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ORIGINAL

ADDRESS

By
C, Everett Koop, M.D,
SURGEON GENERAL
U.S, PupLic HEALTH SERVICE
AND
Deputy ASSISTANT SECRETARY FOR HEALTH
U.S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED AT THE ORGANIZATIONAL MEETING OF THE
AMERICAN COUNCIL ON TRANSPLANTATION
JANUARY 25, 1984
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I’M DELIGHTED TO BE ABLE TO JOIN YOU THIS AFTERNOON, I HAD HOPED
TO HAVE SPENT SOME TIME WITH YOU EARLIER TODAY, BUT THE WHITE HOUSE
PRE-EMPTED MY MORNING CALENDAR. NEVERTHELESS, I MADE IT AND I HOPE
THAT, IN THE NEXT FEW MINUTES, I MIGHT MAKE SOME SMALL CONTRIBUTION 10
THIS IMPORTANT ORGANIZATIONAL MEETING.

I WON’T BE COY WITH YOU. I KNOW TOO MANY OF YOU AND TOO MANY OF
YOU KNOW ME, SO I‘LL BE CANDID AND SAY THAT, OF THE MANY THINGS I’VE
GOTTEN INVOLVED IN DURING MY TENURE SO FAR AS YOUR SURGEON GENERAL,
THIS WHOLE EFFORT IN ORGAN TRANSPLANTATION IS AMONG THOSE FEW THAT
HAVE GIVEN ME THE MOST PERSONAL PRIDE AND SATISFACTION,

THERE IS NOTHING SIMPLE ABOUT THIS MATTER IN THE LEAST. NOR IS
THIS AN ISSUE THAT IS IMPORTANT TO JUST A FEW INDIVIDUALS OR A SMALL
GROUP OF AMERICANS, QUITE THE CONTRARY. JUST ABOUT EVERYBODY FROM
THE PRESIDENT OF THE UNITED STATES DOWN TO THE MOST FRIGHTENED AND
HUMBLE CHILD IS INVOLVED IN THE ISSUE OF ORGAN TRANSPLANTATION,
2

AND LET ME, IF I MAY, TAKE JUST THIS BRIEF MOMENT TO ACKOWLEDGE
THE CONTINUED INTEREST AND SUPPORT THAT YOU AND I HAVE RECEIVED FROM
PRESIDENT AND MRS, REAGAN DURING THE PAST 7 MONTHS. I CAN TELL YOU
THAT WHEN I WAS A PRIVATE CITIZEN -- AGES AND AGES AGO, IT SOMETIMES
SEEMS -- BUT BACK IN THOSE DAYS I WOULD PAY VERY LITTLE ATTENTION TO
THE ROLE OF THE PRESIDENT AND THE FIRST LADY OF THE LAND ON THIS OR
THAT MATTER OF PUBLIC HEALTH OR MEDICINE, IT SOMEHOW ALWAYS SEEMED 10
BE “ALL POLITICS” AND NOT REALLY CONNECTED TO THE REAL WORLD OF
EVERYDAY PEOPLE WHO NEEDED HELP.

I WAS WRONG, HAD I BEEN A PRIVATE CITIZEN DURING THIS PAST HALF
YEAR AND HAD I ASCRIBED THE PRESIDENT’S INTEREST IN ORGAN AVAILABILITY
TO SIMPLE POLITICS, I WOULD HAVE BEEN ABSOLUTELY WRONG, THERE IS A
GENUINE HUMAN INTEREST AND FEELING IN THE WHITE HOUSE FOR THE KIND OF
WORK THAT WE ARE DEDICATING OUR BEST THINKING TO AT THIS MEETING,

THE PRESIDENT AND MRS. REAGAN DON’T KNOW HALF OF WHAT WE IN THIS
ROOM KNOW ABOUT ORGAN TRANSPLANTATION, AND I KNOW THEY WOULD BE THE
FIRST TO ADMIT THAT. BUT I DOUBT THAT THERE IS ANYONE HERE WHO COULD
MATCH THEM FOR THEIR DEPTH OF HUMAN CONCERN... THEIR OVERWHELMING
DESIRE THAT CHILDREN AND ADULTS WHO NEED A NEW AND LIFE-SAVING ORGAN
BE SOMEHOW ABLE TO GET ONE,
3

YOU AND I KNOW ALL THE HUNDREDS OF DIFFICULTIES THAT PREVENT US
FROM GIVING A SIMPLE ANSWER TO THAT SIMPLE REQUEST. TECHNOLOGY...COST
».LAW,. MONEY,.,ETHICS,...YOU NAME IT. AND YET, WE DO HAVE SOME
POWERFUL SUPPORT ACROSS THE LENGTH AND BREADTH OF THIS MARVELOUS
COUNTRY. PEOPLE WANT US TO SUCCEED, ALL KINDS OF PEOPLE ARE ON OUR
SIDE, URGING US TO COME UP WITH GOOD ANSWERS, WORKABLE ARRANGEMENTS,
ETHICAL AND LEGAL SOLUTIONS FOR THE MANY COMPLEX PROBLEMS OF ORGAN
TRANSPLANTATION,

AND 1 AM ABSOLUTELY SURE WE WILL.

I KNOW THERE ARE SOME IN THIS ROOM TODAY WHO HAVE NOT FELT QUITE
AS OPTIMISTIC AS 1 SOUND, YOU MAY, IN FACT, HAVE DEEP RESERVATIONS,
BUT I HAVE COME HERE THIS MORNING TO TELL YOU THAT YOUR SURGEON
GENERAL REMAINS OPTIMISTIC ABOUT THE POSSIBILITIES OF SUCCESSFUL AND
EQUITABLE ARRANGEMENTS DOWN THE ROAD FOR THIS NEAR-MIRACULOUS
PROCEDURE OF GIVING ONE PERSON ANOTHER PERSON’S VITAL ORGAN,
BUT I DID NOT COME HERE TO DELIVER A PEP-TALK, MUCH AS I’D LIKE
TO AND MUCH AS I KNOW IT WOULD BE A GOOD DEAL EASIER TO DO. YES, I’M
PROUD OF MY INVOLVEMENT IN THIS ISSUE SO FAR AND 1 HAVE TOTAL,
SHAMELESS ADMIRATION FOR EVERYONE OF YOU, WHO DEVOTES YOUR PERSONAL
AND PROFESSIONAL LIFE TO THIS EXTRAORDINARY WORK. BUT, AS YOUR AGENDA
MAKES CLEAR ENOUGH, WE ARE STILL IN THE ORGANIZATIONAL STAGES...STILL
ANTICIPATING NEW BREAKTHROUGHS,..AND WE ARE STILL GATHERING IN A WIDER
AND WIDER CIRCLE OF TECHNICIANS, PROFESSIONALS. AND LAYPEOPLE.

THIS IS AN EFFORT AND AN ORGANIZATION THAT ARE STILL IN THE
PROCESS OF BECOMING...STILL EVOLVING. AND WE’VE GOT TO TAKE A MOMENT
OR TWO -- FOR OUR OWN GOOD AND FOR THE GOOD OF THOSE MILLIONS OF
PEOPLE WE HOPE TO SERVE -- TO CLARIFY OUR GOALS AND OBJECTIVES...10
TAKE STOCK OF JUST WHAT WE ARE ABOUT. AND I WANT TO SPEND THE NEXT
FEW MOMENTS DOING JUST THAT,
5
FIRST, A LITTLE BIT OF RECENT HISTORY,

IN JUNE OF LAST YEAR WE CONVENED THE “SURGEON GENERAL’S WORKSHOP”
ON ORGAN PROCUREMENT AND TRANSPLANTATION, IT WAS HELD, APPROPRIATELY
ENOUGH, AT THE HEADQUARTERS OF “PROJECT HOPE” IN WINCHESTER, VIRGINIA,
AND THERE WAS MORE THAN ENOUGH OPTIMISM AND HOPE TO GO AROUND.

I THINK ALL OF US AT THAT WORKSHOP WERE DEEPLY IMPRESSED BY THE
ENORMOUS VOLUME OF EFFORT ALREADY BEING INVESTED IN THE ISSUE OF ORGAN
TRANSPLANTATION. RESERVOIRS OF EXPERIENCE AND KNOWLEDGE WERE OPENED
UP FROM AMONG A WIDE VARIETY OF PROFESSIONAL AND VOLUNTARY ORGANI-
ZATIONS AS WELL AS FROM GOVERNMENT AGENCIES SUCH AS THE NATIONAL
INSTITUTES OF HEALTH AND THE FOOD AND DRUG ADMINISTRATION,

BUT EVEN WITH SUCH BROAD REPRESENTATION. IT WAS CLEAR THAT WE
WERE AT A NEW BEGINNING POINT, AND IN THAT CONTEXT I ASKED EVERYONE
AT THE WINCHESTER MEETING “TO MAKE THAT SPECIAL EFFORT TO MAINTAIN A
GENEROUS PERSPECTIVE, A BROAD FIELD OF VISION, AND A COLLABORATIVE
INSTINCT, WE NEED EACH OTHER -- AND THOUSANDS OF AMERICANS NEED US,”
6
IT DON’T PARTICULARLY LIKE TO QUOTE MYSELF, BUT THOSE TWO
SENTENCES ARE AS APPROPRIATE FOR TODAY'S MEETING AS THEY WERE 6 MONTHS
AGO AT THAT FIRST WORKSHOP, WE MUST NOT ALLOW OURSELVES TO FORGET THE
ULTIMATE PURPOSE OF OUR EFFORTS: WE SAVE LIVES THROUGH THE PROCUREMENT
AND THE TRANSPLANTATION OF HUMAN ORGANS. WE,...SAVE... LIVES,

THE WINCHESTER MEETING ENDED WITH A NUMBER OF IMPORTANT RECOM-
MENDATIONS TO HELP US ACHIEVE THAT PURPOSE. ONE RECOMMENDATION URGED
THE CREATION OF AN UMBRELLA GROUP OF SOME KIND, INVOLVING ALL THE
QUALIFIED AND INTERESTED GROUPS IN THIS FIELD. WE WERE EVEN GIVEN A
DEADLINE: 6 MONTHS,

THE FIRST ORGANIZATIONAL MEETING FOR WHAT IS NOW CALLED THE
AMERICAN COUNCIL ON TRANSPLANTATION TOOK PLACE JUST THIS PAST
SEPTEMBER, WE ALL COULD SEE THAT THIS WAS GOING TO BE A MAJOR
UNDERTAKING AND IT WOULD NEED SOME SEED MONEY. THE PUBLIC HEALTH
SERVICE THEN SCRATCHED AROUND AMONG ITS CONSTITUENT AGENCIES --
N,T,H.. THE F.D.A., AND OTHERS -- AND, AS OF THE BEGINNING OF THIS
MONTH, CAME UP WITH $100,000 TO HELP A.C.T. GET STARTED. THE MONLY
SHOULD COVER THOSE NAGGING HOUSEKEEPING EXPENSES THAT -- TOGETHER --
PERMIT AN ORGANIZATION TO GET STARTED AND TO FUNCTION,
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BUT IT IS STILL TAXPAYERS’ MONEY AND SO THERE ARE SOME ROUTINE
ACCOUNTABILITY REQUIREMENTS THAT GO ALONG WITH THIS KIND OF SUPPORT.
BUT I THINK YOU'D HAVE TO LOOK VERY HARD TO FIND MANY OTHER KINDS OF
STRINGS. THE PURPOSE OF THE MONEY WAS TO GET THIS ORGANIZATION GOING,
NOT TO TIE IT UP IN KNOTS.

BUT GOVERNMENT MONEY DOES PRESENT A NUMBER OF LEGITIMATE CONCERNS
FOR MANY PEOPLE...CONCERNS ABOUT THE ULTIMATE ROLE AND INFLUENCE OF
THE GOVERNMENT. AND WE IN THE PUBLIC HEALTH SERVICE ARE QUITE
SENSITIVE TO THEM,

THAT’S WHY WE'VE MADE THE MONEY AVAILABLE WITH MINIMUM
RESTRICTIONS...

AND WE'VE EMPHASIZED ITS USE FOR THE MORE MUNDANE EXPENSES...

THAT’S WHY WE’VE MADE OUR PEOPLE AVAILABLE TO YOU AT
YOUR REQUEST, AND I WOULD UNDERLINE THAT PART...

AND THAT’S WHY WE STRONGLY FAVOR A REDUCTION IN THE FEDERAL
ROLE IN A.C.T. DURING THE COMING MONTHS.
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I THINK I’M PRETTY GOOD AT KEEPING A CONFIDENCE,..BUT SECRETS
MAKE ME UNCOMFORTABLE. I THINK THE PUBLIC BUSINESS OUGHT TO BE
CONDUCTED OUT IN THE OPEN AS MUCH AS POSSIBLE. AND THAT’S HOW I'VE
TRIED TO PLAY MY ROLE MY IN THIS ISSUE OF ORGAN PROCURMENT AND TRANS-
PLANTATION. DURING THAT JUNE MEETING AND THROUGHOUT THE MANY MONTHS
SINCE THEN, MY AGENDA -- AS SURGEON GENERAL -- HAS BEEN TOTALLY OPEN,

I'VE WANTED A.C,.T, TO GET SOME START-UP MONEY IN ORDER 10 DO JUST
THAT -- IN ORDER TO “START UP.” EXCEPT FOR THIS SPECIAL ELEMENT OF
SUPPORT. I SEE THE GOVERNMENT AS BEING "AEQUUS INTER PARES,” OR “AN
EQUAL AMONG EQUALS.” I‘VE SAID THIS FROM THE VERY BEGINNING AND I
KNOW I SPEAK FOR THE U.S, PUBLIC HEALTH SERVICE IN THIS REGARD. THE
RECORD ON THE GOVERNMENT’S ROLE IS OPEN AND, AS FAR AS I’M CONCERNED.
QUITE CONSISTENT,

BUT I DON’T WANT TO USE THE TERM “GOVERNMENT” TOO LOOSELY. AT
THIS TIME, I’M SPEAKING FOR THE EXECUTIVE BRANCH OF GOVERNMENT,
ALTHOUGH [ BELTEVE MY FEELINGS MAY REFLECT THOSE OF A FAIR NUMBER OF
MEMBERS OF CONGRESS, ALSO.
9
AND, WHILE I’M AT IT. LET ME TAKE A MOMENT HERE TO ADDRESS THE
ROLE THAT THE CONGRESS HAS PLAYED SO FAR AND WILL NO DOUBT CONTINUE TO
PLAY. LET ME BE CLEAR. OF COURSE, THAT I AM NOT SPEAKING FOR THE
CONGRESS NOR FOR ANY INDIVIDUAL MEMBER. MY REMARKS ARE PURELY THOSE
OF AN OBSERVER. MUCH AS YOUR OWN WOULD BE IF YOU, ALSO, HAD AN OFFICE
100 YARDS WEST OF CAPITOL HILL,

FIRST, I THINK EVERY ORGANIZATION HERE TODAY. AS WELL AS EVERY
CITIZEN CONCERNED ABOUT ORGAN TRANSPLANTATION. CAN BE TRULY GRATEFUL
FOR THE INTEREST THAT CONGRESS HAS SHOWN IN THIS ISSUE. I HAVE IN
MIND IN PARTICULAR THE FACT THAT MANY MEMBERS OF BOTH THE HOUSE AND
THE SENATE HAVE HELD HEARINGS, MADE PUBLIC STATEMENTS, AND INVITED
TESTIMONY FROM PERSONS REPRESENTING ALL SHADES OF OPINION AND ALL
MANNER OF EXPERIENCE.

IN OTHER WORDS, FOR NEARLY A YEAR A NUMBER OF SENATORS AND
REPRESENTATIVES HAVE CARRIED OUT A VITALLY IMPORTANT CAMPAIGN OF
PUBLIC EDUCATION ON THIS MATTER THAT, QUITE FRANKLY, COULD NOT HAVE
BEEN DONE AS SUCCESSFULLY WITHOUT THEIR HELP. IN THE COURSE OF THAT
EDUCATION PROCESS, THERE HAVE BEEN A FEW PROPOSALS OF ONE KIND AND
ANOTHER AND WE IN THE EXECUTIVE BRANCH HAVE BEEN ASKED FOR OUR
OPINIONS OF THEM,
10
I SHOULD ADD THAT THE BOOKS ARE NOT CLOSED ON ANY PROPOSALS THAT
HAVE BEEN MADE OR ANY THAT MAY BE COMING ALONG IN THIS SECOND SESSION
OF THE 98TH CONGRESS THAT BEGINS THIS WEEK. A FEW PROPOSALS WE
BELIEVE MAKE A LOT OF SENSE AND MIGHT PROVIDE HELP FOR THE PATIENTS WE
ALL SERVE. BUT WE HAVE RESERVATIONS ABOUT SOME OTHERS,

ONE IN PARTICULAR HAS CAPTURED THE ATTENTION OF MOST OF US AND
CAUSES SOME CONCERN. THIS PROPOSAL CALLS FOR THE ESTABLISHMENT OF A
NATIONAL CENTER FOR ORGAN TRANSPLANTATION WITHIN THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES, THERE WOULD ALSO BE A FEDERAL
“TRANSPLANTATION NETWORK” THAT WOULD MATCH ORGAN DONORS WITH POTENTIAL
RECIPIENTS, AND THERE WOULD BE A WHOLE BRAND-NEW GRANT PROGRAM
SPECIFICALLY TO HELP OUT ORGAN PROCUREMENT ORGANIZATIONS,

SUCH PROPOSALS HAVE A NICE RING TO THEM, BUT WE SERIOUSLY DOUBT
THAT THEY WOULD ACTUALLY PROVIDE ANY REAL SERVICE TO A NEEDY PATIENT
ANYTIME IN THE FORESEEABLE FUTURE. WE ARE LIVING IN AN ERA WHEN THE
SIZE OF GOVERNMENT IS BEING TRIMMED BACK TO A SCALE THAT MIGHT BE A
LITTLE MORE MANAGEABLE AND A LITTLE LESS COSTLY. THESE KINDS OF
PROPOSALS, WE BELIEVE, ARE SIMPLY OUT OF STEP WITH JUST ABOUT
EVERYTHING ELSE THAT IS GOING ON,
I]

ALSO, I MAY BE RELATIVELY NEW TO WASHINGTON, D.C.,. BUT I KNOW THE
DIFFERENCE BETWEEN A PROMISE AND AN AUTHORIZATION... .AND THE DIFFERENCE
BETWEEN AN AUTHORIZATION AND AN APPROPRIATION. IT'S BEEN MANY YEARS
SINCE MOST OF US HAD OUR LAST COURSE CIVICS. BUT THAT INFORMATION IS
WORTH CALLING TO MIND, PARTICULARLY SINCE THERE ARE SOME HERE TODAY
WHO MIGHT WANT TO MOVE AHEAD ON POOR INFORMATION,

AS YOU KNOW, EVERY YEAR, THE CONGRESS DELIBERATES DOZENS OF
PROPOSALS IN HEALTH AND MEDICINE -- MANY OF THEM WITH LARGE NUMBERS OF
SUPPORTERS AMONG THE PUBLIC, BUT VERY FEW OF THOSE PROPOSALS COME
THROUGH THE DELIBERATIVE PROCESS IN THE FORM OF FINISHED LEGISLATION
FOR THE PRESIDENT TO SIGN, THE PROCESS JUST ISN’T THAT EASY, NOR
WOULD WE WANT IT TO BE.

BUT EVEN WHEN A LEGISLATIVE PROPOSAL IS APPROVED. IT HAS NO MONEY
ATTACHED TO IT, THE CONGRESS ONLY INDICATES THE MAXIMUM AMOUNT OF
MONEY A NEW LAW OUGHT T0 HAVE: THAT’S ITS AUTHORIZATION, BUT UNTIL
THAT MONEY IS ACTUALLY APPROPRIATED, THE NEW LEGISLATION REMAINS AS
SIMPLY A GOOD IDEA,
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THE GOVERNMENT CANNOT LEGALLY DIVERT FUNDS FROM OTHER PURPOSES TO
PAY FOR A GOOD IDEA -- PARTICULARLY IF THE CONGRESS ITSELF HAS NOT
SEEN FIT TO PUT UP THE MONEY. BUT EVEN WHEN THEY DO, I SHOULD TELL
YOU THAT THE CONGRESS RARELY APPROPRIATES AN AMOUNT OF MONEY THAT'S AS
HIGH AS THE AUTHORIZED LIMIT,

I UNDERSTAND THE GREAT ATTRACTION OF HAVING THE CONGRESS OF THE
UNITED STATES PUT ITS BLESSING ON AN ACTIVITY SUCH AS THIS COUNCIL ON
TRANSPLANTATION. BUT WE’VE GOT WORK TO DO NOW...WE NEED LEADERSHIP
NOW...WE NEED TO PUT PEOPLE AND MONEY TO WORK NOW, THE PEOPLE OF THIS
COUNTRY OUGHT NOT TO WAIT, WHILE WE RACE UP AND DOWN THE HALLS OF
CONGRESS TRYING TO FIGHT THE LONG, HARD BATTLES OF THE APPROPRIATIONS
PROCESS. THE COUNTRY WON’T BUY THAT...AND I THINK, AFTER A LITTLE
REFLECTION, NEITHER WILL YOU,

I COUNT MYSELF AS ONE OF THOSE PRIVILEGED BUREAUCRATS WHO WAS ON
DUTY LAST FALL WHEN THE CONGRESS ACTUALLY VOTED OUR DEPARTMENT ITS
ANNUAL APPROPRIATION FOR THE FIRST TIME IN 5 YEARS, THE LAST ONE WE
HAD WAS GIVEN TO US FOR FISCAL YEAR 1979. SO WE TEND TO BE VERY WARY
OF PROPOSALS THAT REQUIRE MORE GOVERNMENT OR MORE MONEY.
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BUT. AS I SAID EARLIER, THERE ARE SOME THINGS WE SHOULD BE DOING
JUST AS A MATTER OF COURSE AND FOR WHICH THE CONGRESS ALREADY PROVIDES
US WITH FUNDS, FOR EXAMPLE, WE HAVE THE IMPORTANT FUNCTION OF
SUPPORTING RESEARCH IN EVERY ASPECT OF ORGAN PROCUREMENT AND
TRANSPLANTATION.

I KNOW IT IS NOT NEW INFORMATION TO THIS AUDIENCE, BUT THROUGH
THE YEARS THE N.I.H, HAS BEEN A STRONG AND STEADY SOURCE OF FUNDING
FOR THOMAS STARZL AND NORMAN SHUMWAY AND JOHN NAZARIAN AND MANY, MANY
OTHER PIONEERS -- THE “SUPER-STARS” -- OF ORGAN TRANSPLANTATION, NO
ONE WANTS THE PUBLIC HEALTH SERVICE 10 GIVE UP THAT ROLE AND WE DON’T
INTEND TO,
14

WE ALSO HAVE THE ROLE OF CATALYST, CERTAINLY THIS ASSEMBLY OF
AMERICANS -- OF ANY THAT IS MEETING THIS DAY ANYWHERE IN THIS COUNTRY
-- KNOWS HOW IMPORTANT A ROLE THAT IS. THE GOVERNMENT -- YOUR
GOVERNMENT -- HAS THE WHEREWITHAL AND THE DUTY TO HELP ORGANIZATIONS
GET TOGETHER TO DO THE SOCIALLY USEFUL THINGS, THE RIGHT THINGS FOR
OUR SOCIETY. BUT I’VE ALREADY TALKED ABOUT OUR “LINE OF CREDIT” TO
THIS ORGANIZATION,

AND WE ALSO HAVE AN IMPORTANT EDUCATIONAL ROLE. I’VE TALKED A
LITTLE BIT ABOUT THE UNITED STATES CONGRESS AND ITS EFFECTIVE WAY OF
REACHING THE MASSES OF AMERICANS WITH NEW AND OFTEN COMPLICATED IDEAS
ABOUT LIFE IN AMERICA IN THE 20TH CENTURY. THE SAME MAY BE SAID ABOUT
THE EXECUTIVE BRANCH OR, MORE SPECIFICALLY, THE U.S. PUBLIC HEALTH
SERVICE,

WE HAVE THE SAME KIND OF OBLIGATION TO SHARE AS MUCH INFORMATION
AS WE CAN WITH THE AMERICAN PEOPLE, SO THAT THEY THEMSELVES CAN MAKE
MANY OF THE JUDGMENTS AND DECISIONS THAT WILL AFFECT THEM AND THEIR
FAMILIES,
15
I KNOW THAT A NUMBER OF ORGANIZATIONS REPRESENTED HERE TODAY HAVE
ALREADY COLLABORATED WITH US IN ONE OR ANOTHER CAMPAIGN OF PUBLIC
INFORMATION AND EDUCATION, 1 CAN ASSURE YOU THAT WE TAKE THAT JOB
VERY SERIOUSLY AND WILL CONTINUE TO PLAY OUR EDUCATIONAL ROLE TO THE
VERY BEST OUR ABILITIES,

THOSE ARE SOME OF THE THINGS I THINK THE GOVERNMENT OUGHT 10 DO
AND INDEED DOES DO. NOW, WHAT ABOUT THE THINGS THAT MAY BE OUTSIDE
THE ROLE OF THE GOVERNMENT. FOR EXAMPLE, EXCEPT FOR RATHER SPECIAL
CIRCUMSTANCES, WE BELIEVE THE DELIVERY OF HEALTH OR MEDICAL SERVICES
IS NOT REALLY THE GOVERNMENT'S JOB,

FOR OUR ARMED SERVICES? YES.
FOR AMERICAN INDIANS AND ALASKAN NATIVES? YES,

FOR CERTAIN OTHER GROUPS WHO ARE ECONOMICALLY OR SOCIALLY
DISADVANTAGED? YES,

BUT FOR THE GREAT MAJORITY OF AMERICANS, WE BELIEVE THAT THE
DELIVERY OF THEIR HEALTH AND MEDICAL CARE IS MORE EFFECTIVELY AND
EFFICIENTLY CARRIED OUT BY LOCAL AND STATE GOVERNMENTS AND THE PRIVATE
SECTOR,
16

WE ALSO BELIEVE THAT GOVERNMENT OUGHT NOT TO DUPLICATE WHAT MAY
ALREADY BE SUCCESSFULLY TAKING PLACE IN THE PRIVATE SECTOR, THE BEST
ILLUSTRATION OF THIS IS THE ISSUE OF BLOOD COLLECTION AND
DISTRIBUTION, THAT WAS AN ISSUE OF EXTRAORDINARY COMPLEXITY, BUT ALSO
ONE THAT TOUCHED THE LIVES OF EVERY CITIZEN IN THIS COUNTRY. THE
SOLUTION TO MANY OF THE PROBLEMS SEEMED TO BE TO HELP THE PRIVATE
ORGANIZATIONS -- INCLUDING THE CONGRESSTONALLY CHARTERED RED CROSS --
TO HELP THEM GET TOGETHER, IDENTIFY THEIR COMMON GOALS AND OBJECTIVES,
AND INVEST THEM WITH A LARGE SHARE OF PUBLIC TRUST. AND IT HAS
WORKED,

THE AMERICAN BLOOD COMMISSION, AS YOU KNOW, HAS BEEN LARGELY
RESPONSIBLE FOR THE FACT THAT TODAY...ANYWHERE IN THE UNITED STATES...
YOU WILL BE GIVEN BLOOD IF YOU HAVE A MEDICAL NEED FOR IT,..YOU WILL
NOT BE CHARGED WHAT “THE TRAFFIC WILL BEAR”...AND YOU WILL NOT BE
REQUIRED 10 PUT BACK INTO THE BLOOD BANK THE AMOUNT YOU WITHDREW,
THATS NOT THE WAY IT USED TO BE. BUT THAT’S THE WAY IT IS NOW. IT
TS NOT A FEDERAL ENTERPRISE. BUT IT SERVES THE ENTIRE NATION
EQUITABLY NEVERTHERLESS,

AND WE HOPE FOR THE SAME KIND OF OUTCOME FOR THIS AMERICAN
COUNCIL ON TRANSPLANTATION.
\7
NONE OF US WAS PROMISED A ROSE GARDEN. THIS PERIOD OF NUTS-AND-
BOLTS PLANNING... THIS SO-CALLED NITTY-GRITTY TIME OF ORGANIZATIONAL
LIFE..,THIS IS NO FUN, ALL THE SWEEP AND GRANDEUR OF AN ENNOBLING
IDEA IS REDUCED TO AN INVOICE FOR OFFICE STATIONERY, WE’RE NOT
PICKING BRAINS... WE'RE COUNTING HEADS, AND, AS PEGGY LEE SINGS ON ONE
OF HER HIT RECORDS, “IS THAT ALL THERE IS, MY FRIEND?”

NO, THERE’S MORE THAN THAT. BUT FIRST THINGS FIRST, AND THAT'S
WHERE WE ARE NOW... TODAY...6 MONTHS AFTER THE SEED WAS PLANTED IN
WINCHESTER, VIRGINIA. WE HAVE A LOT OF HARD, PEDESTRIAN, NO-GLAMOR
WORK TO DO. WE WILL NEED TO EXHIBIT ALL OUR BEST POWERS OF
MELTORATION AND COLLABORATION, ..OF COMPROMISE AND GOOD WILL...IN ORDER
TO GET THROUGH THIS PERIOD AND CONTINUE UP TO THE NEXT PLATEAU OF
ORGANIZATIONAL GROWTH,

I AM VERY OPTIMISTIC ABOUT THE CHANCES FOR THE AMERICAN COUNCIL
ON TRANSPLANTATION, AT THE RISK OF BEING TRITE -- BUT NEVERTHELESS
CORRECT -- I BELIEVE THIS IS AN IDEA WHOSE TIME HAS COME. LET US NOT
STUMBLE AND SEE THE IDEA COME,..AND THEN GO,
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I CLOSED MY KEYNOTE REMARKS LAST JUNE WITH A QUOTATION FROM A
WRITER WHO MIGHT BE CALLED “THE PATRON SAINT OF PATIENCE,” HENRY DAVID
THOREAU, IT IS FROM WALDEN AND 1’D LIKE TO LEAVE YOU WITH HIS
THOUGHT, HE SAID...

"TT TS CHARACTERISTIC OF WISDOM NOT TO DO DESPERATE THINGS,”

LET US, IN THE COURSE OF THIS IMPORTANT MEETING, BE DELIBERATE
BUT NOT, FOR HEAVEN’S SAKE, DESPERATE.

THANK YOU,
he E #