1
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Barzi A, Weipert CM, Espenschied CR, Raymond VM, Wang-Gillam A, Nezami MA, Gordon EJ, Mahadevan D, Mody K. ERBB2 (HER2) amplifications and co-occurring KRAS alterations in the circulating cell-free DNA of pancreatic ductal adenocarcinoma patients and response to HER2 inhibition. Front Oncol 2024; 14:1339302. [PMID: 38406801 PMCID: PMC10885695 DOI: 10.3389/fonc.2024.1339302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose Despite accumulating data regarding the genomic landscape of pancreatic ductal adenocarcinoma (PDAC), olaparib is the only biomarker-driven FDA-approved targeted therapy with a PDAC-specific approval. Treating ERBB2(HER2)-amplified PDAC with anti-HER2 therapy has been reported with mixed results. Most pancreatic adenocarcinomas have KRAS alterations, which have been shown to be a marker of resistance to HER2-targeted therapies in other malignancies, though the impact of these alterations in pancreatic cancer is unknown. We describe two cases of ERBB2-amplified pancreatic cancer patients treated with anti-HER2 therapy and provide data on the frequency of ERBB2 amplifications and KRAS alterations identified by clinical circulating cell-free DNA testing. Methods De-identified molecular test results for all patients with pancreatic cancer who received clinical cell-free circulating DNA analysis (Guardant360) between 06/2014 and 01/2018 were analyzed. Cell-free circulating DNA analysis included next-generation sequencing of up to 73 genes, including select small insertion/deletions, copy number amplifications, and fusions. Results Of 1,791 patients with pancreatic adenocarcinoma, 36 (2.0%) had an ERBB2 amplification, 26 (72.2%) of whom had a KRAS alteration. Treatment data were available for seven patients. Two were treated with anti-HER2 therapy after their cell-free circulating DNA result, with both benefiting from therapy, including one with a durable response to trastuzumab and no KRAS alteration detected until progression. Conclusion Our case series illustrates that certain patients with ERBB2-amplified pancreatic adenocarcinoma may respond to anti-HER2 therapy and gain several months of prolonged survival. Our data suggests KRAS mutations as a possible mechanism of primary and acquired resistance to anti-HER2 therapy in pancreatic cancer. Additional studies are needed to clarify the role of KRAS in resistance to anti-HER2 therapy.
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Affiliation(s)
- Afsaneh Barzi
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, CA, United States
| | | | | | | | - Andrea Wang-Gillam
- Division of Oncology, Siteman Cancer Center, St. Louis, MO, United States
| | | | - Eva J. Gordon
- Private Health Management, Inc., Los Angeles, CA, United States
| | - Daruka Mahadevan
- Division of Hematology and Oncology, Department of Medicine, University of Texas Health, San Antonio, San Antonio, TX, United States
| | - Kabir Mody
- Division of Hematology-Oncology, Department of Medicine, Mayo Clinic, Jacksonville, FL, United States
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2
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Al-Aloosi M, Prechtl AM, Chatterjee P, Bernard B, Kemp CJ, Rosati R, Diaz RL, Appleyard LR, Pereira S, Rajewski A, McDonald A, Gordon EJ, Grandori C. Case report: ex vivo tumor organoid drug testing identifies therapeutic options for stage IV ovarian carcinoma. Front Oncol 2024; 13:1267650. [PMID: 38239650 PMCID: PMC10794297 DOI: 10.3389/fonc.2023.1267650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/30/2023] [Indexed: 01/22/2024] Open
Abstract
Patients presenting with stage 4 ovarian carcinoma, including low-grade serous disease, have a poor prognosis. Although platinum-based therapies can offer some response, these therapies are associated with many side effects, and treatment resistance often develops. Toxic side effects along with disease progression render patients unable to receive additional lines of treatment and limit their options to hospice or palliative care. In this case report, we describe a patient with an unusual case of metastatic low-grade serous ovarian cancer with some features of high-grade disease who had received four previous lines of treatment and was suffering from atelectasis, pulmonary embolism, and hydronephrosis. A CLIA-certified drug sensitivity assay of an organoid culture derived from the patient's tumor (PARIS® test) identified several therapeutic options, including the combination of fulvestrant with everolimus. On this treatment regimen, the patient experienced 7 months of stable disease and survived nearly 11 months before succumbing to her disease. This case emphasizes the clinical utility of ex vivo drug testing as a new functional precision medicine approach to identify, in real-time, personalized treatment options for patients, especially those who are not benefiting from standard of care treatments.
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Affiliation(s)
| | | | | | - Brady Bernard
- SEngine Precision Medicine, Seattle, WA, United States
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, United States
| | - Christopher J. Kemp
- Division of Human Biology, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | | | | | | | | | - Alex Rajewski
- SEngine Precision Medicine, Seattle, WA, United States
| | - Amber McDonald
- Private Health Management, Los Angeles, CA, United States
| | - Eva J. Gordon
- Private Health Management, Los Angeles, CA, United States
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3
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Parker D, Zambelli J, Lara MK, Wolf TH, McDonald A, Lee E, Abou-Elkacem L, Gordon EJ, Baum RP. Case Report: Long-term complete response to PSMA-targeted radioligand therapy and abiraterone in a metastatic prostate cancer patient. Front Oncol 2023; 13:1192792. [PMID: 37188199 PMCID: PMC10175697 DOI: 10.3389/fonc.2023.1192792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Despite decades of research and clinical trials, metastatic castration-resistant prostate cancer (mCRPC) remains incurable and typically fatal. Current treatments may provide modest increases in progression-free survival but can come with significant adverse effects and are disaggregated from the diagnostic imaging needed to fully assess the spread of metastatic disease. A theranostic approach, using radiolabeled ligands that target the cell surface protein PSMA, simplifies the visualization and disease treatment process by enabling both to use similar agents. Here, we describe an exemplary case wherein a gentleman in his 70s with mCRPC on diagnosis was treated with 177Lu-PSMA-617 and abiraterone, and remains disease-free to date, over five years later.
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Affiliation(s)
- David Parker
- Private Health Management, Los Angeles, CA, United States
| | | | | | | | - Amber McDonald
- Private Health Management, Los Angeles, CA, United States
| | - Erica Lee
- Private Health Management, Los Angeles, CA, United States
| | | | - Eva J. Gordon
- Private Health Management, Los Angeles, CA, United States
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4
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Gordon EJ, Parker D, Barth K, Pena J, Elvin JA, DeLeon T, Karlin NJ. Genomic Profiling Reveals Medullary Thyroid Cancer Misdiagnosed as Lung Cancer. Case Rep Oncol 2018; 11:399-403. [PMID: 30022943 PMCID: PMC6047557 DOI: 10.1159/000490238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 12/19/2022] Open
Abstract
Mutations or other alterations in the RET gene have been implicated in a variety of malignancies – most commonly thyroid, but also chronic myelomonocytic leukemia, acute myeloid leukemia, and lung, breast, pancreatic, and colon cancers. Here we present a case of a gentlemen initially diagnosed with and treated for non-small cell lung adenocarcinoma. Genomic profiling of his tumor specimen revealed a RET point mutation with a known association with medullary thyroid cancer (MTC). Further pathological and molecular diagnostic evaluation confirmed a diagnosis of MTC, leading to a change in treatment from standard chemotherapy for non-small cell lung cancer to targeted therapy against RET and potential implications regarding inherited cancer risk for his offspring. The patient experienced a clinical response to treatment and several months of improved quality of life. This case illustrates the capacity of genomic profiling to uncover molecular drivers of disease and help ensure proper diagnosis and management of cancer.
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Affiliation(s)
- Eva J Gordon
- Private Health Management, Inc., Los Angeles, California, USA
| | - David Parker
- Private Health Management, Inc., Los Angeles, California, USA
| | - Kelly Barth
- Private Health Management, Inc., Los Angeles, California, USA
| | - Jennifer Pena
- Private Health Management, Inc., Los Angeles, California, USA
| | - Julia A Elvin
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
| | - Thomas DeLeon
- Division of Hematology and Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Nina J Karlin
- Division of Hematology and Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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5
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Henderson ML, Clayville KA, Fisher JS, Kuntz KK, Mysel H, Purnell TS, Schaffer RL, Sherman LA, Willock EP, Gordon EJ. Social media and organ donation: Ethically navigating the next frontier. Am J Transplant 2017; 17:2803-2809. [PMID: 28744966 DOI: 10.1111/ajt.14444] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 03/31/2017] [Revised: 06/30/2017] [Accepted: 07/17/2017] [Indexed: 01/25/2023]
Abstract
As the organ shortage continues to grow, the creation of social media communities by transplant hospitals and the public is rapidly expanding to increase the number of living donors. Social media communities are arranged in myriad ways and without standardization, raising concerns about transplant candidates' and potential donors' autonomy and quality of care. Social media communities magnify and modify extant ethical issues in deceased and living donation related to privacy, confidentiality, professionalism, and informed consent, and increase the potential for undue influence and coercion for potential donors and transplant candidates. Currently, no national ethical guidelines have been developed in the United States regarding the use of social media to foster organ transplantation. We provide an ethical framework to guide transplant stakeholders in using social media for public and patient communication about transplantation and living donation, and offer recommendations for transplant clinical practice and future research.
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Affiliation(s)
- M L Henderson
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - J S Fisher
- Scripps Clinic/Green Hospital, La Jolla, CA, USA
| | - K K Kuntz
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - H Mysel
- The Living Kidney Donors Network, Chicago, IL, USA
| | - T S Purnell
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - R L Schaffer
- Scripps Clinic/Green Hospital, La Jolla, CA, USA
| | - L A Sherman
- Medical College of Wisconsin Milwaukee, WI, USA
| | - E P Willock
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - E J Gordon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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6
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Mittelman M, Thiessen C, Chon WJ, Clayville K, Cronin DC, Fisher JS, Fry-Revere S, Gross JA, Hanneman J, Henderson ML, Ladin K, Mysel H, Sherman LA, Willock L, Gordon EJ. Miscommunicating NOTA Can Be Costly to Living Donors. Am J Transplant 2017; 17:578-580. [PMID: 27599256 DOI: 10.1111/ajt.14036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- M Mittelman
- American Living Organ Donor Network, Philadelphia, PA
| | - C Thiessen
- Yale University School of Medicine, New Haven, CT
| | - W J Chon
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - K Clayville
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - D C Cronin
- Medical College of Wisconsin, Milwaukee, WI
| | - J S Fisher
- Scripps Clinic/Green Hospital, La Jolla, CA
| | - S Fry-Revere
- American Living Organ Donor Network, Center for Ethical Solutions, Washington, DC
| | | | - J Hanneman
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - K Ladin
- Tufts University, Boston, MA
| | - H Mysel
- Living Kidney Donor Network, Winnetka, IL
| | - L A Sherman
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - L Willock
- Biomedical Institutional Review Board, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - E J Gordon
- Northwestern University Feinberg School of Medicine, Chicago, IL
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7
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Zwang NA, Shetty A, Sustento-Reodica N, Gordon EJ, Leventhal J, Gallon L, Friedewald JJ. APOL1-Associated End-Stage Renal Disease in a Living Kidney Transplant Donor. Am J Transplant 2016; 16:3568-3572. [PMID: 27588375 DOI: 10.1111/ajt.14035] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/09/2016] [Accepted: 08/27/2016] [Indexed: 01/25/2023]
Abstract
Homozygosity for apolipoprotein-L1 (APOL1) risk variants has emerged as an important predictor of renal disease in individuals of African descent over the past several years. Additionally, these risk variants may be important predictors of renal allograft failure when present in a living or deceased donor. Currently, there is no universal recommendation for screening of potential donors. We present a case of end-stage renal disease with focal segmental glomerulosclerosis in a living donor 7 years following donor nephrectomy. Genetic assessment revealed homozygosity for the G1 high-risk APOL1 variant.
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Affiliation(s)
- N A Zwang
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.,McGaw Medical Center of Northwestern University, Chicago, IL
| | - A Shetty
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - N Sustento-Reodica
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - E J Gordon
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Healthcare Studies, and Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J Leventhal
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - L Gallon
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J J Friedewald
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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8
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Gordon EJ, Gill JS. US Transplant Policy Should Strengthen Bridges, Not Build Walls. Am J Transplant 2016; 16:1645-6. [PMID: 26752683 DOI: 10.1111/ajt.13713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 01/25/2023]
Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Comprehensive Transplant Center, Medical Humanities and Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - J S Gill
- University of British Columbia, Research Scientist Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
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9
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Mills D, Gomberawalla A, Gordon EJ, Tondre J, Nejad M, Nguyen T, Pogoda JM, Rao J, Chatterton R, Henning S, Love SM. Examination of Duct Physiology in the Human Mammary Gland. PLoS One 2016; 11:e0150653. [PMID: 27073976 PMCID: PMC4830446 DOI: 10.1371/journal.pone.0150653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/16/2016] [Indexed: 11/23/2022] Open
Abstract
Background The human breast comprise several ductal systems, or lobes, which contain a small amount of fluid containing cells, hormones, proteins and metabolites. The complex physiology of these ducts is likely a contributing factor to the development of breast cancer, especially given that the vast majority of breast cancers begin in a single lobular unit. Methods We examined the levels of total protein, progesterone, estradiol, estrone sulfate, dehydroepiandrosterone sulfate, and macrophages in ductal fluid samples obtained from 3 ducts each in 78 women, sampled twice over a 6 month period. Samples were processed for both cytological and molecular analysis. Intraclass correlation coefficients and mixed models were utilized to identify significant data. Results We found that the levels of these ductal fluid components were generally uncorrelated among ducts within a single breast and over time, suggesting that each lobe within the breast has a distinct physiology. However, we also found that estradiol was more correlated in women who were nulliparous or produced nipple aspirate fluid. Conclusions Our results provide evidence that the microenvironment of any given lobular unit is unique to that individual unit, findings that may provide clues about the initiation and development of ductal carcinomas.
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Affiliation(s)
- Dixie Mills
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
| | - Ameer Gomberawalla
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
- Columbia University Medical Center, Department of Breast Surgery, New York, NY, United States of America
- * E-mail:
| | - Eva J. Gordon
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
| | - Julie Tondre
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
| | - Mitra Nejad
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
| | - Tinh Nguyen
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
| | - Janice M. Pogoda
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, 90089, United States of America
| | - Jianyu Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, 90095, United States of America
| | - Robert Chatterton
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 710 North Fairbanks Court, Chicago, IL, 60611, United States of America
| | - Susanne Henning
- Center for Human Nutrition, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, 90095, United States of America
| | - Susan M. Love
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
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10
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Thiessen C, Gordon EJ, Reese PP, Kulkarni S. Development of a Donor-Centered Approach to Risk Assessment: Rebalancing Nonmaleficence and Autonomy. Am J Transplant 2015; 15:2314-23. [PMID: 25868787 DOI: 10.1111/ajt.13272] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 01/25/2023]
Abstract
Living kidney donors are often excluded from the shared decision making and patient-centered models that are advocated in medical practice. Thresholds for acceptable risk vary between transplant centers, and between clinicians and donors. Although donor selection committees commonly focus on medical risks, potential donors also consider nonmedical risks and burdens, which may alter their assessment of an acceptable level of medical risk. Thus, transplant centers may encounter ethical tensions between nonmaleficence and respect for donor autonomy. A donor-centered model of risk assessment and risk reconciliation would integrate the donor's values and preferences in a shared decision about their eligibility to donate. This paper argues for shifting to a donor-centered model of risk assessment, and presents a research agenda to facilitate the greater participation of donors in their own evaluation and approval processes.
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Affiliation(s)
- C Thiessen
- Department of Surgery, Section of Organ Transplantation & Immunology, Yale University School of Medicine, New Haven, CT
| | - E J Gordon
- Comprehensive Transplant Center, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - P P Reese
- Renal-Electrolyte and Hypertension Division, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - S Kulkarni
- Department of Surgery, Section of Organ Transplantation & Immunology, Yale University School of Medicine, New Haven, CT
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11
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Fisher JS, Butt Z, Friedewald J, Fry-Revere S, Hanneman J, Henderson ML, Ladin K, Mysel H, Preczewski L, Sherman LA, Thiessen C, Gordon EJ. Between Scylla and Charybdis: charting an ethical course for research into financial incentives for living kidney donation. Am J Transplant 2015; 15:1180-6. [PMID: 25833728 DOI: 10.1111/ajt.13234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 05/29/2014] [Revised: 12/15/2014] [Accepted: 12/25/2015] [Indexed: 01/25/2023]
Abstract
New approaches to address the kidney scarcity in the United States are urgently needed. The greatest potential source of kidneys is from living donors. Proposals to offer financial incentives to increase living kidney donation rates remain highly controversial. Despite repeated calls for a pilot study to assess the impact of financial compensation on living kidney donation rates, many fear that financial incentives will exploit vulnerable individuals and cast the field of transplantation in a negative public light, ultimately reducing donation rates. This paper provides an ethical justification for conducting a pilot study of a federally regulated approach to providing financial incentives to living kidney donors, with the goal of assessing donors' perceptions.
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Affiliation(s)
- J S Fisher
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic/Green Hospital, La Jolla, CA
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12
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Gordon EJ, Underwood JG, Dahlmann HA. Spotlights. ACS Chem Biol 2015. [DOI: 10.1021/acschembio.5b00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Gordon EJ, Patel CH, Sohn MW, Hippen B, Sherman LA. Does financial compensation for living kidney donation change willingness to donate? Am J Transplant 2015; 15:265-73. [PMID: 25425398 DOI: 10.1111/ajt.13004] [Citation(s) in RCA: 25] [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: 02/20/2014] [Revised: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 01/25/2023]
Abstract
The potential use of financial compensation to increase living kidney donation rates remains controversial in potentially introducing undue inducement of vulnerable populations to donate. This cross-sectional study assessed amounts of financial compensation that would generate motivation and an undue inducement to donate to family/friends or strangers. Individuals leaving six Departments of Motor Vehicles were surveyed. Of the 210 participants who provided verbal consent (94% participation rate), respondents' willingness to donate would not change (70%), or would increase (29%) with compensation. Median lowest amounts of financial compensation for which participants would begin to consider donating a kidney were $5000 for family/friends, and $10,000 for strangers; respondents reporting $0 for family/friends (52%) or strangers (26%) were excluded from analysis. Median lowest amounts of financial compensation for which participants could no longer decline (perceive an undue inducement) were $50,000 for family/friends, and $100,000 for strangers; respondents reporting $0 for family/friends (44%) or strangers (23%) were excluded from analysis. The two most preferred forms of compensation included: direct payment of money (61%) and paid leave (21%). The two most preferred uses of compensation included: paying off debt (38%) and paying nonmedical expenses associated with the transplant (29%). Findings suggest tolerance for, but little practical impact of, financial compensation. Certain compensation amounts could motivate the public to donate without being perceived as an undue inducement.
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Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL; Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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14
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Gordon EJ, Underwood JG, Webb SA. Spotlight. ACS Chem Biol 2014. [DOI: 10.1021/cb500342r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Gordon EJ, Gill JS. Reply (invited response to 2 letters re Iran editorial). Am J Transplant 2014; 14:1226. [PMID: 24707777 DOI: 10.1111/ajt.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Institute for Public Health and Medicine, Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Medical Humanities and Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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16
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Gordon EJ, Underwood JG, Webb SA. Spotlight. ACS Chem Biol 2014. [DOI: 10.1021/cb5002284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Gordon EJ, Underwood JG, Webb SA. Spotlight. ACS Chem Biol 2014. [DOI: 10.1021/cb5001668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Gordon EJ, Mullee J, Beauvais N, Warren E, Theodoropoulos N, McNatt G, Rassiwala J, Ison MG. Education and informed consent about increased risk donor kidneys: a national survey of non-physician transplant providers. Transpl Infect Dis 2014; 16:251-60. [PMID: 24621147 DOI: 10.1111/tid.12199] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 12/17/2012] [Revised: 07/17/2013] [Accepted: 09/22/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Transplant providers must understand the definition of increased risk donor (IRD) organs to effectively educate transplant candidates and obtain informed consent. This study surveyed non-physician providers from 20 transplant centers about their educational and informed consent practices of IRD kidneys. METHODS An anonymous, web-based survey about the content and timing of education and informed consent for potential recipients of IRD kidneys, providers' knowledge of IRD kidneys, and provider and center characteristics was completed by most (67%; 90 of 135) of those invited to participate; 87 responses were included in analysis. RESULTS Most (80%) reported understanding the concept of IRD kidneys. However, few reported sufficient knowledge of the Organ Procurement and Transplantation Network definition of IRDs, risk factors, screening tests, window periods, and infection transmission rates. Most (56%) felt uncomfortable with obtaining specific informed consent for IRD kidneys. Most respondents received informal education about IRD kidneys (78%), and recognized the need for (98%) and were interested in receiving (99%) further education on this topic. CONCLUSION Non-physician transplant providers need and are interested in better education about IRD kidneys to effectively educate patients and obtain patients' informed consent.
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Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Surgery, Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Gordon EJ, Underwood JG, Webb SA. Spotlight. ACS Chem Biol 2014. [DOI: 10.1021/cb500091e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chon WJ, Josephson MA, Gordon EJ, Becker YT, Witkowski P, Arwindekar DJ, Naik A, Thistlethwaite JR, Liao C, Ross LF. When the living and the deceased cannot agree on organ donation: a survey of US organ procurement organizations (OPOs). Am J Transplant 2014; 14:172-7. [PMID: 24369025 DOI: 10.1111/ajt.12519] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The legal concept of first person authorization (FPA) is based on the principle that a decision by a person with decision-making capacity should be respected even after he or she dies. Although the transplant community largely supports this concept, its implementation has not been universal. We conducted a web-based survey of all 58 Organ Procurement Organization (OPO)executive directors in the United States to assess OPOs' procurement policies and practices in the context of family objections. All 58 respondents(100%) responded to our survey. All OPOs except one have an online donor registration website. Most OPOs(89%) (51 of 57 respondents) estimated that the frequency of family objecting to organ donation in cases of registered donors was <10%. No OPOs reported the frequency to be higher than 25%. Only 50% (27 of 54) of the OPOs have a written policy on handling family objections. Approximately 80% of the OPOs reported honoring FPA. However, in the past 5 years, 20 OPOs (35%) have not yet participated in organ procurement from a registered deceased donor over family objection. Further research to identify the barriers and possible solutions to implementing FPA is warranted.
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Gordon EJ, Underwood JG, Webb SA. Spotlight. ACS Chem Biol 2013. [DOI: 10.1021/cb400885c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gordon EJ, Gill JS. Where there is smoke there is fire: the Iranian system of paid donation. Am J Transplant 2013; 13:3063-4. [PMID: 24224692 DOI: 10.1111/ajt.12486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 01/25/2023]
Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Institute for Public Health and Medicine, Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Medical Humanities & Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Gordon EJ, Underwood JG, Webb SA. Spotlight. ACS Chem Biol 2013. [DOI: 10.1021/cb4008138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Underwood JG, Gordon EJ, Webb SA. Spotlight. ACS Chem Biol 2013. [DOI: 10.1021/cb4007503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gordon EJ, Underwood JG, Webb SA. Spotlight. ACS Chem Biol 2013. [DOI: 10.1021/cb4006497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Gordon EJ, Underwood JG, Webb SA. Spotlight. ACS Chem Biol 2013. [DOI: 10.1021/cb400561x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gordon EJ, Webb SA, Underwood JG. Spotlight. ACS Chem Biol 2013. [DOI: 10.1021/cb400473c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gordon EJ. In This Issue. ACS Chem Biol 2013. [DOI: 10.1021/cb400464s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gordon EJ, Webb SA, Underwood JG. Spotlight. ACS Chem Biol 2013. [DOI: 10.1021/cb400358z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tong A, Chapman JR, Israni A, Gordon EJ, Craig JC. Qualitative research in organ transplantation: recent contributions to clinical care and policy. Am J Transplant 2013; 13:1390-9. [PMID: 23648238 DOI: 10.1111/ajt.12239] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 02/25/2013] [Accepted: 02/25/2013] [Indexed: 01/25/2023]
Abstract
Qualitative studies remain relatively uncommon in the transplant literature but are an important approach contributing unique strengths in some areas of research. With the increased focus on patient-centered research and decision-making, it is timely to review qualitative research in the context of transplantation. While quantitative research addresses questions about the effectiveness of interventions or associations between risk factors and outcomes, qualitative research has an equal and complementary role in providing understanding about people's behaviors, attitudes, and values. Qualitative research has provided insights into some of the important but elusive questions in transplantation, including the sources of barriers to organ donation and inequities in access to transplantation, nonadherence to immunosuppressive regimens, and complex psychosocial outcomes. This review highlights recent contributions of qualitative research to transplantation practice and policy, and identifies key principles to guide qualitative research appraisal.
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Affiliation(s)
- A Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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Gordon EJ. In This Issue. ACS Chem Biol 2013. [DOI: 10.1021/cb400283j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gordon EJ, Webb SA, Underwood JG. Spotlight. ACS Chem Biol 2013. [DOI: 10.1021/cb400286s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mahoney ME, Gordon EJ, Rao JY, Jin Y, Hylton N, Love SM. Intraductal therapy of ductal carcinoma in situ: a presurgery study. Clin Breast Cancer 2013; 13:280-6. [PMID: 23664819 DOI: 10.1016/j.clbc.2013.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 10/13/2012] [Accepted: 02/04/2013] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer wherein malignant cells are confined within a ductal lobular unit. Although less than half the cases of DCIS will progress to invasive disease, most women are treated aggressively with surgery, radiation, and/or hormone therapy due to the inability to clinically evaluate the extent and location of the disease. Intraductal therapy, in which a drug is administered directly into the mammary duct through the nipple, is a promising approach for treating DCIS, but the feasibility of instilling drug into a diseased duct has not been established. PATIENTS AND METHODS Four to 6 weeks before their scheduled surgery, 13 women diagnosed with DCIS were subjected to cannulation of the affected duct. After both the absence of perforation and presence of dye in the duct were confirmed by ductogram, pegylated liposomal doxorubicin was instilled. Histopathologic assessment was performed after surgery to assess the treatment effects. RESULTS Of the 13 women enrolled in the study, 6 had their DCIS duct successfully cannulated without perforation and instilled with the drug. The treatment was well tolerated, and no serious adverse events have been reported. Biomarker studies indicated a general decrease in Ki-67 levels but an increase in annexin-1 and 8-hydroxydeoxyguanosine in the lumen of DCIS-containing ducts, which suggests a local response to pegylated liposomal doxorubicin treatment. CONCLUSIONS Intraductal therapy offers a nonsurgical strategy to treat DCIS at the site of disease, potentially minimizing the adverse effects of systemic treatment while preventing development of invasive cancer.
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Gordon EJ, Butt Z, Jensen SE, Lok-Ming Lehr A, Franklin J, Becker Y, Sherman L, Chon WJ, Beauvais N, Hanneman J, Penrod D, Ison MG, Abecassis MM. Opportunities for shared decision making in kidney transplantation. Am J Transplant 2013; 13:1149-58. [PMID: 23489435 DOI: 10.1111/ajt.12195] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/18/2013] [Accepted: 01/18/2013] [Indexed: 01/25/2023]
Abstract
Health researchers and policy-makers increasingly urge both patient and clinician engagement in shared decision making (SDM) to promote patient-centered care. Although SDM has been examined in numerous clinical settings, it has received little attention in solid organ transplantation. This paper describes the application of SDM to the kidney transplantation context. Several distinctive features of kidney transplantation present challenges to SDM including fragmented patient-provider relationships, the time-sensitive and unpredictable nature of deceased organ offers, decision-making processes by transplant providers serving as both organ guardians (given the organ scarcity) versus advocates for specific patients seeking transplantation, variable clinical practices and policies among transplant centers, and patients' potentially compromised cognitive status and literacy levels. We describe potential barriers to and opportunities for SDM, and posit that SDM is feasible, warranting encouragement in kidney transplantation. We propose strategies to promote and overcome obstacles to SDM in kidney transplantation. We contend that engagement in SDM can be facilitated by re-organization of clinical care, communication and education of providers and patients.
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Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Gordon EJ. In This Issue. ACS Chem Biol 2013. [DOI: 10.1021/cb400205q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gordon EJ, Webb SA, Underwood JG. Spotlight. ACS Chem Biol 2013. [DOI: 10.1021/cb400206m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gordon EJ, Underwood JG, Webb SA. Spotlight. ACS Chem Biol 2013. [DOI: 10.1021/cb400141s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gordon EJ, Underwood JG, Webb SA. Spotlight. ACS Chem Biol 2013. [DOI: 10.1021/cb4000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gordon EJ, Underwood JG, Soares JA. Spotlight. ACS Chem Biol 2013. [DOI: 10.1021/cb400015b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Love SM, Zhang W, Gordon EJ, Rao J, Yang H, Li J, Zhang B, Wang X, Chen G, Zhang B. A feasibility study of the intraductal administration of chemotherapy. Cancer Prev Res (Phila) 2012; 6:51-8. [PMID: 23169924 DOI: 10.1158/1940-6207.capr-12-0228] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preclinical data have shown the potential of the intraductal administration of chemotherapy for breast cancer prevention. Direct translation of this work has been stymied by the anatomical differences between rodents (one duct per teat) and women (5-9 ductal systems per breast). The objective of this phase I study was to show the safety and feasibility of intraductal administration of chemotherapy drugs into multiple ducts within one breast in women awaiting mastectomy for treatment of invasive cancer. Thirty subjects were enrolled in this dose escalation study conducted at a single center in Beijing, China. Under local anesthetic, one of two chemotherapy drugs, carboplatin or pegylated liposomal doxorubicin (PLD), was administered into five to eight ducts at three dose levels. Pharmacokinetic analysis has shown that carboplatin was rapidly absorbed into the bloodstream, whereas PLD, though more erratic, was absorbed after a delay. Pathologic analysis showed marked effects on breast duct epithelium in ducts treated with either drug compared with untreated ducts. The study investigators had no difficulty in identifying or cannulating ducts except in one case with a central cancer with subareolar involvement. This study shows the safety and feasibility of intraductal administration of chemotherapy into multiple ducts for the purpose of breast cancer prevention. This is an important step toward implementation of this strategy as a "chemical mastectomy", where the potential for carcinogenesis in the ductal epithelium is eliminated pharmacologically, locally, and without the need for surgery.
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Affiliation(s)
- Susan M Love
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA 90403, USA.
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Abstract
Given the organ scarcity, live organ donation is increasingly considered a viable alternative for kidney and liver transplantation. Yet living donation challenges the ethical principle of nonmaleficence by subjecting healthy individuals to medical, psychosocial and unknown risks. Therefore, transplant providers, policy-makers and donors are committed to ensuring that prospective donors provide adequate informed consent to undergo the procedure. Informed consent for living donation is ethically required as a means of demonstrating respect for donor's autonomy and protecting their safety. However, all elements of informed consent are fraught with difficulties due to the unique nature of the donation process and outcome. This paper reviews empirical research on informed consent for live kidney donors (LKD) and live liver donors (LLD) for both adult and pediatric recipients. As this review shows, studies that empirically assessed the quality of informed consent elements reveal considerable variability and deficiencies across the informed consent process, suggesting the need for improvement. This review highlights challenges to each element of consent for both LKDs and LLDs, and situates trends within broader policy contexts, ethical debates and avenues for future innovative research.
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Affiliation(s)
- E J Gordon
- Institute for Healthcare Studies, Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Gordon EJ, Beauvais N, Theodoropoulos N, Hanneman J, McNatt G, Penrod D, Jensen S, Franklin J, Sherman L, Ison MG. The challenge of informed consent for increased risk living donation and transplantation. Am J Transplant 2011; 11:2569-74. [PMID: 22051226 DOI: 10.1111/j.1600-6143.2011.03814.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Organ Procurement and Transplantation Network (OPTN) mandates that organ recipients provide "specific informed consent" before accepting organs that the OPTN defines as "increased risk". However, the OPTN does not provide specific guidelines for what information should be disclosed to potential recipients. Such vagueness opens the door to inadequate informed consent. This paper examines the ethical dimensions of informed consent when the prospective living donor has self-reported behaviors associated with increased risk for infection transmission. Donor privacy is a primary ethical concern that conflicts with recipients' informed consent for use of increased risk organs. We propose that both the increased risk status and the specific behavior be disclosed to the recipient. Because the actual risk posed is linked to the type of risk behavior, disclosure is therefore needed to make an informed decision. The donor's risk behavior is material to recipients' decision making because it may impact the donor-recipient relationship. This relationship is the foundation of the donation and acceptance transaction, and thus comprises a critical feature of the recipient's informed consent. Optimizing a recipient's informed consent is essential to protecting patient safety and autonomy.
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Affiliation(s)
- E J Gordon
- Institute for Healthcare Studies, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Mills D, Gordon EJ, Casano A, Lahti SM, Nguyen T, Preston A, Tondre J, Wu K, Yanase T, Chan H, Chia D, Esfandiari M, Himmel T, Love SM. The physiology of the normal human breast: an exploratory study. J Physiol Biochem 2011; 67:621-7. [PMID: 21983803 DOI: 10.1007/s13105-011-0109-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 07/19/2011] [Indexed: 01/16/2023]
Abstract
The physiology of the nonlactating human breast likely plays a key role in factors that contribute to the etiology of breast cancer and other breast conditions. Although there has been extensive research into the physiology of lactation, few reports explore the physiology of the resting mammary gland, including mechanisms by which compounds such as hormones, drugs, and potential carcinogens enter the breast ducts. The purpose of this study was to explore transport of exogenous drugs into ductal fluid in nonlactating women and determine if their concentrations in the fluid are similar to those observed in the breast milk of lactating women. We selected two compounds that have been well characterized during lactation, caffeine and cimetidine. Caffeine passively diffuses into breast milk, but cimetidine is actively transported and concentrated in breast milk. After ingestion of caffeine and cimetidine, 14 nonlactating subjects had blood drawn and underwent ductal lavage at five time points over 12 h to measure drug levels in the fluid and blood. The concentrations of both caffeine and cimetidine in lavage fluid were substantially less than those observed in breast milk. Our results support recent evidence that the cimetidine transporter is not expressed in the nonlactating mammary gland, and highlight intriguing differences in the physiology and molecular transport of the lactating and nonlactating breast. The findings of this exploratory study warrant further exploration into the physiology of the nonlactating mammary gland to elucidate factors involved in disease initiation and progression.
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Affiliation(s)
- Dixie Mills
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA 90403, USA
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Gordon EJ, Caicedo JC, Ladner DP, Reddy E, Abecassis MM. Transplant center provision of education and culturally and linguistically competent care: a national study. Am J Transplant 2010; 10:2701-7. [PMID: 21158005 DOI: 10.1111/j.1600-6143.2010.03304.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Although transplant centers are required to educate patients about kidney transplantation (KT) and living donation (LD), little is known about the educational format, and cultural and linguistic competence necessary for patients to make informed treatment decisions. This study surveyed US transplant administrators about education provided concerning KT and LD and culturally and linguistically competent care. Transplant administrators were invited to participate in an anonymous Internet-based survey about education format, education providers, promoting LD, culturally and linguistically competent care and center characteristics. Most (61%) transplant administrators contacted (N = 280/461) completed the survey. Most administrators (91%) reported that their center provides any type of formal education in their pre-KT evaluation. Education was mostly provided by: nurses (97%), social workers (72%) and surgeons (55%), and predominantly as one-on-one (80%) versus group discussions (60%). Education was primarily delivered through written materials (93%). Written educational materials in Spanish (86%) and the provision of interpreters (82%) were emphasized over educational sessions in Spanish (39%), or employing bilingual (51%) and bicultural staff (39%). Half (55%) promoted LD as the best option. Transplant centers need to take greater efforts to consistently provide appropriate education, promote LD, and provide culturally and linguistically competent care to ensure effective communication with all patients.
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Affiliation(s)
- E J Gordon
- Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Gordon EJ, Frader J, Goldberg AM, Penrod D, McNatt G, Franklin J. In response to: Testa et al. 'Elective surgical patients as living organ donors: a clinical and ethical innovation'. Am J Transplant 2010; 10:704-5; author reply 706. [PMID: 20041861 DOI: 10.1111/j.1600-6143.2009.02946.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
Organ procurement coordinators (coordinators) employed by organ procurement organizations (OPOs) are critical to the success of organ donation. However, their high turnover rates may threaten the success of organ donation. This cross-sectional study examined employment satisfaction and factors contributing to job turnover among 326 coordinators representing 52 of 58 OPOs (90%) who completed an online survey. Most (93%) respondents reported high levels of job satisfaction, although 26% reported considering leaving their OPO, and 61% perceived a high turnover rate at their OPO. Considerations of leaving the OPO were most likely to emerge at 2 years of employment. To secure coordinator job satisfaction, it is essential that prospective coordinators be adequately prepared and informed about negative as well as positive aspects of this line of work. In hiring, OPOs should recruit more proactively, using their staff as contacts, and seek experience in critical care, intensive care, or other on-call work. To retain satisfied employees, OPOs should offer more education and advancement opportunities and focus on such issues as call and hours, rather than salary per se. OPOs should consider a variety of alternative pay structures, particularly separate on-call pay, whether or not coordinators are actually called into service.
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Affiliation(s)
- J Kress
- Alden March Bioethics Institute, Albany Medical College, Albany, NY, USA
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Gordon EJ, Underwood JG. Spotlight. ACS Chem Biol 2008. [DOI: 10.1021/cb800291v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Underwood JG, Gordon EJ. Spotlight. ACS Chem Biol 2008. [DOI: 10.1021/cb800272b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Underwood JG, Gordon EJ. Spotlight. ACS Chem Biol 2008. [DOI: 10.1021/cb800211b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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