1
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Perakslis E, Knechtle SJ. Information design to support growth, quality, and equity of the US transplant system. Am J Transplant 2023; 23:5-10. [PMID: 36695621 DOI: 10.1016/j.ajt.2022.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 01/13/2023]
Abstract
The Organ Procurement and Transplantation Network, an arm of the Health Resources and Services Administration, has a contract with the United Network for Organ Sharing since 1986 to provide central oversight of organ donation and transplants in the United States. The United Network for Organ Sharing has recently come under scrutiny, prompting a review by the National Academies of Sciences, Engineering, and Medicine as summarized in its recent report and also by the US Senate Finance Committee. The national news services have opined about organ donation ethics, access to transplantation particularly for medically underserved populations, and management of organ transplantation data. These critiques raise important concerns that deserve our best response as a transplant community. Broadly, we suggest that the data management approach of the Organ Procurement and Transplantation Network be replaced with a patient-centric omnichannel network in which all donor and recipient data exist in a single longitudinal record that can be used by all applications. A more comprehensive and standardized approach to donor data collection would drive quality improvement across organ procurement organizations and help address inequities in transplantation. Finally, a substantial increase in organ donation would be prompted by considering organ donors as a public health resource, meriting transparent publicly available data collection with respect to organ donor referral, screening, and management.
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Affiliation(s)
- Eric Perakslis
- Duke Clinical Research Institute, Population Health Sciences, Durham, North Carolina, USA
| | - Stuart J Knechtle
- Department of Surgery, Duke Transplant Center, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA.
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2
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Heldal TF, Åsberg A, Ueland T, Reisæter A, Pischke SE, Mollnes TE, Aukrust P, Hartmann A, Heldal K, Jenssen T. Inflammation in the early phase after kidney transplantation is associated with increased long-term all-cause mortality. Am J Transplant 2022; 22:2016-2027. [PMID: 35352462 PMCID: PMC9540645 DOI: 10.1111/ajt.17047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/04/2022] [Accepted: 03/24/2022] [Indexed: 01/25/2023]
Abstract
In the general population, low-grade inflammation has been established as a risk factor for all-cause mortality. We hypothesized that an inflammatory milieu beyond the time of recovery from the surgical trauma could be associated with increased long-term mortality in kidney transplant recipients (KTRs). This cohort study included 1044 KTRs. Median follow-up time post-engraftment was 10.3 years. Inflammation was assessed 10 weeks after transplantation by different composite inflammation scores based on 21 biomarkers. We constructed an overall inflammation score and five pathway-specific inflammation scores (fibrogenesis, vascular inflammation, metabolic inflammation, growth/angiogenesis, leukocyte activation). Mortality was assessed with Cox regression models adjusted for traditional risk factors. A total of 312 (29.9%) patients died during the follow-up period. The hazard ratio (HR) for death was 4.71 (95% CI: 2.85-7.81, p < .001) for patients in the highest quartile of the overall inflammation score and HRs 2.35-2.54 (95% CI: 1.40-3.96, 1.52-4.22, p = .001) for patients in the intermediate groups. The results were persistent when the score was analyzed as a continuous variable (HR 1.046, 95% CI: 1.033-1.056, p < .001). All pathway-specific analyses showed the same pattern with HRs ranging from 1.19 to 2.70. In conclusion, we found a strong and consistent association between low-grade systemic inflammation 10 weeks after kidney transplantation and long-term mortality.
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Affiliation(s)
- Torbjørn Fossum Heldal
- Department of Internal MedicineTelemark Hospital TrustSkienNorway,Institute of Clinical MedicineUniversity of OsloOsloNorway,Department of Transplantation MedicineOslo University Hospital – RikshospitaletOsloNorway
| | - Anders Åsberg
- Department of Transplantation MedicineOslo University Hospital – RikshospitaletOsloNorway,Norwegian Renal RegistryOslo University Hospital – RikshospitaletOsloNorway,Department of PharmacyUniversity of OsloOsloNorway
| | - Thor Ueland
- Institute of Clinical MedicineUniversity of OsloOsloNorway,K.G. Jebsen Thrombosis Research and Expertise CenterUniversity of TromsøTromsøNorway,Research Institute of Internal MedicineOslo University Hospital – RikshospitaletOsloNorway
| | - Anna Varberg Reisæter
- Department of Transplantation MedicineOslo University Hospital – RikshospitaletOsloNorway,Norwegian Renal RegistryOslo University Hospital – RikshospitaletOsloNorway
| | - Søren E. Pischke
- Department of ImmunologyUniversity of Oslo and Oslo University HospitalOsloNorway,Department of AnesthesiologyDivision of Emergencies and Critical CareOslo University HospitalOsloNorway
| | - Tom Eirik Mollnes
- K.G. Jebsen Thrombosis Research and Expertise CenterUniversity of TromsøTromsøNorway,Department of ImmunologyUniversity of Oslo and Oslo University HospitalOsloNorway,Research LaboratoryNordland Hospital BodøBodøNorway,Center of Molecular Inflammation ResearchNorwegian University of Science and TechnologyTrondheimNorway
| | - Pål Aukrust
- K.G. Jebsen Thrombosis Research and Expertise CenterUniversity of TromsøTromsøNorway,Research Institute of Internal MedicineOslo University Hospital – RikshospitaletOsloNorway,Section of Clinical Immunology and Infectious DiseasesOslo University Hospital – RikshospitaletOsloNorway
| | - Anders Hartmann
- Institute of Clinical MedicineUniversity of OsloOsloNorway,Department of Transplantation MedicineOslo University Hospital – RikshospitaletOsloNorway
| | - Kristian Heldal
- Department of Internal MedicineTelemark Hospital TrustSkienNorway,Department of Transplantation MedicineOslo University Hospital – RikshospitaletOsloNorway
| | - Trond Jenssen
- Institute of Clinical MedicineUniversity of OsloOsloNorway,Department of Transplantation MedicineOslo University Hospital – RikshospitaletOsloNorway
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3
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Robertson MP, Lavee J. Execution by organ procurement: Breaching the dead donor rule in China. Am J Transplant 2022; 22:1804-1812. [PMID: 35377533 PMCID: PMC9542006 DOI: 10.1111/ajt.16969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/27/2021] [Accepted: 01/19/2022] [Indexed: 01/25/2023]
Abstract
The dead donor rule is fundamental to transplant ethics. The rule states that organ procurement must not commence until the donor is both dead and formally pronounced so, and by the same token, that procurement of organs must not cause the death of the donor. In a separate area of medical practice, there has been intense controversy around the participation of physicians in the execution of capital prisoners. These two apparently disparate topics converge in a unique case: the intimate involvement of transplant surgeons in China in the execution of prisoners via the procurement of organs. We use computational text analysis to conduct a forensic review of 2838 papers drawn from a dataset of 124 770 Chinese-language transplant publications. Our algorithm searched for evidence of problematic declarations of brain death during organ procurement. We find evidence in 71 of these reports, spread nationwide, that brain death could not have properly been declared. In these cases, the removal of the heart during organ procurement must have been the proximate cause of the donor's death. Because these organ donors could only have been prisoners, our findings strongly suggest that physicians in the People's Republic of China have participated in executions by organ removal.
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Affiliation(s)
- Matthew P. Robertson
- Australian National UniversityVictims of Communism Memorial FoundationWashingtonD.C.USA
| | - Jacob Lavee
- Heart Transplantation UnitLeviev Cardiothoracic CenterSheba Medical CenterFaculty of MedicineTel Aviv UniversityRamat GanIsrael
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4
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Opole IO, Deep NN, Snyder Sulmasy L. On the ethics of NRP and the American College of Physicians NRP statement. Am J Transplant 2022; 22:1725-1726. [PMID: 35247291 DOI: 10.1111/ajt.17014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Isaac O Opole
- University of Kansas Medical Center, Kansas City, Kansas
| | - Noel N Deep
- Medical College of Wisconsin, Aspirus Langlade Hospital, Antigo, Wisconsin
| | - Lois Snyder Sulmasy
- Center for Ethics and Professionalism, American College of Physicians, Philadelphia, Pennsylvania
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5
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Parent B, Caplan A, Moazami N, Montgomery RA. Regarding normothermic regional perfusion: Arguing by insistence is not a strong argument. Am J Transplant 2022; 22:1729-1730. [PMID: 35352473 DOI: 10.1111/ajt.17046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Brendan Parent
- Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Arthur Caplan
- Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Nader Moazami
- NYU Langone Medical Center, Transplant Institute, New York, New York, USA
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6
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Parent B, Caplan A, Moazami N, Montgomery RA. Response to American College of Physician's statement on the ethics of transplant after normothermic regional perfusion. Am J Transplant 2022; 22:1307-1310. [PMID: 35072337 DOI: 10.1111/ajt.16947] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 01/25/2023]
Abstract
This paper responds to the position statement released by the American College of Physicians (ACP) entitled "Ethics, Determination of Death, and Organ Transplantation in Normothermic Regional Perfusion (NRP) with Controlled Donation after Circulatory Determination of Death (cDCD): American College of Physicians Statement of Concern." The ACP's statement engages with critical ethical issues surrounding cDCD NRP, but several of their conclusions are flawed. Contrary to the statement, the practice respects the dead donor rule and the legal definition of death while honoring the wishes of the deceased and their loved ones to help save the lives of those in need of organ transplants. cDCD NRP is well established in many countries, it can enhance trust in medical practice and organ donation, and will increase the availability of optimal organs for life-saving transplants.
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Affiliation(s)
- Brendan Parent
- Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York
| | - Arthur Caplan
- Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York
| | - Nader Moazami
- NYU Langone Medical Center, Transplant Institute, New York, New York
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7
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Subramanian V, Anderson C, Karp S, Pastan S, Gerber D, Locke J, Cohen A, Shah M, Casingal V, Strata R, Singh N, DuBay D, Dhanireddy K. COVID-19 and transplantation-Data censoring. Am J Transplant 2022; 22:1958-1962. [PMID: 35451211 PMCID: PMC9111342 DOI: 10.1111/ajt.17065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023]
Abstract
During the early wave of the COVID-19 pandemic, the Scientific Registry of Transplant Recipients (SRTR) designated a "black out" period between March 12, 2020, and June 12, 2020, for transplant outcomes reporting. We discuss the implications and potential bias it has introduced as it may selectively favor the outcomes for certain regions and harm other regions due to varied effects of different waves of COVID-19 infections across the United States.
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Affiliation(s)
| | | | - Seth Karp
- Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - David Gerber
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Jayme Locke
- University of Alabama School of MedicineBirminghamAlabamaUSA
| | - Ari Cohen
- Ochsner Clinic FoundationJeffersonLouisianaUSA
| | - Malay Shah
- University of KentuckyLexingtonKentuckyUSA
| | | | - Robert Strata
- Atrium Health Wake Forest BaptistWinston‐SalemNorth CarolinaUSA
| | - Neeraj Singh
- Willis‐Knighton Medical CenterShreveportLouisianaUSA
| | - Derek DuBay
- Medical University of South CarolinaMt PleasantSouth CarolinaUSA
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8
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Kates OS, Stock PG, Ison MG, Allen RD, Burra P, Jeong JC, Kute V, Muller E, Nino-Murcia A, Wang H, Wall A. Ethical review of COVID-19 vaccination requirements for transplant center staff and patients. Am J Transplant 2022; 22:371-380. [PMID: 34706165 PMCID: PMC8653143 DOI: 10.1111/ajt.16878] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/03/2021] [Accepted: 10/24/2021] [Indexed: 01/25/2023]
Abstract
Transplant centers seeking to increase coronavirus disease 2019 (COVID-19) vaccine coverage may consider requiring vaccination for healthcare workers or for candidates. The authors summarize current data to inform an ethical analysis of the harms, benefits, and individual and societal impact of mandatory vaccination, concluding that vaccine requirements for healthcare workers and transplant candidates are ethically justified by beneficence, net utility, and fiduciary duty to patients and public health. Implementation strategies should mitigate concerns about respect for autonomy and transparency for both groups. We clarify how the same arguments might be applied to related questions of caregiver vaccination, allocation of other healthcare resources, and mandates for non-COVID-19 vaccines. Finally, we call for effort to achieve global equity in vaccination as soon as possible.
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Affiliation(s)
- Olivia S. Kates
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Peter G. Stock
- Department of Surgery, University of California, San Francisco, San Francisco, California,Correspondence Peter G. Stock, Department of Surgery, University of California, San Francisco, San Francisco, CA.
| | - Michael G. Ison
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Richard D.M. Allen
- Bosch Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Patrizia Burra
- Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Jong Cheol Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Vivek Kute
- Department of Nephrology and Transplantation Science, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Elmi Muller
- Transplant Unit, Department of Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | | | - Haibo Wang
- Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Anji Wall
- Baylor University Medical Center, Annette C. and Harold C. Simmons Transplant Institute, Dallas, Texas
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9
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Wood NL, VanDerwerken DN, King EA, Segev DL, Gentry SE. Life expectancy without a transplant for status 1A liver transplant candidates. Am J Transplant 2022; 22:274-278. [PMID: 34487636 PMCID: PMC8720063 DOI: 10.1111/ajt.16830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 01/25/2023]
Abstract
Status 1A liver transplant candidates are given the highest medical priority for the allocation of deceased donor livers. Organ Procurement and Transplantation Network (OPTN) policy requires physicians to certify that a candidate has a life expectancy without a transplant of less than 7 days for that candidate to be given status 1A. Additionally, candidates receiving status 1A must have one of six medical conditions listed in policy. Using Scientific Registry of Transplant Recipients data from all prevalent liver transplant candidates from 2010 to 2020, we used a bias-corrected Kaplan-Meier model to calculate the survival of status 1A candidates and to determine their life expectancy without a transplant. We found that status 1A candidates have a life expectancy without a transplant of 24 (95% CI 20-46) days-over three times longer than what policy requires for status 1A designation. We repeated the analysis for subgroups of status 1A candidates based on the medical conditions that grant status 1A. We found that none of these subgroups met the life expectancy requirement. Harmonizing OPTN policy with observed data would sustain the integrity of the allocation process.
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Affiliation(s)
- Nicholas L. Wood
- Department of Mathematics, United States Naval Academy, Annapolis, MD
| | | | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Sommer E. Gentry
- Department of Mathematics, United States Naval Academy, Annapolis, MD
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10
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Molchan K, Potter J. Further benefits of imminent death donation. Am J Transplant 2021; 21:3199-3200. [PMID: 33559226 DOI: 10.1111/ajt.16525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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11
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Witkowski P, Barth RN, Japour A, Javitt G, Pyda JS, Bachul PJ, Nowicki E, Ricordi C. Regulatory updates are needed to prevent the commercialization of islet transplantation in the United States. Am J Transplant 2021; 21:2620-2622. [PMID: 33683809 DOI: 10.1111/ajt.16555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Piotr Witkowski
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois
| | - Rolf N Barth
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois
| | - Anthony Japour
- Anthony Japour and Associates, Medical and Scientific Consulting Inc, Miami, Florida
| | - Gail Javitt
- Hyman, Phelps & McNamara P.C., Berman Institute of Bioethics, Johns Hopkins, Baltimore, Maryland
| | - Jordan S Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Piotr J Bachul
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois
| | | | - Camillo Ricordi
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida
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12
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Egan TM, Wall S, Goldfrank L, Requard JJ. The real number of organs from uncontrolled donation after circulatory determination of death donors. Am J Transplant 2021; 21:2301-2302. [PMID: 33320990 DOI: 10.1111/ajt.16443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Thomas M Egan
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Organs for Life, Durham, North Carolina
| | - Stephen Wall
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
| | - Lewis Goldfrank
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
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13
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Formica RN. Uncertainty in organ allocation is a catalyst for positive change. Am J Transplant 2021; 21:1996-1997. [PMID: 33527748 DOI: 10.1111/ajt.16511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 01/25/2023]
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14
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Durand CM, Zhang W, Brown DM, Yu S, Desai N, Redd AD, Bagnasco SM, Naqvi FF, Seaman S, Doby BL, Ostrander D, Bowring MG, Eby Y, Fernandez RE, Friedman-Moraco R, Turgeon N, Stock P, Chin-Hong P, Mehta S, Stosor V, Small CB, Gupta G, Mehta SA, Wolfe CR, Husson J, Gilbert A, Cooper M, Adebiyi O, Agarwal A, Muller E, Quinn TC, Odim J, Huprikar S, Florman S, Massie AB, Tobian AAR, Segev DL. A prospective multicenter pilot study of HIV-positive deceased donor to HIV-positive recipient kidney transplantation: HOPE in action. Am J Transplant 2021; 21:1754-1764. [PMID: 32701209 PMCID: PMC8073960 DOI: 10.1111/ajt.16205] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
HIV-positive donor to HIV-positive recipient (HIV D+/R+) transplantation is permitted in the United States under the HIV Organ Policy Equity Act. To explore safety and the risk attributable to an HIV+ donor, we performed a prospective multicenter pilot study comparing HIV D+/R+ vs HIV-negative donor to HIV+ recipient (HIV D-/R+) kidney transplantation (KT). From 3/2016 to 7/2019 at 14 centers, there were 75 HIV+ KTs: 25 D+ and 50 D- (22 recipients from D- with false positive HIV tests). Median follow-up was 1.7 years. There were no deaths nor differences in 1-year graft survival (91% D+ vs 92% D-, P = .9), 1-year mean estimated glomerular filtration rate (63 mL/min D+ vs 57 mL/min D-, P = .31), HIV breakthrough (4% D+ vs 6% D-, P > .99), infectious hospitalizations (28% vs 26%, P = .85), or opportunistic infections (16% vs 12%, P = .72). One-year rejection was higher for D+ recipients (50% vs 29%, HR: 1.83, 95% CI 0.84-3.95, P = .13) but did not reach statistical significance; rejection was lower with lymphocyte-depleting induction (21% vs 44%, HR: 0.33, 95% CI 0.21-0.87, P = .03). In this multicenter pilot study directly comparing HIV D+/R+ with HIV D-/R+ KT, overall transplant and HIV outcomes were excellent; a trend toward higher rejection with D+ raises concerns that merit further investigation.
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Affiliation(s)
- Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wanying Zhang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diane M. Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sile Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Niraj Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew D. Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Serena M. Bagnasco
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fizza F. Naqvi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shanti Seaman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brianna L. Doby
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Darin Ostrander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Reinaldo E. Fernandez
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Friedman-Moraco
- Department of Medicine, Emory University, Atlanta, Georgia
- Department of Surgery, Emory University, Atlanta, Georgia
| | - Nicole Turgeon
- Department of Surgery, Emory University, Atlanta, Georgia
- Department of Surgery, Dell Medical School, University of Texas, Austin, Texas
| | - Peter Stock
- Department of Medicine, University of California, San Francisco, California
| | - Peter Chin-Hong
- Department of Medicine, University of California, San Francisco, California
| | - Shikha Mehta
- Section of Transplant Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Valentina Stosor
- Department of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Catherine B. Small
- Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
| | - Gaurav Gupta
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Sapna A. Mehta
- NYU Langone Transplant Institute, New York University Grossman School of Medicine, New York, New York
| | - Cameron R. Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Jennifer Husson
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alexander Gilbert
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, District of Columbia
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, District of Columbia
| | - Oluwafisayo Adebiyi
- Department of Medicine, Indiana University Health Hospital, Indianapolis, Indiana
| | - Avinash Agarwal
- Department of Surgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Elmi Muller
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Thomas C. Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jonah Odim
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Shirish Huprikar
- Recanati-Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York
| | - Sander Florman
- Recanati-Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aaron A. R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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15
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Helanterä I, Mannon RB, Mengel M. Industry partnerships in transplantation: How should AJT manage the inevitable conflict of interest? Am J Transplant 2021; 21:1988-1989. [PMID: 33315303 DOI: 10.1111/ajt.16447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 10/30/2020] [Accepted: 12/09/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Ilkka Helanterä
- Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Roslyn B Mannon
- Division of Nephrology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Michael Mengel
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Canada
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16
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Witkowski P, Philipson LH, Kaufman DB, Ratner LE, Abouljoud MS, Bellin MD, Buse JB, Kandeel F, Stock PG, Mulligan DC, Markmann JF, Kozlowski T, Andreoni KA, Alejandro R, Baidal DA, Hardy MA, Wickrema A, Mirmira RG, Fung J, Becker YT, Josephson MA, Bachul PJ, Pyda JS, Charlton M, Millis JM, Gaglia JL, Stratta RJ, Fridell JA, Niederhaus SV, Forbes RC, Jayant K, Robertson RP, Odorico JS, Levy MF, Harland RC, Abrams PL, Olaitan OK, Kandaswamy R, Wellen JR, Japour AJ, Desai CS, Naziruddin B, Balamurugan AN, Barth RN, Ricordi C. The demise of islet allotransplantation in the United States: A call for an urgent regulatory update. Am J Transplant 2021; 21:1365-1375. [PMID: 33251712 PMCID: PMC8016716 DOI: 10.1111/ajt.16397] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Abstract
Islet allotransplantation in the United States (US) is facing an imminent demise. Despite nearly three decades of progress in the field, an archaic regulatory framework has stymied US clinical practice. Current regulations do not reflect the state-of-the-art in clinical or technical practices. In the US, islets are considered biologic drugs and "more than minimally manipulated" human cell and tissue products (HCT/Ps). In contrast, across the world, human islets are appropriately defined as "minimally manipulated tissue" and not regulated as a drug, which has led to islet allotransplantation (allo-ITx) becoming a standard-of-care procedure for selected patients with type 1 diabetes mellitus. This regulatory distinction impedes patient access to islets for transplantation in the US. As a result only 11 patients underwent allo-ITx in the US between 2016 and 2019, and all as investigational procedures in the settings of a clinical trials. Herein, we describe the current regulations pertaining to islet transplantation in the United States. We explore the progress which has been made in the field and demonstrate why the regulatory framework must be updated to both better reflect our current clinical practice and to deal with upcoming challenges. We propose specific updates to current regulations which are required for the renaissance of ethical, safe, effective, and affordable allo-ITx in the United States.
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Affiliation(s)
- Piotr Witkowski
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | | | - Dixon B. Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lloyd E. Ratner
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Marwan S. Abouljoud
- Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Melena D. Bellin
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - John B. Buse
- Division of Endocrinology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Fouad Kandeel
- Department of Translational Research and Cellular Therapeutics, Diabetes and Metabolism Research Institute, Beckman Research Institute of City of Hope, Duarte, California, USA
| | - Peter G. Stock
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, California, USA
| | - David C. Mulligan
- Department of Surgery, Transplantation and Immunology, Yale University, New Haven, Connecticut, USA
| | - James F. Markmann
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomasz Kozlowski
- Division of Transplantation, Department of Surgery, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Kenneth A. Andreoni
- Department of Surgery, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Rodolfo Alejandro
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida, USA
| | - David A. Baidal
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida, USA
| | - Mark A. Hardy
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Amittha Wickrema
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, Illinois, USA
| | - Raghavendra G. Mirmira
- Department of Medicine, Translational Research Center, University of Chicago, Chicago, Illinois, USA
| | - John Fung
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Yolanda T. Becker
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Michelle A. Josephson
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Piotr J. Bachul
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Jordan S. Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Charlton
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - J. Michael Millis
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Jason L. Gaglia
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J. Stratta
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jonathan A. Fridell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Silke V. Niederhaus
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Rachael C. Forbes
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kumar Jayant
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - R. Paul Robertson
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Jon S. Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marlon F. Levy
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | | | - Peter L. Abrams
- MedStar Georgetown Transplant Institute, Washington, District of Columbia, USA
| | | | - Raja Kandaswamy
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jason R. Wellen
- Department of Surgery, Washington University, St Louis, Missouri, USA
| | - Anthony J. Japour
- Anthony Japour and Associates, Medical and Scientific Consulting Inc, Miami, FL, USA
| | - Chirag S. Desai
- Department of Surgery, Section of Transplantation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bashoo Naziruddin
- Transplantation Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Appakalai N. Balamurugan
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Rolf N. Barth
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Camillo Ricordi
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida, USA
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17
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Niroomand E, Mantero A, Narasimman M, Delgado C, Goldberg D. Rapid improvement in organ procurement organization performance: Potential for change and impact of new leadership. Am J Transplant 2020; 20:3567-3573. [PMID: 32476235 DOI: 10.1111/ajt.16085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/29/2020] [Accepted: 05/15/2020] [Indexed: 01/25/2023]
Abstract
Recently proposed rulemaking from Centers for Medicare and Medicaid Services would change how organ procurement organizations (OPOs) are evaluated. The proposals include using national inpatient death data to define a standardized denominator to calculate comparable donation rates among OPOs. Based on these objective metrics, OPOs not performing at a prespecified threshold will be required to rapidly improve performance to avoid decertification. We sought to determine whether rapid OPO improvement was possible based on objective donation metrics, and whether leadership change was associated with rapid improvement. We evaluated United Network for Organ Sharing and Centers for Disease Control and Prevention (CDC) data from 2011 to 2018, and measured donation rates using CDC data on inpatient deaths from causes consistent with donation, based on the location of deaths. During the two 4-year cycles, we found that an OPO's ranking relative to other OPOs was fairly static, with more than 90% of the OPOs at risk of flagging at the end of each 4-year cycle (2014, 2018) being in the bottom 75% of OPOs in the preceding 3 years. In multivariable logistic regression models, leadership changes were only statistically significantly associated with an improvement in OPO rankings during the 2011-2014 cycle. These data demonstrate that rapid improvements in OPO performance are uncommon, and while leadership changes increase the odds of rapid improvement, they do not guarantee improvement.
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Affiliation(s)
- Elaheh Niroomand
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Alejandro Mantero
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Cindy Delgado
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - David Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
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18
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Egan TM, Requard JJ. Afterlife for lungs: A way to increase donor lungs for transplant. Am J Transplant 2020; 20:2954-2955. [PMID: 32579288 DOI: 10.1111/ajt.16068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Thomas M Egan
- University of North Carolina at Chapel Hill, Lung Banks of America, Chapel Hill, North Carolina, USA
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19
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Boyarsky BJ, Jackson KR, Kernodle AB, Sakran JV, Garonzik-Wang JM, Segev DL, Ottmann SE. Estimating the potential pool of uncontrolled DCD donors in the United States. Am J Transplant 2020; 20:2842-2846. [PMID: 32372460 DOI: 10.1111/ajt.15981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/10/2020] [Accepted: 04/27/2020] [Indexed: 01/25/2023]
Abstract
Organs from uncontrolled DCD donors (uDCDs) have expanded donation in Europe since the 1980s, but are seldom used in the United States. Cited barriers include lack of knowledge about the potential donor pool, lack of robust outcomes data, lack of standard donor eligibility criteria and preservation methods, and logistical and ethical challenges. To determine whether it would be appropriate to invest in addressing these barriers and building this practice, we sought to enumerate the potential pool of uDCD donors. Using data from the Nationwide Emergency Department Sample, the largest all-payer emergency department (ED) database, between 2013 and 2016, we identified patients who had refractory cardiac arrest in the ED. We excluded patients with contraindications to both deceased donation (including infection, malignancy, cardiopulmonary disease) and uDCD (including hemorrhage, major polytrauma, burns, and poisoning). We identified 9828 (range: 9454-10 202) potential uDCDs/y; average age was 32 years, and all were free of major comorbidity. Of these, 91.1% had traumatic deaths, with major causes including nonhead blunt injuries (43.2%) and head injuries (40.1%). In the current era, uDCD donors represent a significant potential source of unused organs. Efforts to address barriers to uDCD in the United States should be encouraged.
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Affiliation(s)
- Brian J Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kyle R Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amber B Kernodle
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph V Sakran
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shane E Ottmann
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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Sharif A, Montgomery RA. Regulating the risk-reward trade-off in transplantation. Am J Transplant 2020; 20:2282-2283. [PMID: 32243681 DOI: 10.1111/ajt.15882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, University Hospitals Birmingham, Edgbaston, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, UK
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21
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Andreoni KA. Are we ready for truly disruptive positive change? Am J Transplant 2020; 20:2284. [PMID: 32304176 DOI: 10.1111/ajt.15926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Kenneth A Andreoni
- Division of Abdominal Transplantation, Department of Surgery, University of Florida, Gainesville, Florida, USA
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22
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Chen A, Ahmad M, Flescher A, Freeman WL, Little S, Martins PN, Veatch RM, Wightman A, Ladin K. Access to transplantation for persons with intellectual disability: Strategies for nondiscrimination. Am J Transplant 2020; 20:2009-2016. [PMID: 31873978 DOI: 10.1111/ajt.15755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/21/2019] [Accepted: 12/14/2019] [Indexed: 01/25/2023]
Abstract
Disqualifying patients with intellectual disabilities (ID) from transplantation has received growing attention from the media, state legislatures, the Office of Civil Rights, and recently the National Council on Disability, as well as internationally. Compared with evidence-based criteria used to determine transplant eligibility, the ID criterion remains controversial because of its potential to be discriminatory, subjective, and because its relationship to outcomes is uncertain. Use of ID in determining transplant candidacy may stem partly from perceived worse adherence and outcomes for patients with ID, fear of penalties to transplant centers for poor outcomes, and stigma surrounding the quality of life for people with ID. However, using ID as a contraindication to solid organ transplantation is not evidence-based and reduces equitable access to transplantation, disadvantaging an already vulnerable population. Variability and lack of transparency in referral and evaluation allows for gatekeeping, threatens patient autonomy, limits access to lifesaving treatment, and may be seen as unfair. We examine the benefits and harms of using ID as a transplant eligibility criterion, review current clinical evidence and ethical considerations, and make recommendations for transplant teams and regulatory agencies to ensure fair access to transplant for individuals with ID.
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Affiliation(s)
- Ashton Chen
- Department of Pediatrics, Wake Forest University Medical School, Winston-Salem, North Carolina, USA
| | - Mahwish Ahmad
- Center for Bioethics, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Bioethics, Case Western Reserve School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Andrew Flescher
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York, USA
| | | | | | - Paulo N Martins
- Department of Surgery, Division of Transplantation, University of Massachusetts, Worcester, Massachusetts, USA
| | - Robert M Veatch
- Kennedy Institute of Ethics, Georgetown University, District of Columbia, Washington, USA
| | - Aaron Wightman
- Divisions of Nephrology and Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, Washington, USA
| | - Keren Ladin
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts, USA
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23
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Moeckli B, Peloso A, Oldani G, Orci LA, Banz V, Dutkowski P, Toso C, Berney T. The Swiss approach to the COVID-19 outbreak. Am J Transplant 2020; 20:1935-1936. [PMID: 32330352 PMCID: PMC7264619 DOI: 10.1111/ajt.15939] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Beat Moeckli
- Divisions of Transplantation and Visceral Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland
| | - Andrea Peloso
- Divisions of Transplantation and Visceral Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland,Correspondence Andrea Peloso
| | - Graziano Oldani
- Divisions of Transplantation and Visceral Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland
| | - Lorenzo A. Orci
- Divisions of Transplantation and Visceral Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland
| | - Vanessa Banz
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Philipp Dutkowski
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Christian Toso
- Divisions of Transplantation and Visceral Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland
| | - Thierry Berney
- Divisions of Transplantation and Visceral Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland
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24
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Formica RN, Gill JS. Should the United States employ free market practices to solve the hidden public health crisis of chronic kidney disease? Am J Transplant 2020; 20:1217-1218. [PMID: 31746545 DOI: 10.1111/ajt.15718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/10/2019] [Accepted: 11/10/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Richard N Formica
- Section of Nephrology, Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - John S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Gordon EJ, Knopf E, Phillips C, Mussell A, Lee J, Veatch RM, Abt P, Dunn S, Reese PP. Transplant candidates' perceptions of informed consent for accepting deceased donor organs subjected to intervention research and for participating in posttransplant research. Am J Transplant 2020; 20:474-492. [PMID: 31550422 DOI: 10.1111/ajt.15607] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/14/2019] [Accepted: 08/30/2019] [Indexed: 01/25/2023]
Abstract
Deceased donor organ intervention research holds promise for increasing the quantity and quality of organs for transplantation by minimizing organ injury and optimizing function. Such research will not progress until ethical, regulatory, and legal issues are resolved regarding whether and how to obtain informed consent from transplant candidates offered intervention organs given time constraints intrinsic to distribution. This multi-center, mixed-methods study involved semi-structured interviews using open- and closed-ended questions to assess waitlisted candidates' preferences for informed consent processes if offered an organ after undergoing intervention. Data were analyzed thematically. Sixty-one candidates participated (47% participation rate). Most were male (57%), white (61%), with a mean age of 56 years. Most candidates (79%) desired being informed that the organ offered was an intervention organ before accepting it, and were likely to accept an intervention organ if organ quality was good (defined as donor age 30) (81%), but fewer candidates would accept an intervention organ if quality was moderate (ie, donor age 50) (26%). Most perceived informed consent important for decision-making, while others considered it unnecessary given medical necessity to accept an organ and trust in their physician. Our findings suggest that most candidates desire an informed consent process before accepting an intervention organ and posttransplant data collection.
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Affiliation(s)
| | | | | | - Adam Mussell
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Peter Abt
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sue Dunn
- Donor Alliance, Denver, Colorado
| | - Peter P Reese
- University of Pennsylvania, Philadelphia, Pennsylvania
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26
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Lockridge J, Norman D, Rehman S, Scott D, Maynard E, Bowers D, Siegman I, Martin K. A caveat to the MISSION Act: Perspective from a Veterans Administration transplant center. Am J Transplant 2019; 19:3210-3211. [PMID: 31325351 DOI: 10.1111/ajt.15535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Joseph Lockridge
- Department of Medicine, Portland VA Medical Center, Portland, Oregon
| | - Douglas Norman
- Department of Medicine, Portland VA Medical Center, Portland, Oregon
| | - Shehzad Rehman
- Department of Medicine, Portland VA Medical Center, Portland, Oregon
| | - David Scott
- Department of Medicine, Portland VA Medical Center, Portland, Oregon
| | - Erin Maynard
- Department of Medicine, Portland VA Medical Center, Portland, Oregon
| | - Debora Bowers
- Department of Surgery, Portland VA Medical Center, Portland, Oregon
| | - Ingrid Siegman
- Department of Surgery, Portland VA Medical Center, Portland, Oregon
| | - Kelly Martin
- Department of Surgery, Portland VA Medical Center, Portland, Oregon
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27
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Doby BL, Boyarsky BJ, Gentry S, Segev DL. Improving OPO performance through national data availability. Am J Transplant 2019; 19:2675-2677. [PMID: 31219210 DOI: 10.1111/ajt.15508] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/07/2019] [Accepted: 06/14/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Brianna L Doby
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian J Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sommer Gentry
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Mathematics, United States Naval Academy, Annapolis, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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28
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Glazier AK. A legal roadmap. Am J Transplant 2019; 19:2958-2959. [PMID: 31267655 DOI: 10.1111/ajt.15521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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29
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Wilk AR, Hunter RA, McBride MA, Klassen DK. National landscape of HIV+ to HIV+ kidney and liver transplantation in the United States. Am J Transplant 2019; 19:2594-2605. [PMID: 31207040 DOI: 10.1111/ajt.15494] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/21/2019] [Accepted: 05/15/2019] [Indexed: 01/25/2023]
Abstract
The HIV Organ Policy Equity (HOPE) Act, enacted on November 21, 2013, enables research on the transplantation of organs from donors infected with human immunodeficiency virus (HIV) (HIV+) into HIV+ individuals who, prior to transplantation, are infected with HIV. In 2015, the Organ Procurement and Transplantation Network revised organ allocation policies on November 21, and on November 23, the Secretary of Health and Human Services published research criteria and revised the Final Rule accordingly. The HOPE Act appears to be underutilized to date. As of December 31, 2018, there were 56 donors recovered (50 donors transplanted) resulting in 102 organs transplanted (31 liver, 71 kidney). As of December 31, 2018, 212 registrations were indicated on the waiting list as willing to accept an HIV+ kidney or liver, most of which were waiting in active status. Due to the limited number of transplants performed to date, definitive safety conclusions cannot be reached at this time, though current data suggest that 1-year patient and graft survival does not deviate in a major way from that observed in HIV+ recipients of non-HIV+ organs or non-HIV+ recipients. As safety data are reviewed and disseminated, it is anticipated that HOPE participation will increase should safety signals remain low.
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Affiliation(s)
- Amber R Wilk
- Research Department, United Network for Organ Sharing, Richmond, Virginia
| | - Robert A Hunter
- Policy and Community Relations Department, United Network for Organ Sharing, Richmond, Virginia
| | - Maureen A McBride
- Contract Operations, United Network for Organ Sharing, Richmond, Virginia
| | - David K Klassen
- Office of the Chief Medical Officer, United Network for Organ Sharing, Richmond, Virginia
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30
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Troppmann C, Santhanakrishnan C, Sageshima J, McVicar J, Perez R. Barriers to live and deceased kidney donation by patients with chronic neurological diseases: Implications for donor selection, donation timing, logistics, and regulatory compliance. Am J Transplant 2019; 19:2168-2173. [PMID: 30582272 DOI: 10.1111/ajt.15230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/09/2018] [Accepted: 12/12/2018] [Indexed: 01/25/2023]
Abstract
Live and deceased kidney donation by the numerous patients with advanced, progressive systemic neurological diseases, and other chronic neurological conditions (eg, high C-spine injury) remains largely unexplored. In a review of our current clinical practice, we identified multiple regulatory and clinical barriers. For live donation, mandatory reporting of postdonation donor deaths within 2 years constitutes a strong programmatic disincentive. We propose that the United Network for Organ Sharing should provide explicit regulatory guidance and reassurance for programs wishing to offer live donation to patients at higher risk of death during the reporting period. Under the proposal, live donor deaths within 30 days would still be regarded as donation-related, but later deaths would be related to the underlying disease. For deceased donation, donation after circulatory death (DCD) immediately following self-directed withdrawal of life-sustaining treatment ("conscious DCD") is not universally covered by existing DCD agreements with donor hospitals. Organ procurement organizations should thus systematically strive to revise these agreements. Obtaining adequate first-person consent from these communicatively severely impaired patients may be challenging. Optimized preservation and allocation protocols may maximize utilization of these DCD kidneys. Robust public debate and action by all stakeholders is necessary to lower existing barriers and maximize donation opportunities for patients with chronic neurological conditions.
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Affiliation(s)
- Christoph Troppmann
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California
| | | | - Junichiro Sageshima
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California
| | - John McVicar
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California
| | - Richard Perez
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California
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31
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Iyer KR, Gunderson S, Friedman B. Transplantation in foreign nationals: Need for greater transparency. Am J Transplant 2019; 19:1868-1869. [PMID: 30725524 DOI: 10.1111/ajt.15291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Kishore R Iyer
- OPTN Ad Hoc International Relations Committee, Mount Sinai Medical Center, New York, New York
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32
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Gentry SE, Segev DL. Restructuring the Organ Procurement and Transplantation Network contract to achieve policy coherence and infrastructure excellence. Am J Transplant 2019; 19:1622-1627. [PMID: 30378753 PMCID: PMC6494733 DOI: 10.1111/ajt.15161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/25/2018] [Accepted: 10/22/2018] [Indexed: 01/25/2023]
Abstract
The Organ Procurement and Transplantation Network (OPTN) went up for competitive bid again this year, yet this contract has been held by only 1 entity since its inception. The OPTN's scope has grown steadily, and it now embraces several disparate missions: to operate the computing and coordination infrastructure that maintains waitlists and makes organ offers in priority order, to regulate transplant centers and organ procurement organizations, to follow and protect living donors, and to decide organ allocation policy in concert with the many voices of the transplant community. The contracting process and performance work statement continue to discourage both innovative approaches to the OPTN and competitive bids outside of United Network for Organ Sharing (UNOS), with evaluation criteria that either disqualify or strongly disadvantage new applicants. The performance work statement also emphasizes bureaucratic tasks while obligating the OPTN contractor to the specific committee structure that has impeded decision-making and tended to preserve the status quo in controversial matters. Finally, the UNOS computing infrastructure is antiquated and requires months to years to implement small changes. Restructuring the OPTN contract to separate the information technology requirements from the policy/regulatory responsibilities might allow more nimble and effective specialty contractors to offer their capabilities in service of the national transplant enterprise.
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Affiliation(s)
- Sommer E Gentry
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Mathematics, US Naval Academy, Annapolis, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
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33
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Gill JS, Wiseman A. Bandages will not fix a fractured system of chronic kidney disease care: Why the Dialysis PATIENTS Demonstration Act cannot be supported by the transplant community. Am J Transplant 2019; 19:973-974. [PMID: 30457204 DOI: 10.1111/ajt.15190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/07/2018] [Accepted: 11/10/2018] [Indexed: 01/25/2023]
Affiliation(s)
- John S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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34
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Klintmalm GB, Kaplan B, Kirk AD. FDA jeopardizes the lives of lung transplant recipients and in the process severely increases the cost to develop new immunosuppression. Am J Transplant 2019; 19:971-972. [PMID: 30552744 DOI: 10.1111/ajt.15215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Goran B Klintmalm
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Dallas, Texas
| | - Bruce Kaplan
- Transplant Services, Baylor Scott & White Health, Temple, Texas
| | - Allan D Kirk
- Department of Surgery, Duke University, Durham, North Carolina
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35
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Affiliation(s)
- Joseph R Scalea
- Division of Transplantation, Department of Surgery, University of Maryland, Baltimore, MD, USA
| | | | | | - Stephen T Bartlett
- Division of Transplantation, Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Norman Wereley
- Department of Aerospace Engineering, University of Maryland, College Park, MD, USA
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36
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Affiliation(s)
- S Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, USA.,Columbia University Renal Epidemiology (CURE) group, New York, NY, USA
| | - F Sara Winterhalter
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, USA.,Columbia University Renal Epidemiology (CURE) group, New York, NY, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, USA.,Columbia University Renal Epidemiology (CURE) group, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York , NY, USA
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37
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Ye F, Sheng Q, Feurer ID, Zhao Z, Fan R, Teng J, Ping J, Rega SA, Hanto DW, Shyr Y, Karp SJ. Directed solutions to address differences in access to liver transplantation. Am J Transplant 2018; 18:2670-2678. [PMID: 29689125 DOI: 10.1111/ajt.14889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/20/2018] [Accepted: 04/15/2018] [Indexed: 01/25/2023]
Abstract
The United Network for Organ Sharing recently altered current liver allocation with the goal of decreasing Model for End-Stage Liver Disease (MELD) variance at transplant. Concerns over these and further planned revisions to policy include predicted decrease in total transplants, increased flying and logistical complexity, adverse impact on areas with poor quality health care, and minimal effect on high MELD donor service areas. To address these issues, we describe general approaches to equalize critical transplant metrics among regions and determine how they alter MELD variance at transplant and organ supply to underserved communities. We show an allocation system that increases minimum MELD for local allocation or preferentially directs organs into areas of need decreases MELD variance. Both models have minimal adverse effects on flying and total transplants, and do not disproportionately disadvantage already underserved communities. When combined together, these approaches decrease MELD variance by 28%, more than the recently adopted proposal. These models can be adapted for any measure of variance, can be combined with other proposals, and can be configured to automatically adjust to changes in disease incidence as is occurring with hepatitis C and nonalcoholic fatty liver disease.
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Affiliation(s)
- Fei Ye
- Center for Quantitative Sciences and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quanhu Sheng
- Center for Quantitative Sciences and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Irene D Feurer
- Center for Quantitative Sciences and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Surgery and the Transplant Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zhiguo Zhao
- Center for Quantitative Sciences and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Run Fan
- Center for Quantitative Sciences and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jing Teng
- Center for Quantitative Sciences and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jie Ping
- Center for Quantitative Sciences and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott A Rega
- Department of Surgery and the Transplant Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas W Hanto
- Department of Surgery, Veterans Affairs St. Louis Health Care System, Saint Louis, MO, USA
| | - Yu Shyr
- Center for Quantitative Sciences and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Seth J Karp
- Department of Surgery and the Transplant Center, Vanderbilt University Medical Center, Nashville, TN, USA
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38
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Affiliation(s)
| | - Osama Gaber
- Methodist Hospital - Houston, Houston, TX, USA
| | - Alan Reed
- University of Iowa, Iowa City, IA, USA
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39
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Hart A, E.Patzer R. Equity in kidney transplantation: Policy change is only the first step. Am J Transplant 2018; 18:1839-1840. [PMID: 29603627 PMCID: PMC6105400 DOI: 10.1111/ajt.14743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Allyson Hart
- Department of Medicine, Hennepin County Medical Center, University
of Minnesota, Minneapolis, MN, USA,University of Minnesota Medical School, Minneapolis, MN, USA
| | - Rachel E.Patzer
- Department of Surgery, Division of Transplantation, Emory University
School of Medicine, Atlanta, GA, USA,Department of Epidemiology, Rollins School of Public Health, Emory
University, Atlanta, GA, USA,Renal Division, Emory University School of Medicine, Atlanta, GA,
USA
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40
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Fishman JA, Greenwald M. Innovation in organ transplantation: A meeting report. Am J Transplant 2018; 18:1875-1878. [PMID: 29745051 DOI: 10.1111/ajt.14928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 01/25/2023]
Abstract
This workshop targeted opportunities to stimulate transformative innovation in organ transplantation. Participants reached consensus regarding the following: (1) Mechanisms are needed to improve the coordination of policy and oversight activities, given overlapping responsibilities for transplantation and clinical investigation among federal agencies. Innovative clinical trials span traditional administrative boundaries and include stakeholders with diverse interests. Participants identified the need for a governmental interagency working group to coordinate nationwide transplant-related activities. (2) Improvements are required in clinical metrics for transplantation, with alignment of performance goals across transplantation organizations and any development of data requirements being consistent with those goals. Database coordination among clinical centers, organ procurement organizations, regulatory agencies, and payers would facilitate research and better inform policy. New data requirements should provide actionable insights into clinical performance. (3) Innovative research seen as potentially adversely affecting Program-Specific Reports may reduce centers' participation. Cutting-edge research requires mitigation of risk-aversive behaviors created by reporting of clinical outcomes data. Participants proposed a new review process in advance of implementation of clinical trials to guide "carve-outs" of transplant center outcomes data from Program-Specific Reports. Clinical transplantation will be advanced by the development of a shared and comprehensive research agenda to facilitate coordination of research and policy.
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Affiliation(s)
- Jay A Fishman
- Massachusetts General Hospital Transplantation Center, Transplant Infectious Disease & Compromised Host Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Melissa Greenwald
- Uniformed Services University School of Medicine, Silver Spring, MD, USA
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41
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42
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Nazarian SM, Levine MH, Amaral S. Invited Letter Re: The kidney allocation system and its implications for pediatric recipients. Am J Transplant 2018; 18:1825. [PMID: 29673056 DOI: 10.1111/ajt.14882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Susanna M Nazarian
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew H Levine
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Surgical Co-Director of Transplantation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sandra Amaral
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Center for Clinical Epidemiology and Biostatistics, Pennsylvania, Philadelphia, PA, USA
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43
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Potter LM, Maldonado AQ, Lentine KL, Schnitzler MA, Zhang Z, Hess GP, Garrity E, Kasiske BL, Axelrod DA. Transplant recipients are vulnerable to coverage denial under Medicare Part D. Am J Transplant 2018; 18:1502-1509. [PMID: 29446874 DOI: 10.1111/ajt.14703] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/05/2018] [Accepted: 02/07/2018] [Indexed: 01/25/2023]
Abstract
Transplant immunosuppressants are often used off-label because of insufficient randomized prospective trial data to achieve organ-specific US Food and Drug Administration (FDA) approval. Transplant recipients who rely on Medicare Part D for immunosuppressant drug coverage are vulnerable to coverage denial for off-label prescriptions, unless use is supported by Centers for Medicare & Medicaid Services (CMS)-approved compendia. An integrated dataset including national transplant registry data and 3 years of dispensed pharmacy records was used to identify the prevalence of immunosuppression use that is both off-label and not supported by CMS-approved compendia. Numbers of potentially vulnerable transplant recipients were identified. Off-label and off-compendia immunosuppression regimens are frequently prescribed (3-year mean: lung 66.5%, intestine 34.2%, pancreas 33.4%, heart 21.8%, liver 16.5%, kidney 0%). The annual retail cost of these at-risk medications exceeds $30 million. This population-based study of transplant immunosuppressants vulnerable to claim denials under Medicare Part D coverage demonstrates a substantial gap between clinical practice, current FDA approval processes, and policy mandates for pharmaceutical coverage. This coverage barrier reduces access to life-saving medications for patients without alternative resources and may increase the risk of graft loss and death from medication nonadherence.
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Affiliation(s)
- Lisa M Potter
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | | | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Mark A Schnitzler
- Saint Louis University Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Zidong Zhang
- Saint Louis University Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Gregory P Hess
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Scientific Studies & Projects, Symphony Health, Conshohocken, PA, USA
| | - Edward Garrity
- Division of Lung Transplantation, University of Chicago Medicine, Chicago, IL, USA
| | - Bertram L Kasiske
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA.,Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - David A Axelrod
- Transplant and Hepatobiliary Surgery, Lahey Clinic, Burlington, MA, USA
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44
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Denu RA, Mendonca EA, Fost N. Potential yield of imminent death kidney donation. Am J Transplant 2018; 18:486-491. [PMID: 28975705 PMCID: PMC5937230 DOI: 10.1111/ajt.14524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 01/25/2023]
Abstract
About 99 000 people are waiting for a kidney in the United States, and many will die waiting. The concept of "imminent death" donation, a type of living donation, has been gaining attention among physicians, patients, and ethicists. We estimated the number of potential imminent death kidney donors at the University of Wisconsin Hospital and Clinics by assessing the number of annual deaths in individuals with normal kidney function. Based on a previous survey suggesting that one-third of patients might be willing to donate at imminent death, we estimate that between 76 and 396 people in the state of Wisconsin would be medically eligible and willing to donate each year at the time of imminent death. We extrapolated these numbers to all transplant centers in the United States, estimating that between 5925 and 31 097 people might be eligible and willing to donate each year. Our results suggest that allowing donation at imminent death and including discussions about organ donation in end-of-life planning could substantially reduce the nation's kidney waiting list while providing many more donors the opportunity to give this gift.
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Affiliation(s)
- Ryan A. Denu
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Eneida A. Mendonca
- Departments of Pediatrics and Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Norman Fost
- Departments of Pediatrics and Medical History and Bioethics, University of Wisconsin-Madison, Madison, WI, USA
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45
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Affiliation(s)
- K Ladin
- Tufts University, Medford, MA
| | - D W Hanto
- St. Louis Veteran's Administration Hospital, St. Louis, MO
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46
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Affiliation(s)
- C R Bruce
- Center for Medical Ethics & Health Policy Houston, Baylor College of Medicine, Houston, TX.,Houston Methodist Hospital System Houston, Biomedical Ethics Program, Houston, TX
| | - P Koch
- Center for Medical Ethics & Health Policy Houston, Baylor College of Medicine, Houston, TX.,Houston Methodist Hospital System Houston, Biomedical Ethics Program, Houston, TX
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47
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Goldberg D, Kallan MJ, Fu L, Ciccarone M, Ramirez J, Rosenberg P, Arnold J, Segal G, Moritsugu KP, Nathan H, Hasz R, Abt PL. Changing Metrics of Organ Procurement Organization Performance in Order to Increase Organ Donation Rates in the United States. Am J Transplant 2017; 17:3183-3192. [PMID: 28726327 DOI: 10.1111/ajt.14391] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/05/2017] [Accepted: 06/05/2017] [Indexed: 01/25/2023]
Abstract
The shortage of deceased-donor organs is compounded by donation metrics that fail to account for the total pool of possible donors, leading to ambiguous donor statistics. We sought to assess potential metrics of organ procurement organizations (OPOs) utilizing data from the Nationwide Inpatient Sample (NIS) from 2009-2012 and State Inpatient Databases (SIDs) from 2008-2014. A possible donor was defined as a ventilated inpatient death ≤75 years of age, without multi-organ system failure, sepsis, or cancer, whose cause of death was consistent with organ donation. These estimates were compared to patient-level data from chart review from two large OPOs. Among 2,907,658 inpatient deaths from 2009-2012, 96,028 (3.3%) were a "possible deceased-organ donor." The two proposed metrics of OPO performance were: (1) donation percentage (percentage of possible deceased-donors who become actual donors; range: 20.0-57.0%); and (2) organs transplanted per possible donor (range: 0.52-1.74). These metrics allow for comparisons of OPO performance and geographic-level donation rates, and identify areas in greatest need of interventions to improve donation rates. We demonstrate that administrative data can be used to identify possible deceased donors in the US and could be a data source for CMS to implement new OPO performance metrics in a standardized fashion.
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Affiliation(s)
- D Goldberg
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA.,Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Philadelphia, PA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - M J Kallan
- Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - L Fu
- The Bridgespan Group, New York, NY
| | | | | | | | | | | | - K P Moritsugu
- Former Acting Surgeon General of the United States, Great Falls, MT
| | - H Nathan
- Gift of Life Institute, Philadelphia, PA
| | - R Hasz
- Gift of Life Institute, Philadelphia, PA
| | - P L Abt
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA
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48
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Glazier AK. It Is Bad Policy and Contrary to Federal Law to Prioritize Local Allocation of Livers to Address Geographically Based Social Inequities. Am J Transplant 2017; 17:3257. [PMID: 28556433 DOI: 10.1111/ajt.14384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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49
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Affiliation(s)
- L S Baines
- Global Mental Health Distance Learning, Uniformed Services University, Bethesda, MD
| | - R M Jindal
- USU - Walter Reed Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
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50
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Rees MA, Paloyo SR, Roth AE, Krawiec KD, Ekwenna O, Marsh CL, Wenig AJ, Dunn TB. Global kidney exchange: Financially incompatible pairs are not transplantable compatible pairs. Am J Transplant 2017; 17:2743-2744. [PMID: 28758331 DOI: 10.1111/ajt.14451] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- M A Rees
- Department of Urology, University of Toledo, Toledo, OH, USA
| | - S R Paloyo
- Department of Surgery, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - A E Roth
- Department of Economics, Stanford University, Stanford, CA, USA
| | - K D Krawiec
- School of Law, Duke University, Durham, NC, USA
| | - O Ekwenna
- Department of Urology, University of Toledo, Toledo, OH, USA
| | - C L Marsh
- Scripps Clinic, Scripps Center for Organ and Cell Transplant, La Jolla, CA, USA
| | - A J Wenig
- Department of Urology, University of Toledo, Toledo, OH, USA
| | - T B Dunn
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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