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Editor's Corner: Thoughts on Nice and Reflections on the Future of Our Society

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Roger W. Evans, PhD
The United Network for the Recruitment of Transplantation Professionals
Rochester, MN, United States

Nice, France. It looks like a really nice place to be this time of year.

links imageUnfortunately, it's been another long hard winter up here - North that is - where I live. Although it's not been as bad as last year, it's nonetheless been pretty unpleasant. Day after day, the temperature has hovered around zero or below and, even still, the snow flies. People think it's too cold to snow. Not really. There are signs of spring, but we've had a few setbacks. We went over to Sioux Falls, South Dakota for a bull riding event on March 13th. It was 70+ degrees. A week later we received 10 inches of snow - depressing for even the heartiest Minnesotans.

Last Sunday afternoon I came into the house after shoveling snow for two hours. Ice hung from my beard, my shirt was soaked through. I sat down at my desk, cold Hamm's beer in hand to warm up, and instinctively picked up the program for the ISHLT Annual Meeting and Scientific Sessions. Nice. Hmm... it must be nice there... I could actually be there in a few weeks' time. Consumed by reverie, I confronted reality. It's too late.

Months ago, no matter how nice, I decided I wouldn't be going to Nice for the 35th ISHLT Annual Meeting and Scientific Sessions. I can no longer stomach getting on a plane and flying across the Atlantic. In fact, getting on an airplane for any reason has become abhorrent.

A couple weeks ago I was up on Capitol Hill meeting with members of Congress concerning various issues associated with transplantation. I left The Capitol at 1:00 PM, went to the airport, and eleven hours later I walked into the house where our two cats - Teemu and Mighty - anxiously greeted me. Needless to say, I'm losing interest in domestic air travel as well, even when there is important work to be done.

As the ISHLT meeting approaches, people keep asking me "Are you going to Nice?" or they conclude their e-mails with the line "See you in Nice." I will not be in Nice and, at the moment, I don't regret it, although I will miss socializing with friends and colleagues from around the world. I look forward to major meetings for one reason - to spend time with the many friends I have made over the course of a very satisfying and rewarding career (> 35 years).

Now let me take several minutes to share a few thoughts on "Our Society." Independent of me, I'm sure you will hear some of them discussed in Nice.

I joined the International Society for Heart Transplantation (ISHT), as it was known then, in 1982 - the same year in which the 2nd Annual Meeting was held. At that time there were 12 U.S. heart transplant centers and 20 more worldwide. In 1983, 103 heart transplants and 11 heart-lung transplants were performed in the U.S. Unfortunately, I don't have the worldwide figures.

In 1982 the ISHT was a small, but dedicated group of what I would call "enthusiasts." The second Annual Meeting was held in Phoenix on May 2nd. Yes, it was a one day affair, run as a satellite symposium of the American Association of Thoracic Surgery. The registration fee was $30.00 ($73.00 in 2015 dollars), the same as the annual society membership dues. There were no pre-meeting symposia, concurrent, or satellite sessions and, as I recall, fewer than 150 people attended. Indeed, all 20 papers were presented to the entire audience in a small ballroom. It was nice and cozy.

Today, the ISHLT membership, at just over 2,900, exceeds the number of heart transplants performed each year in the U.S. (2,655 in 2014). Over 3,100 people registered for last years' Annual Meeting and Scientific Sessions in San Diego. Clearly, Our Society is doing well, but concerns have been expressed about what I will call "content diversity," and imbalance.

We all accept the fact that heart transplantation is not a "growth industry" and, barring groundbreaking advancements in tissue engineering, it may never be. Meanwhile, mechanical circulatory support systems (MCSS) of all types, as well as extracorporeal membrane oxygenation (ECMO), are becoming an increasingly significant part of what Our Society is about. This has led to reflections about changing the name of Our Society, as well as Our Journal - the Journal of Heart and Lung Transplantation (Incidentally, up until January 1991 it was known as the Journal of Heart Transplantation.). Frankly, changing the name to something more representative of the content we collectively reflect may itself qualify as an abstract.

Let me now shift gears.

Looking back on our organizational history, where did we focus our attention?

As a benchmark, I have reviewed the programs and proceedings for the first three ISHT Annual Meetings (1981 to 1983) to see what content was presented. My findings are summarized in the table below.

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Perhaps you're surprised to find the artificial heart was a topic of considerable interest in 1982. However, as you may recall, Dr. Barney Clark (the Seattle dentist) received his implant at the University of Utah Medical Center on December 2, 1982. He died 112 days later (March 24, 1983). I don't recall whether or not Dr. William DeVries, Dr. Lyle Joyce, or Dr. Chase N. Peterson, all of whom cared for Dr. Clark, were at the ISHT meeting in Phoenix. I do know there were no presentations from the Utah group. However, in 1983, at the New Orleans meeting, which lasted two days, Dr. William DeVries did a presentation entitled "Current Status of the Artificial Heart."

As the above table reveals, even from the very beginning, the ISHT/ISHLT had content diversity, which remains true today. One needs to look no further than the distribution of papers on last years' program, and again on this years' program. Nonetheless, some people still claim the Annual Meeting and Scientific Sessions is more about devices than transplantation. I don't believe this is true, but if it is, I'm fine with that. To enhance our diversity, perhaps it's time to be thinking about how regenerative medicine fits into the overall scheme.

There are many other professional associations that occupy at least some of what I will call "Our Space." I will not identify them here. You know who they are and, like many of you, I am a member of a lot of them. I don't attend all the annual meetings, but I do my best to stay in touch with the "fringe members" of these other societies who have not elected to be a part of the ISHLT.

I think it's time we, as a society, do a little research. We need to come up with a complete list of professional societies and associations with which we have content overlap. Likewise, we need to identify those journals and professional publications where there is content similar to ours. We should compare them on all the relevant metrics, including membership size, annual meeting attendance, content diversity, circulation numbers, and so forth. Depending upon our findings, we might then consider whether or not there are ways we can collaborate and work together.

While competition can be healthy, it can also be detrimental. I think there's room for all of us, but the space we all occupy is getting smaller as the "population" grows. However, who knows? We may even find there is less overlap and competition than we expect. For example, within each category, there are fewer than 50 transplant cardiologists, transplant pulmonologists, and cardiothoracic transplant surgeons who are members of the American Society of Transplantation (In other words, the total for all of these transplant professionals is less than 150 members.).

The ISHT/ISHLT has been a wonderful society of which I am proud to be a part. However, we must make sure Our Society remains relevant to its members, while attracting the next generation of leaders in all the disciplines our membership represents.

Enjoy your time in Nice. I hope it's nice. I will miss those of you I know, as well as those of you I will not have an opportunity to meet.

Merci. ■

Disclosure Statement: The author has no conflicts of interest to disclose.

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