9UNP0155SD_Hans Sollinger_WordPress

- Thank you all for coming to join us this evening. I'm Margaret Lewis the executive director of the Wisconsin Academy of Sciences, Arts and Letters. We're just really pleased to welcome you all here this evening for Dr. Sollinger's presentation, "The Gift of Life." Some of you are joining us for the first time, so this evening offers you an opportunity to learn a little bit more about the Wisconsin Academy. We're an independent nonprofit organization that's been around since 1870. Back then, the organization felt that there needed to be more gathering of information to share with people. Today, that's reversed. 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 of our Foundation board. 

And so I wanted to introduce to you Jesse Ishikawa, here in the front, and Millard Sussman, and Ann Peckham, and Andy Richards from our board, and Howard Marklein, the treasurer of the Wisconsin Academy. So I hope you'll join me in welcoming them as well. 
(applause)

 You'll meet some of the staff that is here, Gail Kohl, our development director up here, and Kathy Dickerson, who has just recently joined us. I would also like to welcome the new president and CEO of the University of Wisconsin Hospitals and Clinics, Donna Katen-Bahensky. Donna, would you stand? 
(applause)

The Wisconsin Hospitals and Clinics are one of our sponsors of 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. 

We try to identify the very best thinkers in our state to shed light on the important issues in the sciences, the arts, and letters, thus our name. We try to offer the best knowledge available in a respectful, agenda-free environment. In addition to our lecture series, we also have an art gallery on the third floor of this building, right under the dome. We call it our home under the dome, the James Watrous Gallery. It's got a new exhibit, just opened this week, from the Wisconsin Visual Arts Lifetime Achievement award winners. 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 to hear from, and what other topics you'd like to hear about. 

So I hope you'll make sure to fill those out and pass them in before you leave, so that we can take full advantage of your input. The last program of the Wisconsin Academy is a public policy project that we do every two years. We try to bring together all the different thought 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 resulted in some groundbreaking groundwater legislation. We just finished up a project called the Future of Farming, which we hope will also have very positive results in preserving our working lands. I want to take this opportunity to just thank all of 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. For our friends and supporters who could not join us this evening, we thank Wisconsin Public Television and City Channel 12 for making this and other presentations available on the Internet. Wisconsin Eye, also does that for us, as well. 

And then it is rebroadcast around the state. We also really appreciate the support of the Madison Community Foundation through the Great Performance Fund. So thanks to all of you, and all of these sponsors, we're able to offer the highest quality programs. So if you are interested in offering support for future programs, please feel free to let me or Gail Kohl know. So with that, what I'd like to do is introduce our director of special events, Laurie Dies, who will introduce our speaker. I hope you enjoy it and have a great evening. Thank you. 
(applause)

- Thank you Margaret. 

And thank you everyone for joining us tonight. Regarding tonight's program, there will be time for questions after the presentation. Professor Hans Sollinger is internationally recognized as one of the leading transplant surgeons in the world. His depth of transplant experience and his affiliation with the University of Wisconsin enable the UW Transplant Program to be among the best 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 in the Immunobiology Research Center. In 1980, he joined the UW faculty under the leadership of another world-renowned transplant surgeon, Dr. Folkert Belzer. In 1982, Dr. 

Sollinger pioneered a technique 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, currently the world's most frequently used immuno-suppressive drug. In 1995, Dr. Sollinger was named chair of the Division of Organ Transplant at the UW and the Folkert Belzer Professor of Surgery. His current research includes experimental gene therapy with a goal to cure diabetes. He was recently awarded an honorary doctoral degree from the University of Leipzig in Leipzig, Germany. He is a member of the American Surgical Association, the Transplant Society, and many other organizations. He's also a past president of the American Society of Transplant Surgeons, and the International Society for Organ Sharing. 

He has served on two governmental advisory boards as the chair of the Advisory Committee on Organ Transplantation, and the chair of the Midwest Regional Advisory Board. During his 27 years on the faculty of the University of Wisconsin, Dr. Sollinger has met with more than 3,000 patients to discuss management of end-stage renal failure and diabetes. We are so pleased that Dr. Sollinger, who I must add is a Fellow of the Wisconsin Academy has joined us this evening to present "The Gift of Life." Please welcome Dr. Hans Sollinger. 
(applause)

- Good evening and thanks much for coming. 

I know it's finally a sunny evening, and you could have gone out to the square and marched up and down State Street. And you decided to come here and listen to my lecture on organ transplantation, and I very much appreciate that. Laurie mentioned some of 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 mine, who's 87 years old. He still cross country skis every day, 15 miles, that the best honors are the ones which come from your home, from the people you know. So this is one I cherish very much, and I am so happy to see so many faces here. Some of them are patients. Some of them are friends. 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 at University of Wisconsin. 

But before I start, I have to tell you a story. And it's not going to be one of my jokes. I was speaking here three weeks ago, when we had the movie premier, and I had a joke about the Pope's visit. I will not repeat that one, despite the fact that it was a great success. 
(laughter)

 Today's story is about the place where you are sitting, because this place, some of you might remember, in the '70s and early '80s was called the Mall Bookstore. 
(laughter)

 And the Mall Bookstore sold, well, let's call it pornographic material. It had aluminum siding, and was just for the wonderful corner on the street, it was just a sore for the eyesight. Now my wife, who had a business in the 500 block, decided that this can't go on this way, and very trickily using her charm, bought the building. 
(laughter)

 And after one year, she didn't renew the lease. And what became then, the Radical Rye, a sandwich store, was the building we owned. And later on, it was transferred over to the arts. It has this wonderful entrance. Mary got the nickname of Mother Teresa of State Street. 
(laughter and applause)

 So this is my story for the start. But let's go back to the University Hospital, which is one of the largest transplant centers in the world now. And we are very, very fortunate to have this center in such a small community. 

As I have said a few weeks ago when I talked to the board, the numbers are 550, 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 because we have a great team. A team, not just doctors, but we have wonderful nursing staff, coordinators, administrators, everybody who is with us is working at the highest level. So we have this great team and we have so much success. 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 waiting for a transplant. 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, the number will have tripled. 

So organ transplantation is a field which will grow, and we have to place much more emphasis on organ donation. Here you can see, just as an example of a slide that I show my students. This is the increasing 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. We have to work very hard to increase organ donation. That's why we have this booth here, and that's why we have now a license plate, thanks to Senator Risser. And 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. Here's Dr. Edwards, who is in charge of the cardio-pulmonary transplant team. Here's Hans Sollinger. And another bald guy 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 to make the OPO what it is nowadays. 

It's the number one 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 were to decide tomorrow to stop working, I would stop too. 
(applause)

 That's what we have accomplished in 2005 and 2004. We were the number one kidney transplant center 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. We don't have the final numbers, but today, we did four kidney transplants. I started out with one of my fellows who is sitting in the back, Sidney Cole, we started out about 6:30. 

I think they're just finishing up with the remainder of the kidneys. So that's a normal day for us. It's not unusual to do four or five kidney transplants on a single day. Now these are the individual teams, there are more pictures. You can see these teams are large. They require a lot of specialists and subspecialists and they all have to work together very well. We have special teams 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 and lung transplantation today. Maybe you invite Dr. Edwards one of these days. 

He gives a little bit more detail. And finally, we need not only doctors and nurses, we need good administration. And this is our new CEO. I knew you were coming, so I put a picture in. 
(laughter)

 But without administration and the understanding of the administration what our needs are, we could do very little. And I haven't worked a lot with Donna, because she's relatively new. But one of my best friends and trainees, Alan Reed, started in Iowa as chief a few months ago, and he told me great stories about how helpful she was in reactivating their transplant program, so I'm looking forward to working with Donna to make our program even better. Now, medical stories, when we make our rounds, usually start out with a presentation, so I would put myself in the role of an intern. And I'm going to sit there with my white coat, and I'm going to present the medical history to you. 

And the history goes like that. A.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. Soon it became clear that she would not survive without the liver transplant. A desperate search for a liver was initiated by the UW transplant team. It was clear that she had only a few days to live. Now I'll let you tell 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. As the slide says, it was actually this February, early February, our daughter's liver failed unexpectedly as a result of an underlying illness. We entered the American Family Children's Hospital on Wednesday. And on Saturday, we received the devastating news that she required a liver transplant to survive. She was given a priority position on the organ donation list managed by the United Network for Organ Sharing, or UNOS. My husband also offered to donate part of his liver to her. I was deemed too petite to share. Her condition deteriorated rapidly that weekend. The physicians and their colleagues in the pediatric intensive care unit fought through Sunday night to preserve my daughter as a transplant candidate. She fought, too. 

We stood in the hallway watching, waiting, and hoping. Our situation was desperate. Although she was on the UNOS list, no organ was offered during that very long weekend. Sometimes that happens, and organs are not available. Thankfully, we were here at UW, the home of the leading organ transplantation program. Bringing art and science to life, the transplant 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, two surgical teams assembled to do amazing work, and, yes, perform a miracle. Because of the skill and courage of everyone who cared for our daughter, my husband, and even me, we have our daughter back. We received the highest possible level of care from everyone who touched our case, and we are grateful beyond words. 

Not only was the medical care superior, that care was compassionate, caring and kind. We left the hospital at the beginning of March. The post-surgical care has continued in the same vein as the hospital-based care. Highly skilled, compassionate and kind. 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 at the beginning of April, actually on her birthday, a sweet irony I'm not sure she appreciated. 
(laughter)

 Because the UW Transplant program was able to perform the complex, difficult dual surgeries required for a live liver donation, our daughter celebrated her 15th birthday in April. As one of the many cards she received said, "Best birthday ever." 

We couldn't agree more. Our experience has impressed upon me the importance and promise of organ donation. I think about the families who have not been fortunate enough to have a live donor, or a donor through UNOS. I ask you to think about the slides Dr. Sollinger showed us this evening. The vast numbers of patients who are looking for organs and the vast number of patients who probably will not get those organs. Please think about becoming an organ donor. It is a gift beyond measure. In closing, we want to thank everyone associated with our case. The UW Transplant program, the pediatric intensive care unit, the pediatric gastroenterology program, our pediatrician, and the nursing staff of the Children's Hospital and the transplant floor at the main hospital for their miraculous work. 

And in particular, I see some familiar faces here tonight. 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. 
(sighs heavily)

 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. 

Also very sweet. It was an amazing experience and one I thought I'd never have, but to have been here at a time of huge need, unbelievable need, we were so very fortunate. 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 and thank the UW Transplant program for the gift of life. 
(applause)

- 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 three all sitting here today and look so good. Now, we talked about a young lady who was saved by a liver transplant, but I wanted to show you some extreme situations. This was a gentleman up north who had the bad luck of picking the wrong mushrooms, and had mushroom poisoning. And you see here the middle console is Med Flight. This bar is the helicopter. He has various lines in to measure and keep him alive. And he had about, you can say, 24 hours left and came to the hospital. His liver was poisoned and had to be taken out. This is just about 14 days later. We have a picture of him six or seven weeks later playing with his granddaughter. 

And he looked about as normal as he can. So, wonderful stories here we can tell. Here's one which I like, because she was transplanted, the little girl was transplanted as a child and the surgeon at that time was Dr. --, who left us two years ago. Look how beautiful she turned out and he liked to do that. He went to weddings of his former patients, and danced with them, like Doris here, who is now a good 25 years off the liver transplantation, and works as a surgical technician in Milwaukee, 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 is very demanding, but on the other hand there are very few surgeries, where on one day, you have a patient who is dying, and the next day, you have a patient who has possibly a full normal life ahead. Now organ donation, this is our major problem. 

If we would have enough organs we could cure everybody. And we could operate every day and life would be wonderful. But unfortunately, that's not the case, as you know. But there's a way how Wisconsin really made a major difference, not only here for Wisconsin, but for the country in general. And let me tell you a little story how it started. The German Ambassador came to the governor's residence, and some of you might have been there. 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." 

Oh, yeah, well let's do that! Okay, and I said I'll never hear again. 
(laughter)

 But indeed four weeks later, the telephone rang and he said come to my office. I want to do something for organ donation. So we had the idea of giving the donor medal, which our current governor, Doyle, is doing it. And he's doing it with greater joy every year. And we very much appreciate it. So this connection between Tommy Thompson and myself started a chain reaction, because first it was the Wisconsin capital, and then he moved to the capital in Washington, D.C. 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 a word for a fairly sophisticated way of getting a product quickly on the market. And we had consultants from all kinds of life. People from Toyota, IBM, etc., they told us how to get something done quickly. So the connection between the Madison capital and Wisconsin became very effective and a giant organization took place. There were some conferences where more than a thousand people listened to how to get more organ donors. Let me just go back. What is our problem? Do we really have 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 100 patients and ask how many of them could have, under medical criteria, could have become organ donors. And let's say, if 50 of the ones who could have become organ donors, actually are organ donors, then you say you have 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. You can see here, and it happens to be the University of Wisconsin, and that was before the Collaborative started. We were high up. We had a conversion rate, I believe it's about 70% or something like that, maybe a little bit higher. 

And then you go down. This is the 60, or so, mark. The majority of the hospitals around the country were below. These hospitals, for instance, and these are not the lowest ones. This is just how it goes down. They could almost double or triple the organ donors they had. So we knew that there are more organ donors available. So this collaborative started, I think, it was in 2003. Tony D'Alessandro was one of the leaders, it started about here. Before that, for many, many years organ donations had been stagnant. 

And look what happened when the collaborative started. It started to skyrocket. First collaborative, second collaborative. I mean, it just skyrocketed up into this system. And see how successful it was. And the other measure was, now you see where the red line is. The red line moved over, more hospitals actually made the conversion rate now. At the beginning it was here, just a few hospitals, maybe five or ten, maybe, now more than half made it. Still there's a long ways to go, but you've made huge progress in about three or four years and the collaborative continues. And the whole nation, not just Wisconsin, is benefiting from that collaborative. 

Now waiting for a transplant organ is very stressful. And for some people, it's actually a death sentence. Because there are deaths on the waiting lists. And in some patient populations, such as diabetics, the death on the wait list is worse than the death rate for patients who have colon cancer. I will show you an example later. You are lucky to live in Wisconsin. Why? Because Madison has the shortest wait times of almost any transplant center 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 you have to go on dialysis, and it doesn't make a difference what kind of dialysis you take, after 12 months, you have about a 20% chance of dying. If you go at five years, you have about a 75% chance of not making it, on dialysis. Dialysis is a death sentence for diabetic patients with kidney failure. Now, if you now get this life-saving kidney or this life-saving kidney pancreas, let's see if we can project it. It doesn't move forward right now, but we can do it this way. For instance in Madison, you have to wait on average four and a half months. So in Madison, you would get your transplant about here. This is the average wait time for a simultaneous kidney pancreas. So basically, nobody would die on the wait list. 

This is a very, very good center, which has also very short waiting times. But it doesn't always work out that way. This is a reasonably good center, a large Midwestern center where waiting times are short. It gets worse, this center, about 30% of the patients are dead before they get a transplant. But look at this one. This is a large center, actually it's San Francisco, UCSF, 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. And this is how important, among many of the reasons, how important it is 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)

 of you go to Wisconsin, you're lucky. You don't have to play the Wisconsin lottery to get a transplant. You just have to do what many, many other people have done for you, sign up for your donor card. And if it should be really happening, don't take your organs to heaven. We need them here. You have seen the bumper sticker before. Now, that brings me to another topic, which is a live donor. And anyone, especially kidney recipients, where it's very frequent, who have a live donor, this is really winning the lottery. Because live donors have a graphed life expectancy from twice to three to four times as long as cadaver donors or disease donor kidneys. 

So getting this kidney almost gets you an assurance for a long happy time with this kidney. Because of the compatibility of the quality of the organs, people need less of the immuno suppressive drugs, so they have fewer side effects, fewer infections. And the risk for the donor is extremely low. For kidneys, we are performing now the laparoscopic technique, where the camera is being put in. The incision is about so long. It's low on the abdomen, and if a younger lady donates, 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 with live donation here. You can see the total number of kidney transplants in blue. And I would say about 35% are live donors. 

Around the country, there are now more live kidney donors than diseased kidney donors, by about, I think, 60:40 ratios. If one out of 13,000 Americans, between the ages of 18 and 65, would donate a kidney, the waiting list would disappear tomorrow. So live kidney donation is very important. Here's a successful example. They just started college together, these two sisters. One got kidney failure in college and here they are 38 years later. Who can tell who the donor or recipient is? It was a perfect match and they're enjoying life. I see them once a year, when she is coming. She's in a study, the recipient is, she gives blood for us and this kidney was a lifetime investment. 

These matched kidneys are hard to come by, and I tell you there is one operation where I personally have problems falling asleep because I am nervous. This is when I do a live donor that is a perfect match, because I know if something bad happens during surgery, or there would be a complication, I would feel very, very bad or guilty of changing this patient's life. So nothing bad can happen. These operations have to have a 100% success rate. As far as live donors is concerned, one of our legislators, who unfortunately is retired now, came up with the idea a few years ago that we should make life a little bit easier for the live donors. He introduced the first bill where patients get a tax break if they're a live donor. It's a small amount. It's almost symbolic. But at least it's a gesture that the government is honoring these individuals. The last time I talked to him, he told me that 23 states either have that law now, 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. Now sometimes live donation would be wonderful in a family, but it turns out that the best donor doesn't have the right blood type. As you know, you can only transplant across certain blood types, just as transfusions. For example, you can't transplant an A to an O, or a B to an A. And it just happens that the best donor in the family has this non-matching blood type. Like here. This is a pair of sisters. 

One, the recipient has B, and the donor has A. So unfortunately, they cannot be used as a donor. But here are two friends. They just have the opposite. Now why not get together and do a crossover. 
(light laughter)

 This is called a paired exchange from transplant to transplant. It really doesn't matter. They're young people. 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. We have other new ways like taking antibodies away, which associated with these blood groups. On the other hand, there might be once in a while... 
(laughter)

 There might be once in a while a problem, which is unforeseen, but it hasn't happened to us. I would be remiss if I didn't talk a little bit about transplant science. I'm going to, for the insiders, it's no news, but I see Millard Sussman in the back, a member of the Academy. He will remember that actually the origin of transplantation biology is right here in Madison, Wisconsin. There is something we call the holy grail of transplantation, which is transplantation of an organ without the need for this powerful side effect, the immuno suppressive drugs. 

That would be what we all want. Transplant an organ and we wouldn't need these immuno suppressants. And the basis for that, that this should be theoretically possible was laid here right in Wisconsin. Remember, it was 1945, I don't think anybody will remember him. His name is Ray Owen, Ray was actually in the School of Agriculture. He was much more interested in pigeon genetics, but he needed money. And the Wisconsin Farmer's Association gave him a $5,000 grant to study blood groups in cattle, because they wanted to identify freemartin cattle. We are in Wisconsin here. 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, which is being transmitted through the placenta makes the female sterile, but the farmer, of course, doesn't know that. And it will raise the cow, but the cow will not have calves. So they wanted him to study if there would be a test to identify this early and what he really found was... Here's the building. What he really found, and what 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 to the other in utero, so they exchange constantly blood. So they actually transplant each other in utero. When they are born, see this is just a schematic representation, when they are born, you can actually transplant, even if they're not identical twins. If one is a boy and one is a girl, you can transplant skin. 

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 antigens, by sharing these blood cells, which made them unresponsive to the transplant. And this was a discovery 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 for transplantation." He's a very humble man, who's now living out in California. I had the pleasure of meeting him several times over the last few years. He's 91 or 92, in great shape. 

And we discovered this letter and this letter was written by the giant of our field. He was the dominant figure in immunobiology in the last century, something like Watson for the DNA science. Sir Peter Medawar was the giant in our field, in immunobiology. And he wrote that letter to Ray after he received the Nobel Prize in 1960. That's the letter he wrote. I'll read it for you. "My dear Ray, Of the 500 letters, I have had about the Nobel Prize yours is the one I most wanted to receive. I think it is very wrong that you are not sharing in this prize; the only consolation is that all your professional colleagues have a perfectly clear understanding of the fact that you started it all..." Right here in Madison, Wisconsin, the School of Agriculture. So we have a little history. 

Here are the giants of transplantation. Some of them I know very well. This Roy Calne, who discovered cyclosporin, and was a great liver transplant surgeon, and was one of my ski students. That's how I wiggled my way into these laboratories. I gave ski lessons to these guys. 
(laughter)

 Tom Starzl is now 82, a great liver transplant surgeon in Pittsburgh. I never met Jim Hardy, but he actually did the first heart transplant, the first lung transplant. Everybody heard it happened in Cape Town with Christiaan Bernard. 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 to the operating room... for heart procedure." The patient signed it. Can you imagine in our day and age of informed consent? 
(laughter)

 And he did the first lung transplant, as well. this was an enormous talent, Richard --, from Minneapolis. He did about everything. Unfortunately, at age 52 died jogging in perfect health, and could not end his career. 

Chris Bernard, who did the first heart transplant. I met him once. I made sandwiches for him in Germany when he was visiting with his girlfriend, Lollobrigida. Anybody know Lollobrigida? 
(laughter)

 All right. He left medicine and enjoyed the Dolce vita a little bit. And here's John --, who actually became a very good friend of Ray. A very humble scientist. And then we go all the way back, actually I have not met him. 

This is Alexis Correl, who first taught us how to sew blood vessels together. Sir Peter, I talked about already. I got to know him, luckily, very well. He had a bad stroke, but he liked to come to the ski meetings in Austria, which I already mentioned. And his wife at the age of 62, tried to become a skier. And everybody was worried about her. I had to become her ski teacher, and look after her. And at night, we were sitting together by the fireplace. I had a chance to talk to Sir Peter and learned immunology from him. Joe Murray did the first successful kidney transplant. 

Saw him last year at a dinner in Boston. He's now 83 or 84. Wonderful gentleman. Rupert Billingham was a basic scientist who worked with Medawar. Here's my hero, Folkert Belzer, who really started transplantation here at the University of Wisconsin, and who got me involved in transplantation. This is just a scheme of the immune response of a transplant. How complex it is, and where all these drugs that patients have to take interact with the immune system. Incredibly complex. This is what one of our patients showed us in clinic, what 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, we can unravel the secret of Ray Owen, and we can trick the immune system so we don't need it. And we have some very talented people in our group who are thinking about ways to accomplish it. We have to get away from the side effects. 
(laughter)

 But I have to tell you one thing. When I walked in the 1980s in the University Hospital, and down to the cafeteria, I could pick out everybody 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 so much better. This is just an arsenal of those drugs. This is my little favorite here. Last year they sold for, I think $1.9 billion, and I forgot to make a little contract with them when I developed the drugs. 
(laughter)

 Just 1%, you know? I would donate it to the Med School, Paul. Okay? 
(laughter)

 Of course. 

Or the research building. But see, that's what I mean. He gets the same drugs now to keep his kidney in, but he looks pretty good, and he doesn't look like a transplant kid anymore. So we got better in adjusting his medication. Our patient will not have to take the immuno suppressants when she grows up and goes to college. Nobody will notice. Now kidney transplantation is not so spectacular when you think about survival. And until a few years ago, we thought, I can go on dialysis or get a kidney transplant. Of course, it's a little bit 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 line, you have better survival. See, when you get a 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. It's for everybody, 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, the better for the patient. We have a few world records, there's actually a Guinness Book of Transplant Records. And see here, we have the University of Wisconsin has the third-longest kidney transplant life. The brothers from Green Bay were transplanted in the late '60s. A little about organ preservation. I have to talk about organ preservation because we are in Wisconsin. I told you, this is my hero. One of the best surgeons I have ever seen. Belzer built up 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. He constantly came in weekends to do office work. And he called you in and he had a new idea. Most of them were crazy, but his brain never stopped to his last day. Unfortunately, he died too early. I would have loved to have him around and 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 they put the kidneys in. And they look a little bit fancier nowadays. They look a little bit more plasticky, glossier, 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. We try to transplant them as early as possible. But it was the first time we could really keep the kidneys a little bit longer for the recipients to come in, and so on and so forth. Major progress. And then he had the big hit in 1985-86. Very few people know the story, why he made the discovery. 

I started to do more pancreas transplants. He wanted to help me and make sure I don't make too many mistakes, so he came in. Usually, I did it at night, because they were done on an emergency basis, you couldn't preserve them. And finally he called me into the office and said, "Hans, I'm getting sick and tired of coming in at night. I spent my whole career to preserve organs longer so I can operate during the day. 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. We tested it on the pancreas, 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. 

The university made 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. This liver was preserved for 26 hours. This was a huge sensation. Belzer made a presentation in Pittsburgh about 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, which has always been my hobby. 

Pancreas transplantation is for severe diabetics, especially the ones who have kidney failure. We know now that if a patient, a diabetic patient gets a kidney alone versus a patient who gets a kidney pancreas, that over ten years, we gain about 20-25% in terms of percent in survival. So having a pancreas and having normal glucose control, and I know at least two patients with a kidney pancreas who are sitting in the audience. It's really a very nice thing to have. Not have to worry about this glucose fix, not having to worry about the ups and downs of glucose values. It's really appreciated by the patient. And John Pirsch, our transplant physician, who sees, every year, a few thousand patients in clinic, tells me that these are the most grateful patients he has. Kidney pancreas transplantation is a wonderful thing. You can see here. When they are on the waiting list, these are the people who are kidney pancreas 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 for a kidney pancreas. These are national data. Now, if you want to become a little more sophisticated, and you don't want to have this big operation, you have to see Luis Fernandez, who is also in the audience. He does things a little bit smarter. He takes these little islets out of the pancreas which make insulin, extracts them, it's a very complicated process. Sometimes they work a day or two days before they have the right number and quality of islets. Then they go to radiology, or to the operating room, and they stick a needle in the ultrasound guide, a fluoroscopy, into the liver, a very fine needle. 

It can be done under local anesthesia. And they infuse these cells into the liver. Now this is, for many, still considered experimental. We do not know what the long-term results are. But I'm really proud to say, if you look at our numbers, which are not large in comparison to some of the earlier ones, but our ratio of success to the number of transplants performed, is probably one of the highest in the country, 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, this would be an alternative procedure to pancreas transplantation. 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 contains a few other elements. And we want to transform your diabetic liver into a pancreas and have it make insulin. Over the last year, Tausif has made very nice progress. He has now a large number of animals, who do clinically quite well. And hopefully if the progress with the work continues as it has been, we might, one of these days, before I retire, go into clinical trials. Finally, perhaps what I am proudest about is our training program. We have, most likely-- And there are a few Fellows in the audience. 

You can boo me now if I lie. Probably, the most competitive surgical training program for young transplant surgeons in the country. Right now, we have them stacked up on the waiting list until 2011. And they stay with us for two years. They become excellent transplant surgeons. And many of them, just to point out a few are already running large transplant centers of their own. They all have gotten great jobs. Alan Reed, let's see if we find him. He's not very small, so we should find him easy. In the middle? 

I have a bad angle here. Where is he? 
(various responses/suggestions)

 There he is! I told you he is not small. He is now running the Iowa program. They all have done really, really well. This is probably what I consider my proudest achievement, that we have trained so many good young people. And this is the end of my talk about transplantation in Wisconsin. Thank you very much for listening. 

And thank you much for stopping by. 
(applause)

- Thank you very much. That was enlightening, fascinating. I invite the audience 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? 

- It seems like one of the real key problems in transplanting is getting donors. 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. Whereas, a number of other countries around the world where they have an opt-out system, where everybody in the population is a potential donor, unless you say I don't want to be. I'm wondering if you could comment a little on that, and if we could encourage legislators to develop opt-out systems, to get a larger donor base. 

- Did everybody understand the question, could hear the question? Basically, there are countries in Europe, unless you specifically state that you don't want to be a donor, if an accident should happen, you're brain dead, and you're admitted to a hospital, you will be automatically considered a donor, and there will be no family consent. It's called presumed consent. Now it was first used in Austria and Belgium, as far as I know. There's a modified version in France. I think there's some success of these programs. But the success is not quite overwhelming as one might think. 

So, also, given the diversity of the population in the United States, it might be much more difficult to have everybody agree on that sort of approach. These are small countries, Austria, maybe 10 million people. 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. What we really often refer to as a very successful model is the Spanish model. The Spanish model has individuals, physicians usually, in the hospitals, in every hospital, more or less, who specifically do nothing else than look for organ donors. It's obviously a very costly model. And somebody got the Spanish government to buy into it. Spain is indeed the most successful, as a country, as far as organ donation is concerned. 

They are still not as good as Wisconsin. 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 we do. The better the relationship with the hospital, with the doctors, with the hospital administration, all of these hospitals, Wausau, Marshfield Clinic, Marquette, the better we do. So it is really a function of education outreach and being familiar with the people. It's very costly and time consuming and hard work. Sir? 

- Dr. Sollinger, I'm a little confused on the donor success at getting a transplant. You talked about the local-- be better off here in Madison and southern Wisconsin. I thought there was a national list and that when a donation is made, that donation goes into the national list. Then wherever you are on the priority of the national list, then that was the only way that you could get a transplant. 

- It's very easy to be confused because 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, if you have a donor and you have the appropriate recipient in your reach, with the exception that there is somebody, for instance in Chicago, who is what's called a status one, the highest urgency for a liver or for a heart, and we don't have somebody with that urgency, we would send that liver, then, to Chicago. Otherwise, organs stay local, with one exception for kidneys with the perfect matches, which are rare, perfect matches. They are being sent to patients around the country. 

But the majority of organs are being used local. I think that's the proper way to do it, because once you would take the local incentive out, I think it would be much harder to get people energized to work for organ donation, if most of the organs would leave the state. Most of it is local, some of it will be shared, depending on the medical condition, as well as the matching conditions. Is that clearer now? 

- Yes, with one exception. What about family members giving to another family member? Is that automatic, then? 

- They decide where they want to have the transplant. That's entirely-- We have situations, for instance, where the donor lives in Madison and the recipient lives in Chicago. And the donor might say, I don't want to travel to Chicago, then the recipient comes to Madison and we do the operation. 

It's nicer here anyhow. But that's an easy one. So, yes, sir, you have been waiting. 

- Thank you, doctor. Could you give me your thought process for an individual who has diabetes with chronic kidney failure, yet is a few years away, possibly, from dialysis. How that person may end up on the transplant wait list. And is that a larger, is that number increasing here at the UW? 

- It really depends what our donor situation is. The length of our waiting list for certain blood types can fluctuate. For instance, right now the wait time for a blood type A, if you're a blood type A, consider yourself lucky, it's very short. 

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 certainly be in touch with a good nephrologist watching you. And I would say it would not be too late if you have a creatinine of two. I assume you are referring to your own situation, because that's how your question sounded to me. If you see me with a creatinine of two, then we could make a plan. Then I can tell you, let's get you're creatinine every three months and get a trajectory so we can predict when you might reach dialysis, and then we put you on the list. 

We know what the wait time is, so we get you well before a transplant-- before you actually 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? 

- Actually, we in Wisconsin, we are proud. We transplant about 50-60% preemptively. National data have shown that preemptive transplantation adds about 30-40% to the lengths of their expected survival. Preemptive transplantation is the best. In addition, you save yourself this shunt business, and everything, which is not very comfortable. So two, is about where I would get alert. Yes? 

- On your first or second slide, you had a chart, that I may have read incorrectly. But what I read was, that the number of transplantations was greater than the number of donors. How does that work? 

- We have two kidneys. A donor has two kidneys, right? So from one donor, we can transplant two patients. Or, has a liver and a pancreas and two lungs and heart. So if you really have a multi-organ donor, we can transplant about six people. That's how it works. Yes, Jessie? 

- Can transplants ever be used as treatment for someone with pancreatic cancer? 

- No, unfortunately not. When somebody has pancreatic cancer, could you do a pancreatic transplant? No, transplants cannot be done for cancer. I get this question quite a bit. I get calls from patients who have pancreatic cancer, but that's unfortunately not possible. Yes? 

- I have heard the answer to this, but... 

- Can you identify yourself please? Please stand up. 
(laughter)

 Say who you are. 

- My name is Lisa. He put a kidney and a pancreas in me 11-1/2 years ago. Is that what you wanted? 
(applause)

 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, because of him. 
(laughter)

- There were many murmurs of "why?" to your answer that no, pancreatic cancer cannot. 

- Oh, yeah the reason is that the overwhelming majority 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. So if you would remove the cancerous pancreas, there would be cancer cells sitting all over and if would do a transplant, we would put the patient on immuno suppressive drugs, and they would even die faster. So that's almost true for all cancers. You can't transplant in the presence of cancer because of the spread of the cancer cells. Yes? 

- Why is the number, the need going up so fast compared to the number of donors? 

- Well our patients are getting older. That's one reason. Actually, our growth population are the elderly patients. There's hardly any increase in the patient population between 10 and 30, as far as need, but as patients get older, they get sicker. And 20 years ago, for instance Dr. Belzer, when he was 50, said we're not going to transplant anybody over 50, because 50 is terribly old. Okay? 
(laughter)

 But when he became 55, he said okay, let's transplant up to 55. Okay? 
(laughter)

 But now, we got so much better our cardiologists, our anesthesiologists, our infectious disease people, our drugs, not only just the transplant drugs, but the antivirals, antibiotics got so much better that we can take on a higher risk population. So now, the typical patient for us, is over 50 years old. So that's the population that's growing. And the baby boomers getting there now, and that's what we're facing. Yes? We have so many questions, I want to do it methodically. Sir, please? 

- Mine's about aging donors. Is there any general upper age limit for donorship given that many older individuals have some kind of degenerative disease that might preclude them? 

- You know, I hesitate to give you a protocol type answer, because there are 80-year-old people who just completed the Boston Marathon. And they are probably very good organ donors. And there are 50-year-old people who have smoked all their life. They have hardening of the arteries. They already have bad kidneys, and maybe drank a little bit too much, and the livers are not good. So let's not have any rules at all. Any questions, call our OPO, if there's a donor situation or something in the family, we have specialists sitting by the phone and they evaluate every case individually. In general, 70 to 75, unless the patient has a serious illness is quite acceptable, I was just told that a 92-year-old kidney was transplanted in Germany, so these things are possible. We have to look at case-by-case. That's why we have people 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 donors, living donors, do you think it's worth doing something like that to increase the number? 

- Oh, yeah. I personally think the altruistic donor, she was asking, did everybody understand the question, or do I have to repeat it? Everybody heard it. The lady was referring about altruistic donor. 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, because they have no pressure. 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. She gave a part of her liver to somebody. Just wanted to do something good for a child. Yeah, this would be wonderful if we had more altruistic donors. Right now, we cannot talk about compensation for donors, because the Justice Department says it is illegal. But there are people in the country, in discussions even about compensating the live donor. But I don't want to get into that now, because that is still a hard topic. 

I know what side I am on. But altruistic donation is wonderful. Yeah. Thank you very much again. 
(applause)