as normal
as he can.
we can tell. So, wonderful stories here
because she was transplanted, the little girl was transplanted
as a child and the surgeon
who left us two years ago. at that time was Dr. --,
out and he liked to do that. Look how beautiful she turned
his former patients, and danced with them, like Doris here,
who is now a good 25 years
and works as a surgical offtechnician in Milwaukee,on,
and has three children. When the liver is too big,
one can slice a little part off and make it smaller and fit.
One make two livers out of one. There are various ways
to do that, so liver surgery
other hand there are very few isurgeries, where on one day,
you have a patient who is dying,
a patient who has possibly and the next day, you have
Now organ donation, this is our major problem.
If we would have enough organs
And we could operate every day we could cure everybody.
But unfortunately, that's anot the case, as you know..
But there's a way how Wisconsin really made a major difference,
not only here for Wisconsin,
And let me tell you a little but for the country in general.
The German Ambassador came story how it started.
and some of you might have been to the govethere. residence,
You sit at roundtables, and the governor goes from table
to table. And Governor Thompson was a very
jolly fellow, actually. And he said "Doctor,
what can I do for you?" And I said, "Governor, help us
to get more organ donors."
Okay, and I said I'll never Oh, yeah,hear again. do that!
( laughter )
the telephone rang But indeed four weeks later,
I want to do something and he said come to my office.
So we had the idea of giving for organ donation.
current governor, Doyle, the donor medal, which our
And he's doing it with greater is doing it.
And we very much appreciate it. So this connection between
Tommy Thompson and myself started a chain reaction,
because first it was
and then he moved to the Wisconsin capital,
And that's where Tony came in and started to play a big role.
We got Tommy Thompson excited to do on a national basis
what we have done in Wisconsin. And we called it
The Collaborative, which is just
sophisticated way of getting a word for a fairly
And we had consultants a product quickly on the market.
People from Toyota, IBM, etc., from all kinds of life.
get something done quickly. So the connection between the
Madison capital and Wisconsin became very effective and
a giant organization took place.
where more than a thousand There were some conferences
more organ donors. people listened to how to get
What is our problem? Let me just go back.
no more organ donors? Are we maxed out?
Or is there still room to grow? And there's one number I want to
throw out, the conversion rate. The conversion rate
is very simple. Let's just say
at University Hospital, 100 patients die each year.
And then you look at these
how many of them could have, 100 patients and ask
could have become organ donors. And let's say, if 50 of the ones
who could have become organ donors,
actually are organ donors,
a conversion rate of 50%. When you look here at the slide,
and it's a very busy slide, but I'm going to go slow
so that you can understand it.
happens to be the University You can see here, and it
and that was before the Collaborative started.
We were high up.
I believe it's about 70% We had a conversion rate,
maybe a little bit higher. or something like that,
This is the 60, or so, mark. And then you go down.
around the country were below. The majority of the hospitals
and these are not These hthe lowest ones.stance,
This is just how it goes down.
or triple the organ donors They could almost double
So we knew that there are more they had.
So this collaborative started, organ donors available.
Tony D'Alessandro was one of the I think, it was in 2003.
Before that, for many, leaders, it started about here.
had been stagnant. many years organ donations
when the collaborative started. It started to skyrocket.
First collaborative,
I mean, it just skyrocketed sup into this system.
And see how successful it was.
you see where the red line is. And the other measure was, now
more hospitals actually made The red line moved over,
At the beginning it was here, tjust a few hospitals,w.
maybe five or ten, maybe, now more than half made it.
Still there's a long ways to go,
in about three or four years but you've made huge progress
And the whole nation, not just and the collaborative continues.
from that collaborative. Wisconsin, is benefiting
organ is very stressful. Now waiting for a transplant
it's actually a death sentence. Because there are deaths
on the waiting lists. And in some patient populations,
such as diabetics, the death
than the death rate for patients on the wait list is worse
I will show you whan example later.er.
You are lucky to live in Wisconsin.
Why?
wait times of almost Because Madison has the shortest
in the country. For almost any blood type.
I show you an example of how that works out.
This is the rate of death for a diabetic patient
who has kidney failure. Now these are national data,
not Wisconsin data, so when you, as a diabetic patient
have kidney failure,
and it doesn't make a difference and you have to go on dialysis,
after 12 months, you have whabout a 20% chance of dying.,
If you go at five years,
of not making it, on dialysis. you have about a 75% chance
for diabetic patients Dialwith kidney failure.ence
Now, if you now get this
life-saving kidney pancreas, life-saving kidney or this
It doesn't move forward right now, but we can do it this way.
For instance in Madison,
four and a half months. So in Madison, you would get
your transplant about here. This is the average wait time
for a simultaneous
So basically, nobody would die kidney pancreas.
This is a very, very good center, which has also
very short waiting times. But it doesn't always
work out that way.
center, a large Midwestern This is a reasonably good
are short. center where waiting times
about 30% of the patients Itare dead before they get,
a transplant. But look at this one.
This is a large center, actually
75% of patients who go on the wait list are actually dead
by the time they would be called in.
And New York is even worse. So this is, how important
organ donation is.
among many of the reasons, And this is how important,
that we do the transplant as soon as possible,
sometimes even before a patient has to go on dialysis.
So I think this is probably the most important demonstration
( laughter )
you're lucky. oYou don't have to play
the Wisconsin lottery to get a transplant.
You just have to do what
have done for you, sign up many, many other people
And if it should be really happening, don't take
your organs to heaven.
You have seen the bumper sticker before.
Now, that brings me to another
And anyone, especially kidney trecipients, where it's very.
frequent, who have a live donor,
the lottery. this is really winning
have a graphed life expectancy Because live donors
to three to four times as long from twice
or disease donor kidneys. So getting this kidney
almost gets you an assurance
with this kidney. Because of the compatibility
of the quality of the organs, people need less
of the immuno suppressive drugs,
fewer infections. so And the risk for the donorts,
is extremely low. For kidneys, we are performing
now the laparoscopic technique, where the camera
is being put in.
It's low on the abdomen, The incision is about so long.
I usually tell them they can still wear a bikini.,
And one wouldn't notice that's they are organ donors.
So we have done well
You can see the total number with live donation here.
And I would say about 35% of kidnare live donors.n blue.
Around the country, there are now more live kidney donors
than diseased kidney donors,
If one out of 13,000 Americans, bbetween the ages of 18 and 65,.
would donate a kidney,
would disappear tomorrow. So live kidney donation
is very important.
They just started college together, these two sisters.
One got kidney failure
38 years later. iWho can tell who the donore
or recipient is?
and they're enjoying life. It was a perfect match
when she is coming. She's in a study, the recipient
is, she gives blood for us
investment. These matched kidneys are hard
to come by, and I tell you
where I personally have problems there is one operation
because I am nervous. This is when I do a live donor
that is a perfect match,
happens during surgery, or because I know if something bad
I would feel there would be a complication,
of changing this patient's life. very, very bad or guilty
These operations have to have So a 100% success rate.en.
As far as live donors is concerned, one of our
legislators, who unfortunately
idea a few years ago that we is retired now, came up with the
easier for the live donors. sHe introduced the first bill
where patients get a tax break
It's a small amount. if they're a live donor.
But at least it's a gesture that the government is honoring
these individuals.
he told me that 23 states Theither have that law now,im,
or are in the process of having a similar law.
But this has been a big success and Wisconsin has been
the leader. I have to give him credit.
He did it on his own. We came in late to help him,
but it was his idea.
would be wonderful in a family, Nowbut it turns out thation
the best donor doesn't have the right blood type.
As you know, you can only transplant across certain blood
types, just as transfusions.
transplant an A to an O, For example, you can't
And it just happens that or a B to an A.
this non-matching blood type. the best doLike here. family has
This is a pair of sisters.
and the donor has A. One, the recipient has B,
be used as a donor. SoBut here are two friends.ot
They just have the opposite.
and do a crossover. ( light laughter )ogether
This is called a paired exchange
It really doesn't matter. fromThey're young people.lant.
They have good kidneys, and both of them are helped.
We are doing this paired exchanges whenever
the situation arises. This is a new way
to increase live donation.
like taking antibodies away, We have other new ways
with these blood groups. which associated
might be once in a while... On( laughter )and, there
There might be once in a while
but it hasn't happened to us. a probI would be remiss ifseen,
I didn't talk a little bit
I'm going to, for the insiders, ait's no news, but I see.
Millard Sussman in the back,
He will remember that actually a member of the Academy.
biology is right here the in Madison, Wisconsin.ion
There is something we call the
which is transplantation holy grail of transplantation,
for this powerful side effect, of an organ without the need
That would be what we all want. the iTransplant an organrugs.
and we wouldn't need these
And the basis for that, that immuno suppressants.
possible was laid here this should be theoretically
Remember, it was 1945, I don't right in Wisconsin.
His name is Ray Owen, think anRay was actuallyber him.
in the School of Agriculture. He was much more interested
in pigeon genetics, but he needed money.
And the Wisconsin Farmer's
grant to study blood groups in cattle, because they wanted
to identify freemartin cattle.
I'm going to ask you, who knows what a freemartin cattle is.
Okay, one person. A freemartin cattle is actually
when a cow has twins, one is a boy and a girl.
The testosterone of the boy,
through the placenta makes which is being transmitted
but the farmer, of course, the female sterile,
And it will raise the cow, but doesn't know that.
So they wanted him to study theif there would be a tests.
to identify this early
Here's the building. and what he really found was...
was already known since 1927, that calves, share a placenta,
and they have a blood supply. So it means the blood
goes from one baby cow
exchange constantly blood. to the other in utero, so they
each other in utero. So they actually transplant
just a schematic representation, When they are born, see this is
you can actually transplant, when they are born,
not identical twins. even if they're
and one is a girl, If one is a boy
This is a skin graft, this is a bandage here..
You can transplant skin grafts. And the skin
doesn't get rejected. All because in utero,
they did something, by sharing
these blood cells, these antigens, by sharing
to the transplant. which made them unresponsive
of enormous importance. This was the paper in science.
And Ray Owen actually said, at the end of the paper, "This
might have some implications
He's a very humble man, who's now living out in California.
I had the pleasure
over the last few years. of meeting him several times
And we discovered this letter Hand this letter was writtene.
by the giant of our field.
in immunobiology He was the dominant figure
like Watson for the DNA science. in the last century, something
was the giant in our field, in immunobiology.
And he wrote that letter to Ray after he received the
Nobel Prize in 1960.
I'll read it for you. That's "My dear Ray, wrote.
Of the 500 letters, I have had
yours is the one about the Nobel Prize
I think it is very wrong I most wanted to receive.
in this prize; the only consolation is that all your
professional colleagues have
of the fact a that you started it all..."ng
Right here
the School of Agriculture. in Madison, Wisconsin,
Here are the giants So wof transplantation.tory.
Some of them I know very well.
cyclosporin, and was a great This Roy Calne, who discovered
was one of my ski students. lThat's how I wiggled my wayd
into these laboratories.
to these guys. I gave ski lessons
Tom Starzl is now 82, a great liver transplant surgeon
in Pittsburgh.
but he actually did the first heart transplant,
the first lung transplant.
in Cape Town Everybody heard it happened
No, Jim Hardy did it first, but it was from a baboon.
He took a baboon heart, took it to the operating room
and transplanted it in a man. And the operative note said,
"Patient going
for heart procedure." tThe patient signed it..
Can you imagine in our day and age
of informed consent?
And he did the first ( laughter )
this was an enormous talent, lung transplant, as well.
He did about everything. Richard --, from Minneapolis.
died jogging in perfect health, and could not end his career.
Chris Bernard, who did the first
I met him once. I made sandwiches for him
in Germany when he was visiting with his girlfriend,
Lollobrigida. Anybody know Lollobrigida?
( laughter )
He left medicine and enjoyed All right.
And here's John --, who actually the Dolce vita a little bit.
of Ray. bA very humble scientist.
And then we go all the way back,
This is Alexis Correl, actually I have not met him.
blood vessels together. who first Sir Peter,how to sew
I talked about already. I got to know him, luckily,
very well.
he liked to come to the ski Hemeetings in Austria,ut
which I already mentioned.
tried to become a skier. And his wife at the age of 62,
about her. And everybody was worried
and look after her. IAnd at night, we were sittingr,
together by the fireplace.
to Sir Peter I had a chance to talk
Joe Murray did the first and learned immunology from him.
Saw him last year succat a dinner in Boston.nt.
He's now 83 or 84.
Rupert Billingham was a basic scientist
who worked with Medawar.
who really started Here's my hero, Folkert Belzer,
at the University of Wisconsin, and who got me involved
in transplantation. This is just a scheme of the
immune response of a transplant.
all these drugs Hthat patients have to takee
interact with the immune system.
This is what one of our patients Incredibly complex.
they have to take every day just to keep the immune system
in check. So this is a big pain.
And we hope one of these days,
of Ray Owen, and we can wtrick the immune systemt
so we don't need it.
people in our group Awho are thinking about waysed
to accomplish it. We have to get away
from the side effects.
But I have to tell you ( laughter )
When I walked in the 1980s one thing.
and down to the cafeteria, in the University Hospital,
who had a transplant. If I knew the patient or not.
Because they had side effects of those medications.
And they were so visible, I could pick out everybody
who had a transplant. Now I can't anymore.
Because we have gotten
This is just an arsenal of those drugs.
This is my little favorite here.
I think $1.9 billion, Laand I forgot to maker,
a little contract with them when I developed the drugs.
( laughter )
I would donate it to the Med School, Paul.
Okay? ( laughter )
Of course.
But see, that's what I mean. Or the research building.
to keep his kidney in, He gets the same drugs now
and he doesn't look like but he looks pretty good,
So we got better in adjusting a trahis medication.more.
Our patient will not have to
when she grows up takeand goes to college.ants
Nobody will notice. Now kidney transplantation
is not so spectacular when you think about survival.
And until a few years ago,
or get a kidney transplant. weOf course, it's a little bitis
nicer if you don't have to go to the machine.
Now we know that, actually, kidney transplantation
is a life saving procedure. And this is a landmark paper,
which came out from Michigan. This is when you're on dialysis.
The statisticians do it in a funny way.
But let's say this is a straight line.
If you fall below the straight
See, when you get la kidney transplant, you start
to fall below the straight line and it goes on and on and on.
And lives here are being saved. Dialysis
versus kidney transplant. It's not just for diabetics
who are waiting.
old people, young people. A kidney transplant
in contrast to popular belief or intuitive belief,
is actually a life saving procedure as well.
And the earlier you do it,
We have a few world records, the better for the patient.
of Transplant Records. there's actually a Guinness Book
the University of Wisconsin has the third-longest
kidney transplant life. The brothers from Green Bay were
transplanted in the late '60s.
organ preservation. I have to talk about
organ preservation
I told you, this is my hero. because we are in Wisconsin.
I have ever seen. One Belzer built upgeons
the program here, taught me everything, surgically, I know.
I know Tony feels the same way. He was a great man.
His brain never stopped.
to do office work. He constantly came in weekends
and he had a new idea. And he called you in
but his brain never stopped Mostto his last day.azy,
Unfortunately,
I would have loved he died too early.
have him come to Grand Rounds and still discuss things
with him. A great loss.
He was the inventor of the kidney profusion machine.
These are the machines where
And they look a little bit they put the kidneys in.
They look a little bit fancier nowadays.
and things like that. But it's the same principle.
You put the kidneys on this machine, and they can stay there
for 20-30 hours.
as early as possible. But it was the first time
we could really keep the kidneys
for the recipients to come in, a little bit longer
Major progress. And then he had the big hit
in 1985-86. Very few people know the story,
why he made the discovery.
more pancreas transplants. I started to do
and make sure I don't make He wanted to help me
so he came in. too many mistakes,
because they were done Usually, I did it at night,
you couldn't preserve them. And finally he called me
into the office and said, "Hans,
of coming in at night. I'm getting sick and tired
to preserve organs longer so I spent my whole career
We've got to find something better to preserve the pancreas
so we can do it during the day as well."
So, he found this solution, which is known as the University
of Wisconsin Solution.
first in dogs, where it had spectacular success, 72 hours
we could preserve the pancreas. Whereas it was four
or five hours with the previous solution, which we called
Collins Solution. Here's a bag of UW Solution,
it's called Biospan.
a lot of money with the patent. And here's our first patient.
Livers, up to that point, were preserved
for four to six hours.
for 26 hours. This was a huge sensation.
Belzer made a presentation
three or four weeks after that transplant was done,
and the whole world immediately jumped on it.
We got phone calls every day, and especially from Pittsburgh.
We could have driven trucks of UW Solution to Pittsburgh.
It was really a huge hit, and a major contribution
that he made. I'm slowly going to finish up
with pancreas transplantation,
Pancreas transplantation which has always been my hobby.
especially the ones who have kidney failure.
We know now that if a patient,
gets a kidney alone versus a patient who gets
a kidney pancreas, that over
in terms of percent in survival. ten years, we gain about 20-25%
having normal glucose control, So having a pancreas and
with a kidney pancreas and I know at least two patients
It's really a very nice thing who are sittto have.he audience.
Not have to worry about this glucose fix, not having
to worry about the ups and downs
It's really appreciated oby the patient.s.
And John Pirsch, our transplant physician, who sees,
every year, a few thousand
that these are the most grateful patients in clinic, tells me
Kidney pancreas transplantation is a wonderful thing.
You can see here. When they are on the waiting
list, these are the people
transplant patients, how fast they die if they don't get one.
Okay? This is just 48 months.
So we in Wisconsin are lucky. Hardly anybody has ever died
on the wait list
These are national data. for a kidney pancreas.
a little more sophisticated, Now, if you want to become
this big operation, you have to see Luis Fernandez,
who is also in the audience.
a little bit smarter. He takes these little islets
out of the pancreas which make insulin,
extracts them,
Sometimes they work a day it's a or two days beforerocess.
they have the right number
Then they go to radiology, and quality of islets.
and they stick a needle oin the ultrasound guide,
a fluoroscopy, into the liver,
It can be done a very fine needle.
And they infuse these cells undeinto the liver.sia.
Now this is, for many,
We do not know still considered experimental.
But I'm really proud to say, what the long-term results are.
which are not large if you in comparisonumbers,
to some of the earlier ones,
to the number of transplants performed,
is probably one of the highest
perhaps in the world. So the quality of islets
with Luis Fernandez and his transplant team
and Jon Odorico is very, very high.
For the right patient,
an alternative procedure this would be
Now Tausif Alam, who is sitting in the audience and I,
we want to be more fancier. We don't even do
a transplant anymore. We just want to modify
genetically the liver to be a pancreas.
And we have over the years, like little puzzlers,
we have put our chins together. And what we are planning to do
is inject this gene into the liver.
This is the gene, if it means anything to you.
It contains insulin and it
And we want to transform contains a few other elements.
into a pancreas and have it make insulin.
Over the last year, Tausif
He has now a large number has mof animals, who doress.
clinically quite well.
with the work continues And hopas it has been,rogress
we might, one of these days,
go into clinical trials. before I retire,
what I am proudest about Finally, perhaps
We have, most likely-- is our training program.
in the audience. And there are a few Fellows
Probably, the most competitive You can boo me now if I lie.
for young transplant surgeons surgiin the country.ogram
Right now, we have them stacked up on the waiting list
until 2011. And they stay with us
for two years.
transplant surgeons. They become excellent
point out a few are already running large transplant centers
of their own. They all have gotten great jobs.
Alan Reed,
He's not very small, let's see if we find him.
In the middle? so we should find him easy.
Where is he? ( various I have a bad angle here.
There he is! responses/suggestions )
He is now running I tolthe Iowa program.mall.
They all have done
This is probably what I consider really, really well.
that we have trained my proudest achievement,
And this is the end of my talk so many good young people.
in Wisconsin. aThank you very muchn
for listening.
for stopping by. And thank you much
Thank you very much. ( applause )
fascinating. That was enlightening,
to ask questions. Hans will repeat your question
for the benefit of all of you here and for the benefit
of future viewers of this presentation.
Sir?
key problems in transplanting >> It sis getting donors.he real
There's basically two systems of drawing in donors,
opt-in programs and opt-out programs.
It seems that most of the programs in the United States
are opt-in, where you have to choose, to raise your hand,
if you want to be a donor.
countries around the world where Whereas, a number of other
where everybody in the they have an opt-out system,
unless you say population is a potential donor,
I'm wondering if you could I don't want to be.
and if we could encourage colegislators to develop,
opt-out systems,
Did everybody understand to get a larger donor base.
could hear the question? the question,
in Europe, unless you Basspecifically state thatries
you don't want to be a donor, if an accident should happen,
you're brain dead, and
you will be automatically youconsidered a donor, andtal,
there will be no family consent.
Now it was first used It'in Austria and Belgium,nt.
as far as I know. There's a modified version
in France.
of these programs. I think there's some success
overwhelming as one might think. But the success is not quite
of the population So, in the United States,sity
it might be much more difficult to have everybody agree
on that sort of approach. These are small countries,
Austria, maybe
Belgium not much different. I think it was much easier.
In the larger countries with larger populations,
especially with diverse populations,
it's more difficult.
as a very successful model What we really often refer to
The Spanish model has individuals, physicians usually,
in the hospitals, in every hospital, more or less,
who specifically do nothing else
It's obviously than look for organ donors.
And somebody got the Spanish a very costly model.
Spain is indeed the most government to buy into it.
as far as organ donation successful, as a country,
They are still not as good is concerned.
That is a very expensive. but successful model.
Tony D'Alessandro, who should actually address the question,
is trying very hard to have as many of our people to go out
to the hospital and perform outreach functions.
And what we have noted, is as soon as we have
the personnel to go out and work with the hospital,
the more we have, the better we do.
The more often they can visit,
The better the relationship with the better we do.
with the hospital the hospadministration,doctors,
all of these hospitals, Wausau, Marshfield Clinic,
Marquette, the better we do.
of education outreach and being familiar with the people.
It's very costly and
Sir? time consuming and hard work.
confused on the donor success >> at getting a transplant.tle
You talked about the local--
and southern Wisconsin. be beI thought there wasdison
a national list and that
that donation goes into the when national list.made,
Then wherever you are on the
then that was the only way priority of the national list,
It's very easy to be confused tbecause the system is complex..
But in principle, it works like that.
If you have, in your region where we are,
what we call our OPO area,
and you have the appropriate if you have a donor
with the exception recipient in your reach,
for instance in Chicago, that there is somebody,
a status one, the highest urgencyd
for a liver or for a heart, and we don't have somebody
with that urgency,
to Chicago. wOtherwise, organs stay local,,
with one exception for kidneys
which are rare, perfect matches. with the perfect matches,
around the country. TheBut the majority of organsts
are being used local. I think that's the proper way
to do it, because once you would
I think it would be much harder takto get people energizedut,
to work for organ donation, if most of the organs
would leave the state.
will be shared, depending Moson the medical condition, it
as well as
Is that clearer now? the matching conditions.
What about family members giving to another family member?
Is that automatic, then?
want to have the transplant. >> They decide where they
We have situations, for instance, where the donor
lives in Madison and
And the donor might say, the recipient lives in Chicago.
to Chicago, then the recipient I don't want to travel
and we do the operation. comes to Madison
But that's an easy one. It's So, yes, sir,yhow.
you have been waiting.
Could you give me your >> Thank you, doctor.
an individual who has diabetes thought process for
yet is a few years away, with chronic kidney failure,
How that person may end up possibly, from dialysis.
And is that a larger, ois that number increasingt.
here at the UW? >> It really depends
what our donor situation is.
for certain blood types The lengcan fluctuate.ing list
For instance, right now the wait time
for a blood type A, if you're a blood type A,
consider yourself lucky,
If you have blood type O, it's very long, because,
for totally irrational reasons. Sometimes we have a year
where we get donors only from one blood type,
and nobody knows. It's the chaos theory.
And nobody can understand it, but it happens.
Now, what you're asking is when should a diabetic
who has some renal impairment see a transplant surgeon.
I would say you should
with a good nephrologist certainly be in touch
And I would say it would watching you.
a creatinine of two. not be too late if you have
to your own situation, I assume you are referring
sounded to me. because that's how your question
with a creatinine of two, then we could make a plan.
Then I can tell you,
every three months and get let's get you're creatinine
when you might reach dialysis, a trajectory so we can predict
We know what the wait time is, and then we put you on the list.
a transplant-- so we get you well before
have to go on dialysis. But I think get serious
with a creatinine of two, as a diabetic.
Are you doing a lot of those preemptive transplants
prior to dialysis?
we are proud. >> ActuaWe transplantsconsin,
about 50-60% preemptively.
that preemptive transplantation adds about 30-40% to the lengths
of their expected survival. Preemptive transplantation
is the best.
this shunt business, In addition, you save yourself
which is not very comfortable. and everything,
I would get alert. So two, is about where
On your first or second slide, you had a chart, that
I may have read incorrectly.
the number of transplantations But what I read was, that
of donors. was greater than the number
We have two kidneys. How does that work?
So from one donor, A donor has two kidneys, right?
Or, has a liver and a pancreas we can transplant two patients.
So if you really have a multi-organ donor, we can
transplant about six people.
Yes, Jessie? That's how it works.
as treatment for someone >> Can transplants ever be used
No, unfortunately not. with pancreatic cancer?
cancer, could you do When somebody has pancreatic
No, transplants cannot be done for cancer.
I get this question quite a bit.
who have pancreatic cancer, Ibut that's unfortunately
not possible. Yes?
I have heard the answer to this, but...
Can you identify yourself please?
Please stand up.
Say who you are. ( laughter )
He put a kidney and a pancreas >> My name is Lisa.
Is that what you wanted? in me 11-1/2 years ago.
And he put one in my buddy here (21-1/2 years ago.
Yeah, he's almost the record holder!
That's why I'm bald,
( laughter ) because of him.
of "why?" to your answer that no, pancreatic cancer cannot.
Oh, yeah the reason is
of pancreatic cancer, the cancer has already spread,
even if it's not visible. The smallest pancreatic cancers,
hardly detectable on CT scan, the cancer cells
have already spread.
the cancerous pancreas, there would be cancer cells
sitting all over
we would put the patient and if would do a transplant,
and they would even die faster. on So that's almost trueugs,
for all cancers.
presence of cancer You can't transplant in the
of the cancer cells. because of the spread
Why is the number, the need going up so fast compared
to the number of donors?
are getting older. >> Well our patients
Actually, our growth population are the elderly patients.
There's hardly any increase in the patient population
between 10 and 30,
but as patients get older, as far as need,
And 20 years ago, for instance Dr. Belzer,
when he was 50, said
anybody over 50, we're not going to transplant
Okay? beca( laughter )rribly old.
But when he became 55, he said
Okay? okay, ( laughter )lant up to 55.
But now, we got so much better
our anesthesiologists, our cardiologists,
our drugs, not only oujust the transplant drugs,e,
but the antivirals, antibiotics got so much better
that we can take on a higher
So now, the typical patient for us, is over 50 years old.
So that's the population
And the baby boomers getting that's growing.
that's what we're facing. thereYes?, and
We have so many questions,
Sir, please? I want to do it methodically.
Is there any general upper >> Mine's about aging donors.
that many older individuals have some kind of degenerative
disease that might
You know, I hesitate to give preclude them?
because there are 80-year-old ypeople who just completed,
the Boston Marathon.
very good organ donors. And there are 50-year-old people
who have smoked all their life. They have hardening
of the arteries.
and maybe drank a little bit They already have bad kidneys,
and the livers are not good. too much,
at all. Any questions, call our OPO,
if there's a donor situation
we have specialists sitting by the phone and they evaluate
every case individually.
patient has a serious illness In genis quite acceptable,ss the
I was just told that
was transplanted in Germany, a 92-year-old kidney
We have to look at case-by-case. so these things are possible.
24 hours on the phone to address those questions.
But donors are getting older, there's no question about it.
Yes, ma'am? >> You talk about the value
of education and outreach to increase the number
of living donors. What are your thoughts
on anonymous or altruistic
do you think it's worth doing something like that to increase
the number? >> Oh, yeah.
I personally think
she was asking, did everybody understand the question,
or do I have to repeat it?
The lady was referring Everybody heard it.
And we have a few every year. And they come to the hospital,
or they call us up and say, I want to donate a kidney.
I want to do something good for mankind, and I think this
is actually the ideal donor,
There's no family pressure. There's no pressure of having.
to give a kidney to a friend, they just want
to do something good. In fact, we all know, Tony
and I, we know a government employee who works in
the Division of Transplantation.
to somebody. She gave a part of her liver
something good for a child. Yeah, this would be wonderful if
we had more altruistic donors.
compensation for donors, Right now, we cannot talk about
says it is illegal. becauBut there are peopletment
in the country, in discussions
the live donor. But I don't want to get
into that now, because
I know what side I am on. thBut altruistic donationc.
is wonderful. Yeah.
Thank you very much again. (
applause )