Curtis Yeager

The past decade has witnessed an inexorable widening in the gap between the supply of organs for transplantation (i.e., the donors) and the need for organs on the part of desperately ill candidates for transplantation. As of June 1990, some 20,882 persons were waiting for organs to become available.1 Three patients on the waiting list die every day as a consequence of this shortage,1 and the scarcity of organs has become the chief limiting factor in clinical transplantation.2 In 1978 the Southeastern Organ Procurement Foundation asked us to identify obstacles to organ donation in the black population, and in particular . . .

PATIENTS REQUIRING KIDNEY TRANSPLANTS HAVE THREE POSSIBLE SOURCES: (1) a kidney from an individual who dies suddenly (approval for the transplant must be given by the next-of-kin of the deceased); (2) a kidney from a relative; and (3) a kidney from one who "willed" it to be transplanted following his or her death. Each of these circumstances requires decision making. On the basis of this information, a research program designed to determine the nature of attitudes of blacks toward kidney donations was developed. Results disclosed a lack of knowledge about kidney transplantation; disassociation and lack of communication between blacks and the medical community; religious fears; fears of premature death; and racism.

To develop a less reactogenic but equally immunogenic vaccine, this study of 91 human volunteers compared the safety and immunogenic potency of a new, cell culture-derived vaccinia virus vaccine administered intradermally and intramuscularly with the licensed vaccinia vaccine administered by scarification. Cutaneous pox lesions developed in a higher proportion of scarification vaccinees. Scarification and intradermal vaccine recipients who developed cutaneous pox lesions had more local reactions but also achieved significantly higher cell-mediated and neutralizing antibody responses than those who did not develop pox lesions. Although less reactogenic, intradermal or intramuscular administration of vaccinia vaccine without the concomitant development of a cutaneous pox lesion induced lower immune responses.