(This recap was provided to Miss Cindy
Naret, University of Pittsburgh, Room M 249
Scaife Hall,  3550 Terrace, Pittsburgh,
PA 15261 on 11/2/87)

  I convened the Surgeon General's workshop on organ transplantation back
in June 1983 partly because I felt that if we could isolate and identify the
key issues surrounding transplant technology, we would, in effect, identify
the issues that underlie all of contemporary medicine.

  Just what are they? First,  I would raise the issue of the role of science
itself in contemporary life.

  in the minds of some people,  this issue may carry the echoes of a
persistent and historic strain of anti-intellectualism. However, I believe we
must take that risk and raise the issue because it forces us to judge the
relevance of science to the human and social needs of contemporary society.
The public -- in its roles as patient, family, and taxpayer -- has already
raised the issue through a variety of forums.  It is asking a series of
questions that hint at a growing popular uneasiness with the course and
direction of science.

  It asks if the newest developments in science are fuelled by real patient
needs. Are the priorities of science coincident with public priorities? willthe
developments in science be available to all who can benefit from them? Are
they consistent with accepted social values ? Do they uniformly support and
strengthen the ethics of modern medicine?

  Those are difficult but relevant questions for anyone who labors in the
technology of organ transplantation. But they are also the questions to be
faced by all of medicine. The role of science needs to be examined in light
of the limitations that we know must henceforth be placed on resources,
whether human, fiscal, or material. The scarcity of resources is the second
issue that we -- and all of medicine -- must continue to explore.

  I was informed earlier this week that 1987 could be a banner year in the
still brief history of organ transplantation.  We expect to transplant over
1,000 livers this year. We expect to at least equal, if not surpass, last
year's level of 1,300 transplanted hearts. And we seem headed for a record
9,000 kidney transplants by the close of 1987.

  Now that the technology has become more widespread -- including the
remarkable achievements in imunosuppressive therapies -- we might well
be concerned that the technology could out-pace resources. Here we should be
grateful to Dr. Tom Starzl. He has again demonstrated his leadership by
coming forward with an equitable way -- using a point system -- of allocating
available kidneys among the pool of waiting patients. Dr. Starzl's point
system will no doubt become the basis for organ allocation in this field
qenerally. I think that's reasonable and safe to say.

  Regardless of the process of allocation,  the resource issue remains the

same : with a limited supply of dollars, people, materials, facilities, and
organs. How will we decide who will get what organ-and when . ..and for how

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much? If you can resolve this issue in a spirit of fairness and genuine
concern, your conclusions will be of great use. Because, today, scarcity is
everybody's issue.

  I am pleased to see that a good number of people here are representing
cooperatives, alliances, joint ventures,  and other organizations that combine
resources and use them more efficiently.  Today we need to pool resources, to
share insights and people, to cooperate, to collaborate, and in all other
ways to stretch and extend the limited resources we have in order to make the
achievements of science available and accessible to all who can benefit from
them. That's a big idea, but I see no other way in which medicine
-particularly the transplant sector -- can respond to the public's expanding
requirements for service.  I believe that a willingness to work cooperatively
would be medicine's best demonstration to the taxpayer, to government, and to
society in general that it will try to honor all its commitments to patients
and families,  not just those that are convenient or comfortable for the
profession.

  But we have some new problems and they ought to be anticipated. Modern
medicine has evolved within a system of law and with the help of fiscal
resources that were most compatible for both the solo practitioner and the
unitary institution. Today,  both the law and financial community need to
demonstrate some new flexibility in order to help foster new and more
efficient institutions.

  I believe this can be done without placing anyone at risk -- neither our
patients nor ourselves. But it must be done thoughtfully, with sufficient
public debate.  I want to stress the role of the public

because, ultimately,  we're talking not only about the evolution of a
technology but also the evolution of public policy toward that technology and
toward medicine, as its host.

  I saw this process begin during that first Surgeon General's workshop on
transplantation. Out of the workshop discussions came the rationale and the
initiative to establish the American Council on Transplantation, to promote a
strengthened community of networks of organ donors and recipients, and, more
recently,  to support an umbrella organization,  the "United Network for organ
Sharing."

   The Federal Government,  clear about its policy in this area so far, has
invested a million dollars in U.N.O.S.  and I believe that it has been money
well-spent.  IN the new contract, we are committed to the support of U.N.O.S.
for 3 more years.

  We ought to be very pleased with our past,  and I know that we're proud of
our present.  But I suspect we're still a little unclear about the future. We
need to build upon our successes thus far, but to do so structurally and
institutionally, as well as scientifically and ethically. These are serious
issues whose resolution could be very far-reaching.  They require a close look
at current public policy, with an eye to progressive adjustments. For this we
need fresh, new thinking. Why not begin here?

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