Toledo celebrates Mike Rees

 Here's the announcement from the University of Toledo:

University Recognizes Faculty Members with Distinguished Honor 

"Rees joined the faculty of the then Medical College of Ohio as an assistant professor in the Department of Urology in 1999 and was promoted to associate professor in 2007 and to professor in 2008.

"His research interests include kidney-paired donation, transplant immunology, immunosuppression, xenotransplantation and value-based healthcare, and he has received numerous grants totaling millions of dollars including grants from the Echoes of Lasting Peace Foundation, the NIH, the Agency for Healthcare Research and Quality (AHRQ), the Stanford Impact Lab, Wyeth Pharmaceutical Corporation, Novartis, the Ohio Department of Development and the Ohio Center for Innovative Immunosuppressive Therapeutics.

Rees mentored three Ph.D. students in xenotransplantation immunology, all of whom have gone on to successful careers in the health sciences and he has trained more than 50 urologists. He has obtained four patents related to his work in transplantation methods, one of which has led to a 30% increase in the supply of deceased donor livers in Europe, and he has written more than 100 publications and book chapters. These publications include: “Nonsimultaneous Extended Altruistic Donors” an idea that has lead to an additional 20,000 living donor kidney transplants around the world, “Delayed Renal Transplant Function,” “Immunological Effects of Hepatic Xenoperfusion” and “Strategies to Increase the Donor Pool.”

His numerous awards and commendations include attending the 2012 Nobel Prize ceremony at the invitation of his mentor for his UToledo-sponsored 2016-2017 sabbatical, Nobel Laureate in Economics, Alvin Roth, the Medal of Excellence from the American Association of Kidney Patients, the Governor’s Award from the National Kidney Foundation, and he was named an American Society of Transplantation’s New Key Opinion Leader.

Rees has given lectures and seminars in France, the United Kingdom, Canada, Belgium, South Korea, Switzerland, Japan, Saudi Arabia, Germany, Hungary, the Netherlands, Italy, India and the Philippines, and he served a three-year fellowship at Cambridge University, where he trained as a multi-organ transplant surgeon under world-renowned surgeon and transplant pioneer, Professor Sir Roy Calne, as well as completing a Ph.D. in xenotransplantation immunology.

“I have been fortunate to be supported by The University of Toledo since 1996 when the Medical College of Ohio made it possible for me to obtain a Ph.D. in immunology and a fellowship in transplant surgery at Cambridge University prior to my arrival in Toledo in 1999,” Rees said. “Transplantation is the great team sport. I am honored to have been chosen for this award, and I am grateful to all those who have trained me, the University of Toledo and Medical Center, the teams that have supported me, and the grant agencies and philanthropists who have supported my dreams over the course of my career.”

 

Kidney exchange: the donor stories, and the movie Abundant

 I'm learning a bit about movie production by following the progress of the movie Abundant, which is about to have a pre-release premier.  Here is the trailer (sponsored by the APKD), and the press release.

Here's the trailer:  https://vimeo.com/1048377579

 

And here's the press release:

LOS ANGELES--(BUSINESS WIRE)--ABUNDANT, a documentary film that follows the unbelievable events surrounding extreme altruists who donated kidneys to complete strangers, has set its world premiere in Hollywood at The Directors Guild of America Theater Complex on March 1, 2025. The event is presented by OneLegacy Inspires Hollywood and The National Kidney Donation Organization (NKDO) as a kickoff to National Kidney Month. OneLegacy Inspires Hollywood champions authentic and accurate storytelling that highlight the power of organ, eye and tissue donation and transplantation.

“ABUNDANT moves us beyond a mindset of scarcity, reminding us of our shared humanity and connection”

The film’s world premiere is an entertainment industry event to showcase the often-miraculous stories connected to altruistic acts such as living kidney donation. “ABUNDANT moves us beyond a mindset of scarcity, reminding us of our shared humanity and connection,” said Sarah E. Fahey, Chair of OneLegacy Inspires Hollywood. “Through a powerful emotional journey of joy, grief, and hope, the film keeps audiences engaged from start to finish—and lingers long after the credits roll. OneLegacy Inspires Hollywood is thrilled to partner with NKDO and Maitri River Productions to premiere this impactful story during National Kidney Month here in Hollywood. This is the movie Los Angeles, and the world, needs right now,” Fahey added.

The choice of Los Angeles for ABUNDANT’s world premiere was in part inspired by the widespread acts of generosity, kindness and abundance displayed by the Los Angeles community during the recent wildfires. “One thing became obvious to me about abundance and altruism when I was making ABUNDANT,” said Director Donald Griswold. “Acts of abundance or generosity don’t have to be life-saving or dramatic to impact another person’s life meaningfully. We’re all fascinated by the non-directed kidney donors who give a kidney to a stranger, but viewers walk away from the film realizing that small acts and everyday kindnesses make an important impact, too. We saw that in so many ways in LA these last few weeks. We had to show ABUNDANT for the first time here and now.”

National Kidney Donation Organization supports ABUNDANT as part of an effort to gain more attention for kidney donation stories. “We are proud to have a hand in sharing this life-affirming message of hope and goodness with the people of LA, and with all those across the country who might be inspired by it,” said Emily Polet-Monteserro, Executive Director, National Kidney Donation Organization. “This compelling film uses the vehicle of kidney donation to encourage the audience to consider what it means for them to live fully and with love toward everyone, including strangers.”

ABUNDANT includes interviews with 2012 Nobel Prize Laureate Alvin Roth, PhD, Freakonomics Radio host Stephen Dubner, author and researcher Abigail Marsh, PhD, and business leader in the field of system change, Tynesia Boyea-Robinson among other notable personalities. The film features first-hand stories of non-directed kidney donation (where a person donates a kidney to a complete stranger) in a never-before-seen way of telling stories. 

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Earlier:

Tuesday, September 24, 2024

Abundant: a moving documentary about living organ donors

Kidney exchange and liver exchange are connected by graph theory

 Practical market design involves logistics, and here's a paper by five doctors at the Liver Transplantation Institute of Inonu University in Malatya, Turkey, explaining how they developed the logistics of their busy single-center liver exchange program.  

They also explain the connection between liver exchange and the graph theory involved in kidney exchange. The relevant graphs are compatibility graphs indicating which donors are compatible with which recipients, which are different for kidneys (involving blood types and antibodies) and for livers (involving blood types and anatomy--chiefly size.) But in either case, when the graph is sparsely connected, two way cycles are likely to be rare, so longer cycles and chains become important.

Multiple Swaps Tested: Rehearsal for Triple and Five Liver Paired Exchanges, by Sezai Yilmaz,  Ahmet Kizilay, Nuru Bayramov, Ahmet Tekin, and Sukru Emre, Transplantation Proceedings
Volume 56, Issue 9, November 2024, Pages 2003-2005

" many potential living liver donors cannot donate their organs to their relatives because of blood group incompatibility, unsuitable anatomy due to small graft to recipient weight ratio, small liver remnant size, and the donor's arterial, venous, or biliary anatomic variants. Liver paired exchange (LPE) can be used to overcome incompatibilities between living donor-recipient pairs and should be considered as a means to expand the donor pool and reduce deaths on the LT waiting list. A small number of liver pair exchanges have been performed [[4], [5], [6]]. In this study, we report the early and late results of three and five LDLTs performed simultaneously to initiate the more complex LPE program. 

...

"Inonu University Liver Transplantation Institute has 12 operating theatres, 3 intensive care units (each with a capacity of 12 patients), and 116 in-patient beds. In our institute, there are 25 LT surgeons, 8 anesthesiologists, 4 intensive care specialists, 3 radiologists, 3 hepatologists, 3 infectious disease specialists, and 1 pediatric hepatologist, and 3 infectious disease specialists who are specialized in both LT and LDLT in adults and pediatrics. As one of the leading LDLT centers in the world, our challenge has been always to deal with patients do not have matching donors. Therefore, our next challenge was to create the Liver Pair Exchange Program. Our experience, facilities, and need for an LPE program convinced us that we should initiate such a program. This was a major undertaking, and we would like to test what kind of problems we could face if we should start an LPE program. To test possible hurdles, we decided to perform five simultaneous LDLTs. In June 2019, we performed 5 simultaneous LDLTs, including 1 pediatric and 5 adult patients. All operations started at 8 am and ended between 4 and 6:30 pm.

... 

 "Collaborations between medical and mathematical modeling professionals have resulted in widespread adoption of kidney pair exchange programs worldwide over the last 2 decades and resulted in a dramatic increase in the number of living donor kidney transplants obtained in this way using tools from fields of optimization and market design [10,11]. These techniques are recently extended to the LPE program as well [12]. One of the important contributions of mathematical modeling professionals had been showing the importance of larger than two-way donor exchanges for increasing the number of transplants that can be obtained through kidney pair exchange or LPE programs [13,14]. Therefore, by demonstrating that our center is capable of performing up to five LDLTs, we have taken an important step for establishing a complex LPE program that can conduct up to five-way donor exchange

...

"[10] AE Roth, T Sönmez, MU Ünver, Kidney exchange
Quarterly J Econ, 119 (2004), pp. 151-188

[11]AE Roth, T Sönmez, M Utku Ünver, A kidney exchange clearinghouse in New England, Am Econ Rev, 95 (2005), pp. 376-380

[12]H. Ergin, T Sönmez, MU Ünver
Efficient and incentive-compatible liver exchange
Econometrica, 88 (2020), pp. 965-1005

[13] AE Roth, T Sönmez, MU Ünver, Efficient kidney exchange: coincidence of wants in markets with compatibility-based preferences, Am Econ Rev, 97 (2007), pp. 828-851

[14] SL Saidman, AE Roth, T Sönmez, MU Unver, FL Delmonico
Increasing the opportunity of live kidney donation by matching tor two-and three-way exchanges, Transplantation, 81 (2006), pp. 773-782 "

Kidneys, compensation, and altruistic activists

 Here's a well written story about kidney donation, and  some of the very interesting people involved in the debate over compensating donors.  It's written by the talented science writer Carrie Arnold, in  Noema magazine (which she described to me as "a pub that has a philosophical bent published by the Berggruen Foundation," when I was among the many people she interviewed for the story). 

 It starts by introducing us to non-directed donors like Elaine Perlman and her son Abie Rohrig (he donated first and she followed). Elaine is now a leader in promoting organ donation and compensation of donors, not least through the End Kidney Deaths Act.   We also meet the indefatigable Frank McCormick, an economist at the forefront of understanding the finances of transplantation (and how much money it saves society and the healthcare system compared to dialysis).

 Here's the story:

How Much Is Your Kidney Worth? To address the deadly organ shortage, some are proposing compensating living kidney donors, creating an ethical dilemma.  By Carrie Arnold , in Noema, February 13, 2025

Ms. Arnold gives me the last word. The very last line of the story concerns the End Kidney Deaths Act:

“This is a proposal that just says donors are really generous,” Roth said, “maybe we can be generous to them in return.”

Kidney exchange reduces demographic disparities, by Bethany Lemont and Keith Teltser

 Here's an interesting recent paper on the differential impact of kidney exchange on different demographic groups...

Does Paired Kidney Exchange Reduce Demographic Disparities in Transplant Outcomes? by Bethany Lemont, Ohio University - Department of Economics, and Keith Teltser, Georgia State University, November 16, 2024

Abstract
Paired kidney exchange programs increase living donor transplants by facilitating matches across immunologically incompatible patient-donor pairs. Given existing concerns about demographic disparities in transplant access and outcomes, we examine the extent to which exchange differentially impacts patients across demographic groups. To estimate causal relationships, we leverage the importance of patient proximity to exchange-facilitating centers and plausibly exogenous spatial and temporal variation in exchange activity. We show that exchange increases the quantity of living donor transplants, improves transplant survival, and reduces waiting time overall. Patients who are Black, younger, more-educated, privately-insured, and women experience the largest living donor transplant gains in percentage terms. Patients who are Black, younger, less-educated, insured by Medicaid, and women experience the largest improvements in survival. Our findings paint a nuanced picture. Kidney exchange seems to narrow gender and racial/ethnic gaps in transplantation, exacerbate disparities by age, and have mixed effects across education and insurance groups.

Kidney exchange chain at Ohio State--a gift transforms 20 lives

 Here's a recent big kidney exchange chain, begun by a nondirected donor, involving patient-donor pairs all at OSU's medical center

The Columbus Dispatch has the story. (If I had written the headline, it would have said "transforming 20 lives," since many of the donors I've met have also been transformed.)

Ohio State Wexner sets record-breaking kidney 'donation chain,' transforming 10 lives   by Samantha Hendrickson

"On Dec. 13, Samantha Fledderjohann donated one of her kidneys to a stranger in need, and in the process, transformed 10 lives.

The 46-year-old was the first of a record-breaking "chain" of 20 surgeries over a two-day period at the Ohio State University Wexner Medical Center Comprehensive Transplant Center, both to remove and transplant kidneys from 10 living donors to 10 recipients. That means 10 people now have another chance to live more of their lives better and longer with a healthy kidney.

...

"The transplant swap begins with an "altruistic non-directed" donor like Fledderjohann, who saw a need for more kidney donors, and felt an internal pull to donate even without someone in mind

...

"The "chain reaction" continued, thanks to individuals like Carnahan staying on OSU's donor list despite not being a match for a loved one, instead extending that offer to a stranger in need.

...

"According to the Organ Procurement and Transplantation Network, there are 104,840 people on the transplant waitlist and 90,506 need a kidney in the United States, and 2,079 of them live in Ohio. Ohio State’s transplant center has performed more than 8,500 kidney transplants since 1967."