Showing posts with label transplantation. Show all posts
Showing posts with label transplantation. Show all posts

Sunday, February 16, 2025

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.

Tuesday, February 4, 2025

Clinical trial of pig kidney transplants

 A clinical trial is good news.

The NYT has the story:

F.D.A. Approves Studies of Pig Organ Transplants for Kidney Patients
The research offers hope to tens of thousands of patients with kidney failure who are on a long waiting list for an organ transplant. By Roni Caryn Rabin  Feb. 3, 2025

"The U.S. Food and Drug Administration has given the green light to two biotechnology companies for clinical trials that will transplant organs from genetically modified pigs into people with kidney failure. If successful, these studies could lead to the broader use of cross-species transplantation, a dream of medical scientists for centuries.

One of the companies, United Therapeutics Corporation, will begin its trial with six patients, but that number could eventually rise to 50. The other, eGenesis, said it would begin with three patients and grow the study from there.

...

"Over the past three years, five patients have been known to receive organs from pigs engineered by these companies — two who received hearts and three who received kidneys. But these surgeries were not part of a formal clinical trial.

...

"The United Therapeutics study, which is expected to begin midyear, will start with six patients who have been on dialysis for at least six months but do not have other serious medical problems. There will be a three-month waiting period between each transplant so that doctors can learn from the outcomes.

If the first six transplants are successful, the trial will expand to include up to 50 participants in what is called a phaseless trial — a type of study that combines the traditional Phase 1, Phase 2 and Phase 3 trials and can lead directly to approval."


Saturday, January 25, 2025

Informed consent and compensation for clinical trial participants (Ambuehl, Ockenfels and Stewart in REStat)

 Here's the latest in a series of papers that suggests that participants who are attracted to e.g. clinical trials by the pay may be those who have the most trouble evaluating the costs and risks. So high pay should be paired with robust procedures for informed consent.

Ambuehl, Sandro, Axel Ockenfels, and Colin Stewart. "Who opts in? Composition effects and disappointment from participation payments." Review of Economics and Statistics 107, no. 1 (2025): 78-94.

Abstract: "Participation payments are used in many transactions about which people know little but can learn more: incentives for medical trial participation, signing bonuses for job applicants, or price rebates on consumer durables. Who opts into the transaction when given such incentives? We theoretically and experimentally identify a composition effect whereby incentives disproportionately increase participation among those for whom learning is harder. Moreover, these individuals use less information to decide whether to participate, which makes disappointment more likely. The learning-based composition effect is stronger in settings in which information acquisition is more difficult. 


"we contribute to the burgeoning literature on the moral constraints on markets (Kahneman et al., 1986; Roth, 2007; Ambuehl et al., 2015; Ambuehl, 2022; Elias et al., 2019). Around the world, the principles of informed consent are fundamental to regulations concerning human research participation, as well as to transactions such as human egg donation, organ donation, and gestational surrogacy (DHEW 1978, The Belmont Report, 1978; Faden & Beauchamp, 1986). According to these principles, the decision to participate in a transaction is ethically sound if it is made not only voluntarily but also in light of all relevant information, properly comprehended.3 Our results show that payments for participation can be in conflict with participants’ understanding about the consequences of participation. They further show that the severity of this conflict grows with respect to both the amount of the payment and the difficulty of acquiring and processing information about the consequences of the transaction."

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Earlier:

Wednesday, September 4, 2024 Incentives matter for getting participation in clinical trials by low income households

 

Sunday, March 10, 2024 Does high pay equal "undue inducement"? An experiment by Sandro Ambuehl



 

 


Monday, January 20, 2025

Emerging Technologies to Stop Biological Time: The Ethics of Refrigeration

 Here's a special issue of the Journal of Law, Medicine & Ethics, exploring the promise and peril of refrigeration (as applied e.g. to organ transplantation). 

Here's how the introduction to the issue begins:

" Human beings depend on biological materials for survival — everything from food to medical interventions such as organ transplantation, to the environments in which we live. So it is no surprise that techniques to avoid the deterioration of biological materials have been used since ancient times.Reference Knorr and Augustin1 Cooling is one of the oldest techniques. Indeed, most of us now live with a cooling machine — a refrigerator — in our kitchens. But the function of those machines is primarily to retard the spoilage of materials that are already in the process of disintegrating: fruit that has already been harvested, meat from beef and chickens already slaughtered, and milk already derived from cows.

Beginning in the mid-20th century, scientists began to develop techniques for cryopreservation with more ambitious goals in mind. Instead of merely slowing the deterioration of biological materials, techniques could be developed to preserve living materials for prolonged periods of time and then allow their revival and use at a future time and place. An early application was cryopreservation of sperm (both human and animal), allowing sperm banking and later use.Reference Walters, Pacey and Tomlinson2 Yet conventional cryopreservation had its limits. Prolonged preservation of solid organs for transplantation was among the applications that proved elusive."

Emerging Technologies to Stop Biological Time: The Ethical, Legal & Policy Challenges of Advanced Biopreservation   Volume 52 - Issue 3 - Fall 2024
Latest issue of Journal of Law, Medicine & Ethics 

Introduction

Symposium Articles

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Earlier post (on what turns out to have been a seminal paper: "Since Giwa and colleagues reviewed the emerging field of biopreservation in biomedicine in 2017, progress has been swift."):

Monday, June 12, 2017 Organ preservation could bring big changes to transplantation