Showing posts with label organ donation. Show all posts
Showing posts with label organ donation. Show all posts

Sunday, January 28, 2024

Experiments for organ allocation (an idea whose time may be coming)

 Experiments to improve how deceased donor organs are allocated to waiting patients seem like a good idea...

OPTN Task Force sets goal of achieving 60K transplants by 2026Jan 26, 2024 

“we need to move quicker, be more responsive, and deliver results for the patients we serve,” said Dianne LaPointe Rudow, DNP, president of the OPTN Board of Directors. “The reality is that while the number of transplants continues to grow, so does the non-use of available organs and allocations of organs out of the intended sequence of offers.

...

"The need is clear. In the case of kidneys, the most transplanted organ, the number of kidneys recovered from deceased donors increased by 56 percent between 2018 to 2023. Yet the number of kidney transplants only increased by 44 percent, meaning that approximately one quarter of kidneys recovered were not transplanted.

...

"Under a proposed variance for expedited placement, currently out for public comment, the task force intends to develop a series of rapid, small-scale tests of innovative organ placement approaches and assess their outcomes to evaluate whether they could be incorporated into future OPTN policies. The task force also has committed to prioritizing studies that evaluate potential frameworks for allocating hard-to-place organs to increase the number of transplants and lower non-use rates."

Sunday, January 21, 2024

Legislative proposals to help living kidney donors

 Martha Gershun brings us up to date on various proposed pieces of legislation to help organ donors and increase access to transplants.

Legislative Efforts to Support Living Kidney Donors,  by Martha Gershun, Guest Blogger

"As a member of the Expert Advisory Panel to the Kidney Transplant Collaborative, I have been honored to provide input during the development of the organization’s priority legislation, the Living Organ Volunteer Engagement (LOVE) Act.  This legislation would help build a comprehensive national living organ donor infrastructure that would support a national donor education program, create a donor navigator system, ensure appropriate donor cost reimbursement, collect essential data, and improve all aspects of living organ donation across the country, substantially reducing barriers that limit participation today.

Key provisions of the LOVE Act would:

  • Provide reimbursement for all direct and indirect costs for living donation, including lost wages up to $2,500 per week.
  • Provide life and disability insurance for any necessary care directly caused by donation.
  • Modify NLDAC rules so neither the recipient’s income nor the donor’s income would be considered for eligibility.
  • Provide for new public education program on the importance and safety of living organ donation.
  • Provide for new mechanisms to collect and analyze data about living organ donation to enable evidence-based continuous process improvement.

Numerous other federal proposals are also currently vying for support to address barriers to living donation on a national level.  They include:

Living Donor Protection Act (H.R. 2923, S. 1384)

  • Prohibits insurance carriers from denying, canceling, or imposing conditions on policies for life insurance, disability insurance, or long-term care insurance based on an individual’s status as a living organ donor.
  • Specifies that recovery from organ donation surgery constitutes a serious health condition that entitles eligible employees to job-protected medical leave under the Family and Medical Leave Act.

Organ Donor Clarification Act (H.R. 4343)

  • Clarifies that reimbursement to living organ donation is not “valuable consideration” (I.e., payment), which is prohibited under the National Organ Transplant Act (NOTA)
  • Allows pilot programs to test non-cash compensation to living organ donors.
  • Modifies NLDAC rules so the recipient’s income would no longer be considered for eligibility.

Living Organ Donor Tax Credit Act (H.R. 6171)

  • Provides a $5,000 federal refundable tax credit to offset living donor expenses.

Honor Our Living Donor (HOLD) Act (H.R. 6020)

  • Modifies NLDAC rules so the recipient’s income would no longer be considered for eligibility.
  • Requires public release of annual NLDAC report.

Helping End the Renal Organ Shortage (HEROS) Act

  • Provides a $50,000 refundable federal tax credit over a period of five years for non-directed living kidney donors.
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And here's one more, from the Coalition to Modify NOTA



Sunday, July 16, 2023

National Living Donor Assistance Center (NLDAC): I rotate off the advisory board

 After seven years, I'm rotating off the advisory board of the National Living Donor Assistance Center (NLDAC). During that time, NLDAC's ability to assist living donors increased substantially, and now includes some reimbursement for lost wages, for example.

 At our meetings I learned to appreciate some of the subtleties involved in the interaction between government regulation and organ transplantation.




Tuesday, July 11, 2023

NYC police officer receives a kidney through Kidneys for Communities (KFC:)

 Police magazine has the story of an anonymous living kidney donor who wanted his/her kidney to go to a first responder, facilitated by  Kidneys for Communities.

NYPD Officer Received Kidney Transplant with Aid of Nonprofit Group and PBA. Kidneys for Communities' Kidneys for First Responders initiative is designed to improve access to and facilitate living kidney donations by connecting those who want to help first responders with those who are in need of a lifesaving kidney donation.  July 7, 2023

"Kidneys for Communities, a national community-directed living kidney donation program, launched its Kidneys for First Responders initiative with its first kidney transplant recipient, New York City Police Officer Melissa Quinones, with assistance from the Police Benevolent Association of the City of New York.

******

And here's the KFC press release (doesn't that acronym already sound familiar?):

Kidneys for Communities Announces their ‘Kidneys for First Responders’ Initiative

"Kidneys for Communities’ Kidneys for First Responders initiative is designed to improve access to and facilitate living kidney donations by connecting those who want to help first responders with those who are in need of a lifesaving kidney donation"

"As Dr. Lloyd E. Ratner, who performed Quinones’ transplant, affirms, “The community-directed model, now available to interested communities and pioneered by Kidneys for Communities, is a common-sense approach to growing the pool of living kidney transplant donors. As more communities come on board, we expect it will shorten the critical waiting time for transplant recipients and save lives.”."

Sunday, June 4, 2023

Organ donation day in Germany

 Yesterday was organ donation day in Germany. Here's a post from the German Health Economics Association (DGGÖ): Day of Organ Donation on June 3, 2023

"In Germany, there are about 8,500 people waiting for an organ donation (www.Bundesärztekammer.de). On the Day of Organ Donation, the German Society for Health Economics (dggö) wants to emphasize the urgency of increasing organ donation rates to improve the lives of these individuals. This applies equally to deceased organ donation and living donation. An international comparison also shows that there is room for improvement in Germany: Both in terms of living and deceased donations per million population, Germany lags behind in the EU (see Figure 1).

Organ donation rates

...

"On Wednesday, May 31, 2023, Nobel laureate in economics and professor at Stanford University, Alvin Roth, spoke to a broad audience in the 6th virtual dggö Talk (see https://www.dggoe.de/aktuelles for details) about the possibilities of kidney exchange between compatible but previously unknown pairs and the implementation of cross-over donations and exchange chains in the US.

"Unlike in the US, in Germany, living donation outside of close family is only possible if a close relationship between the donor and recipient has been officially confirmed. Alvin Roth noted in the case of cross-over kidney donations, that it was very complicated for German hospitals to build up and prove a close relationship between two pairs of donors in front of a commission. This should be simplified, especially considering the overall strong support for kidney exchange among the German population. As Figure 2 from a survey conducted by Roth and Wang (2020) illustrates, 79% even agree to kidney exchange across borders and outside of family and friends, although such an exchange is currently not legally possible in Germany.

population supporting legalization of global kidney exchange


*********

Earlier: 

Tuesday, May 30, 2023


Friday, May 26, 2023

Freakonomics replay and update on kidney exchange and organ donation

 Freakonomics Radio yesterday revisited some of their old podcasts about kidney exchange. In one, they interview me, and in another, they interview Ned Brooks, who listened to that interview and went on to become a non-directed kidney donor and to found an organization to support other kidney donors, the NKDO, National Kidney Donation Organization.  You can listen and/or read the transcript at this link:

EPISODE 209

Make Me a Match (Update)

"Sure, markets work well in general. But for some transactions — like school admissions and organ transplants — money alone can’t solve the problem. That’s when you need a market-design wizard like Al Roth. Plus: We hear from a listener who, inspired by this episode, made a remarkable decision.

"Last month, the federal government announced plans to modernize the U.S. organ-donation system. They want to speed up the process by which organ-transplant patients are matched with donated organs, and they also want to reduce racial inequities in the system. When we saw this news, we decided to go into our archive and put together the episode you’re about to hear. It’s a mashup of a 2015 episode, No. 209, called “Make Me a Match,” and a portion of a 2016 episode, No. 237, which includes a personal story from a listener who was inspired by that earlier episode to make a remarkable decision. All the relevant facts and figures have been updated. As always, thanks for listening."

***********

Here are my previous posts on Freakonomics episodes.

Wednesday, February 8, 2023

Song of the year Grammy award for organ donation: Bonnie Raitt - Just Like That

Stephanie Wang alerts me to the surprising fact that this year's Grammy Award for Song of the Year is Bonnie Raitt's song, Just Like That, about organ donation.  You can listen below (have some tissues handy):




CNN has the story: 
"Raitt’s winning song, “Just Like That,” is about a woman visited by a man who is only alive because of the heart he received – a heart that had belonged to the woman’s son.

“I was so inspired for this song by the incredible story of the love and the grace and the generosity of someone that donates their beloved’s organs to help another person live and this story was so simple and so beautiful for these times,” Raitt explained in her acceptance speech.

Wednesday, February 1, 2023

Donate blood or organs to pay a traffic fine or shorten a prison term?

I spend a lot of my time thinking and writing about repugnant transactions and controversial markets, and some of that intersects with my work on blood and organ donation and transplantation (particularly on the controversial issue of compensation for donors, and how that might intersect with varieties of coercion). But today's post is about two proposals that mix all these things together. (My guess is that many people will find them differently repugnant: think of them as a quick test of your own views.)

In Argentina, a municipal judge proposes blood donation to pay traffic fines, and in Massachusetts several legislators co-sponsor a bill to allow bone marrow (blood stem cell) donation or organ donation to reduce prison sentences.

First, blood donation and traffic fines:

 Mario Macis points me to this story in La Nacion, about a city in the Argentine province of Salta:

En una ciudad de Salta las multas de tránsito se pueden pagar con una donación de sangre  [In a city of Salta, traffic fines can be paid with a blood donation]  (English from Google Translate)

"In the city of Tartagal, Salta, it is possible to pay a traffic ticket with a blood donation . The measure, taken two months ago, generates both support and questioning.

...

"The judge of the Court of Misdemeanors of the Municipality of Tartagal, Farid Obeid , proposed in a ruling last August that those who had traffic fines could pay them with their own blood donation or from third parties on behalf of the offenders.

"It was then determined that donations be made in hospitals, voluntarily and only once; that is to say that repeat offenders cannot opt ​​for blood donation.

...

"The ruling received support and criticism, the latter basically from the health sector. Oscar Torres, president of the Argentine Association of Hemotherapy, Immunohematology and Cellular Therapy , sent a letter to the Deliberative Council of Tartagal indicating that the measure removes the "spirit of solidarity and altruism from blood donation

Here's a related story about the ongoing debate (also using Google translate):

Controversy over an unusual municipal project: they claim that fines can be paid with blood. "This controversial project was presented to the Deliberative Council of Tartagal, and criticism has already begun"

***********

And here's the new bill proposed in Massachusetts (don't hold your breath waiting for it to be passed into law). It's in English, so the phrase about the necessary "amount of bone marrow and organ(s) donated to earn one’s sentence to be commuted" isn't a translation error; I think it's just awkward (i.e. not meant to be chilling). (But the discussion of donated "organ(s)" makes me think of Kazuo Ishiguro's novel "Never Let Me Go"). 

Bill HD.3822, 193rd (Current), An Act to establish the Massachusetts incarcerated individual bone marrow and organ donation program

"Section 170. (a) The Commissioner of the Department of Corrections shall establish a Bone Marrow and Organ Donation Program within the Department of Correction and a Bone Marrow and Organ Donation Committee. The Bone Marrow and Organ Donation Program shall allow eligible incarcerated individuals to gain not less than 60 and not more than 365 day reduction in the length of their committed sentence in Department of Corrections facilities, or House of Correction facilities if they are serving a Department of Correction sentence in a House of Corrections facility, on the condition that the incarcerated individual has donated bone marrow or organ(s)

...

"The Bone Marrow and Organ Donation Committee shall also be responsible for promulgating standards of eligibility for incarcerated individuals to participate and the amount of bone marrow and organ(s) donated to earn one’s sentence to be commuted. Annual reports including actual amounts of bone marrow and organ(s) donated, and the estimated life-savings associated with said donations, are to be filed with the Executive and Legislative branches of the Commonwealth. All costs associated with the Bone Marrow and Organ Donation Program will be done by the benefiting institutions of the program and their affiliates-not by the Department of Correction. There shall be no commissions or monetary payments to be made to the Department of Correction for bone marrow donated by incarcerated individuals."


Simultaneous HT to Ron Shorrer, Kim Krawiec, Akhil Vohra

Sunday, September 11, 2022

Organ donor joke from the Edinburgh fringe

 “My dad suggested I register for a donor card. He’s a man after my own heart.” 

That's a joke by Masai Graham, who won the most popular joke vote this year at the Edinburgh fringe, with 52% of 2,000 votes for another one-liner: “I tried to steal spaghetti from the shop, but the female guard saw me and I couldn’t get pasta.”

Here's the Guardian with more:

Pasta one-liner wins best joke award at Edinburgh festival fringe. West Midlands comedian Masai Graham, who works as a part-time care worker, wins title for second time. by Harriet Sherwood 

Friday, September 9, 2022

Do (some) kidney donors have a right to donate?

 Here's an article that considers whether some potential kidney donors, who have more appetite for risk than some transplant teams, might nevertheless have a right to donate.

Donor Autonomy and Self-Sacrifice in Living Organ Donation: An Ethical Legal and Psychological Aspects of Transplantation (ELPAT) View  , by Nizam Mamode, Kristof Van Assche2, Lisa Burnapp, Aisling Courtney, David van Dellen, Mireille Houthoff, Hannah Maple, Greg Moorlock, Frank J. M. F. Dor, and Annette Lennerling, Transplant International, 35, 2022, https://www.frontierspartnerships.org/articles/10.3389/ti.2022.10131, DOI=10.3389/ti.2022.10131    

ABSTRACT: "Clinical teams understandably wish to minimise risks to living kidney donors undergoing surgery, but are often faced with uncertainty about the extent of risk, or donors who wish to proceed despite those risks. Here we explore how these difficult decisions may be approached and consider the conflicts between autonomy and paternalism, the place of self-sacrifice and consideration of risks and benefits. Donor autonomy should be considered as in the context of the depth and strength of feeling, understanding risk and competing influences. Discussion of risks could be improved by using absolute risk, supra-regional MDMs and including the risks to the clinical team as well as the donor. The psychological effects on the donor of poor outcomes for the untransplanted recipient should also be taken into account. There is a lack of detailed data on the risks to the donor who has significant co-morbidities."

"The donation of a solid organ for transplantation by a person who is alive at the time represents a unique event in healthcare, since the donor will gain no physical benefit from undergoing major surgery, which has a low but nevertheless significant rate of major complications and death (1, 2). Living donors are usually highly motivated individuals, whose appetite for risk differs substantially from that of the healthcare team (3). This may lead to conflicts between the clinical team and potential donors-some examples are given in Figure 1. Were the decisions of the clinical teams correct? This article explores the issues raised by these cases and others, and considers the principles which might help to guide decision-making. It is an overview aimed at healthcare professionals, and is not intended to be an in-depth ethical review."



***********

And here's a news story from People.com about just such a donor, who exercised his right to donate:

When His Patient Couldn't Find a Kidney Donor, This Doctor Gave His: 'It's a Feeling That's Hard to Describe'  "I was always in awe of people who donated organs. It fascinated me. And I soon decided that I didn't just want to talk the talk," said Dr. Aji Djamali    

By Johnny Dodd 

"Djamali, a nephrologist who chairs the department of medicine at Maine Medical Center Department, was wheeled into an operating room and surgeons removed his kidney. Within minutes another team went to work transplanting the organ into Jartz, who had been diagnosed with polycystic kidney disease (PKD) — an inherited disorder that causes the kidneys to enlarge and stop working — seven years earlier. (The two men met when Jartz was Djamali's patient at the UW Health Transplant Center in Madison, Wisconsin.)

"For Djamali, who was back at work two days later (Jartz was discharged after five days), being able to donate an organ was the culmination of a dream that began decades earlier while in medical school.

...

"Looking back on the experience, Djamali struggles to find the words to properly convey what it feels like to give a part of his body to another person.

"It's a feeling that's hard to describe," he says. "It's like watching your child being born. It's just this sensation of freedom, elation and happiness."

"But, of course, there was another reason why he did it. The veteran physician knew that the story of his actions might spur someone else to perform a similar act.

"Half of the reason was to help John," says Djamali, who is in touch with Jartz on a daily basis. "But the other reason was to encourage people to help others, to inspire them to consider stepping up and helping the 90,000-plus patients across the nation who are on waiting lists to get a transplant."


Thursday, September 8, 2022

Three living kidney donors talk about their experience

 Tonight at 6pm Eastern, three donor stories from the National Kidney Donation Organization (NKDO)



Click Here to Register

Monday, August 22, 2022

Gary Becker's last paper: appropriately, on a monetary market for kidneys (with Julio Elias and Karen Ye, JEBO, 2022)

 Gary Becker, who passed away in 2014, has a new paper, finished by his coauthors Julio Elias and Karen Ye. It recounts how the shortage of transplantable kidneys has only increased as the demand has grown, and the argument for paying donors is as strong as ever.  (In the meantime, the obstacles to that approach haven't vanished.)

The shortage of kidneys for transplant: Altruism, exchanges, opt in vs. opt out, and the market for kidneys*  by Gary S.Becker, Julio Jorge Elias, and Karen J.Ye, Journal of Economic Behavior & Organization, Volume 202, October 2022, Pages 211-226 (Another link to the paper is here, temporarily.)

Abstract: "In 2007 we published a paper on organ transplants that used data from 1990–2005. We proposed a radical solution of paying individuals to donate kidneys, and claimed that this would clean out the waiting list for kidney transplants in a short period of time. In this paper, we revisit the topic, and examine 14 years of additional data to see if anything fundamental has changed. We show that the main altruistic based policies implemented, such as kidney exchanges or opt out systems for organ procurement, have been unable to solve the problem of shortages. Our analysis suggests that, because of the reaction of direct living donors to increases in other sources of donations, the supply curve of kidney transplants is highly inelastic to altruistic policies. In contrast, a market in organs would eliminate organ shortages and thereby eliminate thousands of needless deaths."


Here's the most relevant part of the first footnote:

*"We started working on this paper together with Gary Becker in 2011. In 2012, we presented the paper at the Law and Economics Workshop and the MacLean Center's Seminar Series of the University of Chicago. The paper was unfinished when Becker passed away in May 2014. In this version of the paper, we updated the data and made some additions. The paper preserves all the economic analysis that was developed in the last version that we collaborated with Becker.

"Becker wrote his first article about the organ shortage in 1997, as part of his monthly BusinessWeek Column. The article was entitled How Uncle Sam Could Ease the Organ Shortage. In the article, he “suggest(s) considering the purchase of organs only because other modifications to the present system so far have been grossly inadequate to end the shortage.”

"In the 2000s, Julio Elias collaborated with Becker in a paper that uses the economic approach to analyze the consequences of legalizing the purchase and sale of kidneys for transplants from both deceased and living donors. In 2014, Becker published with Julio Elias a column in the Saturday Essay section of the Wall Street Journal entitled Cash for Kidneys: The Case for a Market for Organs. For Becker, the problem of the organ shortage and finding ways to solve it was a lifelong project. This paper reflects some of his last thoughts on this problem."


Here are their conclusions:

"The current state of the market of kidney transplants is a disaster. Over the last years, the waiting list has grown in over 4000 individuals each year, while transplants have grown by only about 250 per year. The result has been longer and longer queues to receive organs. 4000 patients died each year while waiting 3 and a half years on average for a transplant. According to our estimations, the annual social cost of those who die while waiting for kidney transplants is over $7 billion.

"Neither kidney exchange programs nor opt out systems nor educational campaigns to increase donations from altruistic donors have solved the problem of shortages. The main reason for their mild effects, as we show in this paper, is that the altruistic supply curve of kidney transplants is highly inelastic to these type of policies because of the reaction of direct living donors to increases in other sources of donations.

"The only feasible way to eliminate the large queues in the market for kidney transplants is by significantly increasing the supply of kidneys. The introduction of monetary incentives could increase the supply of organs sufficiently to eliminate the large queues and thereby eliminate thousands of needless deaths, and it would do so without increasing the total cost of kidney transplant surgery by a large percent.

"A market for the purchase and selling of organs would appear strange at first. However, much as the voluntary military today has universal support, the selling of organs would come to be accepted over time. " advantages of accepting payment for organs would eventually become clear, and people will wonder why it took so long for such an ovious and sensible remedy to the organ shortage to be implemented.

***********

Some related earlier posts:

Another take on compensating donors:

Tuesday, August 16, 2022

Kim Krawiec interviews Frank McCormick on the kidney shortage (and how to end it)


Commentary on the  legal monetary market for kidneys in Iran (and how it differs from illegal black markets):

Monday, June 27, 2022

A Forum on Kidneys for Sale in Iran, in Transplant International


The Pontifical Academy of Science says that compensating donors is a crime against humanity:

All my posts on compensation for donors (not just kidney donors) are here.

And here's my 2007 paper on repugnance (that came out in the same issue of JEP as the Becker and Elias paper), and was a first attempt at understanding some of the obstacles that face proposals to compensate donors of kidneys (and other things):


I'm slowly writing a book that will expand on it.

Monday, August 8, 2022

Renewal: "My donor wanted to give me her kidney — and get home in time for Shabbat"

 When reporter Stewart Ain needed a kidney transplant, he contacted Renewal. He explains the process that led to him being matched to an altruistic donor and transplanted.

My donor wanted to give me her kidney — and get home in time for Shabbat  By Stewart Ain

"Two months later, my wife Meryl and I were sitting in Renewal’s office speaking with Rabbi Josh Sturm, Renewal’s director of outreach, and Miriam Lefkowitz, Renewal’s kidney coordinator. We were told to reach out to friends, relatives, neighbors — everyone we knew — and ask them to listen to an online presentation the rabbi would make about what kidney donation entails and how it literally gives the recipient a new life. 

"As we walked out the door, the rabbi said they had found that if at least 200 people listened to the presentation, the odds were very good a donor would be found. And the donor would not necessarily be someone actually listening online but often from the advance publicity the presentation would generate.

"Renewal created a flier for us with information about the upcoming presentation. At my request, several synagogues posted it on their websites, a couple of Jewish weekly newspapers ran it each week, and Hadassah Magazine featured my story in an article about kidney transplants. One of the three synagogues we belong to contacted the NBC station in West Palm Beach, Florida. The station’s reporter interviewed both me and one the synagogue’s rabbis. A story about my need for a kidney was on the evening newscasts.

"The presentation took place during the 10 days between Rosh Hashanah and Yom Kippur last fall. More than 250 computers tuned in. In the following days I learned that several people had asked Renewal for the nasal-swab kit needed to see if they were a match for me. Later, I heard from several friends and relatives that they had been disqualified as donors for various reasons. "

His donor may not have been one of those who had heard the presentation about his case.

"The idea of donating one of her kidneys surfaced again last Hanukkah when someone mentioned that their daughter had just donated a kidney through Renewal. She contacted the organization in November, and three days later received a swab kit. On Jan. 17, a rabbi from Renewal called and asked if she was still interested in donating. When she said yes, she was told she was a match for two people.

“I remember saying, `I’m not going to play God, let whoever is a better match have it,” she said."

Both patient and donor are doing well.

Sunday, July 10, 2022

Texas inmate asks to delay execution for kidney donation

 For all you practical ethicists out there, here's a story by the AP that has divided my email correspondents:

Texas inmate asks to delay execution for kidney donation By JUAN A. LOZANO

"A Texas inmate who is set to be put to death in less than two weeks asked that his execution be delayed so he can donate a kidney.

...

"In a letter sent Wednesday, Gonzales’ lawyers, Thea Posel and Raoul Schonemann, asked Republican Gov. Greg Abbott to grant a 30-day reprieve so the inmate can be considered a living donor “to someone who is in urgent need of a kidney transplant.”

...

"Gonzales’ attorneys say he’s been determined to be an “excellent candidate” for donation after being evaluated by the transplant team at the University of Texas Medical Branch in Galveston. The evaluation found Gonzales has a rare blood type, meaning his donation could benefit someone who might have difficulty finding a match.

“Virtually all that remains is the surgery to remove Ramiro’s kidney. UTMB has confirmed that the procedure could be completed within a month,” Posel and Schonemann wrote to Abbott.

"Texas Department of Criminal Justice policies allow inmates to make organ and tissue donations. Agency spokeswoman Amanda Hernandez said Gonzales was deemed ineligible after making a request to be a donor earlier this year. She did not give a reason, but Gonzales’ lawyers said in their letter that the agency objected because of the pending execution date.

...

"In a report, the United Network for Organ Sharing, a nonprofit that serves as the nation’s transplant system under contract with the federal government, listed various ethical concerns about organ donations from condemned prisoners. They include whether such donations could be tied to prisoners receiving preferential treatment or that such organs could be morally compromised because of their ties to the death penalty."


HT: Frank McCormick

Saturday, April 30, 2022

Opioid deaths are behind increases in deceased organ donation

 Medpage Today warns us not to take credit for increases in organ donation that are due to rising numbers of opioid overdose deaths. 

'Shocking Mismanagement' in Our Organ Donation System Is Causing Needless Death— OPTN and OPOs are mischaracterizing organ donation data to block system reform  by DJ Patil, PhD, Greg Segal, Ebony Hilton, MD, and Lachlan Forrow, MD

"The magnitude of the opioid crisis shows no signs of peaking. New data from the CDC's National Center for Health Statistics show that deaths from the opioid epidemic soared by 50% from October 2019 to October 2021, some of which reflected second-order effects of the COVID-19 pandemic. Similarly, alcohol-related deaths, according to recent CDC reports, were also up by a shocking 25% in 2020, from an average increase of 3.6% per year from 1999-2019.

"What does this have to do with organ donation? Drug overdoses and alcohol-related deaths fall into the subset of deaths that allow for organ donation to occur, so this sharp rise in opioid deaths has driven record-breaking organ donation numbers. That might sound like a silver lining to a very dark cloud, but as is often the case with public health data, the picture is much more complex.

"The government contractors in charge of organ donation -- both organ procurement organizations (OPOs), which oversee local organ recovery, and the organ procurement transplantation network (OPTN), which manages the system -- are hiding behind increases in these deaths of despair to deflect criticism from what the House Oversight Committee has characterized as "shocking mismanagement" in organ procurement.

"In fact, HHS has deemed the majority of OPOs to be failing key performance metrics, contributing to 33 Americans dying every day for lack of an organ transplant. And the Senate Finance Committee is investigating the United Network for Organ Sharing (UNOS), the OPTN contractor, over "serious concerns related to [its] role in overseeing our nation's OPOs, which have been severely underperforming for decades."

...

"We have more organ donors in America not because we have a strong -- or even remotely adequate -- organ procurement system, but because on a per capita basis among wealthy nations, we have many times more deaths in those subsets of deaths that allow for organ donation to occur. This includes 20 to 30 times more opioid deaths, 25 times as many gun deaths, the highest suicides rates, and more than twice as many fatal car accidents -- a number that spiked again precipitously last year."

Sunday, March 6, 2022

Kidneys on Kilimanjaro

 The Washington Post has the story

A group of organ donors is climbing Mount Kilimanjaro this week. They each have one kidney.  By Cathy Free

"“We thought, ‘How about if we use this climb to raise awareness and show everyone that you can still lead a healthy and active life if you donate a kidney?’ ” said McLaughlin, a former college soccer coach who lives in Seattle.

“It didn’t take long before we had 22 kidney donors signed up to make the trip,” he said.

"The group hopes the trek, which will begin Friday, will help dispel the notion that donors can’t live full lives with one kidney, said Kidney Donor Athletes founder Tracey Hulick, who donated a kidney to a stranger in May 2017.

...

"The group — which named its adventure the One Kidney Climb — hopes to reach Kilimanjaro’s 19,341-foot volcanic summit at sunrise on March 10, World Kidney Day."

Thursday, January 27, 2022

A brief history of deceased organ donation in one career--Howard Nathan retires

Organ donation and transplantation is still new enough that significant parts of its history can have been experienced in one career.  The WSJ reports on Howard Nathan's retirement from the Gift of Life Organ Procurement Organization, which he joined in 1978:

Howard Nathan Spent Decades ‘On Call’ for Organ Transplants. The CEO of the Gift of Life Donor Program is stepping down after a long career connecting organ donors with patients in need.  By Emily Bobrow

"When Mr. Nathan, 68, first joined the nonprofit that would become Gift of Life, he was one of three employees. Working around the clock, he traveled to hospitals in Pennsylvania, Delaware and New Jersey for hard conversations with grieving families and then made calls to surgeons in the hope of matching a donated organ with a waiting patient. “We would be driving on the Turnpike with a kidney in the car at three in the morning,” Mr. Nathan recalls on a video call from Gift of Life headquarters in central Philadelphia. “In the early days we had to make it up as we went along.”

"In 1994 he helped to draft Pennsylvania’s landmark organ donation law, which mandated that hospitals call organ-procurement organizations whenever a patient died. “Hospitals used to call when they wanted to. We were like Maytag repairmen waiting by the phone,” Mr. Nathan remembers. The law, which included funds for public-awareness campaigns and gave people a chance to register as organ donors when getting or renewing a driver’s license, increased donations by 43% in three years, he says. It became the model for a federal law in 1998.

...

"Brain death was a fairly new concept when Mr. Nathan first worked as an organ-donation coordinator—a job held by maybe 200 people around the country at the time. “We really had to teach and train people in the medical and legal aspects of donation,” he says.

...

"When Mr. Nathan entered the field, the success rate for transplants hovered at 30-35%. With the discovery in the early 1980s of immunosuppressant drugs, which curb the body’s natural rejection of foreign body parts, success rates have climbed above 90%."


HT: Frank McCormick

Monday, December 27, 2021

Overcoming taboos concerning organ donation: a BBC broadcast

 Here's a BBC broadcast on generational change that talks about how young people are helping to overcome taboos regarding organ donation. (They chat with me about organ exchange, including a liver lobe for a kidney, and about having hairdressers talk to customers about deceased donation.)

Listen now

"Generation change: Part two, The Documentary

"BBC presenter Babita Sharma and correspondent Megha Mohan meet the young people from India, Nigeria, the United Kingdom, the United States and the United Arab Emirates fighting to change taboos around organ donation and for greater diversity in the critical fields of science, technology, engineering and maths. We also speak to Nobel Prize awarded contributors including kidney transfer campaigner and economist Alvin Roth as well as astronomer and Physics Laureate Andrea Ghez."

**********

Earlier: 

Monday, May 6, 2019

Saturday, December 25, 2021

Advertising, and kidney donation.

The Guardian has the story:

He put up a Times Square billboard in search of a kidney – and saved more lives than his own.  by Joshua Needelman

"Marc Weiner booked one of the world’s most visible advertising spots, hoping his life would change. He ended up changing the lives of dozens of others, too."

Friday, September 24, 2021

The Transplantation Society reaffirms the value of organ donation and transplantation, even for the poor

 You wouldn't think it would be news that TTS, The Transplantation Society, felt that transplantation is valuable for patients who need it, and would "stand against any form of barriers in access, ... particularly that related to gender, race, religion and income."  

But I think their statement yesterday to that effect, below, may be a reversal of the position adopted by some previous presidents of TTS, who, in arguing against black markets run by criminals, also argued that citizens of poor countries should be denied access to kidney exchange, i.e. that kidney exchange is repugnant when offered to poorer patients.

Here is the new statement (and I include links to some history  below it.)

 A Reaffirmation of Organ Donation (The Tribune Pulse, September 23, 2021)*

"Recent events call for a reaffirmation of essential values held by the worldwide community of transplant providers.

"Indeed, in this period when inequities in access to healthcare are stretched and emphasised, we feel compelled to highlight the universal value of organ donation and the immense success achieved by transplantation. Donation implies generosity and solidarity, and should take place daily, routinely and peacefully around the globe regardless of age, gender, race, education or income of donors. This Gift of Life is gratefully accepted by recipients in dire need of an organ to continue to live regardless of their age and gender, among others. International Medical Societies representing Transplantation Professionals across the globe support and nurture diversity and inclusion among their members, fostering education, and stand against any form of barriers in access, knowledge, transition and required training around the "Gift of Life", particularly that related to gender, race, religion and income. We embrace a call of action to support equitable access to transplantation for all patients with end-stage organ diseases, and the value of gender and race equality in access to education and career development in the diverse fields of transplant healthcare professions."

That sounds like a statement we can all support.

But those of you who have been following how Global Kidney Exchange can remove financial barriers to transplantation know that it has met with considerable opposition to allowing citizens of middle and low income countries access kidney exchange. 

Here's the original article on GKE:


Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation
by M. A. Rees, T. B. Dunn, C. S. Kuhr, C. L. Marsh, J. Rogers, S. E. Rees, A. Cicero, L. J. Reece, A. E. Roth, O. Ekwenna, D. E. Fumo, K. D. Krawiec, J. E. Kopke, S. Jain, M. Tan, S. R. Paloyo
American Journal of Transplantation, Volume 17, Issue 3 March 2017, Pages 782–790

And here is a letter from two former TTS presidents saying that GKE is essentially organ trafficking…

Francis L. Delmonico and Nancy L. Ascher


For a history lesson, see e.g.

Tuesday, September 12, 2017

Monday, December 18, 2017

Monday, December 25, 2017

Monday, January 29, 2018

Tuesday, November 20, 2018

Thursday, October 31, 2019

Thursday, January 2, 2020

Global kidney exchange: continued controversies, perhaps moving towards resolution


* It looks like the statement of reaffirmation of organ donation may have originated with the International Liver Transplant Society, which has a Sept. 20th version, endorsed by many sister societies, here: https://ilts.org/news/reaffirmation-of-organ-donation/