"I mean why a little ole insignificant little fellow like me turns up to run the whole United States transplant network, that was scary. You know, if I'd stopped to think about it, I would've probably passed out. But as it was, I did it and I enjoyed it and I knew I was doing something good."
Gene A. Pierce was Executive Director Emeritus of the United Network for Organ Sharing (UNOS), a position he held from 1986 to 1995. Earning a bachelor’s degree in chemistry from Randolph-Macon College in 1958, Pierce had no medical background when, in 1964, he was recruited to the Medical College of Virginia Department of Surgery. The Chairman, Dr. David Hume, was leading one of the earliest clinical transplant programs in America, and hired Mr. Pierce to be the department administrator. In 1969, Hume, along with Dr. Bernard Amos, a Duke University immunologist, initiated efforts to organize transplant centers to share kidneys and clinical outcomes data. Thus was born the South-Eastern Organ Procurement Foundation (SEOPF), which became the first organization in America dedicated to a computerized matching system linking organ donors and recipients. Gene Pierce was its founding Executive Director and led SEOPF as it became the progenitor organization of UNOS. He retained a wealth of personal knowledge and experience in the field of organ procurement and transplantation, and nurtured extensive contacts throughout the world generating information and goodwill on behalf of organ donors, transplant recipients and many relevant organizations. Gene Pierce’s alma mater, Randolph-Macon College, and Southern Vermont College each awarded him honorary doctoral degrees in recognition of a distinguished career and his numerous lifetime achievements. He passed away in August 2017.
Interviewer: While the ASTS is blessed with a rich history of its surgeon members, we also know that there are very prominent professional individuals who are not surgeons who can be with us from time to time. Chimera Chronicles is honored to have Mr. Gene Pierce. Mr. Pierce, who we should probably call Dr. Pierce because he has two doctorate degrees, each of them an honorary doctorate, a Doctorate of Humane Letters from Southern Vermont College and an honorary Doctor of Laws degree from Randolph-Macon, is in fact the founding executive director of the Southeastern Organ Procurement Foundation and of the United Network for Organ Sharing. Gene?
Gene Pierce: I'm Gene Pierce. I was a former executive director of the Southeastern Organ Procurement Foundation located in Richmond, Virginia and also I was the founder and executive director for The United Network for Organ Sharing located in Richmond Virginia.
Interviewer: How and when did transplantation intersect with your life?
Gene Pierce: My effort actually began working with Dr. David Hume, who was one of the pioneers in the field of kidney transplantation. And I happened to have worked with him as Administrative Director of the Department of Surgery, which brought me into the field of transplantation in no uncertain terms.
Dr. Hume had an interest in developing a transplant program for the entire country, because the number of kidneys that were available to transplant into the few people that were actually awaiting a transplant at the Medical College of Virginia—it was difficult to get these donors.
So he wanted to develop a system whereby people could donate their organs prior to their death and have this whole cadre of people available for the number that were going to be seeking a transplant because he could tell in the future there was going to be a tremendous need for transplantation of kidneys. Of course later on, hearts and livers and other vital organs were important to be donated also for transplantation. But Dr. Hume was the pioneer in pushing that at the Medical College of Virginia. Previously he had been in Boston at The Brigham, and that's where he first got started in transplantation.
Interviewer: You made a transition from the administrator in the department of surgery to an entirely other job. Tell us a little bit about that.
Gene Pierce: Okay. Well, Dr. Hume, when he came to the Medical College of Virginia, wanted to develop a program in kidney transplantation. Later on, he brought in class A people for hearts and livers, Dr. Lower for example in hearts and Dr. H. M. Lee and others that were vital to his program. He had a training grant for six additional surgeons to develop transplantation. Hume wanted to expand, and talked with a number of individuals who were also interested in transplantation: Dr. Amos at Duke and Dr. Williams at Hopkins, and all the way on down to Emory University, and so a cadre of people from about 10 transplant centers formed a group called the Southeastern Regional Organ Procurement Program, SROPP, initially. And that group of people saying we want to share kidneys to get better results for the patients developed a system whereby we put the potential recipients on a central computer system. Whenever a donor was available anywhere from Emory University up to Johns Hopkins, we could feed information into a central computer and get the best recipient for that particular donor organ. And then we had to get the donor organ to that recipient for the transplant. It worked very well; the results were improving graft survival because of better matching of the donor and recipient.
Interviewer: How did the Southeastern Organ Procurement Foundation grow?
Gene Pierce: After the development of SROPP, we'd moved out of the Medical College of Virginia because we were an independent, free-standing organization, so we obtained a house on Monument Avenue and that's where we started developing the whole system from the ground up as the Southeastern Organ Procurement Foundation, SEOPF. Officers were elected, and we started an organization, a business if you wish. When we organized, we had to get somebody that was going to really carry forth the organization of SEOPF, and that was Dr. Keith Johnson. He was head of nephrology at Vanderbilt and developed organizations throughout the country for people needing dialysis, and he was a great president. And it was expanded and growing; from the initial five programs, we became 15, 20, 25, and later we got up to about 45 transplant centers in 22 states. So that was a rather significant growth pattern, people recognizing they needed to share organs for better results and that's what our incredible database showed. We were able to share kidneys and then livers, hearts. I worked with Dr. Lower in the procurement of the first long-distance heart retrieval, out of one of the northern states to bring down to Richmond for the heart transplant and that was a first. So we grew and grew, and while it was called the Southeastern Organ Procurement Foundation, we were up into the New England states and we were all the way over to California; so, that was the Southeast at that time.
Interviewer: Excellent. Now, I want to explore the concept of starting UNOS; that was your idea.
Gene Pierce: Well, we had members, as I stated earlier, all the way to the West Coast and up into New England—and I realized we needed to have another organization that went beyond the Southeast, because even though we were called Southeast, we had already metastasized over to the West Coast. So I talked to a number of the transplanters in other states and they all agreed that we needed to do something. So we had a meeting in Chicago, in a very cold month, and this was the founding meeting of the people that later started UNOS. That year was about 1977, I think. About 40 people there represented all these different programs, and, yes, they wanted to form UNOS. So that's what we did, and we became a national system at that time. And SEOPF remained itself, maintaining its own membership.
Interviewer: Let's take then the next step and it would have been in the early 80s, before the Gore bill, when SEOPF and UNOS were extant and they had similar yet distinct roles. I want then to get into how UNOS changed and I remember after the two places on Monument, the place then out in suburban Richmond and it got so crowded I think you wound up sharing your office with two cubicles or something.
Gene Pierce: (Laughing) Yeah.
Interviewer: So there were changes then in UNOS and ultimately SEOPF became subsumed to UNOS and I want to hear that story from you.
Gene Pierce: Well, surgeons, nephrologists, and immunologists, realized that we needed to have a national system to include the entire United States. So they developed it in the 80s, and it was a time when they all recognized collectively that this needed to be done. At a meeting of the American Society of Transplant Surgeons, which was in Chicago, they decided that they wanted to support the concept of UNOS and Dr. John McDonald became the first president of this newly expanded organization. I was named the Executive Director, but I wanted the surgeons to take hold of this organization, not me. It had to be them. And they wanted to do it and Dr. McDonald was very profound in his desire to have the doctors involved in it. And of course, I promoted that very strongly, because my being a non-doc was not the most satisfactory way of bringing all these doctors together, quite frankly. So, Dr. McDonald was able to get the medical people throughout the country to support this concept. I was just the instrument for them to get this thing together. He was steadfast in promoting a national system and he worked very hard, and there were others also that were committed to a national system.
Interviewer: Okay. I want to go on from there, how UNOS developed with committees, leadership, interaction with the government.
Gene Pierce: Well of course one of the major factors when we were dealing with developing this UNOS system was having to deal with the government because they were our godfathers, if you wish, of the whole system. And you had to satisfy them in order to be able to unify the system under the aegis of the government, and we had to face that. You didn't want to fight 'em. We tried that at one time and we got blown away. (Laughing) So we realized really quick who paid the piper. And that was okay; they were a good group of people to work with, and we were able to get UNOS started as a national system. We divided the country up into regions and we got one of the docs as the head of each region, and they were the ones responsible for gathering all of the transplant programs together as a region.
And I remember one of the region meetings that we had in Texas. The Texans were always a separate group; great guys, wonderful guys, but they liked to do things independently. So we were having our organizational meeting in San Antonio, proper place to have it, right across from the Alamo, and they were talking about organizing this system. One of the surgeons was trying to explain it, and I thought I had explained it to him well enough and he just finally said, "Gene, come up here and tell us why we have to do this." (Laughing) So I started out by saying “Now see you have to do it because the feds have said you have to do it, and it's much better to take the leadership voluntarily than it is to have them step on our necks and make it a real disaster.” So they were okay with that. Texas and Oklahoma were the most outspoken about resisting this, but they all came on. We would have these organizational meetings for the region and I had to go to every one of these things and you know, I got zapped a lot, but nonetheless, the bottom line was the same: it became reality.
Interviewer: I do want just a couple of comments about how committees developed and how the outreach went beyond the surgeons to the coordinators and that kind of thing.
Gene Pierce: One of the interesting aspects of the national system was the development of committees that ranged throughout the country. And each region—there were nine at the time and later two were added—had input into each of our committees, so we had broad representation. No region could say they were not involved because each had a representative on every one of these committees. And there were nine permanent standing committees. We had the tissue typers, the nephrology group. There was a surgeon group. And there were also the coordinators of the public relations people, there were nine of these in all and they covered every aspect of transplantation. They worked very hard. Dr. Frist, who became a senator later on, he chaired our public relations committee initially. These people wanted to be involved in these committees and they were very strong people.
And the surgeons especially were involved in these and they would get upset if they felt that something was being done that they didn't know anything about. And so I had to make sure everybody was informed. (Laughing)
Interviewer: Let's go to 1984 and the Gore bill (The National Organ Transplant Act, or NOTA). I was in Tennessee at the time and invited Congressman Gore to speak at SEOPF; you may remember that day.
Gene Pierce: Oh yeah, I do.
Interviewer: And you may or may not want to talk about Gore, but I'd like you to talk about the NOTA. And I think SEOPF was first involved in 1983.
Gene Pierce: SEOPF had been developing for a number of years and when the federal system got involved because of Congressman Gore’s interest, we applied for the position which UNOS got as the national system. And so it was from there that we got support from the feds to get under way and organized in a way that they thought it should be.
Interviewer: Please chat about the year or two just prior to your retirement and the circumstances that you faced in a mature UNOS with a mature government oversight.
Gene Pierce: Okay. In 1995 was my retirement age and I really was looking forward to it because I had been in that field for a long time and had taken my share (laughing) of the beatings. But I looked back and I thought you know, we've done a pretty good job, to bring the whole United States transplant people, group, into one organization. That was really important. Even the surgeons who were so prominent in this development, there were some that wanted to maintain their own identity and do their own thing but it was clear that even they realized being unified and united, we could do much better and by being united, at least we had an opportunity to, I wouldn't say fight the government, but to work more closely with them and let them understand that we were a united group and that when they talked with us, that they were talking with the entire group. Now that doesn't mean that we didn't have our differences because we did. But at least we were able to do it cordially and work together for the good of the country. We use that phrase a whole lot, for the good of the country, and when we used to have our meetings with the federal people, they would bring 15, 20 people into this conference room and we'd have three or four of the UNOS people in there. But it was a unified effort; that was the thing that pleased me the most from the standpoint of we had come full circle, from the standpoint of “we don't want any part of that” from the transplant community to “yeah well, we're going to have to do it and let's do it together.” And I could name transplant centers that fought us tooth and nail, but they came around and they supported it totally. So it was a pleasing thing to me personally to see the development of this from the standpoint of “don't touch us, we're doing our thing and we know it better than anybody else and you keep away from us and we'll get our own” to “yeah, we gotta work together on it.”
Interviewer: Tell us a little bit about your family and your personal interests and your personal life.
Gene Pierce: Okay. I'd been in the Air Force four years and went back to college and got my degree. I went to Randolph-Macon; I'm proud of that. And majored in chemistry; 1958, when I graduated. So I went to work with a pulp and paper company in West Point, Virginia, as a chemist. I was there for about six years and a friend at the Medical College of Virginia called to tell me that Dr. Hume was looking for someone to run the Department of Surgery administratively, was I interested? And I had been a little tired at that particular time; I was ready to get out of West Point. And so I called Dr. Hume and made an arrangement to meet with him and I just… to be very frank with you, I fell in love with the guy. We spent three hours in the surgical research library talking and he hired me on the spot and I accepted on the spot. So that was the beginning of our relationship; we had a great relationship. Now, I had a hard time seeing him, like everyone, but nighttime, midnight, we had our best meetings. But it was a great relationship. When he was killed flying his own airplane, it was devastating to the department but it went on. You know, we keep on.
Interviewer: Let's go to family and personal. When did you get married?
Gene Pierce: 1950. Well, I'll tell you; it's an interesting thing and maybe I shouldn't be telling the whole country about it, but my wife and I, we came from a small town in Virginia, Franklin, and we'd lived across the street from each other for a few years in Franklin, and then we moved to different parts of the small city. Franklin was only about 6,000 people but it was a great community. And we had just gotten to know each other, played together and all that across the street from each other, and then, when we got into high school, she turned into a good looking girl.
(Laughing) And I thought hey, you know, what have I been missing here? So to make a long story short, we started going together and then the Korean War started. I had been to Randolph-Macon a year and a half and stopped college right in time to be considered for the draft. So in this little community, the Selective Service people, we knew who they were and I called and said, my friend and I—he had stopped college also—that if our name comes up through the Selective Service, call us because they were running them through basic and straight to Korea they went, as new recruits. So she called one day and said you and Billy are scheduled for next month. So we joined the Air Force and I joined for four years when it would have been two years. But it was good. We got married and she was with me at all times and in fact, we had a child born in Newfoundland and then we had twins born at Bolling Field in Washington. And so we had three Air Force babies and then we had two additional kids, all girls.
But they've been great and they've supported me all the way, my midnight travels, because I committed myself to Dr. Hume; there's no question about it. My wife will verify that. And they all supported it. They all felt it was a great thing that we were doing and when we had our retirement dinner, they were all there, every one of them. And they took on transplantation just like I did because I'm serious, we lived and breathed transplantation in our home. They knew all the doctors, they knew who was doing what and kidneys were going here and there and everywhere. But I mean this sincerely, I give the good Lord credit for putting me there. I mean why a little ole insignificant little fellow like me turns up to run the whole United States transplant network, that was scary. You know, if I'd stopped to think about it, I would've probably passed out. (Laughing) But as it was, I did it and I enjoyed it and I knew I was doing something good. That's it.
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