Dr. McDonald had long been concerned with increasing the available supply of donor organs and making sure that those organs are shared and utilized in the most efficient manner. This interest paved the way for his involvement as a founding member of organ sharing organizations on the local, state, regional and national level.
The Metropolitan New Orleans Organ Procurement Program was supported from 1971 to 1973 by funds obtained from the Department of Health, Education and Welfare. The grant proposal was written by Dr. McDonald and the contract was between the Tulane University School of Medicine and the Louisiana Regional Medical Programs. Nine area institutions — Mercy Hospital, Hotel Dieu, Touro Infirmary, USPHS Hospital, Veterans Administration Hospital, Charity Hospital, Ochsner Foundation Hospital, Southern Baptist Hospital and Tulane University — were involved in this program to procure and share kidneys in the state of Louisiana. During the two-year pilot program, thirty-three kidneys were obtained from eight different hospitals and transplanted into patients from nine different dialysis units at four different institutions, proving the value of a system for sharing. Due to a change in Medicare funding, the program was temporarily suspended, but was reorganized a year later.
McDonald continued his efforts to establish a statewide sharing system by delivering lectures and writing professional papers such as “Organ Procurement and Renal Transplantation in Louisiana” (see also) that appeared in The Journal of the Louisiana State Medical Society in March 1975. The purpose of the article was to “review the history of renal transplantation in Louisiana; to point out the urgent need for cadaver kidneys for transplantation to patients in renal failure; and to seek the active participation of the profession in providing this service to our citizenry.”
It was 1987 before a statewide organ procurement program became a reality, but there were individual programs administered at transplantation centers in New Orleans and Shreveport. In the meantime, surgeons in Louisiana who were interested in organ sharing offered their expertise to the formation of the South-Eastern Organ Procurement Foundation.
South-Eastern Organ Procurement Foundation
The South-Eastern Organ Procurement Foundation (SEOPF) evolved from the Southeastern Regional Organ Procurement Program (SEROPP), one of seven original organ procurement programs funded by the federal government in 1969. SEROPP was organized by David M. Hume, M.D., a pioneer in human organ transplantation and Chairman of the Surgery Department at the Medical College of Virginia in Richmond. Hume’s goal for SEROPP was to improve transplant outcomes and patient survival through the matching and sharing of kidneys for transplantation.
When SEROPP became independent of the Medical College of Virginia in 1975, the name was changed to SEOPF. This group of approximately 45 transplant centers pioneered computerized matching of donors and recipients, inter-institutional organ sharing, and research. In 1976, SEOPF developed a computer program for matching donors and recipients, called the United Network for Organ Sharing. This program was made available to all transplant centers in the United States who wished to register their patients.
Dr. McDonald contributed his time and expertise to SEOPF in many capacities. He served as Secretary from 1981 to1982, Vice-President from 1982 to 1983, and President from 1983 to 1984. In May 1994, at the 25th anniversary meeting of SEOPF, McDonald recounted the organization’s accomplishments in "SEOPF Contributions to Transplantation." (see also) He received the Upjohn/SEOPF Award for distinguished service in 1991, and in 2004, received the SEOPF Lifetime Achievement Award. Members of SEOPF contributed a significant amount of research and scholarship to the body of knowledge in transplantation, organ procurement and organ sharing. A 1994 bibliography contained 69 scholarly articles that utilized the SEOPF database. Of those 69, Dr. McDonald was an author of five articles which are cited here.
United Network for Organ Sharing
As previously mentioned, the concept of the United Network for Organ Sharing (UNOS) began as a computer program devised by the South-Eastern Organ Procurement Foundation (SEOPF). In 1977, UNOS was established as an unincorporated alliance in order to give transplant programs throughout the United States the ability to share transplantation data, as well as donor and recipient information.
In 1984, in anticipation of the passage of the National Organ Transplant Act, a joint committee of SEOPF and the American Society of Transplant Surgeons (ASTS), chaired by Dr. McDonald, wrote the original Articles of Incorporation of UNOS, establishing it as a 501c(3) organization. UNOS did not have a staff or operating funds and was administered entirely by SEOPF. McDonald served as Vice President/President Elect of UNOS in 1985 and assumed the Presidency in 1986 when UNOS was awarded the national Organ Procurement and Transplantation Network (OPTN) contract by the U.S. Department of Health and Human Services. As a result, assets and personnel were transferred from SEOPF to UNOS, enabling it to administer the OPTN.
It was during McDonald’s second term as President and Chairman of the Board of Directors, that the first meeting of the UNOS Board of Directors, as constituted under the provisions of the OPTN contract, was held in Richmond, Virginia on March 3, 1987. This was a landmark meeting in the annals of transplantation. It marked the first time that a broad-based group of experts in numerous disciplines and health professions met to formulate national policy and organizational goals affecting the entire transplant community, transplant recipients, their families, and society. Serving on the UNOS Board of Directors were prominent, knowledgeable individuals with extensive expertise in organ transplantation, histocompatibility, management, law, ethics, religion, and patient/family advocacy.
On April 2, 1987, the House Subcommittee on Health and the Environment, chaired by Representative Henry A. Waxman, held its sixth hearing to hear testimony regarding the status of organ transplantation. As the UNOS President, McDonald offered testimony to this congressional subcommittee on the tasks and policies of UNOS. Throughout the many years of his active participation in UNOS, McDonald worked to raise awareness of the national procurement network through lectures and published articles, a list of which is accessible here. He remained active after that time, serving on the Past Presidents Committee and as the Councillor for Region III in 1990.
Louisiana had always played a major role in the development of organ procurement policies on both the regional and national level. All of the transplant programs in Louisiana became members of the South-Eastern Organ Procurement Foundation. By the mid-1980s, there were four independent organ procurement efforts in Louisiana operated by the Louisiana State University Medical Center-New Orleans, the Louisiana State University Medical Center-Shreveport, Ochsner Foundation and Clinic, and Tulane University. The collective goal of these programs was to establish one independent statewide organ procurement system. To that end, a proposal, “Development of a Unified Organ Procurement Program in Louisiana”, was submitted by Dr. McDonald, on behalf of the four programs, to the Department of Health and Human Services. In September 1986, a grant of $40,580 was initially awarded to the LSU Medical Center in Shreveport to fund the project from October 1986 through November 1987.
Representatives of the four institutions agreed to consolidate their efforts so that the entire state could be authorized by the National Office of Transplantation as a single organ procurement area. Each of the four parent institutions designated two representatives to comprise a Board of Directors and the Louisiana Organ Procurement Agency (LOPA) was incorporated on September 11, 1987 as an independent, non-profit organ and tissue recovery agency. Their mission was to enhance and promote the recovery of organs and tissue for the purpose of transplantation and to establish a professional standard in donation and transplantation practice.
Dr. McDonald was instrumental in the formation of this statewide effort and served on the organization’s first Professional Advisory Committee. He was continuously involved in setting policies and procedures and served as President from 1992 to 1993. McDonald updated his 1975 study, referenced above, with “Organ Procurement and Transplantation in Louisiana: an Update after 16 years” published in 1991. LOPA engages in a number of activities designed to honor the memory of “individuals who have generously given the gift of life through donation.” The Donor Family Quilt and receptions to remember and honor donors and their families are two such activities.
Dr. McDonald has dedicated four decades of his professional life to the ideal that as many organs as possible should be donated and those that are donated be used in the most efficient and effective manner. The existence of our national system for organ procurement and sharing is, in part, due to his leadership, compassion, intellect, and tenacity.