"A Time and a Place for Wisdom: Keynote Address to the Surgeon General's Workshop on Solid Organ Procurement for Transplantation,
Winchester, Virginia" [Reminiscence]
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Koop, C. Everett
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A Time and a Place for Wisdom: Keynote Address to the Surgeon General's Workshop on Solid Organ Procurement for Transplantation,
Winchester, Virginia (June 7, 1983)
Vol. 4, -- #3
"A Time And A Place For Wisdom"
Keynote address to the Surgeon General's Workshop On Solid Organ Procurement for Transplantation
June 7, 1983
The background for this Surgeon General's Workshop was a Consensus Development Conference at the National Institutes of
Health, and another workshop had a special background beginning with President Ronald Reagan's interest in biliary atresia
(congenital anomaly of the liver where there are no bile ducts connecting to the intestinal tract). In Washington, many major
efforts hang on chance meetings and I am not aware of the reason why one family with a sweet little girl with biliary atresia
managed not only to get the President's attention, but also to get multiple audiences with him and access to him by telephone.
The President did not understand the situation, because it was presented to him through the eyes of the child's mother
and the President was under the impression that if we could just find a donor for this little girl she could have a liver
transplant and all would be well.
In actual fact, if the child's mother would have been willing to put her on the list of any liver transplant surgeon and
let her child work her way to the top of that list, she probably would have ended up having a liver transplant at an appropriate
time. However, the mother refused to have her child go on any list, but she wanted to leverage her relationship with the President
into having her child leapfrog over all the other waiting patients on some transplant surgeon's list in order to be number
one. That's not the way transplant surgeons work and as we shall see, eventually, the mother of this young child inadvertently
caused a lot of furor, which helped the country's understanding of liver transplantation, but in the long run did not
save her child's life.
(Another child with the same problem caught the President's attention and after the youngster died, the President arranged
for the child's father to be in the Presidential Detail of the Secret Service.)
When I addressed this Surgeon General's Workshop, I called attention to the fact that the printed program entitled my
address "Solid Organ Procurement", but I reminded the audience that I had changed the title to "A Time and A Place
For Wisdom" reflecting my concern about much broader issues economic, physiologic, and ethical, which had to do with organ
procurement in the United States.
It would be helpful to know how I organized Surgeon General's Workshops, which were the chief vehicle by which I brought
major health issues to the attention of the right government and non-governmental people in this country in order to accomplish
my agenda as Surgeon General. The meetings had a theme and the attendees were invited on the basis of demonstrated interest
and expertise. Day one began with a dinner followed by a charge or a keynote by the Surgeon General, day two was individual
workshops of not more than ten to fifteen people discussing a specific aspect of the major theme, and day three was a time
for reports back to the Surgeon General from those work groups and the day concluded around noon by a response by the Surgeon
General, which usually included some hope for the future with ideas, personnel, and agencies at his disposal, but not with
great funds, because the Surgeon General is not blessed with much of a budget. I started off with a concept that we, each,
had to maintain a general perspective, a broad field of vision, and a collaborative instinct. We need each other - and thousands
of Americans need us.
There were no hard and fast rules about organ procurement or donation at the time of this conference. There were "organ
banks" in some parts of the country, which worked on entirely different principles than those of other parts of the country.
The questions were based upon the fact that there were always more available recipients than there were available organs and
the questions had to be decided on the basis of need, urgency, geography, and the surgeon preference - a delicate, but nevertheless
very important part of a surgeon's decisions -- of what he or she thought might be accomplished in a given situation.
I acknowledged that all those present already had some feelings about a number of related issues, such as, the technology
of organ procurement and transplantation, the ethical issues surrounding the question, "Who shall be eligible for the
next available organ?`. . . or the legal questions raised in any definition of death and finally issues of cost and reimbursement.
As important as these are, I hoped the participants would leave the conference, having made more progress on one major issue,
and that is the procurement of more organs.
I went out of my way to mention three families that had worked very closely with the White House, the surgeon General's
Office, and the medical community in reference to the matter of organ procurement, inasmuch as each had a child desperately
waiting for a liver transplantation. I did not mention the child referred to above, whose family on the day of this conference
sought press notoriety to push their point of putting their daughter ahead of all the other folks in the country in this same
My involvement in this Workshop came at the direct request of President and Mrs. Reagan and I acknowledged that and recognized
and encouraged the leadership of others present on this very vital issue. In my typical way, I emphasized that it was important
that all participants accept the current system of organ procurement as being voluntary, decentralized, and imperfect, and
therefore, open to improvement. Having accepted that, to relay that information to the public in the most reassuring way possible.
I pushed all the right buttons of fairness, equality, compassion, voluntarism, and education. Decried the limitations of notations
on driver's licenses, expressed amazement at the success in procurement in transplantation with such a spotty, incomplete
database as that from which we worked.
I closed the proceedings of the first night with a plea for proceeding with wisdom and not desperation.
A copy of the meeting's agenda of June 7th to 9th, 1983 is attached.