The 2007 Nora And Edward Ryerson Lecture

Mark Siegler
“At the Crossroads of organ transplantation and Medical ethics: A Century of Innovation at the University of Chicago"
April 24, 2007

I am deeply honored to have been chosen by a faculty committee to present this year’s Ryerson Lecture. Perhaps my strongest qualification for this honor is that, beginning with Professor John Hope Franklin’s inaugural Ryerson Lecture in 1974 and Professor Subrahmanyan Chandrasekhar’s second lecture, I have attended thirty of the thirty-three previous lectures. My being selected shows, if there ever was any doubt, that attendance really does count. Since starting medical school here forty-four years ago, it has been my great privilege to be a student and colleague of many former Ryerson lecturers.

Introduction

Today I will speak on the topic “At the Crossroads of Organ Transplantation and Medical Ethics: A Century of Innovation at the University of Chicago.” I have chosen to talk about organ transplantation and medical ethics for the following three reasons:

  1. First, beginning a century ago, and continuing to the present time, physicians from the University of Chicago have made foundational contributions to the field of organ transplantation.
  2. Second, transplantation illumin-ates the incredible successes in medicine and surgery during the last century. The first long-term successful kidney transplantation, in 1954, was an extraordinary event. For the first time in human history, a person who was dying from failure of a critical organ—such as a kidney, liver, heart, or lung—was saved from death by replacing the failing organ with a healthy one. Since 1954, more than one million organ transplantations have been performed worldwide.
  3. Finally, in focusing on organ transplantation, we encounter every important ethical issue in medicine. In poetic moments, I sometimes use the image of the Rosetta Stone to suggest that organ transplantation can help us understand the complexities of medical ethics, just as the Rosetta Stone helped us to understand and translate the mysteries of hieroglyphics. Essentially, if you understand the ethical issues in transplantation, you understand the major ethical issues in medicine.

Figure 1. 126-0035321 SS. Cosmas and Damian Graft the Leg of a Moor onto the Stump of an Amputee, Jaume Huguet (1415–92) / Santa Maria of Egara in Terrassa, Barcelona, Spain, Index / The Bridgeman Art Library

A Brief History of organ transplantation

The idea of transplanting organs and limbs is not new. Throughout medical history, physicians and patients have sought ways to extend life or to improve the quality of life by transferring an organ or a limb from one person to another.

The painting in figure 1 depicts two thirdcentury physicians, Cosmas and Damian, performing innovative surgery, transplanting a leg obtained from a recently deceased person to a patient whose own leg was removed because of cancer. (You can see the removed leg at the end of the bed.) This extraordinary scene was recorded in many Renaissance paintings. We are not told the outcome of the operation but perhaps it can be surmised from figure 2, a painting by Fra Angelico. This scene, which shows the beheading of Cosmas and Damian, suggests that innovative transplantation surgery is a high-risk enterprise. Folks! Please don’t try this at home! Some regard Cosmas and Damian’s fate as even worse than a malpractice suit. From the time of Cosmas and Damian in 300 AD, there was very little progress on the transplantation scene for quite a while, actually, about 1,600 years, until the following statement was made: “The problem of organ transplantation in man has been solved.”

Figure 3 Alexis Carrel

This remarkably optimistic statement was published in 1905, more than a century ago, by Dr. Alexis Carrel (see figure 3), who was then working as an assistant to Professor G. N. Stewart at the Hull Biological Laboratories at the University of Chicago. How can I say it? This statement is so Chicago!

Figure 2. The Martyrdom of St. Cosmas and St. Damian, from the predella of the San Marco altarpiece, c. 1440 (tempera on panel), Angelico, Fra (Guido di Pietro) (c. 1387–1455) / Louvre, Paris, France, Giraudon / The Bridgeman Art Library

Let me explain what Dr. Carrel meant by his statement and consider whether it was true.

In the twenty-one months from November 1904 to August 1906 that Carrel was at the University of Chicago, his research achievements were astounding. He published thirty-three papers describing research breakthroughs that remain the basis of modern transplantation surgery. His breakthroughs included:

  1. the ability to sew blood vessels together,
  2. the ability to reattach severed limbs,
  3. the technical ability to transplant organs including kidneys and hearts into dogs and cats, and
  4. the ability to preserve organs outside of the body by perfusing them.

“The Transplantation of Organs: A Preliminary Communication,” published in the Journal of the American Medical Association in July–December 1905, was Carrel’s earliest description of his transplantation work. The article included the prophetic statement: “From a clinical standpoint, the transplantation of organs may become important . . . and may open new fields in therapy and biology.”

For his work at the University of Chicago, Alexis Carrel received the Nobel Prize in medicine in 1912 “in recognition of his work on vascular suture and the transplantation of organs.” Remarkably, Carrel was the only physician or surgeon between 1901, when the Nobel Prize was first awarded, and 1933 to receive the Nobel Prize in medicine for work done in the United States. Aside from Carrel, Nobel Prizes in medicine in the first thirty-four years of the prize went exclusively for scientific work done in Europe. Carrel also was only the second University of Chicago person to win the prize, after A. A. Michelson in physics in 1907.

Figure 4 David M. Hume

We can now ask whether Carrel’s statement about solving the problem of organ transplantation was true. It was not. Despite Carrel’s great technical achievements in 1905, scientists did not understand immunology. Most of Carrel’s animals died from immune rejection of the transplanted organs after several weeks or months. In fact, despite Carrel’s optimism, more than forty years passed before a partially successful organ transplantation was done in a human. And when it was done, you guessed it, it was done by a graduate of the University of Chicago medical school, Dr. David Hume, Class of 1943 (see figure 4).

The story of the first transplant goes like this: While working as a surgical resident in Boston in 1947, David Hume was caring for a twenty-nine-year-old woman who was dying from acute renal failure. Hume decided to try to save her life by performing the first human kidney transplant. One evening, he obtained a kidney from an elderly patient who had just died during surgery. He and another resident wheeled the twenty-nine-year-old woman to the treatment room at the end of the hall and, using two gooseneck lamps for light, they attached the donor kidney to the woman’s forearm so it rested outside the skin. They then covered the kidney with a plastic bag and watched as her urine drained into a jar. This primitive transplant lasted only four days, but that was long enough to allow the woman’s own kidneys to recover, and she survived to be discharged. This was the first successful kidney transplant.

In the years following this unusual case, Hume conducted the first series of more traditional kidney transplants and performed nine transplants using cadaver kidneys. Unfortunately, immune-suppression drugs did not become available for another ten years, and the longest survival among Hume’s nine cases was 175 days. For his pioneering work, Hume is regarded today as the “Father of Renal Transplantation.”

My teachers and Mentors

Carrel and Hume were two in a long line of great clinicians and scholars from the University of Chicago.

The advancement of knowledge and intellectual innovation have been at the core of the University’s mission since its founding. In an 1897 convocation speech, President William Rainey Harper expressed his hope that when the University of Chicago finally opened a medical school, it would be one committed to research and innovation. President Harper stated:

I do not have in mind . . . an institution which shall devote itself merely to the education of a man who shall be an ordinary physician, but rather an institution . . . whose aim it shall be to push forward the boundaries of medical science, one in which honor and distinction will be found for those only who make contributions to the cause of medical science, one from which announcements may be sent from time to time so potent in their meaning as to stir the whole civilized world.

I reflect back on my own medical school experience here and on my great teachers who contributed to the growth of knowledge and made amazing scientific discoveries. Leon O. Jacobson was the first physician to use chemotherapy. Charles B. Huggins won the 1966 Nobel Prize for establishing the relationship between hormones and cancer. Don Steiner discovered proinsulin and revolutionized the fields of diabetes and endocrinology. Eugene Goldwasser, my biochemistry teacher, isolated erythropoietin in 1977, a substance now used to treat anemia in more than three million people each year. And Janet Rowley, my teacher and colleague who presented the Ryerson Lecture in 1988, established the link between cancer and genetics.

I also think of my clinical mentors, who taught me to be a doctor and to care for patients: the incomparable Joe Kirsner, who is in the audience today; Louis Cohen, Joseph M. Baron, Alvin R. Tarlov, Arthur H. Rubenstein, and the late John E. Ultmann and George E. Block.

These brilliant, innovative scientists and clinicians at Chicago have changed medicine and medical practice nationally and internationally. They were my teachers, and they remain my role models.

the Intensive CareUnit and the Development of Clinical Medical ethics

This was the rich intellectual tradition that I experienced as a medical student and resident; I was honored to be invited to join the faculty in 1972. And then, my very first assignment as a young faculty member changed my career path permanently. My Chairman, Alvin R. Tarlov, asked me to establish and then direct the first medical intensive-care unit in our hospital and one of the first such ICUs in the city. At that time, we didn’t have good ways to monitor patients; we didn’t have effective breathing machines to treat patients; and we didn’t have doctors who specialized in intensive care, as we do now. Instead we had enthusiastic amateurs, physicians like me, who suddenly found ourselves in the ICU facing a range of clinical and ethical issues for which we were neither trained nor prepared.

I remember my residents and students asking me questions about whether we could ever stop a breathing machine after we had started using it, about how truthful we should be when we told families the prognosis of their loved ones, or how we decided who got admitted to our ICU and whether we could move people out if sicker patients came along later. These three issues—end-of-life concerns, truth telling, and rationing of beds—were tough problems for which I could find no answers in medical journals or textbooks. My residents and I started to call this kind of practical, patient-centered work “clinical medical ethics.” That is how the field got started.

At about this time, other worldwide developments in the transplant field made it imperative that we begin to address in a systematic way the clinical ethical issues associated with organ transplantation: Dr. Thomas E. Starzl had performed the first liver transplant in 1963 at the University of Colorado; Dr. Christian N. Barnard had performed the first heart transplant in 1967 in South Africa; and the first brain-death standards were developed in 1969.

We realized that clinical ethics was an important area for doctors, nurses, and patients, and I have spent my entire career working to develop this new field by teaching, training fellows, consulting for patients and hospital staff, and doing research and writing. In 1984, we started the MacLean Center for Clinical Medical Ethics at the University of Chicago, and this work has been the center’s mission for more than twenty years. In fact, the MacLean Center remains the first and leading ethics program in the world that is primarily devoted to research and training in clinical medical ethics. I would like to recognize and thank the center’s benefactors and visionary advisers, who are here today, Mary Ann and Barry MacLean.

In our search for answers to the ethical problems we faced in caring for patients, I discovered that many of the intellectual leaders of the new American bioethics movement were on the University of Chicago faculty in the early 1970s. These ethics scholars were willing to teach me and help me learn on the job—a kind of apprentice system.

My main teacher was James M. Gustafson, at that time University Professor in the Divinity School, with whom I met weekly beginning in 1972 to discuss real cases that I had seen in the ICU the previous week that raised troubling ethical questions. Jim introduced me to Father Richard A. McCormick, one of the foremost Catholic moral theologians of the twentieth century, who was at that time at the Jesuit School of Theology in Hyde Park, and to Stephen E. Toulmin, a philosopher who joined the faculty in the Committee on Social Thought in 1973. Several years later, Leon R. Kass, another distinguished bioethicist and recently the Chair of the President’s Council on Bioethics, joined the faculty. These mentoring relationships continued for the next ten years. Jim Gustafson also introduced me to Ann Dudley Goldblatt, a brilliant teacher and legal analyst, who has been a valued colleague and friend for more than thirty years.

Clinical Medical Ethics

Clinical ethics aims to improve patient care and health outcomes. It does so by helping patients and families, as well as doctors and nurses, reach good clinical decisions—decisions based on both the medical facts of the situation as well as the patient’s personal preferences and values.

I have spent my career as a physician taking care of people. Nothing that I do gives me as much joy and satisfaction as providing good and conscientious care to my patients. I also have spent a great deal of time thinking and writing about the doctor-patient relationship. To my surprise, my paper, “A Proposal for a New Model of the Doctor-Patient Encounter,” published in the Bulletin of the New York Academy of Medicine, was discovered in 1982 by the President’s Commission for the Study of Ethical Problems in Medicine. The commission was then rethinking the doctor-patient relationship in the United States. My paper rejected the extreme versions of physician paternalism and patient autonomy and instead proposed a new model, that of accommodation and “shared decision-making.” The President’s Commission accepted my view and concluded: “In this report, the commission encourages a relationship between patients and professionals characterized by mutual participation and by shared decision-making.” Since then, shared decision-making has become the prevailing model in the United States.

Figure 5 Teri and Alyssa Smith in 1990

While, of course, I would like to claim priority for proposing this new model, I hesitate to do so because I was scooped, beaten to the punch, you might say, by Plato, about 2,400 years ago. Plato clearly had shared decision-making in mind when he wrote his views about the doctor-patient relationship.

In a remarkable passage in Laws, Plato contrasts bad and good doctor-patient relationships. In the bad relationship, according to Plato: “The physician never asks the patient for an account of his complaints. The physician prescribes treatments in the brusque fashion of a dictator, and then rushes off in haste to the next patient.” (Sounds like managed care to me.) In contrast, in the good doctor-patient relationship, “The physician treats the patient by going into things thoroughly from the beginning in a scientific way and takes the patient and family into confidence. The physician never treats until he has won the patient’s trust and then aims to produce a complete restoration to health.” This sounds very much like shared decision-making, stressing the importance of communication, trust, and agreement between patient and doctor.

My discussion of shared decision-making in the doctor-patient relationship is just one example of how clinical ethics contributes to improving patient care and health outcomes. In the past year alone, faculty at the center have published books on a wide range of ethics topics, including Drs. John D. Lantos and William L. Meadow on neonatal bioethics, Dr. Mary Mahowald on bioethics and women, and Dr. Lainie F. Ross on children in medical research.

Faculty members at the MacLean Center have pursued a broad range of research during the past twenty years. Topics have included the doctor-patient relationship, medical decision-making, confidentiality and privacy, informed consent, medical error, health care disparities, clinical research, end-of-life care, palliative care, neonatal and pediatric ethics, surgical ethics, reproductive ethics, ethics and oncology, ethics and genetics, and transplantation ethics. Much of this work is interdisciplinary and relies on the great opportunities at this University to involve faculty from many disciplines, including public policy, law, the social sciences and the humanities. And now, I will turn to one of these topics, transplantation ethics, to show how clinical ethics contributes to medical innovation and helps improve patient care.

 Figure 6. Alyssa Smith in 2006

Organ Transplantation Case Examples

Physician ethicists at the MacLean Center have worked closely with transplant surgeons for more than twenty years to help solve the two central ethical challenges in transplantation surgery: first, how to increase the supply of organs, and second, how to distribute available organs in a fair and equitable way. I will begin by discussing two solutions for increasing the organ supply, one involving livers for children and the second involving kidneys for adults.

Here is the pediatric liver story:

In the 1980s, liver transplantation had become very effective at saving lives. Unfortunately, because there were not enough small pediatric livers, 30 percent of infants and children with congenital liver disease died before they received a transplant. Dr. Christoph E. Broelsch and his University of Chicago team solved this problem by developing and perfecting a new operation that allowed living donors, usually parents of the child, to donate segments of their own liver to their child.

The living-donor liver operation was challenged on ethical grounds because the procedure was new and the risks to living donors were unknown. Would it be safe to remove a portion of a healthy person’s liver? What would be the short- and longterm consequences? One commentator asked, “Will this be the first operation with a 200 percent mortality?”

The general issue being raised by Broelsch’s critics involved the ethics of surgical innovation. Surgical innovation is not controlled by a regulatory process like that used for new drugs. As one observer put it: “There is no FDA for surgeons.” Most surgical innovation is controlled not through formal review mechanisms but through professional and peer oversight. This is how most surgical progress has occurred in the past, for example, appendectomy, coronary bypass, heart valve surgery, minimally invasive laparoscopic surgery, and organ transplantation.

In working with Dr. Broelsch and his team, our group of ethicists developed a new approach to address the ethical problems in innovative surgery. “The Chicago Model” emphasized four key elements:

  1. establishing the clinical need for innovation;
  2. assuring adequate scientific and clinical strength of the team;
  3. meticulously protecting human subjects; and
  4. announcing the plans for surgery publicly before the first operation was performed.

On the matter of public disclosure, we did something that had never been done before. We published a paper—“Ethics of Liver Transplantation with Living Donors”—in the New England Journal of Medicine four months before the first operation was performed. This was done to alert the public and the transplantation community to our plans and to invite responses and criticisms of our approach. “The Chicago Model” for ethical surgical innovation has improved the process of professional self-regulation and has helped advance scientific knowledge while protecting patient rights and patient safety. Our clinical ethics work enabled Dr. Broelsch’s program to go forward, initially in Chicago and later worldwide.

Figure 5 shows the first recipient, Alyssa Smith, in 1990, with her mom, Teri, who was her donor. We also see Alyssa in figure 6 at the time of her graduation from high school in May 2006—a healthy and happy teenager.

After Chicago published its excellent results from its series of pediatric living donor transplants, many surgical programs in the United States, Europe, and Asia began to perform the operation. Since 1989, living liver pediatric transplantation has been done successfully in more than thirty countries and has saved the lives of more than ten thousand infants and children. In the United States and Europe, thanks to this new operation developed by Dr. Broelsch, mortality for children born with congenital biliary atresia and needing a liver transplant has decreased from 30 percent in the 1980s to less than 5 percent today.

We also face an inadequate supply of kidneys for adults. Figure 7 shows that in 2006, while there were more than 100,000 people on the transplant waiting list—most of whom required kidneys—fewer than 30,000 transplants were performed in that year. Even with dialysis, many potential recipients suffer and die while awaiting a kidney transplant.

A University of Chicago team headed by Drs. Lainie F. Ross and Richard J. Thistlethwaite, and including Drs. Michelle A. Josephson and David T. Rubin, proposed a new model called “the paired kidney exchange model” to increase the supply of adult kidneys. Figure 8 illustrates their proposal:

Let’s say Donor One wants to give a kidney to a relative, Recipient One, but there are biological barriers—like the wrong blood type—that do not allow for such a donation. Let’s say a similar problem exists for another pair of relatives, Donor Two and Recipient Two—biologic incompatibility. But what if Donor One were a good donor for Recipient Two and Donor Two were a good donor for Recipient One? You could do a swap, this is what we called a paired exchange of kidneys. Please note that now Donor One and Recipient Two are not related and Donor Two and Recipient One are not related; they don’t even know each other. We predict that paired exchanges like these could greatly increase the supply of kidneys, in part, by opening the possibility of a national or even an international registry of unrelated donors.

Figure 7. Shortage of Adult Organs in the United States: Waiting List Registrations and Transplants Performed 1996–2006

Unfortunately, a major ethical obstacle has delayed the implementation of this novel idea. In the United States, only altruistic donations are currently permitted. A 1984 federal law prohibits the exchange of organs for “valuable consideration.” And the question arose: Does paired kidney exchange violate federal law?

Ross and Thistlethwaite considered this issue in their 1997 New England Journal of Medicine paper, “Ethics of a Paired-Kidney Exchange Program,” and stated: “In our view, the transplantation law was not designed to prohibit altruistic donations of organs by family members or close friends.”

Despite this 1997 statement, for the past ten years legal and ethical uncertainty has limited the widespread application of paired kidney exchanges. I am delighted to say that this uncertainty is about to be resolved very soon. In March 2007, the U.S. House and Senate unanimously passed legislation, called the Charlie W. Norwood Living Organ Donation Act, which amends the National Organ Transplant Act of 1984 specifically to allow paired exchange to go forward without risk of criminal or civil penalties. The president is expected to sign the Norwood bill when it reaches his desk.

Because the paired exchange program encouraged the use of living donors who were unrelated to each other, many think this proposal opened the door to a broader consideration of using market solutions to address the organ shortage problem. Two of our distinguished colleagues at the University, Professors Gary S. Becker and Richard A. Epstein, have written powerful and controversial papers proposing that the buying and selling of organs be legalized. Dr. Janet Rowley, who is a member of the President’s Council on Bioethics, tells me that various market proposals are currently attracting a lot of discussion in Washington.

Figure 8. Paired Kidney Exchange Model

I now turn to an example of how to improve the fair distribution of organs.

The United States is divided into sixtythree organ procurement areas, generally representing states or large metropolitan areas. In the past, donated organs were kept within the same area in which they were donated. From one area to another, however, there are often great disparities in the waiting time to receive a liver transplant. Figure 9 illustrates different waiting times by geographic area. Sometimes the areas with the shortest and longest waiting times are adjacent states. The ethical problem is whether the allocation of organs based primarily on geographic area results in the fairest and most effective distribution of scarce livers.

Figure 9. Geographic Distribution of Waiting Times

My colleague Dr. David O. Meltzer conducted research for the Institute of Medicine that showed that in transplant areas with larger populations, donated livers were more likely to go to the sickest patients who really needed a liver to survive. By contrast, in less populous transplant areas, livers often went to people who could have waited two or three more years before needing a transplant. Based on this research, Dr. Meltzer and the Institute of Medicine committee recommended sharing livers across geographic regions and allocating livers based on clinical need rather than on either geography or time on the waiting list. The official name for this new recommendation is the MELD system, which stands for “Model for End-Stage Liver Disease.” Several years of data now suggest that the new MELD system is more equitable and more effective than the previous geographic system and is saving an additional 300 to 500 lives per year.

My concluding example at the crossroads of organ transplantation and clinical ethics relates to China and brings us to the present time. This exciting new work could potentially affect a quarter of the world’s population.

Our work with Chinese doctors and health policy leaders offers an unprecedented opportunity to apply the earlier ethics work at the University of Chicago to help China increase its supply of organs for transplantation and to obtain the organs in an ethically acceptable way.

The clinical problem in China is the dire scarcity of organs. China estimates that as many as 1.5 million people currently need an organ, usually a liver transplant. The need is so great because of the high incidence of liver failure from hepatitis B, which is endemic in China.

Currently, China performs only ten thousand transplants a year, which doesn’t come close to meeting their need for 1.5 million organs.

Even with regard to the ten thousand transplants that are done in China each year, there is also a major ethical problem.

Currently, 95 percent of Chinese donor organs come from executed prisoners. This raises such further ethical questions as:

  • Are prisoners being executed to get organs?
  • Can condemned prisoners really give voluntary informed consent the night before their execution?
  • Should organs be sold to non-Chinese visitors (so-called “transplant tourism”)?

The Chinese organ transplantation system is under attack. Nationally, China is accused by the Falun Gong of killing dissidents to use their organs in transplantation. Globally, China is reviled for human rights violations, such as using executed prisoners to obtain organs.

Three key players are working to improve the organ transplantation system in China.

Huang Jiefu, MD, is the Chinese Vice-Minister of Health, and himself a distinguished liver transplant surgeon. In November 2006, at a national transplantation meeting in Guangzhou, China’s president, Hu Jintao, appointed Dr. Huang to chair a new national transplantation committee charged with substantially changing China’s transplantation policies.

M. Roy Schwarz, MD, is a distinguished physician and medical educator and former dean at the University of Colorado Medical School. Dr. Schwarz chairs the University of Chicago’s Visiting Committee to the Division of the Biological Sciences and the Pritzker School of Medicine. Dr. Schwarz is also the former president of the China Medical Board, a philanthropic foundation in New York. In November 2006, the China Medical Board awarded a grant of $1 million to the University of Chicago and to China, with Dr. Huang and Dr. Michael B. Millis as the co-principal investigators.

Michael Millis is the Chief of Transplantation at the University of Chicago. In March and April of this year, Dr. Millis has been doing a Henry Kissinger imitation—shuttle diplomacy—and has been in Beijing twice this month. In March, a Chinese delegation spent a week visiting at the University of Chicago.

China hopes to achieve these clinical outcomes through this new partnership with the University of Chicago:

  1. Improve the training of Chinese transplant surgeons.
  2. Decrease the number of approved transplant programs in China.
  3. Establish a national registry of organ transplants, which no country currently has.
  4. Develop a national system of organ sharing across regions.

China hopes to achieve these ethical outcomes through this new University of Chicago partnership:

  1. China wants to join the world transplantation community by adhering to global ethics standards and plans to stop using executed prisoners as the source of organs. Two weeks ago, the Supreme Court of China announced that it would review every death sentence in China before the sentence is carried out. Most people believe that this decision is meant to discourage using executed prisoners to obtain organs.
  2. China hopes to join most other advanced technological countries by establishing brain death standards.
  3. China will use the new brain death standard to greatly increase its supply of cadaveric organs.
  4. China will greatly expand its use of living donors.
  5. China intends to prohibit the buying and selling of organs and to criminalize transplant tourism.

An extraordinary paper was published this month in Liver Transplantation, the leading U.S. journal in the field. “Ethical and Legislative Perspectives on Liver Transplantation in the People’s Republic of China” is authored by Huang Jiefu, the Vice-Minister of Health and the co–principal investigator on the University of Chicago–China grant. In this paper, Dr. Huang announces China’s goals over the next three years for achieving the clinical changes and the ethical changes I have just described. In fact, two weeks ago, the first changes were instituted when China decreased the number of approved transplant programs from six hundred to approximately one hundred and established the national transplant registry

My point in examining the China story at some length is to tell you what the University of Chicago and its clinical ethics group are doing in the world to improve not only transplantation practices but also to contribute to improving global human rights. Those of us working on the Chicago side of the China grant are not naïve. It is not a done deal that the changes promised in China’s transplantation policy will happen or that they will happen in the short time frame we would like. But our collaboration with the leaders of Chinese medicine is a milestone. Vice-Minister Huang’s paper in Liver Transplantation was a public declaration of China’s intent, and we at the MacLean Center and at the University are cautiously hopeful that improved clinical and ethical transplantation standards will come from this partnership.

Summary

Today I have described about a century of contributions by University of Chicago physicians and ethicists to the field of organ transplantation.

It has been our privilege at the MacLean Center to work closely with colleagues at the University, and with health professionals nationally and globally, to improve ethical standards in organ transplantation. These improvements have helped to advance transplantation and have contributed to saving lives in this country and throughout the world.

We know that we will see many more innovations in medicine and surgery in the next one hundred years as diseases that today are incurable yield their secrets and become curable. Isn’t that the meaning of the University of Chicago motto, Crescat scientia; vita excolatur? Professor Paul Shorey, who created this motto in 1910, translated it as follows: “Let knowledge grow from more to more; and so be human life enriched.” As a physician/ethicist, I am proud that our group will continue working with basic and translational scientists to assure that we develop and apply new cures quickly and that we do so while adhering to the highest ethical standards of medicine.

Mark Siegler is the Lindy Bergman Distinguished Service Professor in the Departments of Medicine and Surgery, Committees on Clinical Pharmacology & Pharmacogenomics and on Interdisciplinary Studies in the Humanities, and Cancer Research Center; and Director of the MacLean Center for Clinical Medical Ethics.