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Dr. Selwyn Vickers: Hi, and welcome to The Checkup podcast. My name is Selwyn Vickers. I'm the Senior Vice President of Medicine and Dean at the University of Alabama at Birmingham. On The Checkup, we introduce you to people who are powering science and medicine at UAB and around the globe. We discuss the broader issues of healthcare including clinical outcomes, disparities, research as well as our overall growth of our faculty and the maturation of our school. We hopefully will provide tremendous insight to where healthcare is going and the opportunities UAB is providing for the care for our patients and leading in research in this part of the country. So thank you for listening to The Checkup. We'll dive right now into our next episode.

Selwyn Vickers, MD, FACS (Host): Dr. Locke, I'm excited to have you here. And I've looked forward to this for some time. For those listeners who might not know who you are, tell us a bit about your background, who you are, your journey to UAB. How'd you get in this field of transplantation?

Jayme Locke, MD (Guest): Well, it's really great to be here. Thank you for having me. So my name's Jayme Locke. I am both a transplant surgeon ,and a health services researcher that's very invested and interested in overcoming health disparities as it relates to end-stage diseases and how transplant can play a critical role in that.

I grew up as a military brat. When my dad retired from the military, we moved to a very small town in rural eastern North Carolina, and there were about 500 people and spent time on our fish farm where I probably learned the meaning of hard work and attention to detail, more so than any other place I've ever worked. But fell in love with science and really as cliche as it sounds, always wanted to be able to help people. So, decided that medicine was probably my path. Interestingly thought I was going to be a pediatric oncologist when I went to medical school and happened upon surgery and it was sort of love at first sight.

I couldn't imagine myself doing anything else, sort of the ability to be an extremely well-rounded physician, but to be able to do something technically that others couldn't do for their patients was just extraordinarily appealing. I also fell in love with the concept of being both a surgeon and a scientist at that point. Really wanting to drive things for my patients beyond what I could do for them at the bedside, but answering questions that might help more than just the individual patient. So, I was pretty specific about where I wanted to train. Really wanted to go to a place where I could really learn how to be both a surgeon and a scientist.

And that's how I landed in Baltimore and at Hopkins and spent a good 10 years there. And when I finished was looking to be a transplant surgeon and a scientist but really looking for a community, a place where I felt like I could see myself working and succeeding, an institution that I felt like valued people because to me that was more important than really anything else. And had several opportunities. But very easily came to the decision that I should be at UAB. I've been here now for about 10 years. Being able to live out the dream that I had and hopefully help a few folks along the way.

Host: Great for our listeners, Dr. Locke has described a number of things and in our medical world, we look for individuals who are outstanding clinicians, who have some capacity to either do that or be great educators. And then we look for some people to do research. Dr. Locke highlights, one of these rare instances where I would say we call them unicorns, where they're actually quadruple threats. She's an accomplished administrator. An accomplished clinical surgeon, an accomplished researcher and educator. Those are, those individuals are quite rare.

We're proud to have them. She has a number of nationally funded grants she leads as well, leads one of the busiest transplant institutes in the country. So, thank you for being here and thank you for serving our community and our institution. Just to give our community a little bit of bird's eye view of our Comprehensive Institute, it clearly holds a unique place I think in American medicine, it's completed over 15,000 organ transplants. It for the longest time was really one of the few comprehensive transplant institutes in the deep south. It is also one of the busiest institutes in the country now doing over 400 annual procedures.

And in that legacy of being one of the early and first, it for the longest was the largest and most, if you would prolific kidney transplant program and arguably one of the most diverse waiting lists in patients that were transplante. Dr. Locke has also led the development not only of these other areas that I've mentioned, but also to create a busy pediatric program that is growing and hopefully being one of the largest in the country, as well as one of the 13 VA transplant programs in the US. So, there's a lot of things she has to lead and has successfully done.

So, Jayme in discussing the transplant institute, what about our institute that you're really, if I were to ask you that you're most proud of?

Dr. Locke: Oh, it's the people. I think we have an extraordinary team and I'm really proud of the culture and the environment that team has helped to define and cultivate. And I think it's something that we do well. And I think our success really reflects that. And when we work well as a team it's what allows us to innovate. It's what allows us to grow. And to me, without question that is what I am most proud of.

Host: Great. When you say the people, that obviously means talented individuals, but that also means some unique accomplishments and outputs. What are the things that the people do, that make you proud?

Dr. Locke: Well, I think one, just delivering outstanding patient care. You mentioned our kidney transplant program. You know, we are the program who's performed more living donor kidney transplants for African-Americans than any other program in the country. And we know that African-Americans are disproportionately impacted by end-stage kidney disease. And it's really the population that we serve and that we see that as part of our mission is to help overcome those disparities. And so for us to be able to lead the way, not just in kidney transplantation for African-Americans, but living donor kidney transplantation where others really struggle to help African-American patients, achieve that as something that we're really proud of. We also continue to innovate. We just launched our inaugural Vascular Composite Allograft Program and are bringing uterine transplantation to the Southeast. And I think that again, sort of identifies our interest and our need to help the most vulnerable among us. So, this really is designed to help women who have uterine factor infertility and aren't able to bear children.

And we're really excited about that program. It is very much life-changing for those individuals and to be able to partner with our colleagues in the Department of Obstetrics and Gynecology to make this happen, has just really, again, highlighted our ability, not only to be a great transplant team, but how we are able to operate and interact in a multidisciplinary environment, that's the larger institution; to bring something here that doesn't really exist at any other program in the country. And those things to me are really, really exciting.

Host: Yeah, arguably, you've done more transplants or living donor transplants in African-American for kidneys than any institution in the world? I suspect that even in countries that have a higher population of people of color have not had transplant program volumes that you've seen here. So, I think it's conservative to say America, but I suspect it's in the world. So, tell me what's the realities of waiting on a transplant list. And we will talk further about the new uterine transplant program.

But tell me a little bit about if I'm a patient, what's it like to be on the transplant list and what are the things that are affect my ability to get a transplant? And what's it like to have this program in the deep south where there's so much chronic disease?

Dr. Locke: Great question. The best thing is just to put it in a little bit of perspective. And I'll sort of stick with kidney for a moment. But if you take someone who has end-stage kidney disease and you think through what is their week like? So, in order to live, they have to go to dialysis and they are typically, if they're on hemo dialysis, they're attached to a machine for anywhere from two to four hours, three to four times a week. So, now think through like, how do you actually function? How do you maintain a job? Do you do the night shift of dialysis? So, you're up all night taking dialysis, so you can go to work the next day. If you're a younger person, how do you go to college? If you are a teenager, how do you think about going to the prom to school, to all the things that I think most of us take for granted. It really becomes very challenging and the path forward for these individuals is to really be able to come off dialysis through the miracle of transplantation.

Kidney transplantation without question is the gold standard. With a functioning kidney, these individuals can go back to doing all the things that they were doing before they had to be on a dialysis machine and it's life changing both for the individual patient but also their families. Think about someone who wasn't able to work and now they're able to work and provide for their family. When you think about opportunity and how do you really overcome health disparities, it's not even just the chronic disease that you're treating. You're actually treating the environment, right.

You're helping that individual be able to go and do the things that the rest of us just do and take for granted. And I think that for me is what makes transplant so powerful and probably why I was drawn to it sort of the ability to really make that kind of fundamental difference, not just for the patient, but for their entire social network.

What are the realities? Well, without question, we have an organ shortage. It is crisis, I'm not even sure does it justice. If you look, we roughly have about 90,000 individuals waiting for a kidney transplant. We perform about 20 to 22,000 kidney transplants per year in this country. But if you look at the dialysis population, there are about 700,000 people on ,dialysis.

So, you look at that and you realize everybody who needs a kidney, doesn't even make it to the kidney list because we have so few to go around, we're very selective in who can actually make the list. So there are all sorts of realities that these individuals face. And I think it's our job as transplant surgeons; one to figure out how to get to yes. So, how do we empower individuals so that they can get wait-listed? Are we resourcing them properly? We spend a lot of money, time and effort looking at how we move organs around. We don't spend a lot of money, time or effort looking at how do we help the patient get to the transplant center that may be from an under-resourced area so that they can complete that workup and actually be wait-listed and then how do we look for innovative sources of organs?

You know, one of the things that we played a large role in is helping with the HIV Organ Policy Equity Act in which we amended the National Organ Transplant Act to really allow HIV positive individuals to serve as donors at their deaths for the sole purposes of transplanting individuals with HIV.

And that's a win-win. Every HIV person that takes an HIV kidney frees up an HIV negative kidney for someone who doesn't have HIV. And that's innovative work that we helped with through the epidemiology and health services research we did. We actually helped change policy and actually UAB's research is cited in the formal research criteria that President Obama mandated.

But we also have to think more broadly than that. And I think one of the things that we are trying very hard to be innovative around and pioneering around, is really how do we actually maybe create additional sources and UAB has taken an interest and has a lot of pride around trying to develop Xeno transplantation.

And we continue that mission, understanding that if we're going to solve this crisis, if we're going to really fix health disparities and give everyone Aan opportunity to have a seat at the table and to really create equity, not just in healthcare, but really in our country, then we got to figure out how to fix end stage disease. So, those not just that 90,000 patients, but those 700,000 patients have an opportunity to get their life back and be able to contribute and be able to care for their families and be able to do the things that they otherwise often are held back from doing because of their disease.

Host: Well, you've described the process of transplantation that really is life restoring, right? Not only correcting a defect, but restoring a life opportunity where people who to some degree have to be considered nearly disabled because of the requirements that are put on them if they're doing hemo dialysis, that if they're being dialyzed through their blood.

And so it is a powerful impact that getting a kidney can do to transform a person's life, both in their own personal worth and contribution, but certainly to the contribution to their family. You spoke of a term that many of our listeners may not know. You spoke of the 700,000 number of the annual dialysis patients number, which appears to be an insurmountable and incomprehensible number of donors that we would ever get to do that. But then you spoke of the term of Xeno transplantation. I'm not sure that many of our listeners know what that means, and it's been around for some time, but it certainly seems like it has had a new advent. Could you speak to what that is and why is it a possibility for the future?

Dr. Locke: Absolutely. So, Xeno transplantation really sort of is referring to taking an organ from an animal, in this case, a porcine or a pig model that has been genetically modified to make it as human as possible and actually transplanting that animal organ or porcine organ into a human being. So, it actually creates a source of organs that don't currently exist. And this is really, you know, as you said, it's been around for some time. But I think the reality of it has just become just much more likely in part related to the Nobel prize and sort of the ability to genetically modify, edit things through CRISPR CAS and we've had wonderful partnerships private industry, which I think is an equally important component. If you want to innovate and be able to do research, it's not just looking at things like the National Institutes of Health, but how do we partner with private industry to better our patients. And we have had a lot of success doing that with United Therapeutics. And I think we're really close to being able to actually do the first in human Xeno transplant and then in the next little bit.

Host: Well, that's awesome. And you mentioned another thing for all of those listeners, the Nobel prize that Dr. Locke mentioned for CRISPR CAS, which is a powerful editing tool for the genes that we have in our bodies or any organ has, or animal has, was won by two women, a woman, one of American woman, and when French woman who were awarded the Nobel prize, which was quite powerful and tremendous to see. So, that does bring and shed light of a new hope of how we might make a dent in a number that seems to be insurmountable, when you talk about both 90,000 and 700,000.

You also mentioned earlier, your passion for clinical care in transplant, but also this other area that you toil in as a funded investigator of health disparities. Your CTI and your transplant program has been a leader in this space for years. And we talked about that. Tell me what drives you in dealing with these disparities and how does your transplant center make an impact for the southeast and the country? Because this is a focus of what you have as a research career.

Dr. Locke: What really drives my research is really the clinical care. And I think it's really what drives our research collectively as a group. And, you know, I sort of think of the CTI is really a tripartite group of people, you know we don't need every person has to be good at all three things, but we have individuals who are expert clinicians, as well as expert researchers and expert educators. But most of our really great research ideas come from the bedside. It's sitting there talking to the patient and a problem presents itself, and you're trying to sort through, you know, how do we make this better? How do we better understand it? And then you go back to the lab so to speak and you start tossing around you know how can we go about answering that question? How can we move the field forward?

And that really for me has been what has always driven the research enterprise. It's what drives us to bring in innovative clinical trials that is being led right now by Dr. Shikha Mehta and Dr. Paige Porrett and they're doing a tremendous job growing that portfolio, bringing in cutting edge innovative therapies and that's something UAB has been known for many years.

I mean, UAB was instrumental in the development of a drug called mycophenolate mofetil also known as CellCept or MMF. We enrolled more patients than any other center in the country. And MMF is now the standard of care for maintenance immunosuppression across the globe. And that's something that one of our pioneers Mark Deierhoi brought here and we are looking to continue that tradition because that's where we see how we make a difference. You know, a kidney transplant, as we discussed is extraordinarily powerful. So is a liver, a heart a lung, they all change people's lives. They all give life back, but it's for that one person. And what do we do about the masses?

How do we study these diseases so perhaps we can even prevent them? I hate to say it, but maybe the best thing would be for me to be without a job. Right. But that's really what we strive to do, but I think the fact that we all approach patient care and what we choose to study with that in mind, speaks volumes about the professionals you have here working at this institution, that we are so desperate to fix disparities, to fix chronic diseases that we're even willing to study things that might ultimately prove to not need transplant in the future. But that's what we really aim to do.

Host: Well, it's so important because in this region, a large percentage of our people who are seeking transplants are those individuals who suffer from disparities, African-Americans and this program has been committed to make sure that we could bring all of the expertise and sometimes creating the new opportunities for our country and the world to a population that needs it the most. It's impressive that as you share this idea of really relieving our communities of disparities, I'm reminded that most of the data would show, as you described, if you would relieve a disproportionate outcome for a population that's suffering from it by your work and your science, you tend to make the care for better for those who actually don't experience it, you actually improve care for everybody. And so this is not a self-focused or an individual driven drive for helping just one entity. And in fact, that improves care for everybody, which is a powerful outcome, which I think you've helped demonstrate. And it really serves also a unique opportunity for UAB to continue to express both and deliver on what I think is one of the most compelling whys of any institution in the country. We sit in an area where the percentage of individuals who suffer from chronic disease are some of the highest in the country. And it's not something we want to be proud of, but it's where we live.

And we serve a role of actually dealing with those disparities and dealing with those really high end organ failure issues that face us in diabetes, heart, kidney as well as liver disease. So thank you for what you do. You spoke earlier very passionately and excited about the uterine transplant program. Let us know a little bit, what does it take to get a new program off the sort of ground where might we look forward to hearing about this program as it relates to treating patienets.

Dr. Locke: Well, I think, you know, any program certainly takes a team, that also takes a thought leader and an expert. And we were really fortunate to be able to recruit Dr. Paige Porrett here to UAB who developed the program at the University of Pennsylvania. And we've been able to successfully recruit her here. And I think that's really been the first step. And then it has been all about collaboration. You know, uterine transplant goes well beyond just the transplant itself. It requires the expertise of our GYN oncology colleagues in terms of the implantation of the graft, then our reproductive health individuals in terms of helping the pregnancy be viable and ensuring that the mom makes it to full term and that the baby is healthy.

It also takes a cadre of nurses, coordinators, administrators to pull all of these things off. And it has really been an extraordinary process. And we were really pleased to receive the good news from UNOS that we were approved to open our program. And we've been actively evaluating individuals now for several months and we actually already have several individuals listed and are looking to do our first uterine transplant in the coming months. How do you find out more? If you go to our Transplant Institute webpage, there will be information there on uterine transplantation with a number to call or an email address where you can reach out and start your evaluation process.

Host: Great to hear. Excited and we look forward to hearing of that first transplant and subsequent birth. Obviously, what has dominated our healthcare landscape is COVID-19. Can you speak to, in some broad terms, what impact has this had on the Transplant Institute? We've heard the ideas that we've had to limit some cases and limit our access because of the number of people in our institution who are suffering from severe SARS COV2 infection. Can you give us some insight, what has been the impact on your program as you try to treat people with this significant issue of end organ damage and failure?

Dr. Locke: Well, fortunately, you know, I think we have in many ways been able to persevere through COVID-19 through a coordinated effort with our leaders at UAB Hospital. So, we have not had to close or shut down our transplant programs and that has been tremendous and certainly has not been the case at many places across the country. And I think that just really reflects just the hard work, teamwork and really having a vision for how we're going to navigate these very difficult times.

But we have certainly play now a major role in encouraging our patients and our healthcare providers to get vaccinated. There is a ton of data to suggest that transplant patients do much better if they've been vaccinated and subsequently contract COVID-19, and we have had a concerted education program around that as part of our evaluation and our referral processes. And at least on the kidney side, my latest numbers are around 90% of our patients have chosen to get vaccinated. And that is really impressive when you look at vaccination rates across the country. And in many ways I think our transplant patients are leading the way. Our providers have followed suit.

And we really sort of see this as our way to navigate these very treacherous times. I think the other thing to highlight is that the federal government encouraged all of us to not shut down transplantation or dialysis access during this time, really viewing this as a critical and life saving therapy that should not be delayed or postponed, to the extent that resources allowed.

And UAB has just been tremendous at working with us to be able to allow us to continue to offer these life-saving therapies. In addition, our transplanters have been called to action. So, our lung transplant surgeons do a lot of our ECMO. In fact, do all of our ECMO along with our transplant pulmonology team. And so they've been instrumental in caring for individuals who have become ill from COVID, whose lungs are failing them and needed ECMO services. Our pediatric team worked carefully and closely with our adult team when a young patient presented with acute liver failure related to COVID, we were able to get that individual transferred over to UAB and our ID team under the direction of Dr. Marrazzo, we're able to get appropriate therapy before all the trials had been finished. We were able to get a compassionate use and that young woman was able to make it through her acute liver failure and ultimately didn't need a transplant. And so our team has, you know, I think really rallied around trying to be there for patients who already knew they had end-stage disease and then patients who are discovering what end-stage disease is because of their COVID infections. And how do we help those individuals get through the infection, regain their functional status so that they're actually able to be transplanted. And we're now transplanting a large number of individuals who have had COVID-19.

Host: That is awesome. There's a lot of misinformation out there. We clearly live in an age of information, but in this pandemic, we live in a world of an age of misinformation. I've seen headlines and people speak of the fact that if you need organ transplantation or blood donations, you would not be able to get a transplant or give blood if you get vaccinated. How do we combat these truths? And to some degree, how do they, your sense of how do they get started? I assume you'll tell people that none of that is true.

Dr. Locke: You're correct. None of that is true. I really think it's all about education, but it's not just education. It's trust, right? I mean, it's a partnership with the community. It's when I talk about team, I mean, that includes our patients. That includes our referring providers. I mean, all of us are on the same team and really building that trust is absolutely critical.

And I think that's really where misinformation comes from. You know, when you want to know something about your health, we hope that patients turn to their physicians, but often that's not the case. And I think that's really on us to work really hard to bridge those gaps. There are reasons why that mistrust exists. Things have not always been great. I mean, Tuskegee was real. And I think we have to acknowledge that has contributed to health disparities and contributed to difficulty disseminating information. And so I see it as my job every day, in addition to doing transplants and other things is how do I build trust with my patients, with the patients in the community that have yet to make it to UAB. And some of that I think is as simple as living by example, you know, when you're out and about, you know, what good does it do if I'm telling everyone to wear their mask and then I don't wear mine, or I tell everyone, I think you need to get a vaccine and then I don't get vaccinated.

So I think living what you preach is super important, but I think also being available and not being judgmental when people don't want to do something, it is often fear drives it. And how do you sort of help them overcome that and meet them where they're at? And I think we just need to spend more time with that 10% that we haven't quite gotten convinced to get vaccinated that are on our transplant list. How do we work with them to make sure that we've done our job at building that trust, at answering those questions and helping them get to yes.

Host: Yeah, it's it is often a dichotomy to realize that our society probably has vested so much in the healthcare arena and their daily lives built on really physicians, as you've described being, I would argue being purveyors of truth really delivered on a foundation of trust. Right? There are so many times where we give people information and they have no symptoms and have no ability to know what we're saying, except trust. I shared in a town hall that it's daily. We see the young woman who gets a mammogram and feels nothing wrong. And she's told she has a cancer. She has to believe that truth based on trust because there's nothing in her that tells her that's wrong.

The middle-aged man who has indigestion and says, I'd be better if you just give me some TUMS and we give him his blood work back and say, you're having a heart attack. And he has to really accept that truth based on trust, not what he feels or thinks, but what we believe and what we know is right, and him trusting us.

And it's sad to see we've lost some of that in our community today as it relates to vaccinations as if our whole history as medical providers has not been about offering what's best for our, for our patients in our community. You're right. It is the doctor's responsibility to continually reinforce this idea of truth and trust. And that when we speak about vaccinations, it's about that from those areas of the principles of how we built our entire business and our whole entire model of caring for people on those two things. So, what's next for the CTI? Give us a little update of where you want to see your program and your institute go to and grow. I know you are, in a good way, a competitive person, you want to be the best and you clearly love innovation and you don't want to do anything that's not your best. So, tell me, what does the best of CTI look like in the.

Dr. Locke: Great question. I think first and foremost is to continue to cultivate our culture because I think our culture is what really drives our success. So, excited to do that and to partner with the folks in the Transplant Institute to accomplish that. But I think the sky's really the limit, you know, I would love for us to consistently be closer to 600 organs, solid organs transplanted every year. I think we can get there. I think we're consistently afford a 500 a year kidney program.

We had our best year in the 50 year history of UAB last year. And I think we can continue to grow that. Our liver program is expanding. We are about to open our living donor liver program. I think it's something we've needed for some time. And we're excited to do that. And I think that will not only grow our adult program, but will also allow us to continue to serve our pediatric population where we often struggle to find appropriately sized.

It also sticks with our mission of overcoming disparities. Women face massive disparities in liver transplantation, typically related to size. It's really hard to find a liver small enough for them and so the living donor liver transplant program will really help us overcome gender-based disparities as well.

Our lung program is growing by leaps and bounds. I'm just really proud of that group. They have gone from doing roughly 10 transplants a year. They're on pace to do 30 this year. That's remarkable. And making sure that we support that. I think that they are easily going to be a 40 to 50 year lung program.

Continuing to work with our heart team as they continue to be leaders in VAD therapies and how we can grow that to continue to grow our heart program. And then of course our inaugural VCA program. I think uterine is just the beginning. You know, we have a world class trauma program here. We have a unique partnership with the United States Armed Services and Walter Reed, and we help train those individuals and a perfect and natural extension of that, is to be able to help our soldiers who were wounded in war and looking at how we might extend hand transplant, for example, as part of our VCA program and building on that, we also have a world-class burn center here. That's something that we do very well at UAB. And is there a role to expand VCA to even include face? And I really take the word comprehensive to heart and seriously, and I think it really encompasses above and below the diaphragm and innovative things like face and hand transplantation that will require unique collaborations with our plastic surgery colleagues in much the same way that uterine has required unique collaborations with our OB-GYN department. And really, you know, honestly, these aren't just me. This is the strategic vision that when you talk to individuals in the Institute, that folks have really wrapped their mind around.

And I want to make sure that as the leader of the CTI, that I am supporting the leaders within the Institute to be able to achieve their vision. I think we're well on our way. And I think the future's really bright.

Host: Dr. Locke you've highlighted some really lofty goals, which I think are very much achievable, but obviously one of the factors of achieving those is organ donation. What would you say to individuals today of what is the importance of organ donation,

Dr. Locke: it's a great question. And a challenging one. I guess I would say first and foremost, that it is genuinely the gift of life. The other thing I would say is I think organ donation, particularly well, in general, I think it's a hard thing for people to wrap their minds around. If you step back and think for a minute, how has the Susan Komen Foundation been so successful with their breast cancer campaign?

Well, one out of eight or one out of every nine women is going to experience breast cancer in their lifetime. That means that most every single person knows someone who's had or will have breast cancer. It's so much easier to relate to something that you have familiarity with. That's not the case in the setting of organ transplantation.

It's on the order of like one in 3000 for people. And so not everyone knows someone who's actually had a transplant or how that can be transformative. And as grim as this may sound, the one thing that we all have in common, is actually death. We can't avoid it. It will happen to all of us, but what decisions we make leading up to that. What legacy will we have? And can we have a conversation around that? And I really see organ donation as an opportunity for someone after life, to be able to really leave a tremendous legacy of hope and of life and of joy and all the things that organ disease takes away from people. That gift, gives all of that back. And in terms of living donation, you know, I hope people can understand and see how transformative it is, how you can be a living kidney donor, and go on to live a completely normal life with one kidney and do all the things that you would've done with two kidneys you can do with one.

And I hope more than anything, people could begin to wrap their mind around the concept of donating in honor of someone, because the most common reason people can't be living kidney donors is because of incompatibilities. And if people could really wrap their minds around donating in honor of someone, we could just facilitate so many more transplants.

Host: You know, this has been an exciting conversation with you. I could go on for several more hours to hear about the exciting things, as well as the passion and the accomplishments that have occurred to the Comprehensive Transplant Institute. But we are time limited, like in most things, but it has been exciting to hear you speak about our programs and what the future may hold for our citizens because of your leadership.

So, Dr. Locke, thank you for joining me and thank you for sharing very profoundly of how the transplant world impacts so many of our citizens in this country. Thank you again.

Dr. Locke: Thank you very much.