I was appointed in 2000, and we had our call for papers in September of 2000.

“There are something like 80,000 Americans on waiting lists for organ transplants, and there will be only maybe 25,000 organ transplants each year.”

We had a sense that there was a niche in transplantation for a journal that could achieve a higher impact than the existing journals, and which would repatriate some papers that were being published in other disciplines outside the transplantation field. The transplantation journals themselves did not have a very high impact, so the sense was that if you wanted to publish a paper regarding the immunology of transplantation, for instance, you went to the Journal of Immunology. If you wanted to publish a paper about kidney transplantation and wanted high impact, you had to go to a kidney journal. In that sense, there seemed to be an opportunity here for a journal that would perform differently than the other transplantation journals and would reverse this trend of relevant papers going to non-transplantation journals.

The established journals were really of two kinds: there were the journals that overlapped the transplantation field. These included a number of surgical journals, the Journal of Immunology, the kidney journals, etc. Those were the journals that had impact factors in the five, six, seven, and eight range. Then there were the journals in transplantation itself: Transplantation, Clinical Transplantation, and a journal called Transplantation Proceedings, which is not a peer-reviewed journal. Those would be the main journals people would be publishing in, if they didn’t go outside the field to one of these higher-impact journals.

Well, there are two transplantation societies in the United States: the American Society of Transplantation, known as AST, and the American Society of Transplantation Surgeons, ASTS. We decided it was possible for these two societies to publish one journal, which would be the official journal of the American societies.

They were privately owned and so they appointed their own editorial boards.

There were certainly cultural differences between the two of them. The project was initiated by the AST, and then the ASTS came on board. There were some intense feelings, as one would expect, about a variety of issues. It involved a number of levels of discussion, but in the end there was full commitment by both societies to the project.

I was on the board of the AST. I would attribute the idea of the journal, however, to Dr. John Neylan. He conceptualized the idea of an official journal of the AST, and then the Society approached me to be the editor. I did not think that such a journal could be a real success unless it incorporated the ASTS, as well. I explained this and the AST allowed me to take the project to the ASTS. That was the key step of having one journal supported by the entire American transplantation community. It was difficult, however, to have one journal run by two societies, so we then had to take into account that these were human institutions that would have political differences within and between societies. We proceeded to build a firewall to make the editorial policy of the journal independent of any politics within or between the societies.

There was a joint council of the two societies already, and this council managed joint projects and it ran a successful annual meeting. So we asked this joint council to undertake overview of the journal and this gave us one reporting structure rather than two. Then we created a journal-management committee that would manage some of the day-to-day issues arising from the journal. Then I did something a little different. I said, "I am the editor-in-chief, and I will appoint the entire editorial board, and you, the journal-management committee, will approve the entire editorial board en bloc," so no one will say that they are a member from the AST or a member from the ASTS. They will all be appointed en masse by me. And the societies accepted that. We did not want any loyalty from the two founding societies or identification of individual members with the two founding societies and this seemed like the best way to do it. I guess one way of phrasing it is to say that we had an active strategy to neutralize any political issues, so they might still exist above the level of the journal, but nothing would be translated to the journal itself. We would have no one saying they are the ASTS editor or an AST editor. They are all appointed in the same process and approved in the same process.

I think having done that, we then found the right publisher. One of our deputy editors, Dr. Hugh Auchincloss, had worked on a small journal with a publisher called Munksgaard in Copenhagen, and they had quite a presence already in small transplantation journals. So Hugh said that he had had a very good experience with a quite senior person there, Peter Hartmann, and Peter had a lot of experience in medical publication in both transplantation and immunology. Peter had helped Hugh a lot when he was running a small transplantation journal. So Hugh said this person could really guide us to a successful launch, and the societies undertook a process to look at this and then ended up appointing Munksgaard, which was then taken over by Blackwell. And Peter Hartmann and his team were the people inside who helped us the most. So I think having solved the politics about the concept, we found the right publisher who had a lot of experience, and then that was key to making the rest of the choices.

We started with the editorial board. We went to people who were in the active phase of their careers. Then we recruited two levels of editorial board: one set of senior editors, known as deputy editors, and then a level of editors who would actually run the journal. These were associate editors and they would actually allocate manuscripts to referees and make the first level of decisions on manuscripts. This was perhaps a different hierarchy than other journals. But it works because it created a level of redundancy. It allows us to make rapid decisions when necessary and bypass the associate editor or the deputy editor when that person is temporarily unable to be involved. So we have quite a short decision time of 20 or 21 days with original articles. In other words we tried to establish very favorable editorial characteristics; people get an answer quickly. They have their articles fully refereed. We try to get two editors and two referees commenting on every manuscript, and then it comes to me. And we can do that in an average of 21 days. Last year we had 1,200 submissions and this year we will be well above that number.

The total right now: of every submission that comes to us, invited or not, 25 percent will eventually appear in the journal. About 12 percent are accepted on the first pass, and another 12 or 13 percent are rejected and then are accepted with resubmission on the next pass.

One thing we’ve been learning to deal with is that of supplements. We see supplements as potentially detracting from the quality of the journal and taking away our brand that we want to protect. This brand means that if you are published in AJT, you have a certain level of editorial review and an established quality. There is no industrial bias. Everything is up to ethical standards and institutional review. We didn’t want to have supplements that lower the standard of the brand. So we’re still trying to define the role of supplements vis a vis the journal. Some kinds of supplements are highly successful, as clinical practice guidelines, supplements that deal with single issues, or with a definitive treatment of an issue at a very high editorial level. Other supplements—for example, the proceedings of a meeting—are more problematic. We do not like to publish meeting proceedings because we think generally they will be below the standards of the journal. People usually will not put their best work in a meeting, and if they do, it is often an overlapping or a duplicate publication, because they will then submit it for peer review in a journal. A meeting supplement, or an industry-sponsored supplement, will generally have inferior work, either duplicate publications or publications with an industry bias by virtue of having been selected by an industrial sponsor. We are still dealing with this issue of how to have successful supplements and I am sure every journal is dealing with this same issue. Supplements can potentially make a lot of money for a journal, which is then available to the societies to do good work, but it can detract from the overall quality of the journal.

In the next five years we hope to address this issue that some aspects of the field of transplantation do not have a lot of loyalty to transplantation journals. And that’s just natural. For example, the American Transplantation Congress, which is the annual meeting of our two societies, isn’t the main vehicle at which lung and heart transplantation work tends to be presented. So these people don’t associate so much with transplantation societies as with cardiovascular or thoracic societies. Papers from those fields do not come to us as often as we would like. We knew that going in, and we are still working with those communities to try to make them see that publishing in the AJT is good for their work, and for their constituency. Basic science is another interesting issue we will have to deal with. Basic scientists have to get NIH grant support for their laboratories, and they think they need to get into higher-impact-factor journals to maximize their competitive edge in the peer-review process. So these researchers would always like to send their work to higher-impact journals and established journals, and they are considerably less likely to take a chance on a new journal. They do not know how it will be perceived by the study sections of NIH. So we tend to have trouble attracting the better basic science in transplantation. The truth is, if clinicians think they can get into the New England Journal of Medicine, they won’t send us their clinical papers either. In basic science, though, there is more of a tendency for people to send things to intermediate-level journals. The working immunologist likes to send things to the Journal of Immunology, for instance, which has an impact factor of seven to eight. We have an impact factor in the fives. So we are working with that perception and trying to create an appropriate forum for the basic sciences that says they should be publishing in a transplantation journal.

I think it is just a process of working day by day with these scientists, and talking to them individually and creating editorial features in the front end of the journal, so they will see that issues in the basic science of transplantation are very well discussed in AJT, and well read, as a result.

Yes. In fact, we like to focus on these controversies because they add a little more spice. You get different points of view. Take one in particular, the public policy around organ donation. What are the frontiers of organ donation? What about the use of donors whose hearts have stopped beating? And what about paid donation? There are something like 80,000 Americans on waiting lists for organ transplants, and there will only be maybe 25,000 organ transplants each year. How should those waiting lists be managed? Some people are waiting for five years for an organ and they have a life expectancy of considerably less than that. And so there is the issue of whether paid donations will help this situation. That evokes very strong opinions and we’ve been a forum for articles addressing that. The field of transplantation just has that characteristic: it attracts a high level of public interest. Unlike most fields of medicine, organ transplantation requires two individuals—a patient and a donor—and so we have to use publicity much more than those fields, where there is only a patient who requires service. The issue of donation gets us into issues of public policy, ethics, and economics and those are all quite interesting. So we have tried to capitalize on that and present the journal as a place where those issues are dealt with fairly and openly and where we do not shy away from controversy.