Sir Peter Medawar was foremost a scientist who was tipped into the immunology of allotransplantation by the problem of failed skin transplantation as a salvation for burnt airmen in the Battle of Britain. He received the 1960 Nobel prize, shared with the Australian immunologist Macfarlane Burnett for acquired immune tolerance, illustrating the transformative nature of a scientific mind. He was the second president of The Transplantation Society (TTS), after the inauguration was managed by the American immunologist Bernard Amos who left the fledgling society in Sir Peter’s capable hands. Sir Peter was also the first editor of Transplantation. In his illustrative inaugural editorial, he places the science and practice of transplantation firmly in the hands of the journal’s authors.1 The first successful organ transplant between the identical twins Richard as the donor and Ronald Herrick in Boston in December 1954 is a key event that is very well known to all in the field. Richard lived for 8 more y, while Ronald lived for >56 y after the donation, but died after withdrawing from dialysis. Less well known are the identical twin sisters Edith and Wanda Helm who were transplanted in 1955. Edith was the longest surviving transplant recipient when she died in 2011. She and her sister were also the first donor and recipients who gave birth to healthy babies (a total of 6 between the 2 of them) (Figure 1). Those early transplant donors and recipients were the “Wright brothers” of transplantation—they flew as the result of their bravery combined with the ingenuity and skill of some remarkable individuals. The outcomes of transplantation over the next 20 y are shown in the ANZDATA record of early results (Figure 2)2 when transplantation was still flying slowly on unreliable wings.FIGURE 1.: Wanda and Edith Helm. Identical twin transplants performed in Boston in 1955.FIGURE 2.: Long-term graft survival in Australia and New Zealand in kidney transplants performed between 1963 and 2005. Source ANZDATA.2Transplantation is both built on and encouraged by the work of many Nobel awardees whose synergizing lifetime work created modern transplantation (Table 1). Elion and Hitchings, for example, introduced, among other things, Azathioprine and Co-trimoxazole still in daily use. What led to the most progress between 1978 and 2000, however, were well-run academic and pharmaceutical laboratories and academic clinical transplant units. The advances are shown in Figure 2, with ever improving results of kidney transplantation seen in these careful and comprehensive records. Introduction and optimizing novel immunosuppression, better precision in the HLA laboratory, and standardization of surgery and postoperative care have all been critical for these advances. TABLE 1. - Nobel prizes contributing to the development of clinical transplantation 1908 Mechniker, Erlich Immunity 1912 Carrel Vascular suture 1930 Landsteiner Blood Groups 1960 Macfarlane Burnett, Medawar Acquired immunological tolerance 1980 Benacerraf, Dausett, Snell HLA molecules 1984 Jerne, Kohler, Millstein Monoclonal Antibodies 1988 Black, Elion, Hitchings Drug treatments 1990 Murray, Thomas Organ and Cell transplant 1996 Doherty, Zinkernagel Cell mediated immunity The problem from 2000 onward, illustrated by analogy with the development of commercial flight, is that to advance—like building an A380 or Boeing Dreamliner—takes massive, skilled, inventive, cohesive, and well-organized teams, regulators, and governments. It is no longer the province of the inventive individual with determination that drives our field. My professional life has been split three ways: Westmead and Australia, TTS, and the Australian Bone Marrow Donor Registry and World Marrow Donor Association. Here, I will not cover bone marrow transplantation except to note that comparable features apply strongly in the field of unrelated Hemopoetic Stem Cell transplantation. Westmead is a large academic public health care, research, and education precinct, built since 1980 out of the dirt of a racehorse track and football fields. The walking distance from end to end through our corridors is around a kilometer. The hospital was built to serve that half of the Sydney population that does not live in the picturesque harbor city with the well-known Opera House and Harbour Bridge. We have been privileged to grow our precinct into the enterprise it is today, with for example, > 1000 clinical trials running and at least $100 million in research grants annually. Westmead’s transplant program, which Richard Allen and I started in 1987, has focused on creating very detailed long-term data on the clinical problems we face. We started a pancreas transplant program and long-term protocol renal biopsies which delivered—mostly through Brian Nankivell’s assiduous analysis—what remains the most substantial histological and clinical dataset on long-term outcomes of kidney transplantation.3 Our team has many areas of interest, driven by individuals such as Richard Allen, Brian Nankivell, Philip O’Connell, Germaine Wong, Henry Pleass, Wayne Hawthorne, Angela Webster, Natasha Rogers, Jonathan Craig, Steve Alexander, and David Harris, among others. Notably, the success of this team has always included internal and external collaborations. There was a period when we carried the burdens of presidency of TTS and ISN simultaneously, which is a way to get things done—cooperatively, collaboratively, supported by global teams. Success based on teams is not limited to Westmead. TTS, after our congress in 2000, was set for bankruptcy even before we reached the 2002 congress. Change was forced upon us. We set 6 goals: global membership; advancing the Science and Practice of transplantation; comprehensive education programs; effective communications; global leadership in ethical practice; and professional management of our society. We have since added one further goal: to build global relationships. We built a one-page strategic plan, but the full plan ran to 60 pages of detail, tackling every part of the interactions between the global membership of this largest transplant society. TTS is today a flourishing academic professional society with widespread linkages and programs, and it is a stable financial entity, well managed by our Executive Directors—Phil Dombrowski, succeeded by Jean Pierre Mongeau and now Marcelle McFadden. Relationships with the World Health Organisation (WHO) started with a WHO consultation in Madrid in 2003, run by Luc Noel, but chaired by our then President Carl Groth and for which I had the privilege to be a Rapporteur helping to turn the meeting presentations into a textual WHO report. This work has been carried out through the many consultations documented by Francis Delmonico in his Medawar Award speech 2 y ago, the revised guiding Principles,4 the important work of the Declaration of Istanbul,5 and recently through President Marcelo Cantarovich’s presentation to the WHO Executive Board. TTS holds the precious responsibility of retaining global focus on the ethical and humanitarian goals of transplantation while moving the field forward as a multidisciplinary society representing the highest standards of clinical care, academic advancement, and education. We are not simply replacing hip joints. At the heart of this work have been the Councils of the Society and the affiliated sections that have undertaken this work—unpaid, substantial, intrusive on daily work and additional, but essential. The task of editing the Transplantation Journal has fallen to other teams over the years, including many past Medawar laureates and my coawardee this year—Manikkam Suthanthiran. In 2015, we created the sibling open access journal Transplantation Direct, and today, I am fortunate to lead an executive of 6 and a team of >100 editors and 3000 reviewers across the globe maintaining Sir Peter Medawar’s mandate. Publishing a paper may feel like being immersed in an Escher drawing, but we strive to increase the impact of our journals while providing simple submission, rapid and excellent peer review and above all a trusted source of information. Organ transplantation started with the pioneering few making the work that we do today achievable but there remains much to build if we are to fly the “A380” or “Dreamliner” of Transplantation. I leave you to consider the challenge of “Geographic and Gender Equity,” illustrated in the WHO GODT data6 (Figure 3). Analyzing these data carefully, it is becoming clear that is not simple wealth that separates access for these communities, neither is the gender disparity of donor and recipient’s access to transplantation explained “only” by economic inequalities.FIGURE 3.: World Health Organisation global observatory on donation and transplantation.3We are fortunate to have a younger generation of innovative, creative, collegial, and enthusiastic individuals taking responsibility for coordinating the team efforts that will be needed.