'
In this Section:
More:
In This Section:

Dr. Simmons

In their own words:

One of the things I do now is worry about anything within our institution that goes wrong, that’s the way I define my job. So if someone gets the wrong pill, I worry about it. And if we do not utilize every organ that is available, that’s a problem, too. So we have implemented a program in which the critical care medicine leadership has become chaperones for the patients who were dying so that they die dignified deaths so that they are given appropriate comfort measure and all of the measure to care for this. But as part of it, you want to develop a relationship with the families. And when you develop a relationship with the families which precedes death, you will find that there are more organs available and this is I think one step in making sure that all available organs are utilized appropriately.

Biography:

Richard Simmons, MD was a charter member of the ASTS and its 8th President. He received his medical degree from Boston University and completed a general surgical residency at Columbia University Hospital in New York, with additional fellowship training at the Massachusetts General Hospital, Harvard Medical School, and Columbia University. Following service at the Walter Reed Army Institute for Research, he spent two decades at the University of Minnesota, where he defined post transplant viral infection and its effective prevention. He was also a pioneer in the design of clinical protocols for effective patient care. Moving to the University of Pittsburgh from Minnesota, Dr. Simmons continues to apply clinical and administrative skills at that multi-organ transplant center and institute.

Transcript:

Richard Simmons: My name is Richard Simmons; I am the Medical Director of the University of Pittsburgh Medical Center in Pittsburgh.

Thomas Peters: And when did you and how did you first become interested in transplantation surgery?

Richard Simmons: Well I was in college in medical school in the fifties in Boston. And in Boston you are very aware of the publicity put out by the local institutions. And though I was not at Harvard Medical School I became aware of the transplantation work at the Brigham Hospital. In those days, Joe Murray and John Marrow and Dave Hume were publicized in the local newspapers when they did their transplants. Murray’s of course got a lot of publicity and Hume’s didn’t, but we were generally aware of it and I thought that was a great thing to be involved in as a kind of childhood wish, even though I was in my twenties. And I thought I would grow up to be a transplant surgeon very early and a researcher.

I was working in the Thorndike Memorial Hospital, which is part of the Boston City Hospital, and was in those days a research hot spot. I was working summers and that combination of doing basic research on the one hand and being a clinical transplant surgeon became an ambition very early, certainly before half-way through medical school.

Thomas Peters: The work that you were doing then was as a medical student?

Richard Simmons: Yes, I had done an undergraduate thesis at Harvard on hemoglobin and so the Thorndike was a center of hematology research. Castle was, William Castle, was a major figure in hematology in those days. And he had a young fellow named Jim Jandl, J-A-N-D-L, who because you might not be able to recognize it, who became a professor at Harvard and he was a young fellow who was interested in hemoglobinopathies primarily.

And so I got a job in the summer after graduating from, from college and medical school was right across the street, BU was right, Boston University Medical School, was right across the street and so it was very easy to go back and forth during my medical school career.

Thomas Peters: Relate for us how then beyond medical school you sustained an interest that ultimately led to transplantation? Tell us about your residency a little bit and where we go from there.

Richard Simmons: Sure.

Thomas Peters: How did you get to Minnesota?

Richard Simmons: A lot of things happened before I went to Minnesota, but I trained at Columbia Presbyterian Medical Center, which I didn’t know much about, but I wanted to go to New York. My wife particularly wanted to go to New York. And it was the biggest hospital in the world, a great big tall building and I was very impressed with that. If you know what Boston University Medical Center looked like in those days, it had three stories and that was a little red brick building.

It was very impressive and it was Columbia and it was a clinical program and I thought that I wanted to go through a clinical program in five years and be out and do my thing. It took a little bit longer than that. And at Columbia there was a… The way they ran their program, they didn’t have mandatory lab time, but they actually had a mandatory lab time. And the mandatory lab time was spent with Paul Russell who had just come from Mass General to be a professor at Columbia, where they were trying to build a research program. So I went to the lab at the time that Paul was just coming, and so I became Paul’s fellow. It was very important in life, my life, that he was there. And you should have him here if he is still able to do that, because he is quite a neglected figure in this society. But he was president on the International Transplantation Society.

And we worked on the immunology of pregnancy, which was essentially the question of why babies weren’t rejected by mothers. And in particular, if you look at the placenta as kind of a skin graft rather than a vascularized graft, we looked at what the barrier might be that interfered with the rejection of the placenta. And it turned out to be the trophoblasts which doesn’t present or express Histocompatibility antigens and we were able to show that in a variety of ways. That was a terrific experience and then in two years or so, he went off to become Chair of Mass General. This was in 1963 or something like that.

And he then invited me when I finished my residency to have a little post-doctoral training program. I had kind of a six month gap before I became Chief Resident. And at that time it was a terrific place. Peter Morris was there, John Burke was there, Tony Monaco became a very close friend, and so I spent six very productive months at the Mass General and met all of those people. That was… you know became interested in anti-lymphocyte globulin and wrote a number of papers on the first use of anti-lymphocyte globulin or serum, ALS, is dog kidney transplants with Tony Monaco and Bill Abbott and Paul Russell. And then when I went back to Colombia, I inherited Paul’s lab. And by the way I did that during the residency and was able to continue work along these lines and did a number of independent pieces of work with Dick Weil in particular, who became a transplant surgeon as well, on the combination of immunosuppressants. It occurred to me that the toxicity of various immunosuppressants would be minimized if we used more of them, more different kinds. And then I was put on the faculty at Columbia and I was kind of recognized as the potential developer of a transplant program there, but I was quite junior. And the fact that I got drafted into the military and was assigned to Walter Reed Army Institute of Research was actually quite fortunate because Columbia was having difficulty developing such programs.

Thomas Peters: Um, actually I didn’t realize you were an alumnus of Walter Reed, so am I.

Richard Simmons: Rare and it was a terrific opportunity, it was really good.

Thomas Peters: Walter Reed was a cradle of transplantation, not many people really know that.

Richard Simmons: It was interesting during the Vietnam War, which is when I was drafted, it was ’66. They told me transplantation was not a military mission and so I became interested in shock and infection and you know had a parallel career in infection in surgery and that was very… It was really quite fortunate. I love the rare and I love the Army. And I went to Vietnam for six months and did clinical research in the Third Surgical Hospital in Vietnam.

Thomas Peters: When did you see your first organ transplant?

Richard Simmons: I first saw my first organ transplant at the Mass General during the six month period. It was 1965, July to December of 1965 and they had done about half dozen transplants during that period of time. It is interesting that Olga Jonasson was there at the same time and Olga and I did the first hemodialysis at the Mass General Hospital in which you poured the salts into the tub and used one of these coil kidneys. And I remember Olga and me putting our arms into the bath to mix up the salt solution for dialysis.

Thomas Peters: So you were the nephrologist as well as the surgeon?

Richard Simmons: Well we had a nephrologist, but he hadn’t done dialysis either and so we became… And so he told us what to do and we went ahead and did it. Then I observed, didn’t scrub, on a couple of kidney transplants at that time that Paul did.

Thomas Peters: Where did we go from there?

Richard Simmons: Well I went back to Columbia and was a Chief Resident, which was kind of a vascular fellowship in those days. You did portacable shunts and aneurysms and bypasses and old-fashioned vascular surgery. And then I went to the Army for two years and then Paul invited me back to the Mass General to do what Ben Cosimi ultimately did and did very well, better than perhaps I would have done it. And he got the sense that I had agreed to come back and I had the sense that -- that was a great opportunity, but I was very attracted to the kind of dynamic personality that John Najarian expressed. I was very impressed by his research with Frank Dixon, which had been done at Pittsburgh, by the way.

I was attracted by this mysterious, domineering character and we met in Paris at one of the transplant society meetings in maybe ’66 or ’67. And you know it was quite memorable, we were sitting at a sidewalk café, and I decided that I was going to marry this guy and did so and agreed to go. Unfortunately Paul didn’t understand this or I misunderstood his commitment and there was a disappointing experience for me to…

Thomas Peters: Leaving?

Richard Simmons: To disappoint him unexpectedly. Of course you know he is just such a great gentleman.

Thomas Peters: So you moved to Minneapolis and that must have been some time around ’72?

Richard Simmons: It was ’68. I had got out of the Army and I went directly to Minneapolis, it was in September of ’68. He had come in the previous year in late ’67 and had you know taken off transplant program and had reorganized. Rich Lillehei and Bill Kelly had been running a kidney transplant program. Such transitions are very important you know, a lot of things happened during those transitions. Frequently you don’t understand the culture you are entering and the change of culture you are leaving and as a young person you don’t understand this at all, actually. So there was considerable controversy of which I was totally unaware and so a number of things happened, and one I learned how to do kidney transplants under John’s direction. That was very good and I began filling in the kinds of things that he couldn’t do as a Chair of Surgery; the day-to-day management of the patient became of interest to me. And so we began using standardized order sets for a variety of circumstances. We used to joke that if a patient came into the hospital with a creatinine of 2.4 and they were 3.5 months post-transplantation and they had a fever or they weren’t on their Bactrim, we knew exactly what the diagnosis was. And we had a series of these standardized protocols; otherwise you would have to instruct every new resident group. That sounds silly now, but that in fact has grown to be a very important part of one’s life, standardizing best practices.

Two things happened, one is we began seeing febrile illness as a part of transplantation. There was a paper by Moore and Hume about death after transplantation from Virginia Medical College and they were describing what we were seeing, but they were attributing it to allergic reactions to the kidney, rejection a very mysterious stuff. And I thought that this was likely to be some kind of infectious disease and working with Bob Good who was at Minnesota at that time and who was a kind of fabulous genius, clinical genius, and a great immunologist, a very important person. I asked him if we could get a virologist and there was no virology laboratory in Minnesota in those times and there was no infectious disease division. So that the surgeons really had to do a lot of medicine and I was kind of predisposed to towards that way of looking at things anyway.

So he found a virologist who wanted to do a fellowship with him and his name was Lopez, Carlos Lopez. And Carlos and I began just doing virological studies on every single patient every single day in order to determine the correlation, clinical pathological, clinical virological correlations between the clinical picture and the virological. We sent all of our material to the state lab, which was the only virology lab in that region and part of the country. And so that for many years the only virus culture of the Minnesota Department of Health was cytomegalovirus. And cytomegalovirus coincided with all of these clinical patterns, not all of them of course, but a vast majority of them. And I think that was probably the most important thing I ever did in my life, which was to try to point out how there were recognizable clinical patterns you could use to make diagnoses and then you could confirm them months later with virological studies.

Thomas Peters: Just to interject what we just heard here was a landmark in clinical medicine and I can recall the days before transplant surgeons really knew what cytomegalovirus was.

Richard Simmons: Oh yeah.

Thomas Peters: And it was you who did that, yeah.

Thomas Peters: Tell us what your day-to-day life was like during those early years in Minnesota. Just what were you doing after you read the morning paper?

Richard Simmons: Sure. You know it sounds very self-important to describe it. I chose Minnesota to go to for several reasons. One, John was a very attractive personality to work with and he proved to be a terrific mentor. Because not only did he provide guidance, but he allowed you to do whatever you wanted to do and I think that one of the reasons Minnesota has been prominent in this area, in the transplantation area, is because John provided a you know crucible of encouraging growth for so many people. He allowed all kinds of ideas to take shape and to prove themselves right or wrong and he was very encouraging. And so John let me do what I wanted to do, but he also wanted you to do something for him.

The second reason I went to Minnesota which is very important to understand for me and for anybody else who is looking at such matters is that Minnesota had in which all of the residents were Ph.D. candidates and all of the residents being Ph.D. candidates, they had to go into the laboratory. And I recognized that from afar as being a great opportunity for me to recruit help, intellectually smart help. I am afraid I called them my slaves and so after you spent a few years there and people got confidence that you weren’t going to steal all of their ideas and take all of the credit, a lot of people came into the laboratory who proved to be quite talented and that environment permitted me to be an idea person and to encourage the research programs of these residents and fellows and to refine their ideas or to steal them if you will. That was really terrific.

And so every day I would… So we would make rounds in the morning and make rounds in the evening and do the regular transplants. And the rest of the time I would sit and think about how we could publish or present or analyze our clinical results in such a way that they became clearer to ourselves and also began basic science researchers. The thing researchers at Minnesota we are not really very startling. I think we made a lot of progress in peritonitis research, but not so much in immunological transplant research. But we were able to use this army of fellows and residents to develop our clinical analyses, so that cytomegalovirus and then Epstein-Barr virus and a definition of the experiences with antilymphocyte globulin or pediatric transplantation and transplantation in infants, the things that John wanted to do, we were able to do the analysis and put forward a series of clinical studies. I used to call them documentary studies; you are just describing what you see. They would call them observational research nowadays and that was I think a major contribution at that time.

Thomas Peters: You were present at the beginning of the ASTS of the twenty-some-odd papers at the first meeting. You were the second author on two and I think a third author on a third one. Tell us a little bit about the genesis of the ASTS, the role that you played.

Richard Simmons: The American Society of Transplant Surgeons, so-called ASTS, I played no role in its genesis and I certainly don’t remember the papers we presented. But in those days, we were presenting papers about the virus infection patters, the various infectious complications, you know the fungal infections and other strange opportunistic, and in particular, the anti-lymphocyte serum, ALS program. And as you know, John, we all were involved in anti-lymphocyte serum and John’s in particular contribution in my opinion was to recognize that giving it intravenously would eliminate many of the complications that Tom Starzl had encountered and that by giving it intravenously and then learning how to titrate it was an important program.

So the most important study we did was an exchange of skin grafts between people who were immunologically normal though they had multiple sclerosis and then we would give them anti-lymphocyte serum as an experiment, an experimental trial of immunosuppression for multiple sclerosis, but we would exchange skin grafts between groups of four or five. What we were able to show is that anti-lymphocytes serum was immunosuppressive in humans because they prolonged skin grafts and prolonging skin grafts is really nearly impossible in humans.

Thomas Peters: So could you do that research today?

Richard Simmons: Could we do that research today? I mean it has been tried to immunosuppress multiple sclerosis patients extensively and nothing have really worked very well. So I think that we would not be able to do that research today.

Thomas Peters: Did you have to have an IRB [institutional review board]?

Richard Simmons: It probably wasn’t called an IRB, but we had an internal review group and an institutional review board which approved the program and we signed all of the papers. We did it an ethically, I think, approved manner but it certainly was not as bureaucratic as it currently is. But it was a good study because it showed that this stuff worked and if you don’t have a… If you don’t know what dose to give; you are lost in such a poorly described, poorly documented efficacious serum.

Thomas Peters: Tell us a story or two from the operating room that is memorable, either funny or hopefully not tragic…You have done a lot of kidney transplants.

Richard Simmons: Yeah, I did so… And I don’t… And you know it has been so long since I have operated, it’s hard to remember. I mean the funniest… story is of course not… Danny Kaye, you people may have talked about Danny Kaye before. Danny Kaye was of course a great entertainer and celebrity and during those last years of his active life he went around and conducted symphony orchestras and he came to Minnesota to conduct the Minnesota Opera, the Minnesota Orchestra and John invited him to come and see a kidney transplant and so I did the donor and John did the recipient.

And John ran into some bleeding and he kept controlling the bleeding and of course Danny Kaye I’m sure was not terribly interested in the three or four hours of controlling the bleeding and meanwhile we were standing around the donor room ready to remove the kidney. So John got tired and they went off to have a cup of coffee with Danny Kaye. And so I went into the recipient room to put my finger on the bleeding, it was you know one of these venous plexuses in the case. And John had melted several bovies, and the tip would fall off and people were commenting about that and we just put our finger on it and waited a few minutes and it stopped bleeding and they finished the transplant. You know that operation tends to be rather simple from a technical point of view and not too many things went wrong from a technical point of view.

Thomas Peters: I’d like to hear one or two remembrance of the early days of the society, the Drake Hotel, the camaraderie and how you view your own specialty society that you really were an important part it, at least on the scientific side for sure.

Richard Simmons: You know it was organized at a time when I didn’t realize it was being organized. So the first thing I remember was that Tom Starzl was giving an inaugural presidential address to me and his point was that you wanted to make this a scientific society, and not a political society. So there it was and so I participated actively and it was great fun. It was held every year at the Drake Hotel in Chicago. They had a room that was just about the right size. And we were very eager to present our material there and it was a principal place for Minnesota to say what it had to say, both I and the other members of the group. And so it was a great party every year, it was extremely well done.

The very early presidents, I think Fred Merkel in particular, provided a very hospitable environment. And it just about fit the room and around the time ’85 or so, it began to overflow the Drake Hotel.

Thomas Peters: How do you think the Society has played a role in advancing transplantation?

Richard Simmons: Well it has professionalized it. Charisma has to become bureaucratized sooner or later and so the… Kind of the early pioneers who were charismatic figures or at least as seen as such now, so I am a part of a bureaucratization. I’m the guy who standardizes the order sets. That was the role that I played in the Society, I was a member of various committees.

And then when I became president, which I think was the sixth or seventh or eighth or something like that, it became apparent that we weren’t doing what the Society is doing now, which is that it has an committee of education, a committee of training, a committee for political involvement, a lobbying group. We didn’t have any of that and so one of the things I did was put together a book in which we try to define the various roles. It’s hard to know how important that was or whether it was carried on. But I remember there wasn’t, we didn’t have an agenda essentially of what the society was supposed to do. And UNOS didn’t exist any longer and you didn’t have… Medicare wasn’t paying for transplants or was just coming in and the… So my little role was as president was to kind of put together what you now take for granted, which is fine. I don’t take particular credit for it, but you had to address certain problems.

For example, the decision not to make this part of the ACGME, I played an important role in that. And Minnesota had been an important center for training and I think the Minnesota training program, which is a perfectly you know bread-and-butter type program now, I think was a good model for the Society at that time.

Thomas Peters: Looking back, can you imagine your thoughts in the time of your presidency of the Society that transplantation would grow as it has? Look back and tell us what you thought the future might be and compare it with what the future really turned out to be.

Richard Simmons: In the early seventies, there were committees of nephrologists and transplanters who were beginning to look at dialysis and transplantation. One of the reasons Minnesota transplant did so well was that Minnesota dialysis did so badly. In the late sixties, dialysis was not an option and so many of the patients we saw were patients who came in with fresh, recently-diagnosed, end-stage renal failure with seizures and heart failure and a variety of problems. So we had a dialysis program at Minnesota which John had hired Carl KJellstrand to do that and he did a terrific job and so I became a member of the various committees to talk about the end-stage renal disease as a problem.

And I remember that some of the discussions that surprised me when I began talking about end-stage renal disease as a public health problem and the nephrologists all laughed. And they said “It’s not a public health problem.” The American Society of Nephrology had not yet been established and as you know, it went from one member to 25,000 members as soon as Medicare started paying for dialysis. And now of course it’s a huge public health problem, you have a solution; suddenly you recognize what the problem was.

We were not thinking certainly, we were thinking in terms of the technical issues associated with liver transplantation and then we had so many diabetic patients at Minnesota due to a fellow named Fred Goetz and Rich Lillehei had done pancreas transplant at Minnesota in the sixties, maybe sixty-six. And they were far more future-oriented than I certainly was. Nevertheless, we had a lot of diabetic transplant patients and this permitted or encouraged Dave Sutherland to develop the pancreas program that he has developed there.

I am not so sure I have drifted, not drifted away from your question. But we were not thinking, I was not thinking about other organs. They seemed to me to be technically challenging and required a much more technically oriented surgeon.

Thomas Peters: What developments would you foresee in the near future for organ transplantation?

Richard Simmons: In many ways, transplantation was you saw a patient, they were sick, you wanted to find a solution for it and you found an extraordinarily expensive, cumbersome solution for it, which is what transplantation is. Wonderfully effective when it works well, but terribly expensive and hopefully not the solution. The solution is in prophylaxis. I think the solution for heart is artificial organs and that we have spent a lot of time when I was at Pittsburgh in developing the organ replacement program for the heart and in fact that has worked out fairly well. And you have ventricular assist devices as a routine procedure in Pittsburgh and many other places; you know I am not familiar with it.

But transplantation carries its own defeat with it, which is the lack of organs. It’s not original thought. And there simply is never going to be enough organs to suit the problem unless we develop some kind of artificial kidney growth system. My guess is that this is a really long way off, though certainly attempts are being made. So my impression is that transplantation has not changed except in detail in the last decade or so. People have gotten better at putting them in, it’s safer, immunosuppressants are improved. But the better you get, the less successful you going to be, because you end up with simply a lot of people who do not have access to what they need.

And then when you look at the healthcare problem, transplantation is part of the healthcare problem. It simply is kind of a remarkable example of what you can do. And if you can do this kind of thing like replace the liver, heart, kidney, intestines in anybody, then of course why not do more and more and more for people whose life is threatened? And so I think the biggest problem in transplantation is going to be deciding who deserves the organs and that’s a terribly difficult problem because its not one that society can decide. It tends to be delegated to the individual centers and their own philosophical, if you will, or ethical point of view.

Thomas Peters: There is discussion now about paying living donors for kidneys, can you comment perhaps on some of the ethical matters that you see as important?

Richard Simmons: Well you know, Roberta Simonson who was my wife at the time, who is since deceased, was quite a well known medical sociologist. And her first or her second book on which I am a co-author, basically for my editorial talents, was on living donation and its ethical implications, psychological, and sociological issues, and this was put out in, I don’t know ’72 or so. Of course nobody refers to anything anymore that was done, but it was a useful subject at the time because it became apparent that by-and-large patients, people, were willing to donate if they thought it was going to be successful. And when it was successful, they gained in self-esteem as it is now called and they… It was okay.

Now I think that everything in this world has its price and there is nothing unethical about paying for your dinner or providing an additional incentive or a counter-incentive, something against the disinclination. So I think Arthur Matas’ approach which is to provide financial incentive for cadaver donation is important and useful. I think altruisms is great. But altruism, it’s been shown if you pay an appropriate price, altruism goes up. And I think providing relief in some way. The danger of course it that we’ll be... Is already with us, we put people to sleep and take out their kidneys and it wouldn’t be surprising to find that people are being murdered for their organs. But that is occurring whether or not you pay for it, so I don’t have an ethical problem with paying. I think deciding on what the appropriate reward or compensation is might save some lives.

Thomas Peters: Anyone in the room have a comment or question? We’re approaching…

Participant: I think as society gets safer and safer, motorcycle helmet laws, seatbelt laws, you know, food guidelines, every time we are just totally being watched. Big Brother is watching us like crazy, trying to put us in bubble wrap so that we do live longer. The natural selection of natural donors via accidents or whatever is diminishing everyday; it’s getting less and less and less.

Richard Simmons: One of the things I do now is worry about anything within our institution that goes wrong, that’s the way I define my job. So if someone gets the wrong pill, I worry about it. And if we do not utilize every organ that is available, that’s a problem, too. So we have implemented a program in which the critical care medicine leadership has become chaperones for the patients who were dying so that they die dignified deaths so that they are given appropriate comfort measure and all of the measure to care for this. But as part of it, you want to develop a relationship with the families. And when you develop a relationship with the families which precedes death, you will find that there are more organs available and this is I think one step in making sure that all available organs are utilized appropriately. And of course I have always been enthusiastic for encouraging living donation because the results simply speak for themselves.

Thomas Peters: Other comments or question?

Richard Freeman: There was a story… This is a story about one of the kidney transplants that I think transpired before I was there, about John dropping a kidney on the floor.

Richard Simmons: Uh hum, that has happened certainly in lots of places. I don’t remember that incident, but certainly there have been… At Pittsburgh they have dropped hearts on the floor that are being transplanted and we are of course being very careful not to do that very often. And you wash them off and you put them in. Every one of those that I have heard about has done well, perhaps nobody has told me about the ones that didn’t do well. But the infections of course are very rare.

There is a McGowan Center at Pittsburgh that is endowed by a person who got a heart transplant who is a founder of one of the companies that turned into AT&T or something. And Mr. McGowan’s heart was dropped on the floor and it was picked up and put in and Mr. McGowan was told about it. And Mr. McGowan gave multi-million dollars to the University of Pittsburgh in reward and developed the McGowan Center for regenerative medicine.


Thomas Peters: Would you want to say a word about anyone who has left us, Dr. Belzer, Tommy Fitz, Myron Kauffman?

Richard Simmons: Fred Belzer was a good friend and I thought he was definitely appreciated. He was not an unappreciated genius, but he was an extraordinary contributor to this area. And of course he was highly imaginative and one of the areas of important research of course is of course is to make those extended indication organs, better on the pump or in some other method and I think that is something he would contribute to…

David Hume, I mean you almost never hear about David Hume anymore. And as you know, David was really the first transplanter. He did a dozen or so cadaver transplants at the Brigham in the fifties, which nobody talks about because we were so sensitive to IRB issues, but he did a number of cadaver transplants with total body irradiation. Some of them went six or eight months or such thing. They have been published, nobody ever talks about it.

They talk about the living, you know the twin donor that Joe Murray did and was quite good, but preceding that was David Hume. He was an extraordinary personality and a great leader in transplantation and an inspiration to us all. And those papers describing the early disasters after kidney transplantation, so frank they were very inspirational to me. They really made me think seriously about what kinds of problems occur. He was not a friend, I hardly knew him. In fact we hardly exchanged a civil word because he didn’t like anti-lymphocyte serum. But he was a great man and you may have forgotten him.

[END OF AUDIO]