Medical history professor at the university of wisconsin. You focus on bioethics. Organ transplants. How did attitudes about death change in the United States after world war ii . One of the ways in which death changed after world war ii is that there was a growing interest in the increasing costs associated with the funeral industry. Great concern about Funeral Directors who unscrupulously took advantage of people during their time of need. And so, in response to this exploitation, there was a trend toward simple burial and the formation of socalled memorial societies that offered workingclass families a much cheaper alternative for the burial costs associated with the death of their loved ones. Another Major Development was the popularity, the enormous attention to the possibility that blindness could be cured by cornea transplants in the 1940s. Thousands of americans volunteered their corneas after their deaths in the effort to restore the sight of a blind person. Among many of these individuals, they thought if i am giving my corneas when i am dead, why not the rest of me . So, there was increasing interest and you see it in the archives of medical schools of individuals saying, my eyes are going to be eyebanked at stanford. What about the rest of my body . In the immediate postwar. , in the immediate postwar period, you see the establishment for the first time organized, systematic body donor programs at virtually every American Medical School in the United States. Was their Public Resistance to this . It seems like a new concept with cornea transplants . A lot of people have focused on the cultural resistance. What i find more interesting is the cultural acceptance and the extraordinary lengths people are willing to go to in the hope that they will have restoration of function or restoration of appearance. I am much more struck by their willingness to try almost anything in the hope of being made whole once again or having restored function. Again, a lot of my work focuses on archives of medical schools, and so, i have seen hundreds of letters from americans who write in, say to a surgeon, and they and to me they are really tragic and poignant letters. They will say, i lost my foot in a street car accident. I hear that you have been experimenting with women transplants. Transplants. I would do anything to have my foot restored to me. They were not really doing limb transplants, but just the prospect that people were willing to be experimented on. Many people have emphasized the resistance. What i find remarkable is the willingness to try something new in the hope of a better outcome. So, this is something new for people to have medical schools come to them and say, after death, i want to donate my body. That is the standard in the United States, but a small cohort of people donate their bodies to medical science. A very small percentage. As early as the 1880s, some americans, physicians, agnostics or freethinkers, unitarians who wanted to continue their utility to society after death, for example, tried to donate their bodies to science. And what they encountered was resistance from the anatomists. The anatomists preferred sick they preferred bodies that had no relatives or histories. The john does. Thats right. They relied on laws that states had passed that made the bodies of the unclaimed or indigent available to medical schools for research and teaching. Even though people were trying to donate their bodies, medical medical schools didnt innovate. They were afraid of lawsuits or a relative changing their mind or, you know, they just did not want to be bothered by that. They much preferred anonymous bodies. Tell us about the logistics the had to develop for Organ Transplants to be more common and easily done across the country . I need to tell you the conventional story and the story that i am somewhat more interested in. The conventional story about when Organ Transplantation began is in the 1950s with the First Successful kidney transplant between two identical twins in a massachusetts hospital in 1954. It takes off from their. From there. Again, that is to overlook American Investment in the repair of the body, its function or appearance. I include skin grafting as a transplant. Include the thyroid gland. This is the heyday of the, you know, sort of the glands. The idea that internal secretions in the body are very important of the regulation or function or growth. In my work, i was very struck by the willingness, again, of men and women to undergo ovarian transplants and testicular transplants in the 1920s. This is before the isolation of testosterone and estrogen. But again, in an effort on the part of women, the chance to have a child, and on the part of men, you know, to be rejuvenated. What was it about world war ii that sort of propel was it the medical advances that propelled the issue or acceptance of Organ Transplants or donations . I think there were some very significant medical advances that came out of the war and many ordinary americans believed they would be contributing to medical research by donating their bodies or their organs. To me, the two chief advances from world war ii were penicillin, the wonder drug, but its not until the 1940s that its remarkable antibiotic capability is discovered and it really transforms medical practice. The other, i would say, is blood transfusion. Blood transfusion first gained popularity in the united date in the early 20th century. World war i, there was a very few number of blood transfusions performed, even though it was obviously a very bloody war. But in world war ii, the u. S. Military really geared up. They had massive blood drives, drives for britain and the American Red Cross conducted drives to send american men overseas and in various theaters of war. I was going to ask you that. When were the blood drives in the United States . When did that start to be accepted by the general public . I would say during world war ii. Before that, you had individuals a list ofmaintaining people willing to give blood. Sometimes there would be a radio announcement that there was a train wreck and they would need lots of blood transfusions, and people would come to the hospital. There were innovations that allowed blood to be stored for a time, and alsof for blood to be separated into plasma and red blood cells. Blood drives, the blood for britain program, where again, more than 20,000 americans donated blood that was going to be sent to aid the british people during the war. What hast battles what hospitals after the war are doing the first types of transplants . Mass general, Harvard Medical School is a center for kidney transplants. There are centers, for example, at tulane university. Here in denver, a very significant transplant surgeon began his career at the university of colorado, and later moved to the university of pittsburgh. Minnesota. California at stanford. So, these were all places where surgical departments began to invest in the possibility of transplanting kidneys and then in the 1960s, heart and lungs. And then livers. What types of ethical issues have you seen in your studies of this field that have come up over the issue of donating ones organs. Well, i think one of the main concerns that i see over the course of the 20thcentury has to do with the equitable distribution of organs, and the idea that was very unsatisfactory to many people that if you were rich you could get a lifesaving organ, but if you were poor, you would not have access. So, there were efforts to try to ensure that even a poor person, an indigent person would have access if they needed it to stay alive, and that remains a concern throughout the 1950s and the 1960s, the 1970s, and 1980s. For example, there was great concern that wealthy foreigners, for example, were coming to places like pittsburgh or the mayo clinic and they were somehow taking organs from americans who needed them, you you know, the organ. How has the ama or other organizations may be logistics or the operations so that there is a level of fairness in that regard . How do they avoid the superrich or whoever coming in to that in to cut in front of the line . Well, one of the other concerns you see over the course of the 20th century is people are not relying on donors, but paying people for their organs. Because of the concern of poor people selling their organs to the rich, Congress Passed the national Organ Transplantation act, which outlaws the sale of organs and the possibility of a Kidney Exchange that would match people with recipients who were willing to sell an unpaired organ. And as part of the act, the federal government sponsored the development of a system of organ procurement organizations that were regional that had rules for, you know, who would have a list of priority, and organ list for they would go systematically based on need, based on their ability to, you know, have a good outcome, based on age in some cases, that were intended to provide a more equitable distribution. Thats United States. What about the other countries in the world . Is selling of organs a problem in other places . Well, there remained trafficking in organs in other parts of the world. I think in most countries, it is illegal, but we know it goes on. There are certain villages, for example, in india, where many people have a scar because they have sold their kidney. And one of the concerns is in such a system, you know, 100 seems like a trifling amount, but it might be a big amount to a villager, to an impoverished person. But that the middleman can greatly raise the price of that organ. And there have been concerns about socalled transplant tourism, where people go to other countries, like china, for example, have access to an organ that has not come voluntarily. It is clear they are not voluntarily obtained organs. And then the moral problem for some American Physicians is, what do you do . How do you continue to provide care for your patient, when you know you have gone out of the system, gone to a foreign country, maybe purchased an organ or got an organ from a prisoner . That has been discussed in the literature. Lets talk about the primary sources and resources you go to , to keep an eye on this field, to study this field. I think i already mentioned, i do rely on archives at medical schools. In the case of body donation, in the departments of anatomy. I also used to the archival papers of american surgeons. You know, Joseph Murray who performed one of the first transplants in 1954, and received a nobel prize for his work, has an extensive archive , and one of the frustrations ar me is that harvard has 75year embargo on the use of these papers. I cant see them until 2050. I am not counting the minutes. Have you ever have the opportunity to witness a transplant or an autopsy at a medical i have not witnessed a transplant. I have witnessed autopsies and i have been in the dissecting room when medical students are learning anatomical dissection. Weve been talking about organs, natural organs as we move into the 21st century medicine with artificial organs and other things that may be medical solutions to current problems, what sort of bioethical issues do you see as confronting the u. S. In the years to come . The thing that everyone points to is the number of indications for organ transplant has risen geometrically, but the supply has remained flat. Where are those organs going to come from . There is the hope that artificial organs so far, i think it has been fairly limited. There has been great interest in the idea that you can use a guerrilla gorilla heart or kidney. But theres the concern that wealthy people will get the human organs and that the poor will get the less acceptable organs. But i will say, going back to my interest in the early 20th century, americans have been experimenting with animal organs since the late 19th century. Its very striking to me, for example, when somebody needs a skin transplant because they have been badly burned, they may bring a puppy to the Doctors Office and the skin from the dog will be used to graft onto an injured child or injured adult. Do you think the American Public is more accepting of that sort of procedure or those sorts of approaches than they were 100 years ago . It is hard to say. Again, i think people who are faced with a catastrophic loss of function or nonhuman appearance, whether they had their face destroyed in a fire or through some disease, are willing to go to Great Lengths to be made whole. I think that is a remarkable feature, the willingness to try new things on the part of many americans. And there are doctors who want to be able to address the real needs of their patients. Susan lederer, thanks for being with us here on American History tv. Thank you. It resulted in a naval victory in the u. S. Over japan, just six months after the attack on pearl harbor. American history tv will be live from the Macarthur Memorial Visitors Center for the 70 that anniversary of the battle of midway. Feature speakers include walter , elliott carlson, Anthony Timothy orr. Watch the battle of midways 75th Anniversary Special live from the Macarthur Memorial Visitors Center in norfolk, virginia on june the second. Announcer next, sculptor gordon kray talks about his artistic process in creating a statute of president james monroe for the college of william and mary in waynesburg, virginia. He attended the college until he enlisted to fight the british in the revolutionary war. William and mary is also gordon krays alma mater. This is an hourlong event which is part of a symposium titled, james monroe, president ial migration. Our speaker today is gordon kray. We go way back