Virginia Postrel on Kidney Exchange, and other (less distinguished) news coverage

Virginia Postrel's latest article in the Atlantic is about kidney exchange: ...With Functioning Kidneys for All.

She writes well (check out her Dynamist blog). In addition, as someone who gave one of her kidneys to a friend, she writes with a personal as well as a professional interest and authority. Her article mostly talks about kidney exchange as it is developing in the U.S., but also discusses possible donor compensation, and the international black market.

The article is well worth reading, and contains interesting links (including to this paper, in the New England Journal of Medicine, about a ten-transplant kidney chain, of which I'm happy to be among the coauthors).

It's a great thing to have kidney exchange covered in the press, because that allows more potential kidney exchange candidates to hear about the possibility, and it allows potential donors to know just how big an impact they could have. On this latter point, Postrel's article points out that
"Since the current transplant system extols altruism, one way to end the [long deceased donor waiting] list would be to find more altruists. With, say, 50,000 new living donors, deceased donation could easily pick up the slack. Again, the numbers aren’t that big. The Southern Baptist Convention includes 42,000 member churches; the United Methodist Church, whose Web site earlier this year featured the quote, “As United Methodists, we’re life savers,” counts more than 34,000 U.S. congregations. If each congregation produced just one new living donor, the waiting list would disappear. "

But press coverage is a bit puzzling. Not all of it is as careful and accurate and well reported as the Postrel article. (Which is not to say that even inaccurate coverage still isn't a good thing, for the way it spreads the news.) But I've been a little bemused at the way coverage sometimes simply follows press releases. Here's a story for those of you who find media an interesting subject.

Remember that NEJM article I mentioned above? It got a lot of press when it came out in March, maybe because the NEJM embargoes its articles until a day before publication, and that creates some buzz. That journal article reported a novel, non-simultaneous chain of transplants which begain in July 2007, in which 10 donors gave kidneys to 10 recipients, involving 6 transplant centers in 5 states. The innovative surgeon who was responsible for organizing that, Mike Rees, was the lead author of that article, and is the founder of the Alliance for Paired Donation. I thought the coverage was pretty accurate, perhaps because it was a news story that was about an article in a medical journal that the reporters could refer to.

But not all press releases are about peer-reviewed journal articles. This past week there have been a lot of stories about another remarkable accomplishment, another such chain, which accomplished 8 transplants, almost as many. It was organized out of Johns Hopkins, one of the leading hospitals doing kidney exchange in the U.S. It's not surprising that Hopkins surgeons should be among those pushing this kind of innovation forward; two of them who were involved in this new chain were among the coauthors of the NEJM article. And, while the accomplishment, so soon after the NEJM article, is noteworthy, the news coverage is in some ways as remarkable.

Here's the lead paragraph of the first of two stories about it in the Washington Post: "A Maryland transplant surgeon says he and doctors at four hospitals in four states have transplanted eight kidneys and he considers that the largest series of multi-kidney donations ever. "

The second Post story, the next day, repeats that claim (under the headline Successful Eight-Way Chain of Surgeries Involving Johns Hopkins Is a First:
"The first-of-its-kind surgery -- believed to be the largest chain of donations in history -- involved hospitals in four cities..."

The Post isn't alone. A few days later, after a chance to do some more in depth reporting and fact checking, the (July 11) CBS evening news reports on how one of the patients experienced "...a surprise rescue - the chance to be a part of the biggest multi-city, multi-patient domino kidney exchange ever."

There are three surprises for those interested in news reporting. First, the surgeon quoted above in the first Post story is one of the coauthors of the NEJM article about the earlier, larger chain, so that quote was an odd slip of the tongue (or, maybe he was misquoted, or maybe that's what's required to get kidney exchange the press coverage it deserves). Second, the AP and Post and CBS evening news reporters weren't aware of the earlier chain despite all the press coverage it received, including this (March 12) story (also) on the CBS Evening News about the earlier chain: A Transplant Surgeon Matches 10 Donors With Recipients In The Longest Chain In History .

But the third surprise is that there's a really great human interest story about this latest, Hopkins led chain. It's not just about the surgeons, it's also about the donors. One of the donors was a Hopkins hospital administrator, who had seen first hand the good that kidney donors can do, and wanted to help a friend, but turned out to be incompatible with that friend. That is just the kind of situation that kidney exchange was invented to help. (How do I know this? I read the Hopkins press release, which was headlined
Johns Hopkins leads first 16-patient, multicenter 'domino donor' kidney transplant.

The subheadline was "Johns Hopkins vice president 1 of the donors".

So, hats off to the Hopkins surgeons and their talented colleagues at Barnes-Jewish Hospital in St. Louis, INTEGRIS Baptist Medical Center in Oklahoma City and Henry Ford Hospital in Detroit. And a deep bow to the donors. As for the reporters, yours is a noble craft too; kidney exchange is complicated, keep trying.

(And thank you, Virginia, for your thoughtful story in the Atlantic.)