Tuesday, June 14, 2016

White House Organ Summit--video and links. Deceased donor chains planned at Walter Reed

Here's a video of the plenary talks/announcements at the White House Organ Summit yesterday. I give the last brief talk, from minute 43-48. (5 minute talks are hard:). I report on the plan to start some nondirected donor kidney exchange chains with deceased donor kidneys at Walter Reed, which has some flexibility in the allocation of deceased donor kidneys.

Here's the accompanying White House FACT SHEET: Obama Administration Announces Key Actions to Reduce the Organ Waiting List

Here's the text of my five-minute speech (which I wrote out in advance, to stay on script and keep on time):

"White House Organ Summit: Deceased Donor Chains

I’m Al Roth, an economist at Stanford.

Most people waiting for transplants are waiting for kidneys. And kidneys are special, because healthy people have two and can remain healthy with one. So kidneys can be donated by living as well as deceased donors.  Each year in the U.S. we transplant over 5,000 living donor kidneys, along with over 11,000 deceased donor kidneys.

Kidney transplantation is also special: it is both the best treatment for kidney failure, giving recipients many more years of life—and it is also the cheapest treatment. The American health care system saves over $250,000 in five years after a transplant, because dialysis is much more expensive than transplantation and post-transplant care.

          I’m going to tell you now about how some living donor kidney transplants are organized, as background for one of the quite concrete announcements we have today.

Sometimes a person is healthy enough to donate a kidney but can’t give to the patient he loves, because kidneys have to be biologically compatible. This opens up the possibility of kidney exchange (and exchange is where economists come in). Kidney exchange is a kind of matching market in which patient-donor pairs can donate compatible kidneys to one another so that each patient gets a compatible kidney. For example, if you and I are healthy enough to donate a kidney, but can’t donate to the patient we love, maybe my kidney is compatible with your patient and yours with mine, and so a simple exchange between two patient-donor pairs can make two additional transplants possible. In the last 10-15 years, kidney exchange has become a standard part of American medicine, resulting in thousands of additional transplants.

          Sometimes a non-directed donor comes forward—an altruistic donor who wishes to donate a kidney, and doesn’t have a particular patient in mind. These donors can spark chains of transplants that help patient-donor pairs in the kidney exchange pool, and patients on the deceased donor waiting list who don’t have a living donor. Some of these chains can produce many transplants, ever since we have learned to organize them as Non-simultaneous chains, in which the non-directed donor initiates a chain by giving to a patient-donor pair whose donor then gives to another pair, etc., most often ending with a donation to someone on the waiting list who doesn’t have a living donor.  These chains can be long because they don’t have to be conducted simultaneously since every pair receives a kidney before giving one, so that they don’t risk giving a kidney and not getting one.  Mike Rees who is here today organized the first non-simultaneous chain, which had twenty people--ten donors and ten transplant recipients--in the picture that was eventually published in People Magazine.

The average non-directed chain produces five transplants. That is, if someone offers to donate a kidney to start a chain - someone offering to help a stranger with this amazing gift of a kidney and a life free from dialysis - then on average, that one donor's gift will start a chain which produces 5 transplants

With that in mind, earlier this year, several eminent surgeons and I published an article in the American Journal of Transplantation noting that deceased donor kidneys are almost all non-directed. So we proposed that we should occasionally start non-directed donor chains with deceased donor kidneys – which are non-directed donor kidneys that today are used to produce just a single transplant. Carefully done, this could substantially increase the number of transplants for all patients –both those waiting without a living donor and those waiting for a kidney exchange.

Today, surgeons at Walter Reed who are here today have announced that they are going to pilot this idea through the military share program, which gives them the flexibility to allocate certain deceased donor kidneys to the benefit of veterans and service members. This new initiative at Walter Reed may soon show us how to move forward on a larger scale in using some deceased donor organs to start chains of multiple transplants.

To summarize, kidney chains can play an important role in increasing transplants. Since the first long non-simultaneous non-directed donor chain was organized by Dr Rees in 2007, thousands of kidney exchange transplants have been accomplished, more than half through non-directed donor chains. These save both lives and money by increasing the number of transplants. So we should take good care of our non-directed living donors—and there is growing consensus that we should at least figure out ways to reimburse all donors for their financial costs, including lost wages. And we should, in gratitude to our deceased donors, make the best use possible of their non-directed donation.

I’d like to personally thank Walter Reed for their initiative in pioneering the use of deceased donor kidneys to start kidney exchange chains that will increase donations and benefit both those waiting for deceased donors and those waiting for exchange with other patient donor pairs. Starting kidney transplant chains with deceased donor kidneys has the potential to be a very significant innovation."

Here's a link to my post on our AJT article (by Melcher, Roberts, Leichtman, Roth, and Rees) advocating for starting kidney exchange chains with deceased donor kidneys:

Monday, April 11, 2016

Using deceased donor kidneys to start living donor kidney exchange chains

Here's the announcement from the DoD:
"BETHESDA, Md., June 13, 2016 — Walter Reed National Military Medical Center officials today announced a pilot program to pioneer kidney paired donation chains started via the military share program, in which families of active duty military service members donate one of their kidneys to patients listed for transplant at the medical center’s campus here.
""We are excited to participate in this initiative, which has the potential to increase organ allocation for our patients,” Navy Capt. (Dr.) Eric Elster, professor and chairman of surgery at the Uniformed Services University of Health Sciences and Walter Reed National Military Medical Center said. “While it will require overcoming logistical barriers, we in military medicine excel at such challenges."

Walter Reed surgeons perform an average of 25 transplants per year on patients from across the country, and the medical center also maintains a living donor kidney transplant program that participates in national paired kidney exchanges.

Army Maj. (Dr.) Jason Hawksworth, transplant chief at Walter Reed, said his team “looks forward to contributing to the innovative initiative that may exponentially increase the availability of life-saving transplants on patients throughout the nation."

According to the Scientific Registry of Transplant Recipients, a regulatory body that tracks transplants, Walter Reed has the best organ transplant outcomes in the greater Washington-Baltimore region."

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