Kidney exchange in Brazil, continued (with pictures)

 In August I posted about a trip to Brazil with Mike Rees where we traveled with Dr. Gustavo Ferreira, the director of transplantation at the hospital Santa Casa de Misericórdia de Juiz de Fora

Part of our trip was spent in the capital, Brasilia, talking to the government about extending Brazilian transplant law to allow kidney exchange, after which we went to Juiz de Fora.  Here's my blog post about that trip:  Kidney exchange in Brazil: prelude. 

That post concluded by saying "On Saturday we had an exciting finish to the trip, but it's not my story to tell yet, so I'll blog again after there is an official announcement."

Now Brazil's first three-way kidney exchange has been announced, as part of a clinical trial that I hope will help change Brazilian law to allow kidney exchange as a regular medical procedure.  The three donors and three recipients all did well, and left the hospital very shortly after the actual surgeries, but came back to tell their stories to the Brazilian news show Profissão Repórter (Professional Reporter). You can see the video here  https://globoplay.globo.com/v/12997336/

It's in Portuguese but you will quickly get the idea, presented even more briefly on Instagram by the transplant nephrologist Dr. Juliana Bastos here: https://www.instagram.com/reel/DA4JBVIsFta/?igsh=d2hnb3hoNjJxN2I4     where you can see the three incompatible patient-donor pairs rearrange themselves for the camera into the three-way exchange in which each patient received an organ from a compatible donor. (Dr. Bastos recently added a PhD to her MD, with a dissertation on kidney exchange.)

Here's another Instagram link to the video.

I had the privilege of observing parts of five of the six surgeries (three nephrectomies and three transplants), and some pictures are below.  

If someone directs a movie about this kind of transplant surgery, there will be two dramatic scenes, one in which the donated kidney is carried across the hall to the transplant operating room, and the second showing the moment the clamps are removed from the blood vessels of the transplanted kidney, so that it turns from grey to pink as blood returns to it. 

But here's a photo I took at  the start of what I think is the most dramatic moment of the surgery, as the artery from the kidney is just about to be connected to the artery of the recipient.

The artery from the donated kidney is the small white tube being pointed to by the instrument held in the fingers at the top right of the picture. Immediately in front of it--the long red tube--is the artery of the recipient, to which it must be connected so that blood can again flow to the kidney.  Notice that a small incision has already been made in the recipient's artery--this is where the two will be attached. The connection has to be perfect, so that the blood can flow without obstruction that could cause a clot.

The surgeon who first figured out how to do this kind of vascular surgery, Dr. Alexis Carrel, won the 1912 The Nobel Prize in Physiology or Medicine

I was able to follow the proceedings thanks to the running commentary offered to me by the Brazilian surgeons and by Mike Rees (who wasn't busy doing surgery). That wasn't the only kind of support Mike offered me in the OR (as I balanced on a pair of stools to better appreciate the commentary):

And here's a post-op picture of most of the big team that made it happen:

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Parabéns ao Gustavo e à Juliana! Congratulations. Your work and leadership can make a big difference not just to your patients, but to people all over Brazil.

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Earlier:

Monday, August 12, 2024

Kidney exchange in Brazil: prelude

IV fluid shortages in the U.S.--perhaps we should allow international imports?

There's a hurricane-induced shortage of intravenous (IV) fluid.  Maybe we should import some? (But...international borders...)

An obstacle is that FDA approval of the factories is usually needed, but can be (and in the past has been) suspended, to allow imports from places that do their own high quality inspection (like Australia and Ireland in 2017--I guess it's good that the labels are in English) .  

More generally, after the Covid pandemic we learned of the fragility of supply chains that have concentrated overseas sources (like surgical masks from Wuhan).  The reaction has been to onshore more production. But concentrated domestic production also makes for fragile supply chains, and being able to diversify to overseas producers could strengthen them.

Statnews has the story:

White House should declare national emergency over IV fluid shortages caused by Helene, says hospital group. Hurricane Helene shuttered a Baxter plant that manufactures 60% of IV solutions for the U.S.  By Brittany Trang 

"Amid Hurricane Helene shuttering a major IV solution manufacturing plant and Hurricane Milton now barreling toward other IV manufacturing facilities in central Florida, the American Hospital Association on Monday asked the Biden administration to declare a shortage of IV solutions and invoke national emergency powers to ease the crisis. 

'In late September, Hurricane Helene shut down a Baxter plant in Marion, N. C., which manufactures approximately 60% of the IV solutions for the U.S. Both Baxter and “all other suppliers” of IV solutions have restricted how much their customers can order and have stopped taking new customers, AHA president Rick Pollack wrote in the organization’s letter to Biden. As a result, hospitals have declared internal shortages and restricted IV use. 

...

"In addition, the letter asked for the government to declare a national emergency and public health emergency so that Medicare and Medicaid rules around IV infusions can become more flexible, and to invoke the Defense Production Act to expand the production of IV solutions and bags. The AHA also suggested the government put the Federal Trade Commission and Department of Justice on alert for price gouging during the shortage.

Another step the FDA could take is to allow the importation of IV bags from other countries,* as it did when Hurricane Maria shut down Baxter’s Puerto Rico-based IV saline plants in 2017. That shortage mostly affected small IV bags. According to Vizient, a health care performance improvement company, the North Carolina Baxter plant is largely a producer of large IV bags, including saline, dextrose, and Ringer’s lactate solutions.

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*In 2017: "To address a shortage of intravenous solution bags exacerbated by Hurricane Maria, the Food and Drug Administration has granted permission for a health supply company to import certain products to the United States from Australia and Ireland."

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Related:

Wednesday, August 28, 2024

WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood, by Krawiec and Roth

An own-goal in replication science--retraction of a paper that reported high replicability

  A 2023 paper reporting high replicability of psychology experiments has been retracted from Nature Human Behavior. The retraction notice says in part 
"The concerns relate to lack of transparency and misstatement of the hypotheses and predictions the reported meta-study was designed to test; lack of preregistration for measures and analyses supporting the titular claim (against statements asserting preregistration in the published article); selection of outcome measures and analyses with knowledge of the data; and incomplete reporting of data and analyses."

RETRACTED ARTICLE: High replicability of newly discovered social-behavioural findings is achievable

• John Protzko, 
• Jon Krosnick, 
• Leif Nelson, 
• Brian A. Nosek, 
• Jordan Axt, 
• Matt Berent, 
• Nicholas Buttrick, 
• Matthew DeBell, 
• Charles R. Ebersole, 
• Sebastian Lundmark, 
• Bo MacInnis, 
• Michael O’Donnell, 
• Hannah Perfecto, 
• James E. Pustejovsky, 
• Scott S. Roeder, 
• Jan Walleczek & 
• Jonathan W. Schooler 

Nature Human Behaviour volume 8, pages311–319 (2024)Cite this article

• 47k Accesses

• 470 Altmetric

• Metricsdetails

This article was retracted on 24 September 2024

Matters Arising to this article was published on 24 September 2024

This article has been updated

Abstract

Failures to replicate evidence of new discoveries have forced scientists to ask whether this unreliability is due to suboptimal implementation of methods or whether presumptively optimal methods are not, in fact, optimal. This paper reports an investigation by four coordinated laboratories of the prospective replicability of 16 novel experimental findings using rigour-enhancing practices: confirmatory tests, large sample sizes, preregistration and methodological transparency. In contrast to past systematic replication efforts that reported replication rates averaging 50%, replication attempts here produced the expected effects with significance testing (P < 0.05) in 86% of attempts, slightly exceeding the maximum expected replicability based on observed effect sizes and sample sizes. When one lab attempted to replicate an effect discovered by another lab, the effect size in the replications was 97% that in the original study. This high replication rate justifies confidence in rigour-enhancing methods to increase the replicability of new discoveries.

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In general, I'm more optimistic about replications than preregistrations for identifying replicable results and testing hypotheses about them.  In this case, preregistration apparently revealed that what was written up as a replication study had begun as something else, and that the goal posts had been moved ex post, apparently in inappropriate ways.

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Somewhat related are my posts on the Einstein Foundation Award for Promoting Quality in Research.

October 7, 2023

 There aren't enough days in the year to remember all of important history by naming a day, but some days stand out. The oldest one I know is the 9th day of the month of Av in the Jewish calendar, Tisha b'Av. 

But October 7 is likely to be remembered for a long time, an unimaginable day whose dire consequences are still unfolding.

The Genesis Prize Foundation remembers the first anniversary with these videos:

"This week we mark a full year since October 7 when Hamas murdered 1,200 innocent people in Israel and dragged over 200 hostages into Gaza. And while media attention has shifted to Iran and Lebanon, it is important that the world not forget that over 100 hostages still remain in captivity in unbearable conditions in Gaza. "Our foundation will not stop speaking out until they are all home. "As we all struggle with how to cope with this unimaginable reality, one thing we can do is continue to share the stories of those directly impacted, and keep the plight of the hostages top of mind for communities around the world. "Please watch and share these documentaries about October 7.

 

Screams Before Silence Sheryl Sandberg https://youtu.be/zAr9oGSXgak?feature=shared

Coming to Kill You Israel News 13https://youtu.be/dd-86D__zSk?feature=shared

 

October 7th, 2023 Dan Gordon https://www.tbn.org/programs/october-7th-2023

Facts – October 7 War Izzy Stream https://www.streamisrael.tv/facts

 

"May the new year bring peace, health, and the return of our stolen loved ones. Shana Tova to you and your families. "The Genesis Prize Foundation"

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This from The Telegraph:

‘Not one girl could be shown to her parents’: The horrors of Oct 7 – as told by the survivors

In a heartbreaking dispatch to mark the anniversary, witnesses recall the heroism of victims and the true depravity of the attack.  by Allison Pearson  

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The New Yorker has this story:

A Year After October 7th, a Kibbutz Survives. In Be’eri, where more than a hundred people were killed and thirty taken captive, former residents are attempting to rebuild. By Ruth Margalit  October 6, 2024

In the same issue is this poem by the Gazan poet Mosab Abu Toha about deaths there:

Under the Rubble

Published in the print edition of the October 7, 2024, issue.

Technology and crime: cloning giant sheep

 There are things you can go to prison for that wouldn't have been possible to do not long ago.

The Washington Post is on the case:

Rancher sentenced to 6 months in prison for illegally cloning giant sheep. Arthur “Jack” Schubarth, 81, previously pleaded guilty to creating giant hybrid sheep via illegally imported genetic material.  By Kyle Melnick

"The Montana rancher’s illegal scheme began in 2012, when he paid for his son to hunt one of the world’s largest sheep species in Kyrgyzstan, court documents say. Arthur “Jack” Schubarth then used parts of the sheep in the following years to breed an even larger hybrid species and sell those animals to hunters.

"Now, Schubarth is set to spend six months in prison for the ploy after pleading guilty to two felony wildlife counts in March. Both counts stemmed from violations of the Lacey Act, a federal conservation law that prohibits interstate sales of falsely labeled animals and sales of animals to states where they’re illegal to own.

...

"Much of the scheme played out at Schubarth’s 215-acre ranch in Vaughn, Mont., where he bred and sold mountain sheep, mountain goats and similar breeds. Schubarth paid for his son to take multiple trips to Kyrgyzstan in 2012 and 2013. In January 2013, Schubarth’s son brought back viable tissue from a Marco Polo argali, a rare and large species native to central Asia, but didn’t declare the materials when he reentered the United States, court documents allege.

...

"Schubarth sought to create an even more valuable species, according to prosecutors. Sheep with larger horns and bodies are worth more to hunters, including at private shooting preserves, where hunters pay to pursue captive game.

...

"Schubarth agreed to a contract with a cloning facility in 2015, and by late the following year, he had 165 cloned embryos of Marco Polo argali. He implanted embryos in his ewes and in May 2017 bred a male argali, who he named Montana Mountain King.

"In the following years, Schubarth bred Montana Mountain King’s semen with other ewe species, creating more hybrid sheep that he sold to captive hunting facilities, mainly in Texas. To do so, he bought Rocky Mountain bighorn sheeps’ testicles, despite Montana prohibiting trade of game animals."

The NAS proposes that bans on studying marijuana and its effects should be relaxed

 The National Academy of Sciences has just issued a new report on marijuana and public health.  Among their recommendations is that bans on research should be rescinded. (Because marijuana is currently a Schedule I drug in the Controlled Substances Act, it's hard to get permission to study it and its effects...)

Cannabis Policy Impacts Public Health and Health Equity (2024)

Nondirected liver donation in Canada--from the beginning

The Ottawa Citizen has the story:

The Gosling Effect: How one man (and his liver) forever changed Canadian health care. In 2005, Kevin Gosling became the first living Canadian to anonymously donate an organ to a stranger. It set a cascade of kindness into motion.  by Elizabeth Payne 

"It had been a long road for the then-46-year-old from Cornwall, Ont. For months, health officials wouldn’t take him seriously when he offered to donate the organ anonymously. We don’t do that here, he was told. Not only that, it had never been done before anywhere in Canada.

"Some top officials in Canada’s leading liver transplant program were adamantly opposed to Gosling’s proposal. They said it was unethical and immoral. They questioned his motives, even his sanity. But Gosling persisted, so far as to undergo months of physical and psychological testing and preparation.

"After more than a year and a half, everything was set to go.

...

"Gosling didn’t know much about the recipient. He only knew that it was a child.

...

"Gosling’s stubborn altruism and unwavering belief that he could make a life-changing difference to someone in desperate need almost single-handedly changed Canada’s health-care system.

"In the 19 years since that fateful day when transplant surgeons removed part of Gosling’s liver and transplanted it into the body of the very ill child, the Toronto General Hospital has completed more than 137 such operations involving people donating anonymously to strangers – more than any other hospital in the world.

...

"He was a pioneer in an area in which Canada is now a world leader – the act of anonymously donating part of a liver – a phenomenon that continues to be met with disbelief in some parts of the world.

...

"Gosling’s offer was turned down multiple times until he was eventually put in touch with the head of the multi-organ transplant program at University Health Network, one of only two hospitals in the country where living liver transplants are now routinely done. Along the way he met health officials who were adamantly opposed to the idea, even citing the Hippocratic oath. (Later, he was told by one staunch opponent that following Gosling’s case had made him change his mind.)"

HT: Colin Rowat

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See also:

Cattral, Mark S., Anand Ghanekar, and Nazia Selzner. "Anonymous living donor liver transplantation: The altruistic strangers." Gastroenterology 165, no. 6 (2023): 1315-1317.

and here are all my posts on nondirected donors: https://marketdesigner.blogspot.com/search/label/nondirected%20donor