Dr. Neylan's testimony before the
House Appropriations Subcommittee For Veterans Affairs, HUD,
and Independent Agencies
Date posted on the Web: April 27,
1998
Statement Of John F. Neylan,
M.D. President-Elect American Society of Transplant Physicians
April 21, 1998 Presented to House Appropriations Subcommittee
For Veterans Affairs, HUD, and Independent Agencies
Mr. Chairman and Members of the
Subcommittee, thank you for the opportunity to present testimony
on behalf of the American Society of Transplant Physicians
(ASTP).
I am John F. Neylan, M.D., Medical
Director of Kidney Transplantation at Emory University and
I am President-Elect of theAmerican Society of Transplant Physicians
(ASTP). The ASTP, which has no governmental support, was established
in 1982. Our membership, now over 1,100 members strong, is
comprised of physicians, surgeons, and scientists actively
engaged in the research and practice of transplantation medicine
and immunobiology. The ASTP represents the majority of professionals
in the field of transplantation in the United States.
Today, my testimony
will focus on Fiscal Year 1999 appropriations for the Department
of Veterans
Affairs Health Administration and its Transplant Program. Since
1961, this program has provided more than 7,000 solid organ
transplants (over 100 a year) to U.S. veterans in need. In
addition, VA-funded basic research has made important contributions
both to our understanding of diseases which may lead to organ
failure as well as to those basic mechanisms regulating the
immune system which may critical to the success of organ transplantation.
Although VA initiatives in transplantation have provided many
U.S. veterans with the critical "gift-of-life," the
program could be broadened in the area of research to more
effectively serve ourveterans and the overall health of the
nation.
Over the last 30 years, transplantation
of solid organs has moved from experimental to accepted therapy,
with over 20,000 performed in 1997 alone. The success of this
procedure has improved greatly over the last few years with
almost all solid organ recipients enjoying an 83 - 97% survival
rate at one year. Much of this success can be attributed to
basic research initiatives in immunobiology funded by previous
federal appropriations. Our better understanding of the body's
response to foreign proteins has led to countless other breakthroughs
in all areas of medical science. However, this success has
brought with it new challenges.
During the next hour, four new names
will join those 56,793 individuals in this country waiting
for a solid organ transplant. And by the time I get home to
Atlanta this evening, 10 individuals will have died because
the wait for a transplant was just too long. It is unfortunate
and absolutely unnecessary, but the sad fact is that we as
a nation are not living up to our potential. Too many families
are turning down the option of organ donation.
In December, 1997, the Administration
launched a national organ and tissue donation initiative to
encourage more families to discuss and understand their loved
ones' wishes in regard to donation. This may help in reducing
family refusal, which is the number one cause of loss of potential
donors today. Therefore, the ASTP urges this Subcommittee to
provide additional resources in FY 1999 to insure the success
of the Administration's initiative and other federally initiated
programs that enhance donor awareness and improve the public
trust in the process.
Research is also
critical to all that occurs in the transplantation process.
The ASTP believes
that we are on the threshold of many important scientific breakthroughs
in areas of transplantation research, including the better
understanding of the mechanisms of rejection, improvements
in immunosuppression, the achievement of drug-free immunological
tolerance, and the potential use of animal organs and tissues
- xenotransplantation. Because of this, the ASTP agrees with
the Friends of VA that this Subcommittee should provide an
FY 1999 VA research appropriation of at least $325 million
- the amount necessary to sustain the new initiatives VA is
implementing in FY 1998 and to fully implement new initiatives
in FY 1999, such as research in the area of solid organ transplantation.
The VA currently supports research centers in a variety of
areas such as HIV, alcohol, and kidney disease. These centers
have successfully allowed for the advancement of knowledge
in targeted areas as a result of the talented investigators
that are assembled "under-one-roof." By providing
funds to operate additional research centers focusing on areas
such as solid organ transplantation, the VA could contribute
even more effectively to advances in diagnosis and treatment
of disease and disability. By increasing the FY 1999 VA research
appropriation to at least $325 million, the Department would
also have the resources necessary to address a backlog of medical
research career development applications and increase awards
to first-time principal investigator applicants. Such an effort
would work to ensure that the VA will be able to meet its need
for highly trained investigators in all research disciplines
and in all fields important to our U.S. veterans.
For more than six decades, the VA
system has made unique contributions to the health of the nation's
veterans and to the entire country's medical, scientific and
health care efforts. The scientific community is on the edge
of many new breakthroughs in the field of solid organ transplantation
- and the ASTP believes that increased funding for VA research
will greatly improve the lives of U.S. veterans, while increasing
the capacity for critical transplantation research for the
entire nation.
