Blood transfusion for dogs and cats

 Somewhat as in human donation around the world, blood donors for veterinary transfusions of cats and dogs are both volunteers and professionals. (Of course all these donors are themselves dogs and cats.)

Here's the NYT on the story:

 The Pet ‘Superheroes’ Who Donate Their Blood.
Transfusions have become an important part of veterinary medicine, but cat and dog blood is not always easy to come by.  By Emily Anthes

 "All kinds of ailments — including injuries, infectious diseases, immune conditions and cancer — can leave a pet in desperate need of blood, and transfusion has become an increasingly routine part of veterinary care.

“It is just as important a part of veterinary medicine as it is for human medicine,” said Dr. Dana LeVine, a small-animal internist at Auburn University and the president of the Association of Veterinary Hematology and Transfusion Medicine.

...

"There is no canine Red Cross. Instead, there are hospitals with in-house blood donation colonies, veterinary clinics with a roster of ad hoc donors on call and a small number of commercial blood banks, with wait lists that can stretch for months. There is also a growing community of pet owners who are signing their animals up to provide blood for other pets in need 

...

"Commercial blood banks for animals began emerging in the 1980s. Some rely on “closed colonies,” a group of cats or dogs that live on site, providing blood for several years before they are put up for adoption.

"Closed colonies have been a critical source of animal blood and can be run humanely, experts said. “I know many places that have fabulous cat rooms for cat donors,” said Dr. LeVine, who adopted her previous cat, Salt, from a blood donation colony.

"But animal rights activists have also exposed mistreatment and abuse at some commercial blood banks with closed colonies, and demand far outstrips the volume of blood they can provide.

"These factors have helped fuel interest in an alternate model, which recruits local pets to become regular donors. At DoveLewis, roughly 90 dogs and 40 cats serve as regular donors, or what the hospital calls “superheroes.”

...

"Community blood banks don’t pay pet owners for blood, but they do offer other perks, which often include free veterinary exams, blood work and flea and tick preventatives. The animals are rewarded, too. At DoveLewis, donor dogs get a jar of chicken or beef baby food. “It’s just the perfect size jar of smelly meat,” said Kelsey Reinauer, the blood bank director. “And then they get to pick out a toy from our toy bucket.”

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See also

California Animal Blood Banks Program

“Historically, California required commercial blood banks for animals to be closed-colony establishments. On January 1, 2022, Assembly Bill 1282, the California Pet Blood Bank Modernization Act, went into effect. This law aims to address the shortage of animal blood available for veterinary transfusion medicine in California and transition the state from closed-colony blood banks to community blood banks.”

Another transplant of a pig kidney

A very highly sensitized patient, even one with lots of priority on the deceased donor waiting  list (a prior donor) may not find a compatible human kidney.  Right now pig kidneys are still very experimental. The Washington Post has the story:

Years after donating a kidney, Alabama woman receives one from a pig
She became the third human to receive a genetically engineered pig’s kidney, raising hopes for thousands of Americans on the waiting list for organ transplants. By Mark Johnson

"Twenty-five years after donating a kidney to her mother, an Alabama woman became the third human to receive a genetically engineered pig’s kidney, raising hopes for thousands of Americans on the waiting list for organ transplants, officials at NYU Langone Health announced Tuesday. She is the first live patient to receive a pig’s kidney with 10 gene edits designed to reduce the risk of organ rejection.

...

"In March, doctors at Massachusetts General Hospital performed the first transplant of a gene-edited pig’s kidney, implanting the organ in Richard Slayman, a 62-year-old worker for the Massachusetts Department of Transportation. He lived for 52 days.

"Lisa Pisano, a 54-year-old grandmother, was the next to receive a gene-edited pig’s kidney, the first time such a kidney had been transplanted in a person also receiving a heart pump; the two procedures were performed on different days in April. She survived 86 days, though the gradually failing kidney had to be removed after 47 days.

...

"The gene-edited pig used in Looney’s transplant was developed by Revivicor Inc., a subsidiary of United Therapeutics Corporation.

"The 10 changes to the pig’s genetic code included the removal of three immunogenic antigens, molecules that can trigger an immune response. A growth hormone receptor, which can regulate growth and metabolism, was also removed.

"In addition, scientists gave the pig six human transgenes, pieces of DNA that have been experimentally constructed, and were intended to make the pig organ more compatible to the human body.

"Doctors received permission to perform the procedure under the Food and Drug Administration’s compassionate use program, which allows the use of investigational medical products outside of clinical trials when a patient has a life-threatening condition."

New rules for evaluating transplant centers

 Historically, transplant centers ('hospitals') have been primarily evaluated on the one year graft survival on the transplants that they do.*  Now Medicare announces it will test a new model, that will emphasize the number of transplants conducted ("achievement"), in addition to somewhat less emphasis on the ratio of deceased donor kidneys accepted or rejected ("efficiency") and graft survival ("quality").

Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model.  A Rule by the Centers for Medicare & Medicaid Services on 12/04/2024 

"a. Proposed IOTA Model Overview

"End-Stage Renal Disease (ESRD) is a medical condition in which a person's kidneys cease functioning on a permanent basis, leading to the need for a regular course of long-term dialysis or a kidney transplant to maintain life.[2]

"The best treatment for most patients with kidney failure is kidney transplantation. Nearly 808,000 people in the United States are living with ESRD, with about 69 percent on dialysis and 31 percent with a kidney transplant.[3]

"Relative to dialysis, a kidney transplant can improve survival, reduce avoidable health care utilization and hospital acquired conditions, improve quality of life, and lower Medicare expenditures.[4 5]

"However, despite these benefits of kidney transplantation, evidence shows low rates of ESRD patients placed on kidney transplant hospitals' waitlists, a decline in living donors over the past 20 years, and underutilization of available donor kidneys, coupled with increasing rates of donor kidney discards, and wide variation in kidney offer acceptance rates and donor kidney discards by region and across kidney transplant hospitals.[6 7] 

...

"The IOTA Model will be a mandatory model that will begin on July 1, 2025, and end on June 30, 2031, resulting in a 6-year model performance period comprised of 6 individual performance years (“PYs”). The IOTA Model will test whether performance-based incentives paid to, or owed by, participating kidney transplant hospitals can increase access to kidney transplants for patients with ESRD, while preserving or enhancing quality of care and reducing Medicare expenditures. CMS will select kidney transplant hospitals to participate in the IOTA Model through the methodology proposed in section III.C.3.d of this final rule. As this will be a mandatory model, the selected kidney transplant hospitals will be required to participate. CMS will measure and assess the participating kidney transplant hospitals' performance during each PY across three performance domains: achievement, efficiency, and quality.

"The achievement domain will assess each participating kidney transplant hospital on the overall number of kidney transplants performed during a PY, relative to a participant-specific target. The efficiency domain will assess the kidney organ offer acceptance rate ratios of each participating kidney transplant hospital relative to a national ranking or the participating kidney transplant hospital's past organ offer acceptance rate ratio. The quality domain will assess the quality of care provided by the participating kidney transplant hospitals via a composite graft survival ratio. Each participating kidney transplant hospital's performance score across these three domains will determine its final performance score and corresponding amount for the upside risk payment that CMS would pay to the participating kidney transplant hospital, or the downside risk payment that would be owed by the participating kidney transplant hospital to CMS. The upside risk payment will be a lump sum payment paid by CMS after the end of a PY to a participating kidney transplant hospital with a final performance score of 60 or greater. Conversely, beginning in PY 2, the downside risk payment will be a lump sum payment paid to CMS by any participating kidney transplant hospital with a final performance score of 40 or lower. There is no downside risk payment for PY 1 of the model.

...

"The three performance domains will include: (1) an achievement domain worth up to 60 points, (2) an efficiency domain worth up to 20 points, and (3) a quality domain worth up to 20 points.

"The achievement domain will assess the number of kidney transplants performed by each IOTA participant for attributed patients, with performance on this domain worth up to 60 points. The final performance score will be heavily weighted on the achievement domain to align with the IOTA Model's goal to increase access to kidney transplants to improve the quality of care and reduce Medicare expenditures. The IOTA Model theorizes that improvement activities, including those aimed at reducing unnecessary deceased donor discards and increasing living donors, may help increase access to kidney transplants."

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CMS gives a high level overview here: Increasing Organ Transplant Access (IOTA) Model

and later today there's a webinar you can register for:

"The CMS Innovation Center will be hosting a welcome webinar to present an overview of the model on December 18, 2024, from 2 to 3 p.m. ET. Register to attend: https://cms.zoomgov.com/webinar/register/WN_hvGDyZTxQ5eNhX1OBolevA
 

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*see Wednesday, October 2, 2024 Regulation of Organ Transplantation and Procurement (Chan and Roth in the JPE)

That paper suggests desirable regulations  would coordinate transplant and OPO incentives, and link them both to the health outcomes of all patients attributable to a given transplant center (and not just those patients who were transplanted). 

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quick update (from the Q&A following the webinar): 

this is viewed as an experiment on roughly half the transplant centers, but there isn't currently a commitment about what to do after the projected 6 years of the experiment.

. all transplant patients are considered, but payments are only for Medicare fee for service patients

achievement: . each center's target for annual transplants will be it's average number over the three years ending a year before the beginning of the experiment...(at least that was the answer for the first year).

    . both deceased and living donor outcomes will be included in the achievement metric.

quality: .the first year will consider one-year graft survival, and year n will consider graft survival for the first n years.

OPOs: there are no requirements for OPOs within the IOTA model 

risk adjustment: not for year 1, they are hoping to have risk adjustment measures in subsequent years.

. 

Marriage markets among religious Jews

 Here's a 2024 report:

The Challenges of Singlehood among American Orthodox Jews Part II  by  Dr. Matt Williams, Dr. Michelle Shain, Dr. Guila Benchimol, Channah Cohen, and Elisha Penn, The Center for Communal Research of the Orthodox Union  ou.org/research

Note: a shadchan is a matchmaker, a shidduch is a match.

 

"Matchmakers believe single men and women need someone “in the middle” to coach or guide them through the dating process. Some matchmakers see it as their role to help single individuals understand what compatibility looks like in a partner and that some single individuals’ expectations are “very unrealistic.” They express “trying to change the mindset” of the people they try to set up. Because some matchmakers feel that single people are inflexible about their “list” and are “looking for people they cannot have,” they may offer “a little bit of tweaking” or “point certain things out” to single men and women about their dating choices. One matchmaker describes her work as “1% idea, 99% counseling, guiding, phone calls.”  

...

"In summary, the single men and women interviewed and surveyed rarely feel they can successfully find a spouse on their own. Based on the survey findings, they are correct—the more one diversifies the types of finders they use, the more likely they are to meet eligible dates.
"At the same time, single men and women express frustration at the difficulty of accessing relevant potential partners. Few women and less than half of men feel they are frequently exposed to quality potential matches.
"Within our sample, more than a third (male 35%, female, 36%) of respondents met someone they dated in  the last six months through friends and family, well over the 20% who met through a matchmaker. Friends  and family play a key role in helping single men and women find a suitable partner as they are the ones who know them best and can suggest compatible people to date. This finding is echoed in the forthcoming OU study on the shidduch system in the Yeshivish community. Perhaps because it is not formalized like matchmakers, the role friends and family play is often overlooked, but it is a very effective way to meet  potential dates"

 

HT: Daniel Lerer 

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Earlier, for  some secular comparisons: 

Friday, August 9, 2019

Coupling up with the help of the internet

 

and on the importance of matchmaking: 

Tuesday, June 5, 2012

What has G-d been doing since the Creation? (Matchmaking, of course...))