51
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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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52
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Kates OS, Stohs EJ, Pergam SA, Rakita RM, Michaels MG, Wolfe CR, Danziger-Isakov L, Ison MG, Blumberg EA, Razonable RR, Gordon EJ, Diekema DS. The limits of refusal: An ethical review of solid organ transplantation and vaccine hesitancy. Am J Transplant 2021; 21:2637-2645. [PMID: 33370501 PMCID: PMC8298607 DOI: 10.1111/ajt.16472] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 08/27/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 01/25/2023]
Abstract
Patients pursuing solid organ transplantation are encouraged to receive many vaccines on an accelerated timeline. Vaccination prior to transplantation offers the best chance of developing immunity and may expand the pool of donor organs that candidates can accept without needing posttransplant therapy. Furthermore, transplant recipients are at greater risk for acquiring vaccine-preventable illnesses or succumbing to severe sequelae of such illnesses. However, a rising rate of vaccine refusal has challenged transplant centers to address the phenomenon of vaccine hesitancy. Transplant centers may need to consider adopting a policy of denial of solid organ transplantation on the basis of vaccine refusal for non-medical reasons (i.e., philosophical or religious objections or personal beliefs that vaccines are unnecessary or unsafe). Arguments supporting such a policy are motivated by utility, stewardship, and beneficence. Arguments opposing such a policy emphasize justice and respect for persons, and seek to avoid worsening inequities or medical coercion. This paper examines these arguments and situates them within the special cases of pediatric transplantation, emergent transplantation, and living donation. Ultimately, a uniform national policy addressing vaccine refusal among transplant candidates is needed to resolve this ethical dilemma and establish a consistent, fair, and standard approach to vaccine refusal in transplantation.
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Affiliation(s)
- Olivia S. Kates
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Erica J. Stohs
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Steven A. Pergam
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Robert M. Rakita
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Marian G. Michaels
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Pittsburgh, School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Cameron R. Wolfe
- Division of Infectious Diseases, Duke University Medical School, Durham, NC, USA
| | - Lara Danziger-Isakov
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael G. Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily A. Blumberg
- Department of Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Raymund R. Razonable
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elisa J. Gordon
- Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Douglas S. Diekema
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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53
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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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54
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Johnson MR, Nadim MK. Simultaneous heart-kidney transplant: Working together to define when one organ is not enough. Am J Transplant 2021; 21:2323-2324. [PMID: 33721402 DOI: 10.1111/ajt.16564] [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: 02/14/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Maryl R Johnson
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Mitra K Nadim
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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55
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Kobashigawa J, Dadhania DM, Farr M, Tang WHW, Bhimaraj A, Czer L, Hall S, Haririan A, Formica RN, Patel J, Skorka R, Fedson S, Srinivas T, Testani J, Yabu JM, Cheng XS. Consensus conference on heart-kidney transplantation. Am J Transplant 2021; 21:2459-2467. [PMID: 33527725 DOI: 10.1111/ajt.16512] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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: 09/29/2020] [Revised: 01/13/2021] [Accepted: 01/24/2021] [Indexed: 01/25/2023]
Abstract
Simultaneous heart-kidney transplant (sHK) has enabled the successful transplantation of patients with end-stage heart disease and concomitant kidney disease, with non-inferior outcomes to heart transplant (HT) alone. The decision for sHK is challenged by difficulties in differentiating those patients with a significant component of reversible kidney injury due to cardiorenal syndrome who may recover kidney function after HT, from those with intrinsic advanced kidney disease who would benefit most from sHK. A consensus conference on sHK took place on June 1, 2019 in Boston, Massachusetts. The conference represented a collaborative effort by experts in cardiothoracic and kidney transplantation from centers across the United States to explore the development of guidelines for the interdisciplinary criteria for kidney transplantation in the sHK candidate, to evaluate the current allocation of kidneys to follow the heart for sHK, and to recommend standardized care for the management of sHK recipients. The conference served as a forum to unify criteria between the different specialties and to forge a pathway for patients who may need dual organ transplantation. Due to the continuing shortage of available donor organs, ethical problems related to multi-organ transplantation were also debated. The findings and consensus statements are presented.
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Affiliation(s)
- Jon Kobashigawa
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | | | | | | | | | - Lawrence Czer
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Shelley Hall
- Baylor University Medical Center, Dallas, Texas, USA
| | | | | | - Jignesh Patel
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Rafael Skorka
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | | | | | | | - Julie M Yabu
- University of California at Los Angeles, Los Angeles, California, USA
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56
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Fitch ZW, Doberne J, Reynolds JM, Jamieson I, Haney JC, Klapper JA, Hartwig MG. Expanding donor availability in lung transplantation: A case report of 5000 miles traveled. Am J Transplant 2021; 21:2269-2272. [PMID: 33675176 DOI: 10.1111/ajt.16556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/17/2020] [Revised: 01/22/2021] [Accepted: 02/05/2021] [Indexed: 01/25/2023]
Abstract
We present the case of a 41-year-old female who underwent bilateral lung transplantation after the donor lungs were placed on a normothermic ex vivo lung perfusion and ventilation device and flown nearly 5000 miles from Honolulu, Hawaii to Durham, North Carolina. The patient experienced no primary graft dysfunction. One year after transplantation she has remained rejection-free and exhibits excellent pulmonary function. This case highlights the challenge that active organ preservation systems pose to questions of organ allocation and geographic sharing.
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Affiliation(s)
- Zachary W Fitch
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Julie Doberne
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - John M Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Ian Jamieson
- Duke University Hospital, Duke University, Durham, North Carolina, USA
| | - John C Haney
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Jacob A Klapper
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Matthew G Hartwig
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
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57
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Adler JT, Husain SA, King KL, Mohan S. Greater complexity and monitoring of the new Kidney Allocation System: Implications and unintended consequences of concentric circle kidney allocation on network complexity. Am J Transplant 2021; 21:2007-2013. [PMID: 33314637 DOI: 10.1111/ajt.16441] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 10/29/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 01/25/2023]
Abstract
The deceased donor kidney allocation system in the United States has undergone several rounds of iterative changes, but these changes were not explicitly designed to address the geographic variation in access to transplantation. The new allocation system, expected to start in December 2020, changes the definition of "local allocation" from the Donation Service Area to 250 nautical mile circles originating from the donor hospital. While other solid organs have adopted a similar approach, the larger number of both kidney transplant centers and transplant candidates is likely to have different consequences. Here, we discuss the incredible increase in complexity in allocation, discuss some of the likely intended and unintended consequences, and propose metrics to monitor the new system.
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Affiliation(s)
- Joel T Adler
- Department of Surgery, Division of Transplant Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, Massachusetts
| | - Syed A Husain
- Department of Medicine, Division of Nephrology, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York.,The Columbia University Renal Epidemiology (CURE) Group, New York, New York
| | - Kristen L King
- Department of Medicine, Division of Nephrology, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York.,The Columbia University Renal Epidemiology (CURE) Group, New York, New York
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York.,The Columbia University Renal Epidemiology (CURE) Group, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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58
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Boyarsky BJ, Segev DL, Ottmann SE. Response to "The real number of organs from uncontrolled donation after circulatory determination of death donors". Am J Transplant 2021; 21:2303. [PMID: 33559349 DOI: 10.1111/ajt.16526] [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] [Indexed: 01/25/2023]
Affiliation(s)
- Brian J Boyarsky
- 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 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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59
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Goff RR, Wilk AR, Toll AE, McBride MA, Klassen DK. Navigating the COVID-19 pandemic: Initial impacts and responses of the Organ Procurement and Transplantation Network in the United States. Am J Transplant 2021; 21:2100-2112. [PMID: 33244847 PMCID: PMC7754561 DOI: 10.1111/ajt.16411] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 07/12/2020] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023]
Abstract
COVID-19 has been sweeping the globe, hitting the United States particularly hard with a state of emergency declared on March 13, 2020. Transplant hospitals have taken various precautions to protect patients from potential exposure. OPTN donor, candidate, and transplant data were analyzed from January 5, 2020 to September 5, 2020. The number of new waiting list registrations decreased, with the Northeast seeing over a 50% decrease from the week of 3/8 versus the week of 4/5. The national transplant system saw near cessation of living donor transplantation (-90%) from the week of 3/8 to the week of 4/5. Similarly, deceased donor kidney transplant volume dropped from 367 to 202 (-45%), and other organs saw similar decreases: lung (-70%), heart (-43%), and liver (-37%). Deceased donors recovered dropped from 260 to 163 (-45%) from 3/8 compared to 4/5, including a 67% decrease for lungs recovered. The magnitude of this decrease varied by geographic area, with the largest percent change (-67%) in the Northeast. Despite the pandemic, discard rates across organ has remained stable. Although the COVID-19 pandemic continues to evolve, OPTN data show recent evidence of stabilization, an indication that an early recovery of the number of living and deceased donors and transplants has ensued.
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Affiliation(s)
- Rebecca R. Goff
- Research Department, United Network for Organ Sharing, Richmond, VA, USA,Correspondence Rebecca R. Goff, Research Department, United Network for Organ Sharing, Richmond, VA, USA.
| | - Amber R. Wilk
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - Alice E. Toll
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - Maureen A. McBride
- Contract Operations, United Network for Organ Sharing, Richmond, VA, USA
| | - David K. Klassen
- Office of the Chief Medical Officer, United Network for Organ Sharing, Richmond, VA, USA
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60
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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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61
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Schold JD, Mohan S. A deeper dive into the impact of multiple-organ transplant policy on kidney transplant candidate prognoses. Am J Transplant 2021; 21:2004-2006. [PMID: 33512775 DOI: 10.1111/ajt.16508] [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: 11/18/2020] [Revised: 12/20/2020] [Accepted: 01/13/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.,Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sumit Mohan
- Department of Medicine, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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62
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Gordon EJ, Abt P, Lee J, Knopf E, Phillips C, Bermudez F, Krishnamurthi L, Karaca HS, Veatch R, Knight R, Conway PT, Dunn S, Reese PP. Determinants of kidney transplant candidates' decision to accept organ donor intervention transplants and participate in post-transplant research: A conjoint analysis. Clin Transplant 2021; 35:e14316. [PMID: 33844367 DOI: 10.1111/ctr.14316] [Citation(s) in RCA: 2] [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: 12/29/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 01/23/2023]
Abstract
Deceased organ donor intervention research aims to increase organ quality and quantity for transplantation. We assessed the proportion of kidney transplant candidates who would accept "intervention organs," participate in organ intervention research, and factors influencing acceptance. Kidney transplant candidates were presented 12 hypothetical scenarios, which varied three attributes, donor age, predicted waiting time to receive another organ offer, and research risk to the organ. Candidates were also randomly assigned to one of two conditions varying recipient risk. For each scenario, candidates agreed to accept the intervention organ or remain waitlisted. We fit a multivariable logit model to determine the association between scenario attributes and the acceptance decision. Of 249 participants, most (96%) accepted intervention organs under some or all conditions. Factors independently associated with candidates' greater likelihood of accepting an intervention organ included: low risk to the kidney from the intervention (OR 20.53 [95% Confidence Interval (CI), 13.91-30.29]); younger donor age (OR 3.72 [95% CI, 2.83-4.89]), longer time until the next organ offer (OR 3.48 [95% CI, 2.65-4.57]), and greater trust in their transplant physician (OR 1.03 [95% CI, 1.00-1.06]). Candidates with a lower likelihood of acceptance had been waitlisted longer (OR 0.97 per month [95% CI, 0.96-0.99]) and were Black (OR 0.21 [95% CI, 0.08-0.55]). Most candidates would accept an intervention organ, which should encourage transplant leaders to conduct deceased donor organ intervention trials.
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Affiliation(s)
- Elisa J Gordon
- Department of Surgery, Northwestern University, Chicago, IL, USA.,Center for Health Services and Outcomes Research, Northwestern University, Chicago, IL, USA
| | - Peter Abt
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jungwha Lee
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Elizabeth Knopf
- Center for Health Services and Outcomes Research, Northwestern University, Chicago, IL, USA
| | - Caitlin Phillips
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Francisca Bermudez
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Robert Veatch
- Kennedy Institute of Ethics, Georgetown University, Washington, DC, USA
| | - Richard Knight
- American Association of Kidney Patients, Washington, DC, USA
| | - Paul T Conway
- American Association of Kidney Patients, Washington, DC, USA
| | | | - Peter P Reese
- Department of Medicine, Renal-Electrolyte & Hypertension Division, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
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63
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Raveh Y, Simkins J, Nicolau-Raducu R. Liver transplantation in COVID-19 positive patients. Am J Transplant 2021; 21:1978. [PMID: 33131211 PMCID: PMC9800490 DOI: 10.1111/ajt.16389] [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: 10/09/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Yehuda Raveh
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA,
| | - Jacques Simkins
- Department of Medicine, Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Ramona Nicolau-Raducu
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
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64
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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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65
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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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66
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Padela AI, Duivenbode R, Quinn M, Saunders MR. Informing American Muslims about living donation through tailored health education: A randomized controlled crossover trial evaluating increase in biomedical and religious knowledge. Am J Transplant 2021; 21:1227-1237. [PMID: 32772460 DOI: 10.1111/ajt.16242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/06/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 01/25/2023]
Abstract
Biomedical and religious knowledge affects organ donation attitudes among Muslims. We tested the effectiveness of mosque-based, religiously tailored, ethically balanced education on organ donation among Muslim Americans. Our randomized, controlled, crossover trial took place at 4 mosques randomized to an early arm where organ donation education preceded a control educational workshop or a late arm with the order reversed. Primary outcomes were changes in biomedical (Rotterdam Renal Replacement Knowledge Test living donation subscale, R3KT) and religious (Islamic Knowledge of Living Organ Donation, IK-LOD) living kidney donation knowledge. Statistical analysis employed a 2 (Treatment Arm) X 3 (Time of Assessment) mixed-method analysis of variance. Of 158 participants, 59 were in the early arm and 99 in the late arm. A between group t test comparison at Period 1 (Time 1 - Time 2), demonstrated that the early arm had a significantly higher mean IK-LOD (7.11 v 5.19, P < .05) and R3KT scores (7.65 v 4.90, P < .05) when compared to the late arm. Late arm participants also had significant increases in mean IK-LOD (5.19 v 7.16, P < .05) and R3KT scores (4.90 v. 6.81, P < .05) postintervention (Time 2-Time 3). Our novel program thus yielded significant kidney donation-related knowledge gains among Muslim Americans (NCT04443114 Clinicaltrials.gov).
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Affiliation(s)
- Aasim I Padela
- Initiative on Islam and Medicine, University of Chicago, Chicago, Illinois, USA.,MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA.,Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Rosie Duivenbode
- Initiative on Islam and Medicine, University of Chicago, Chicago, Illinois, USA
| | - Michael Quinn
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Milda R Saunders
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA.,Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
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67
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Kulkarni S, Ladin K. Leveling-up versus leveling-down to address health disparities in transplantation. Am J Transplant 2021; 21:917-918. [PMID: 33326686 PMCID: PMC7986107 DOI: 10.1111/ajt.16458] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 01/25/2023]
Abstract
Health disparities are best addressed by improving the underserved up to the level afforded to those with the greatest opportunities. See the Viewpoint from Reese et al. on page 958.
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Affiliation(s)
- Sanjay Kulkarni
- Department of SurgeryYale School of MedicineNew HavenConnecticut
| | - Keren Ladin
- Departments of Community Health and Occupational TherapyTufts UniversityMedfordMassachusetts
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68
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Berrigan M, Austrie J, Fleishman A, Tercyak KP, Pollak MR, Pavlakis M, Rohan V, Baliga PK, Kayler LK, Feeley TH, Rodrigue JR. Opinions of African American adults about the use of apolipoprotein L1 (ApoL1) genetic testing in living kidney donation and transplantation. Am J Transplant 2021; 21:1197-1205. [PMID: 32659871 PMCID: PMC7854990 DOI: 10.1111/ajt.16206] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/28/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023]
Abstract
Apolipoprotein L1 (ApoL1) predictive genetic testing for kidney disease, and its emerging role in transplantation, remains controversial as it may exacerbate underlying disparities among African Americans (AAs) at increased risk. We conducted an online simulation among AAs (N = 585) about interest in ApoL1 testing and its cofactors, under 2 scenarios: as a potential living donor (PLD), and as a patient awaiting transplantation. Most respondents (61%) expressed high interest in genetic testing as a PLD: age ≥35 years (adjusted odds ratio [aOR], 1.75; 95% confidence interval [CI], 1.18, 2.60, P = .01), AA identity (aOR, 1.67; 95% CI, 1.02, 2.72, P = .04), perceived kidney disease risk following donation (aOR, 1.68; 95% CI, 1.03, 2.73, P = .03), interest in genetics (aOR, 2.89; 95% CI, 1.95, 4.29, P = .001), and genetics self-efficacy (aOR, 2.38; 95% CI, 1.54, 3.67, P = .001) were positively associated with ApoL1 test interest. If awaiting transplantation, most (89%) believed that ApoL1 testing should be done on AA deceased donors, and older age (aOR, 1.85; 95% CI, 1.03, 3.32, P = .04) and greater interest in genetics (aOR, 2.61; 95% CI, 1.41, 4.81, P = .002) were associated with interest in testing deceased donors. Findings highlight strong support for ApoL1 testing in AAs and the need to examine such opinions among PLDs and transplant patients to enhance patient education efforts.
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Affiliation(s)
- Margaret Berrigan
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jasmine Austrie
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth P Tercyak
- Departments of Oncology and Pediatrics, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Martin R Pollak
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Martha Pavlakis
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Vinayak Rohan
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Prabhakar K Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Liise K Kayler
- Department of Surgery, University at Buffalo (SUNY) Jacobs School of Medicine & Biomedical Sciences and Erie County Medical Center, Buffalo, New York, USA
| | - Thomas H Feeley
- Department of Communication, University at Buffalo (SUNY), Buffalo, New York, USA
| | - James R Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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69
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Karami F, Kernodle AB, Ishaque T, Segev DL, Gentry SE. Allocating kidneys in optimized heterogeneous circles. Am J Transplant 2021; 21:1179-1185. [PMID: 32808468 DOI: 10.1111/ajt.16274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/08/2020] [Revised: 07/19/2020] [Accepted: 08/12/2020] [Indexed: 01/25/2023]
Abstract
Recently, the Organ Procurement and Transplant Network approved a plan to allocate kidneys within 250-nm circles around donor hospitals. These homogeneous circles might not substantially reduce geographic differences in transplant rates because deceased donor kidney supply and demand differ across the country. Using Scientific Registry of Transplant Recipients data from 2016-2019, we used an integer program to design unique, heterogeneous circles with sizes between 100 and 500 nm that reduced supply/demand ratio variation across transplant centers. We weighted demand according to wait time because candidates who have waited longer have higher priority. We compared supply/demand ratios and average travel distance of kidneys, using heterogeneous circles and 250 and 500-nm fixed-distance homogeneous circles. We found that 40% of circles could be 250 nm or smaller, while reducing supply/demand ratio variation more than homogeneous circles. Supply/demand ratios across centers for heterogeneous circles ranged from 0.06 to 0.13 kidneys per wait-year, compared to 0.04 to 0.47 and 0.05 to 0.15 kidneys per wait-year for 250-nm and 500-nm homogeneous circles, respectively. The average travel distance for kidneys using heterogeneous, and 250-nm and 500-nm fixed-distance circles was 173 nm, 134 nm, and 269 nm, respectively. Heterogeneous circles reduce geographic disparity compared to homogeneous circles, while maintaining reasonable travel distances.
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Affiliation(s)
- Fatemeh Karami
- Industrial Engineering Department, University of Louisville, Louisville, Kentucky, USA.,Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Amber B Kernodle
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Tanveen Ishaque
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.,Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
| | - Sommer E Gentry
- Department of Mathematics, United States Naval Academy, Annapolis, Maryland, USA
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70
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Lin YP, Chen J, Lee WC, Chiang YJ, Huang CW. Understanding family dynamics in adult-to-adult living donor liver transplantation decision-making in Taiwan: Motivation, communication, and ambivalence. Am J Transplant 2021; 21:1068-1079. [PMID: 32860293 DOI: 10.1111/ajt.16281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/19/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 01/25/2023]
Abstract
This study investigated how multiple family members co-construct the ethical significance of living donor liver transplantation (LDLT) and how the family structure and dynamics of donor-recipient-caregiver relationships shape the communication and decision-making process within the sociocultural context of Taiwan. We conducted in-depth interviews with 36 participants from 13 families at the Chang Gung Memorial Hospital from February to December 2019. Interviews were audio recorded, transcribed, and translated from Mandarin to English and analyzed utilizing grounded theory and thematic analysis. Our findings revealed that LDLT in Taiwan is not merely a personal choice of either donor or recipient but essentially a collaborative process of family-centered medical decision-making, intertwined with socioeconomic conditions, cultural and social norms, gender roles, and the division of labor in the household. The notion of reciprocity and indebtedness for family members is a central theme underlying the entire process of motivation, deliberation, and decision-making, thereby reinforcing the naturalness of LDLT. However, our study highlighted that donors from families with traditional gender hierarchy and power imbalance may experience psychological and social vulnerabilities. Conclusively, we suggest that healthcare professionals should be sensitive to the contextual and relational factors involved in family dynamics and provide appropriate support to the ambivalent donors.
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Affiliation(s)
- Ya-Ping Lin
- Institute of Public Health; Department of Public Health and Medical Humanities, Faculty of Medicine, National Yang Ming Chiao Tung University.,Department of Medical Humanities and Social Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jung Chen
- Department of Medical Humanities and Social Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yang-Jen Chiang
- Department of Urology and Renal Transplantation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Wan Huang
- Department of Psychiatry, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.,Division of Rehabilitation & Community Psychiatry, Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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71
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Cooper M, Leeser DB, Flechner SM, Beaumont JL, Waterman AD, Shannon PW, Ronin M, Hil G, Veale JL. Ensuring the need is met: A 50-year simulation study of the National Kidney Registry's family voucher program. Am J Transplant 2021; 21:1128-1137. [PMID: 32506647 PMCID: PMC7984283 DOI: 10.1111/ajt.16101] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 09/08/2019] [Revised: 05/23/2020] [Accepted: 05/24/2020] [Indexed: 01/25/2023]
Abstract
The National Kidney Registry (NKR) Advanced Donation Program enables living donors the opportunity to donate altruistically, or in advance of a potential recipient's transplant, and to receive a voucher that can be redeemed for a future transplant facilitated by the NKR. Family vouchers allow a donor to identify multiple individuals within their immediate family, with the first person in that group in need of a transplant being prioritized to receive a kidney. An increase in vouchers introduces concerns that demand for future voucher redemptions could exceed the supply of available donors and kidneys. A Monte Carlo simulation model was constructed to estimate the annual number of voucher redemptions relative to the number of kidneys available over a 50-year time horizon under several projected scenarios for growth of the program. In all simulated scenarios, the number of available kidneys exceeded voucher redemptions every year. While not able to account for all real-life scenarios, this simulation study found that the NKR should be able to satisfy the likely redemption of increasing numbers of vouchers under a range of possible scenarios over a 50-year time horizon. This modeling exercise suggests that a donor family's future needs can be satisfied through the voucher program.
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Affiliation(s)
- Matthew Cooper
- Medstar Georgetown Transplant InstituteWashingtonDistrict of ColumbiaUSA
| | - David B. Leeser
- Department of SurgeryEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Stuart M. Flechner
- Glickman Urological and Kidney InstituteCleveland ClinicClevelandOhioUSA
| | | | - Amy D. Waterman
- Terasaki Research InstituteLos AngelesCaliforniaUSA,Department of NephrologyUniversity of CaliforniaLos AngelesCaliforniaUSA
| | | | | | - Garet Hil
- National Kidney RegistryBabylonNew YorkUSA
| | - Jeffrey L. Veale
- Department of UrologyUniversity of CaliforniaLos AngelesCaliforniaUSA
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72
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Reese PP, Mohan S, King KL, Williams WW, Potluri VS, Harhay MN, Eneanya ND. Racial disparities in preemptive waitlisting and deceased donor kidney transplantation: Ethics and solutions. Am J Transplant 2021; 21:958-967. [PMID: 33151614 DOI: 10.1111/ajt.16392] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 08/03/2020] [Revised: 10/04/2020] [Accepted: 10/27/2020] [Indexed: 01/25/2023]
Abstract
Kidney transplantation prior to dialysis, known as "preemptive transplant," enables patients to live longer and avoid the substantial quality of life burdens due to chronic dialysis. Deceased donor kidneys are a public resource that ought to provide health benefits equitably. Unfortunately, White, better educated, and privately insured patients enjoy disproportionate access to preemptive transplantation using deceased donor kidneys. This problem has persisted for decades and is exacerbated by the first-come, first-served approach to kidney allocation for predialysis patients. In this Personal Viewpoint, we describe the diverse barriers to preemptive waitlisting and kidney transplant. The analysis focuses on healthcare system features that particularly disadvantage Black patients, such as the waitlisting eligibility criterion of a single glomerular filtration rate or creatinine clearance ≤20 ml/min, and neglect of wide variation in the rate of progression to end-stage kidney disease (ESKD) in allocating preemptive transplants. We propose initiatives to improve equity including: (1) standardization of waitlisting eligibility criteria related to kidney function; (2) aggressive education for clinicians about early transplant referral; (3) innovations in electronic medical record capabilities; and (4) rapid status 7 listing by centers. If those initiatives fail, the transplant field should consider eliminating preemptive waitlisting and transplantation with deceased donor kidneys.
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Affiliation(s)
- Peter P Reese
- Department of Medicine, Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Kristen L King
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, New York
| | - Winfred W Williams
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Vishnu S Potluri
- Department of Medicine, Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Meera N Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.,Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania.,Tower Health Transplant Institute, Tower Health System, West Reading, Pennsylvania
| | - Nwamaka D Eneanya
- Department of Medicine, Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
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73
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Jesse MT, Hansen B, Bruschwein H, Chen G, Nonterah C, Peipert JD, Dew MA, Thomas C, Ortega AD, Balliet W, Ladin K, Lerret S, Yaldo A, Coco T, Mallea J. Findings and recommendations from the organ transplant caregiver initiative: Moving clinical care and research forward. Am J Transplant 2021; 21:950-957. [PMID: 32946643 DOI: 10.1111/ajt.16315] [Citation(s) in RCA: 6] [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: 07/31/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 01/25/2023]
Abstract
Lay-caregivers are essential to the continuum of care in adult organ transplantation. However, we have a limited understanding of the experiences, exigencies, and outcomes associated with lay-caregiving for organ transplant patients. While much discussion and debate has focused on caregiver requirements in relation to transplant candidate selection, little focus has been given to understanding the needs of caregivers themselves. In response to this, the Organ Transplant Caregiver Initiative was created, and a meeting was held during October 6-7, 2019. Transplant healthcare professionals, researchers, and lay-caregivers discussed the experiences, educational needs, existing research, and research recommendations to improve the experience of lay-caregivers for adult organ transplant patients. In this report, we summarize the Organ Transplant Caregiver Initiative and meeting findings, providing a preliminary action plan to improve education, research, and advocacy for organ transplant caregivers.
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Affiliation(s)
- Michelle T Jesse
- Transplant Institute, Henry Ford Health System, Detroit, Michigan.,Consultation-Liaison Psychiatry, Behavioral Health, Henry Ford Health System, Detroit, Michigan.,Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, Michigan.,Psychiatry & Behavioral Neurosciences, Wayne State School of Medicine, Detroit, Michigan
| | | | - Heather Bruschwein
- Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Gloria Chen
- Memorial Hermann Hospital Transplant Center, Houston, Texas
| | - Camilla Nonterah
- Department of Psychology, University of Richmond, Richmond, Virginia.,Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | | | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | - Wendy Balliet
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Keren Ladin
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Stacee Lerret
- Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alexander Yaldo
- Michigan Medicine - The University of Michigan, Ann Arbor, Michigan
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74
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Lushin EN, McDermott JK, Truax C, Lourenco LM, Mariski M, Melaragno JI, Potter LM. A multicenter case series documenting Medicare Part D plan denials of immunosuppressant drug coverage for organ transplant recipients. Am J Transplant 2021; 21:889-896. [PMID: 32976706 DOI: 10.1111/ajt.16321] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 01/25/2023]
Abstract
Medicare Part D plans make coverage decisions according to FDA-labeled indications and off-label uses endorsed by two CMS-recognized compendia. Patients who rely on Medicare Part D for immunosuppressive drug coverage are at risk for denied coverage when these medications are prescribed off-label. The purpose of this multicenter collaboration was to assemble a case series documenting situations where immunosuppressive therapies prescribed for transplant patients were denied by Medicare Part D prescription drug plans. This case series documents 66 instances in 39 patients where immunosuppressive drug claims were denied coverage due to off-label use not endorsed by the compendia. Patients were recipients of lung (n = 28, 72%), heart (n = 7, 18%), or liver (n = 4, 10%) transplants. Denied claims were for mycophenolate mofetil (n = 22, 33%), azathioprine (n = 18, 27%), sirolimus (n = 15, 23%), mycophenolate sodium (n = 5, 8%), everolimus (n = 5, 8%), and belatacept (n = 1, 1%). Most denials were upheld across all the levels of attempted appeal, including those escalated to a Medicare Administrative Law Judge. This case series demonstrates a critical flaw in the construct of the Medicare Prescription Drug Benefit. The currently referenced compendia are not up to date and do not reflect best practices in organ transplantation.
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Affiliation(s)
- Erin N Lushin
- Department of Pharmacy, Indiana University Health, Indianapolis, Indiana
| | | | - Crystal Truax
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah
| | - Laura M Lourenco
- Department of Pharmacy Services, University of Chicago Medicine, Chicago, Illinois
| | - Mark Mariski
- Department of Pharmacy, University of California San Diego Health, San Diego, California
| | - Jennifer I Melaragno
- Department of Pharmacy, University of Rochester Medical Center, Rochester, New York
| | - Lisa M Potter
- Department of Pharmacy Services, University of Chicago Medicine, Chicago, Illinois
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75
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Washburn L, Galván NTN, Moolchandani P, Price MB, Rath S, Ackah R, Myers KA, Wood RP, Parsons S, Brown RP, Ranova E, Goss M, Rana A, Goss JA. Survey of public attitudes towards imminent death donation in the United States. Am J Transplant 2021; 21:114-122. [PMID: 32633023 DOI: 10.1111/ajt.16175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/08/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 01/25/2023]
Abstract
Imminent death donation (IDD) is described as living organ donation prior to a planned withdrawal of life-sustaining care in an imminently dying patient. Although IDD was ethically justified by United Network for Organ Sharing, the concept remains controversial due to presumed lack of public support. The aim of this study was to evaluate the public's attitudes towards IDD. A cross-sectional survey was conducted of US adults age >18 years (n = 2644). The survey included a case scenario of a patient with a devastating brain injury. Responses were assessed on a 5-point Likert scale. Results showed that 68% - 74% of participants agreed or strongly agreed with IDD when posed as a general question and in relation to the case scenario. Participants were concerned about "recovery after a devastating brain injury" (34%), and that "doctors would not try as hard to save a patient's life" (33%). Only 9% of participants would be less likely to trust the organ donation process. In conclusion, our study demonstrates strong public support for IDD in the case of a patient with a devastating brain injury. Notably, participants were not largely concerned with losing trust in the organ donation process. These results justify policy change towards imminent death donation.
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Affiliation(s)
- Laura Washburn
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | | | - Priyanka Moolchandani
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew B Price
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - Smruti Rath
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - Ruth Ackah
- Department of Surgery, Ohio State University, Columbus, Ohio, USA
| | | | | | | | | | | | - Matthew Goss
- McGovern Medical School at UT Health, Houston, Texas, USA
| | - Abbas Rana
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - John A Goss
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
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76
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Hurst DJ, Padilla LA, Cooper DKC, Cleveland DC, Paris W. Clinical trials of pediatric cardiac xenotransplantation. Am J Transplant 2021; 21:433-434. [PMID: 32946176 DOI: 10.1111/ajt.16151] [Citation(s) in RCA: 4] [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: 05/20/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Daniel J Hurst
- Department of Medical Professionalism, Ethics, and Humanities, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Luz A Padilla
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David K C Cooper
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David C Cleveland
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Wayne Paris
- Department of Social Work, Abilene Christian University, Abilene, Texas, USA
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77
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Paul S, Melanson T, Mohan S, Ross-Driscoll K, McPherson L, Lynch R, Lo D, Pastan SO, Patzer RE. Kidney transplant program waitlisting rate as a metric to assess transplant access. Am J Transplant 2021; 21:314-321. [PMID: 32808730 PMCID: PMC7980228 DOI: 10.1111/ajt.16277] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/07/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/25/2023]
Abstract
Kidney transplant program performance in the United States is commonly measured by posttransplant outcomes. Inclusion of pretransplant measures could provide a more comprehensive assessment of transplant program performance and necessary information for patient decision-making. In this study, we propose a new metric, the waitlisting rate, defined as the ratio of patients who are waitlisted in a center relative to the person-years referred for evaluation to a program. Furthermore, we standardize the waitlisting rate relative to the state average in Georgia, North Carolina, and South Carolina. The new metric was used as a proof-of-concept to assess transplant-program access compared to the existing transplant rate metric. The study cohorts were defined by linking 2017 United States Renal Data System (USRDS) data with transplant-program referral data from the Southeastern United States between January 1, 2012 and December 31, 2016. Waitlisting rate varied across the 9 Southeastern transplant programs, ranging from 10 to 22 events per 100 patient-years, whereas the program-specific waitlisting rate ratio ranged between 0.76 and 1.33. Program-specific waitlisting rate ratio was uncorrelated with the transplant rate ratio (r = -.15, 95% CI, -0.83 to 0.57). Findings warrant collection of national data on early transplant steps, such as referral, for a more comprehensive assessment of transplant program performance and pretransplant access.
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Affiliation(s)
- Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Taylor Melanson
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia
| | - Sumit Mohan
- Department of Medicine, Vagelos College of Physicians & Surgeons, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Katherine Ross-Driscoll
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Laura McPherson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Raymond Lynch
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia
| | - Denise Lo
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia
| | - Stephen O. Pastan
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Rachel E. Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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78
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Kassam AF, Cortez AR, Winer LK, Conzen KD, El-Hinnawi A, Jones CM, Matsuoka L, Watkins AC, Collins KM, Bhati C, Selzner M, Sonnenday CJ, Englesbe MJ, Diwan TS, Dick AAS, Quillin RC. Extinguishing burnout: National analysis of predictors and effects of burnout in abdominal transplant surgery fellows. Am J Transplant 2021; 21:307-313. [PMID: 32463950 DOI: 10.1111/ajt.16075] [Citation(s) in RCA: 19] [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: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/25/2023]
Abstract
Burnout among surgeons has been attributed to increased workload and decreased autonomy. Although prior studies have examined burnout among transplant surgeons, no studies have evaluated burnout in abdominal transplant surgery fellows. The objective of our study was to identify predictors of burnout and understand its impact on personal and patient care during fellowship. A survey was sent to all abdominal transplant surgery fellows in an American Society of Transplant Surgeons-accredited fellowship. The response rate was 59.2% (n = 77) and 22.7% (n = 17) of fellows met criteria for burnout. Fellows with lower grit scores were more likely to exhibit burnout compared with fellows with higher scores (3.6 vs 4.0, P = .026). Those with burnout were more likely to work >100 hours per week (58.8% vs 27.6%, P = .023), have severe work-related stress (58.8% vs 22.4%, P = .010), consider quitting fellowship (94.1% vs 20.7%, P < .001), or make a medical error (35.3% vs 5.2%, P = .003). This national analysis of abdominal transplant fellows found that burnout rates are relatively low, but few fellows engage in self-care. Personal and program-related factors attribute to burnout and it has unacceptable effects on patient care. Transplant societies and fellowship programs should develop interventions to give fellows tools to prevent and combat burnout.
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Affiliation(s)
- Al-Faraaz Kassam
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Leah K Winer
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kendra D Conzen
- Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Ashraf El-Hinnawi
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | | | - Lea Matsuoka
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony C Watkins
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Kelly M Collins
- Department of Transplantation and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Chandra Bhati
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Markus Selzner
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | - Tayyab S Diwan
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - André A S Dick
- Department of Surgery, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Ralph C Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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79
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Drolen C, Cantu E, Goldberg HJ, Diamond JM, Courtwright A. Impact of the elimination of the donation service area on United States lung transplant practices and outcomes at high and low competition centers. Am J Transplant 2020; 20:3631-3638. [PMID: 32506618 DOI: 10.1111/ajt.16098] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/27/2020] [Accepted: 05/20/2020] [Indexed: 01/25/2023]
Abstract
In November 2017, the donation service area (DSA) was removed as the primary unit of US donor lung allocation. Our primary objective was to evaluate the effect of this change on recipient characteristics, the use of pretransplant extracorporeal membrane oxygenation (ECMO), and on index hospitalization length of stay (LOS) and early posttransplant complications. We also assessed whether these outcomes differed in high and low competition centers, as defined by the Herfindahl-Hirschman Index. Following DSA removal, there was a 9-day decrease in median waitlist time (P = .001) and an increase in median lung allocation score (40 vs 42, P < .0001) but no difference in the need for pretransplant ECMO (incidence rate ratio = 1.16, P = .12). Median LOS increased from 17 to 19 days in the post-DSA era (P = .01). There was no difference in posttransplant outcomes, including prolonged ventilation, new dialysis, or early survival, in the general cohort or between competition groups. High competition centers saw an 18.5-minute increase in ischemic time compared to low competition centers (P = .04) but did not differentially increase single lung transplants or pretransplant ECMO utilization. Overall, DSA elimination was associated with increased posttransplant LOS but no significant differences in pretransplant ECMO or other posttransplant outcomes. Effects were largely similar at low and high competition centers.
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Affiliation(s)
- Claire Drolen
- Division of Pulmonary and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward Cantu
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hilary J Goldberg
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boson, Massachusetts, USA
| | - Joshua M Diamond
- Division of Pulmonary and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Courtwright
- Division of Pulmonary and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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80
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Kates OS, Fisher CE, Rakita RM, Reyes JD, Limaye AP. Emerging evidence to support not always "just saying no" to SARS-CoV-2 positive donors. Am J Transplant 2020; 20:3261-3262. [PMID: 32502313 PMCID: PMC7300931 DOI: 10.1111/ajt.16119] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Olivia S. Kates
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA,Correspondence Olivia S. Kates
| | - Cynthia E. Fisher
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Robert M. Rakita
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Jorge D. Reyes
- Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Ajit P. Limaye
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
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81
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Ramadan OI, Naji A, Levine MH, Porrett PM, Dunn TB, Nazarian SM, Weinrieb RM, Kaminski M, Johnson D, Trofe-Clark J, Lorincz IS, Blumberg EA, Weikert BC, Bleicher M, Abt PL. Kidney transplantation and donation in the transgender population: A single-institution case series. Am J Transplant 2020; 20:2899-2904. [PMID: 32353210 DOI: 10.1111/ajt.15963] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/15/2019] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 01/25/2023]
Abstract
The medical needs of the transgender population are increasingly recognized within the US health care system. Hormone therapy and gender-affirming surgery present distinct anatomic, hormonal, infectious, and psychosocial issues among transgender kidney transplant donors and recipients. We present the first reported experience with kidney transplantation and donation in transgender patients. A single-center case series (January 2014-December 2018) comprising 4 transgender kidney transplant recipients and 2 transgender living donors was constructed and analyzed. Experts in transplant surgery, transplant psychiatry, transplant infectious disease, pharmacy, and endocrinology were consulted to discuss aspects of care for these patients. Four transgender patients identified as male-to-female and 2 as female-to-male. Three of 6 had gender-affirming surgeries prior to transplant surgery, 1 of whom had further procedures posttransplant. Additionally, 4 patients were on hormone therapy. All 6 had psychiatric comorbidities. The 4 grafts have done well, with an average serum creatinine of 1.45 mg/dL at 2 years (range 1.01-1.85 mg/dL). However, patients encountered various postoperative complications, 1 of which was attributable to modified anatomy. Thus, transgender kidney transplant patients can present novel challenges in regard to surgical considerations as well as pre- and posttransplant care. Dedicated expertise is needed to optimize outcomes for this population.
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Affiliation(s)
- Omar I Ramadan
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali Naji
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew H Levine
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paige M Porrett
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ty B Dunn
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susanna M Nazarian
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert M Weinrieb
- Department of Psychiatry, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Kaminski
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Johnson
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer Trofe-Clark
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Nephrology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ilona S Lorincz
- Division of Endocrinology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily A Blumberg
- Division of Infectious Disease, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Blair C Weikert
- Division of Infectious Disease, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa Bleicher
- Division of Nephrology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter L Abt
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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82
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Pierson RN, Burdorf L, Madsen JC, Lewis GD, D’Alessandro DA. Pig-to-human heart transplantation: Who goes first? Am J Transplant 2020; 20:2669-2674. [PMID: 32301262 PMCID: PMC9448330 DOI: 10.1111/ajt.15916] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 03/06/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 01/25/2023]
Abstract
Cardiac xenotransplantation has recently taken an important step towards clinical reality. In anticipation of the "first-in-human" heart xenotransplantation trial, we propose a set of patient characteristics that define potential candidates. Our premise is that, to be ethically justified, the risks posed by current state-of-the-art options must outweigh the anticipated risks of a pioneering xenotransplant procedure. Suitable candidates include patients who are at high immunologic risk because of sensitization to alloantigens, including those who have exhibited early onset or accelerated cardiac allograft vasculopathy. In addition, patients should be considered (1) for whom mechanical circulatory support would be prohibitively risky due to a hypercoagulable state, a contraindication to anticoagulation, or restrictive physiology; (2) with severe biventricular dysfunction predicting unsuccessful univentricular left heart support; and (3) adults with complex congenital heart disease. In conclusion, because the published preclinical benchmark for clinical translation of heart xenotransplantation appears within reach, carefully and deliberately defining appropriate trial participants is timely as the basis for ethical clinical trial design.
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Affiliation(s)
- Richard N. Pierson
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts,Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Lars Burdorf
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts,Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Joren C. Madsen
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts,Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Gregory D. Lewis
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - David A. D’Alessandro
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
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83
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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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84
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Artzner T, Michard B, Weiss E, Barbier L, Noorah Z, Merle JC, Paugam-Burtz C, Francoz C, Durand F, Soubrane O, Pirani T, Theocharidou E, O'Grady J, Bernal W, Heaton N, Salamé E, Bucur P, Barraud H, Lefebvre F, Serfaty L, Besch C, Bachellier P, Schneider F, Levesque E, Faitot F. Liver transplantation for critically ill cirrhotic patients: Stratifying utility based on pretransplant factors. Am J Transplant 2020; 20:2437-2448. [PMID: 32185866 DOI: 10.1111/ajt.15852] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [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: 11/30/2019] [Revised: 01/19/2020] [Accepted: 02/27/2020] [Indexed: 01/25/2023]
Abstract
The aim of this study was to produce a prognostic model to help predict posttransplant survival in patients transplanted with grade-3 acute-on-chronic liver failure (ACLF-3). Patients with ACLF-3 who underwent liver transplantation (LT) between 2007 and 2017 in 5 transplant centers were included (n = 152). Predictors of 1-year mortality were retrospectively screened and tested on a single center training cohort and subsequently tested on an independent multicenter cohort composed of the 4 other centers. Four independent pretransplant risk factors were associated with 1-year mortality after transplantation in the training cohort: age ≥53 years (P = .044), pre-LT arterial lactate level ≥4 mml/L (P = .013), mechanical ventilation with PaO2 /FiO2 ≤ 200 mm Hg (P = .026), and pre-LT leukocyte count ≤10 G/L (P = .004). A simplified version of the model was derived by assigning 1 point to each risk factor: the transplantation for Aclf-3 model (TAM) score. A cut-off at 2 points distinguished a high-risk group (score >2) from a low-risk group (score ≤2) with 1-year survival of 8.3% vs 83.9% respectively (P < .001). This model was subsequently validated in the independent multicenter cohort. The TAM score can help stratify posttransplant survival and identify an optimal transplantation window for patients with ACLF-3.
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Affiliation(s)
- Thierry Artzner
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Baptiste Michard
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Emmanuel Weiss
- Département Anesthésie et Réanimation, AP-HP, Hôpital Beaujon, Clichy, France.,UMR S 1149 Inserm/Université Paris Diderot, Paris, France
| | - Louise Barbier
- Service de Chirurgie Digestive et Transplantation Hépatique, CHU Trousseau, Université de Tours, Tours, France.,FHU SUPORT (Fédération Hospitalo-Universitaire SUrvival oPtimization in ORgan Transplantation), Strasbourg, France
| | - Zair Noorah
- Service d'Anesthésie et Réanimation Chirurgicale, Hôpital Henri Mondor, Créteil, France
| | - Jean-Claude Merle
- Service d'Anesthésie et Réanimation Chirurgicale, Hôpital Henri Mondor, Créteil, France
| | - Catherine Paugam-Burtz
- Département Anesthésie et Réanimation, AP-HP, Hôpital Beaujon, Clichy, France.,UMR S 1149 Inserm/Université Paris Diderot, Paris, France
| | - Claire Francoz
- UMR S 1149 Inserm/Université Paris Diderot, Paris, France.,Département d'Hépatologie, AP-HP Hôpital Beaujon, Clichy, France
| | - François Durand
- UMR S 1149 Inserm/Université Paris Diderot, Paris, France.,Département d'Hépatologie, AP-HP Hôpital Beaujon, Clichy, France
| | - Olivier Soubrane
- UMR S 1149 Inserm/Université Paris Diderot, Paris, France.,Service de Chirurgie Hépato-Pancréato-Biliaire, AP-HP Hôpital Beaujon, Clichy, France
| | - Tasneem Pirani
- Institute of Liver Studies, King's College Hospital, London, UK
| | | | - John O'Grady
- Institute of Liver Studies, King's College Hospital, London, UK
| | - William Bernal
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Ephrem Salamé
- Service de Chirurgie Digestive et Transplantation Hépatique, CHU Trousseau, Université de Tours, Tours, France.,FHU SUPORT (Fédération Hospitalo-Universitaire SUrvival oPtimization in ORgan Transplantation), Strasbourg, France
| | - Petru Bucur
- Service de Chirurgie Digestive et Transplantation Hépatique, CHU Trousseau, Université de Tours, Tours, France.,FHU SUPORT (Fédération Hospitalo-Universitaire SUrvival oPtimization in ORgan Transplantation), Strasbourg, France
| | - Hélène Barraud
- FHU SUPORT (Fédération Hospitalo-Universitaire SUrvival oPtimization in ORgan Transplantation), Strasbourg, France.,Service d'Hépatologie, CHU Trousseau, Université de Tours, France
| | - François Lefebvre
- Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Lawrence Serfaty
- Service d'Hépato-Gastro-Entérologie et d'Assistance Nutritive, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Camille Besch
- Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Philippe Bachellier
- Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Francis Schneider
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,UMR S 1121 Inserm/Université de Strasbourg, Strasbourg, France
| | - Eric Levesque
- Service d'Anesthésie et Réanimation Chirurgicale, Hôpital Henri Mondor, Créteil, France
| | - François Faitot
- Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Laboratoire ICube, UMR 7357, Université de Strasbourg, Strasbourg, France
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85
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Wall AE, Pruett T, Stock P, Testa G. Coronavirus disease 2019: Utilizing an ethical framework for rationing absolutely scarce health-care resources in transplant allocation decisions. Am J Transplant 2020; 20:2332-2336. [PMID: 32282992 PMCID: PMC7262060 DOI: 10.1111/ajt.15914] [Citation(s) in RCA: 25] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 01/25/2023]
Abstract
The novel coronavirus disease 2019 (COVID-19) is impacting transplant programs around the world, and, as the center of the pandemic shifts to the United States, we have to prepare to make decisions about which patients to transplant during times of constrained resources. In this paper, we discuss how to transition from the traditional justice versus utility consideration in organ allocation to a more nuanced allocation scheme based on ethical values that drive decisions in times of absolute scarcity. We recognize that many decisions are made based on the practical limitations that transplant programs face, especially at the extremes. As programs make the transition from a standard approach to a resource-constrained approach to transplantation, we utilize a framework for ethical decisions in settings of absolutely scarce resources to help guide programs in deciding which patients to transplant, which donors to accept, how to minimize risk, and how to ensure the best utilization of transplant team members.
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Affiliation(s)
- Anji E. Wall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas,Correspondence Anji E. Wall
| | - Timothy Pruett
- Division of Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Peter Stock
- Division of Transplant Surgery, University of California San Francisco, San Francisco, California
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
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86
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Andreoni KA. Now is the time for the Organ Procurement and Transplantation Network to change regulatory policy to effectively increase transplantation in the United States; Carpe Diem. Am J Transplant 2020; 20:2026-2029. [PMID: 31883214 DOI: 10.1111/ajt.15759] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 01/25/2023]
Abstract
With the Centers for Medicare and Medicaid Services proposing to remove outcome measures from the transplant centers' renewal for Conditions of Participation an exciting opportunity surfaces for the Organ Procurement and Transplantation Network to make an equally bold change and allow for increased transplantation options for patients in the United States.
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Affiliation(s)
- Kenneth A Andreoni
- Division of Abdominal Transplantation, Department of Surgery, University of Florida, Gainesville, Florida
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87
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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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88
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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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89
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Axelrod DA, Shah S, Guarrera J, Shepard B, Scalea J, Cooper M, Kandaswamy R. Improving safety in organ recovery transportation: Report from the ASTS/UNOS/AST/AOPO transportation safety summit. Am J Transplant 2020; 20:2001-2008. [PMID: 32320532 DOI: 10.1111/ajt.15930] [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: 02/05/2020] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 01/25/2023]
Abstract
Despite the passage of a decade since the tragic loss of an organ recovery team from the University of Michigan, there are currently no national standards governing air and ground transportation of organ recovery personnel. Consequently, the American Society of Transplant Surgeons, the Association of Organ Procurement Organizations, and the United Network for Organ Sharing jointly convened a transportation summit to review and update recommendations for national transportation standards. Expanded air transport quality assurance protocols, including a requirement for two engine turbine-powered aircraft piloted by two qualified pilots certified through onsite inspections was recommended. Ground transportation providers must ensure adequate safety restraints are available, ambulance avoided if possible, and the use of lights and sirens minimized. Finally, adequate insurance coverage for all team members, including trainees should be provided and should not rely on carrier liability insurance policies. The summit participants have committed the support of their organizations to promote and enact these regulations nationally.
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Affiliation(s)
| | - Shimul Shah
- University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Brian Shepard
- United Network for Organ Sharing, Richmond, Virginia, USA
| | | | - Mathew Cooper
- Medstar-Georgetown University, Washington, District of Columbia, USA
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90
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Kates OS, Fisher CE, Rakita RM, Reyes JD, Limaye AP. Use of SARS-CoV-2-infected deceased organ donors: Should we always "just say no?". Am J Transplant 2020; 20:1787-1794. [PMID: 32400087 PMCID: PMC7272824 DOI: 10.1111/ajt.16000] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/20/2020] [Accepted: 05/01/2020] [Indexed: 01/25/2023]
Abstract
In the context of a rapidly evolving pandemic, multiple organizations have released guidelines stating that all organs from potential deceased donors with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection should be deferred, including from otherwise medically eligible donors found to have mild or asymptomatic SARS-CoV-2 discovered on routine donor screening. In this article, we critically examine the available data on the risk of transmission of SARS-CoV-2 through organ transplantation. The isolation of SARS-CoV-2 from nonlung clinical specimens, the detection of SARS-CoV-2 in autopsy specimens, previous experience with the related coronaviruses SARS-CoV and MERS-CoV, and the vast experience with other common RNA respiratory viruses are all addressed. Taken together, these data provide little evidence to suggest the presence of intact transmissible SARS-CoV in organs that can potentially be transplanted, specifically liver and heart. Other considerations including ethical, financial, societal, and logistical concerns are also addressed. We conclude that, for selected patients with high waitlist mortality, transplant programs should consider accepting heart or liver transplants from deceased donors with SARS-CoV-2 infection.
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Affiliation(s)
- Olivia S. Kates
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA,Correspondence Olivia S. Kates
| | - Cynthia E. Fisher
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Robert M. Rakita
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Jorge D. Reyes
- Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Ajit P. Limaye
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
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91
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Sharma S, Lawrence C, Giovinazzo F. Transplant programs during COVID-19: Unintended consequences for health inequality. Am J Transplant 2020; 20:1954-1955. [PMID: 32314551 PMCID: PMC9800440 DOI: 10.1111/ajt.15931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Shivani Sharma
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK,Correspondence Shivani Sharma
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92
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Gori A, Dondossola D, Antonelli B, Mangioni D, Alagna L, Reggiani P, Bandera A, Rossi G. Coronavirus disease 2019 and transplantation: A view from the inside. Am J Transplant 2020; 20:1939-1940. [PMID: 32181969 PMCID: PMC9800453 DOI: 10.1111/ajt.15853] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Andrea Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Daniele Dondossola
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy,General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Correspondence Dondossola Daniele
| | - Barbara Antonelli
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Mangioni
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Laura Alagna
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Reggiani
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giorgio Rossi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy,General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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93
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Shah MB, Lynch RJ, El-Haddad H, Doby B, Brockmeier D, Goldberg DS. Utilization of deceased donors during a pandemic: argument against using SARS-CoV-2-positive donors. Am J Transplant 2020; 20:1795-1799. [PMID: 32368850 PMCID: PMC7267604 DOI: 10.1111/ajt.15969] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 01/25/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly become an unprecedented pandemic that has impacted society, disrupted hospital functions, strained health care resources, and impacted the lives of transplant professionals. Despite this, organ failure and the need for transplant continues throughout the United States. Considering the perpetual scarcity of deceased donor organs, Kates et al present a viewpoint that advocates for the utilization of coronavirus disease 2019 (COVID-19)-positive donors in selected cases. We present a review of the current literature that details the potential negative consequences of COVID-19-positive donors. The factors we consider include (1) the risk of blood transmission of SARS-CoV-2, (2) involvement of donor organs, (3) lack of effective therapies, (4) exposure of health care and recovery teams, (5) disease transmission and propagation, and (6) hospital resource utilization. While we acknowledge that transplant fulfills the mission of saving lives, it is imperative to consider the consequences not only to our recipients but also to the community and to health care workers, particularly in the absence of effective preventative or curative therapies. For these reasons, we believe the evidence and risks show that COVID-19 infection should continue to remain a contraindication for donation, as has been the initial response of donation and transplant societies.
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Affiliation(s)
- Malay B. Shah
- Department of Surgery, Division of Abdominal Transplant Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA,Correspondence Malay B. Shah
| | - Raymond J. Lynch
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hanine El-Haddad
- Department of Medicine, Division of Infectious Diseases, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Brianna Doby
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - David S. Goldberg
- Department of Medicine, Division of Hepatology, University of Miami Miller School of Medicine, Miami, Florida, USA
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94
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Ho QY, Chung SJ, Gan VH, Ng LG, Tan BH, Kee TY. High-immunological risk living donor renal transplant during the COVID-19 outbreak: Uncertainties and ethical dilemmas. Am J Transplant 2020; 20:1949-1951. [PMID: 32337825 PMCID: PMC7267290 DOI: 10.1111/ajt.15949] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 03/27/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Quan Yao Ho
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore,SingHealth Duke-NUS Transplant Centre, Singapore, Singapore,Correspondence Quan Y. Ho
| | - Shimin J. Chung
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore,SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | - Valerie H.L. Gan
- Department of Urology, Singapore General Hospital, Singapore, Singapore,SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore, Singapore,SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore,SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | - Terence Y.S. Kee
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore,SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
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95
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Flechner SM, Cooper M, Waterman A, Kennealey P, Redfield R, Verbesey J. Ethical principles governing organ transplantation apply to paired exchange programs. Am J Transplant 2020; 20:1756-1757. [PMID: 32277552 DOI: 10.1111/ajt.15906] [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] [Indexed: 01/25/2023]
Affiliation(s)
- Stuart M Flechner
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington, District of Columbia, USA
| | - Amy Waterman
- Division of Nephrology, UCLA School of Medicine, Los Angeles, California, USA
| | - Peter Kennealey
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, California, USA
| | - Robert Redfield
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Jennifer Verbesey
- Medstar Georgetown Transplant Institute, Washington, District of Columbia, USA
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96
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Parent B, Moazami N, Wall S, Carillo J, Kon Z, Smith D, Walsh BC, Caplan A. Ethical and logistical concerns for establishing NRP-cDCD heart transplantation in the United States. Am J Transplant 2020; 20:1508-1512. [PMID: 31913567 DOI: 10.1111/ajt.15772] [Citation(s) in RCA: 25] [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: 09/19/2019] [Revised: 12/12/2019] [Accepted: 12/31/2019] [Indexed: 01/25/2023]
Abstract
Controlled heart donation after circulatory determination of death (cDCD) is well established internationally with good outcomes and could be adopted in the United States to increase heart supply if ethical and logistical challenges are comprehensively addressed. The most effective and resource-efficient method for mitigating warm ischemia after circulatory arrest is normothermic regional perfusion (NRP) in situ. This strategy requires restarting circulation after declaration of death according to circulatory criteria, which appears to challenge the legal circulatory death definition requiring irreversible cessation. Permanent cessation for life-saving efforts must be achieved to assuage this concern and ligating principal vessels maintains no blood flow to the brain, which ensures natural progression to cessation of brain function. This practice-standard in some countries-raises unique concerns about prioritizing life-saving efforts, informed authorization from decision-makers, and the clinician's role in the patient's death. To preserve public trust, medical integrity, and respect for the donor, the donation conversation must not take place until after an un-coerced decision to withdraw life-sustaining treatment made in accordance with the patient's treatment goals. The decision-maker(s) must understand cDCD procedure well enough to provide genuine authorization and the preservation/procurement teams must be kept separate from the clinical care team.
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Affiliation(s)
- Brendan Parent
- Department of Population Health, Division of Medical Ethics, NYU Langone Health, New York, New York
| | - Nader Moazami
- NYU Langone Transplant Institute, New York, New York
| | - Stephen Wall
- Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, New York, New York.,Department of Population Health, Division of Health and Behavior, NYU Langone Health, New York, New York
| | - Julius Carillo
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Zachary Kon
- NYU Langone Transplant Institute, New York, New York
| | - Deane Smith
- NYU Langone Transplant Institute, New York, New York.,Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - B Corbett Walsh
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Langone Health, New York, New York
| | - Arthur Caplan
- Department of Population Health, Division of Medical Ethics, NYU Langone Health, New York, New York
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97
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Bambha K, Shingina A, Dodge JL, O'Connor K, Dunn S, Prinz J, Pabst M, Nilles K, Sibulesky L, Biggins SW. Solid organ donation after death in the United States: Data-driven messaging to encourage potential donors. Am J Transplant 2020; 20:1642-1649. [PMID: 31917505 DOI: 10.1111/ajt.15776] [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: 10/21/2019] [Revised: 12/11/2019] [Accepted: 12/23/2019] [Indexed: 01/25/2023]
Abstract
US deceased donor solid organ transplantation (dd-SOT) depends upon an individual's/family's altruistic willingness to donate organs after death; however, there is a shortage of deceased organ donors in the United States. Informing individuals of their own lifetime risk of needing dd-SOT could reframe the decision-making around organ donation after death. Using United Network for Organ Sharing (UNOS) data (2007-2016), this cross-sectional study identified (1) deceased organ donors, (2) individuals waitlisted for dd-SOT (liver, kidney, pancreas, heart, lung, intestine), and (3) dd-SOT recipients. Using US population projections, life tables, and mortality estimates, we quantified probabilities (Pr) of (1) becoming deceased organ donors, (2) needing dd-SOT, and (3) receiving dd-SOT. Lifetime Pr (per 100 000 US population) for males and females of becoming deceased organ donors were 212 and 146, respectively, and of needing dd-SOT were 1323 and 803, respectively. Lifetime Pr of receiving dd-SOT was 50% for males, 48% for females. Over a lifetime, males were 6.2 and females 5.5 times more likely to need dd-SOT than to become deceased organ donors. Organ donation is traditionally contextualized in terms of charity toward others. Our analyses yield a new tool, in the form of quantifying an individual's own likelihood of needing dd-SOT, which may assist with reframing motivations toward deceased donor organ donation.
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Affiliation(s)
- Kiran Bambha
- Division of Gastroenterology and Hepatology, Liver Care Line, University of Washington Medical Center, Seattle, Washington.,Center for Liver Investigation Fostering discovEry (C-LIFE), University of Washington, Seattle, Washington.,Clinical and Bio-Analytics Transplant Laboratory (CBATL), Department of Surgery, Division of Transplantation, University of Washington, Seattle, Washington
| | - Alexandra Shingina
- Division of Gastroenterology and Hepatology, Liver Care Line, University of Washington Medical Center, Seattle, Washington.,Center for Liver Investigation Fostering discovEry (C-LIFE), University of Washington, Seattle, Washington
| | - Jennifer L Dodge
- Center for Liver Investigation Fostering discovEry (C-LIFE), University of Washington, Seattle, Washington.,Department of Transplant Surgery, University of California San Francisco, San Francisco, California
| | | | - Sue Dunn
- Donor Alliance, Denver, Colorado
| | | | - Mark Pabst
- Center for Liver Investigation Fostering discovEry (C-LIFE), University of Washington, Seattle, Washington
| | - Kathy Nilles
- Division of Gastroenterology and Hepatology, Georgetown University Medical Center, Washington, District of Columbia
| | - Lena Sibulesky
- Clinical and Bio-Analytics Transplant Laboratory (CBATL), Department of Surgery, Division of Transplantation, University of Washington, Seattle, Washington.,Department of Surgery, Division of Transplantation, University of Washington, Seattle, Washington
| | - Scott W Biggins
- Division of Gastroenterology and Hepatology, Liver Care Line, University of Washington Medical Center, Seattle, Washington.,Center for Liver Investigation Fostering discovEry (C-LIFE), University of Washington, Seattle, Washington.,Clinical and Bio-Analytics Transplant Laboratory (CBATL), Department of Surgery, Division of Transplantation, University of Washington, Seattle, Washington
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98
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Hippen BE, Reed AI, Ketchersid T, Maddux FW. Implications of the Advancing American Kidney Health Initiative for kidney transplant centers. Am J Transplant 2020; 20:1244-1250. [PMID: 31561276 DOI: 10.1111/ajt.15619] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 08/18/2019] [Revised: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 01/25/2023]
Abstract
The announcement of the Advancing American Kidney Health (AAKH) Initiative on July 10, 2019 was met with a mix of excitement and trepidation, befitting a proposed radical reconfiguration of the delivery of kidney disease care. Aspiring to reduce the incidence of end-stage renal disease, increase the prevalence of home dialysis, and double the number of organs available for transplant, the AAKH payment models primarily focus on incenting behaviors of general nephrologists, though actualizing positive incentives will require the active cooperation of dialysis providers and transplant centers. Here, we review the AAKH initiatives' potential impact on all stakeholders and opine on financial and regulatory pressures on kidney transplant programs, outlining areas of uncertainty and concern, and suggest key points of reflection for clinical and administrative leaders of kidney transplant centers weighing participation in any of the voluntary payment models.
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Affiliation(s)
| | - Alan I Reed
- University of Iowa Organ Transplant Center, Iowa City, Iowa
| | - Terry Ketchersid
- Integrated Care Group, Fresenius Medical Care, North America, Waltham, Massachusetts
| | - Franklin W Maddux
- Global Medical Office, Fresenius Medical Care AG & Co., KGaA, Waltham, Massachusetts
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99
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Dorent R, Jasseron C, Audry B, Bayer F, Legeai C, Cantrelle C, Smits JM, Eisen H, Jacquelinet C, Leprince P, Bastien O. New French heart allocation system: Comparison with Eurotransplant and US allocation systems. Am J Transplant 2020; 20:1236-1243. [PMID: 32037718 DOI: 10.1111/ajt.15816] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 09/25/2019] [Revised: 01/09/2020] [Accepted: 02/02/2020] [Indexed: 01/25/2023]
Abstract
Graft allocation rules for heart transplantation are necessary because of the shortage of heart donors, resulting in high waitlist mortality. The Agence de la biomédecine is the agency in charge of the organ allocation system in France. Assessment of the 2004 urgency-based allocation system identified challenging limitations. A new system based on a score ranking all candidates was implemented in January 2018. In the revised system, medical urgency is defined according to candidate characteristics rather than the treatment modalities, and an interplay between urgency, donor-recipient matching, and geographic sharing was introduced. In this article, we describe in detail the new allocation system and compare these allocation rules to Eurotransplant and US allocation policies.
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Affiliation(s)
- Richard Dorent
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Carine Jasseron
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Benoît Audry
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Florian Bayer
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Camille Legeai
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Christelle Cantrelle
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | | | - Howard Eisen
- Division of Cardiology, Heart and Vascular Institute, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Christian Jacquelinet
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Pascal Leprince
- Department of Thoracic and Cardiovascular Surgery, Pitié-Salpêtrière Hospital, UPMC, AP-HP, Paris, France
| | - Olivier Bastien
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
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100
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Niazi SK, Spaulding A, Vargas E, Schneekloth T, Crook J, Rummans T, Taner CB. Mental health and chemical dependency services at US transplant centers. Am J Transplant 2020; 20:1152-1161. [PMID: 31612625 DOI: 10.1111/ajt.15659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/08/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 01/25/2023]
Abstract
The purpose of this study was to assess the availability of mental health (MH) and chemical dependency (CD) services at US transplant centers, because appropriate psychosocial assessment and care is associated with better transplant outcomes. We used the 2017-2018 American Hospital Association survey, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases to quantify availability of services and examined associations of hospital- and health services area-level characteristics with odds of offering services with generalized linear mixed models. We found that 15% of transplant centers did not offer MH services and 62% did not offer CD services. Hospitals were more likely to offer MH services if they were larger (OR [95% CI]: 1.03 [1.01, 1.06]) and had a lower rate of uninsured patients in the health services area (OR [95% CI]: 0.89 [0.80, 0.99]) and were more likely to offer CD services if they were larger (OR [95% CI]: 1.02 [1.01, 1.03]) or were members of a system (OR [95% CI]: 2.31 [1.26, 4.24]). Additional research is needed to understand whether lack of MH or CD services at transplant centers affects patients' ability to access comprehensive psychosocial care and whether this affects patient outcomes.
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Affiliation(s)
- Shehzad K Niazi
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida.,Department of Transplantation, Mayo Clinic, Jacksonville, Florida
| | - Aaron Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida.,Department of Health Services Research, Mayo Clinic, Jacksonville, Florida
| | - Emily Vargas
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida.,Department of Health Services Research, Mayo Clinic, Jacksonville, Florida
| | - Terry Schneekloth
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Julia Crook
- Department of Health Services Research, Mayo Clinic, Jacksonville, Florida
| | - Teresa Rummans
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - C Burcin Taner
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida
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