Sunday, August 31, 2008

Heart and lung transplant recipient free of the debilitating asthma that almost killed him.

Brian Guy with children Zachary and Natalie

Brian Guy with children Zachary and Natalie

This is another feel good story about how lives are transformed by an organ transplant made possible by the generosity of a donor family.

From the Herald Sun, Australia:

By Robyn Riley

MELBOURNE father Brian Guy has a new lease of life. He has received a heart and lung transplant and is free of the debilitating asthma that almost killed him.

"From day one after the transplant I could breathe easily," Mr Guy, 43, said.

"I feel great."

Not so long ago Mr Guy's severely damaged lungs were functioning at a dangerous 13 per cent capacity and he feared he would not live to see his children grow up.

Now he can play football with son Zachary, 7, and enjoy the cuddles lavished on him by blue-eyed Natalie, 5.

"I don't have a better husband," wife Cathy, 41, said. "I have a new husband. Brian received an awesome gift."

He is relishing feeling fit and healthy for the first time in more than 20 years and says it is because of the donor and the donor's family whose generosity gave him back his life.

"I don't think you can put your gratitude into words," he said. "Thank you doesn't seem enough, but that's what I want to say to the donor's family."

Mr Guy's health problems started when he developed asthma at 22.

"I had gone away for the weekend with some friends to Geelong," he said. "We went out for the night and all of a sudden I couldn't catch my breath. A friend, an asthmatic, helped me with his inhaler."

But a few hours later Mr Guy was again struggling for air and he was rushed to hospital.

Doctors prescribed asthma medication and - for a while - life for the young chef returned to normal.

Asthma attacks were triggered by anything from temperature change to rye grass and his family life suffered.

"Even on a simple outing we had to stop two or three times so Brian could catch his breath," Mrs Guy said.

Then he developed a severe chest infection that did not respond to antibiotics.

"I couldn't shake it and then I suffered a massive asthma attack and woke up three days later in intensive care at The Alfred," Mr Guy said.

Two years ago, problems with asthma caused Mr Guy to require a lung transplant. And, while preparing him for a transplant list, it was found he also had heart problems.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Friday, August 29, 2008

FDA OKs blood test for heart transplant rejection

From Associated Press:

By RICARDO ALONSO-ZALDIVAR

WASHINGTON (AP) — Government regulators on Wednesday cleared the way for broader use of a blood test that can spare heart transplant patients the ordeal of repeated biopsies to check if their bodies are rejecting the new organ.

The Food and Drug Administration said the test, called AlloMap, is an example of how the science of genetics is changing the practice of medicine.

The test analyzes certain kinds of genetic information contained in white blood cells. These are the cells that help the body fight off infections — but can also turn against a donated organ with devastating effects. After a patient's blood sample is checked in the lab, it is assigned a score that tells doctors what the odds are that the body is rejecting a transplanted heart.

"It is noninvasive," said Dr. James Yee, chief medical officer of XDx, Inc., the California company that devised the test. "It requires only a simple blood sample." The test is especially useful in detecting a "silent rejection"_ one in which there are no evident symptoms, he added. The test costs $2,950.

Heart transplant patients are closely followed for signs of organ rejection, and must visit their doctors frequently. Before the test, doctors relied on a biopsy to check for signs of rejection. A minuscule probe threaded through a vein would be used to snip off a tiny amount of heart tissue, which would then be analyzed by a pathologist. The estimated cost of a such a biopsy ranges from $3,000 to $4,000.

The AlloMap test had been previously approved in 2005 under federal laws that govern clinical labs. But Yee said it is being used at fewer than half of the nation's heart transplant centers, and that FDA clearance should speed its adoption elsewhere.

More than 2,000 heart transplants were performed in the United States in 2006.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Thursday, August 28, 2008

Judaism’s perspectives on Organ Donation After Death

Donor Card


"Whoever saves one life, it is as if he saved the entire world."


From The Philadelphia Jewish Voice:

By Gabrielle Loeb

Although many Jews believe that Jewish law forbids organ donation, most rabbinical authorities not only permit it, but also encourage it. In 1990, the Rabbinical Assembly of America approved a resolution to “encourage all Jews to become enrolled as organ and tissue donors by signing and carrying cards or driver’s licenses attesting to their commitment of such organs and tissues upon their deaths to those in need.” Organ donation during life is generally permitted as long as there is little risk for the donor and great benefit for the recipient, but in the case of an already deceased donor, the risk is not an issue. For already deceased donors, the main issues are Kavod Ha-met (honor of the dead) Nivul Ha-met (disgrace if the dead), and the definition of death.

Kavod Ha-met is the reason for the extensive Jewish laws regarding burial customs. The body must be treated with respect since it is God’s property; we are simply borrowing our bodies for the duration of our lives and we must return them at death unblemished. This is the reason that permanent tattoos and piercings are forbidden. Because of Kavod Ha-met, delaying the burial of the deceased or gaining benefit from a dead body are considered Nivul Ha-met, disgrace to the dead, and are therefore forbidden. This obviously poses a problem since organ donation can delay the burial and allows us to benefit from the dead body.

This problem with delayed burial and benefits from the dead body, however, is superceded by the commandment Pikuach Nefesh, saving a life, which takes precedence over every other commandment excluding murder, idolatry, incest, and adultery. The Talmud Tractate Yoma 85b says, referring to the commandments, “You shall live by them, but you shall not die because of them.” This means that we should not “stand idly by the blood of [our] neighbor” (Lev. 19:16) because of the less important commandment of Kavod Ha-Met. In fact, not only does this commandment cancel the Nivul Ha-met, it gives Kavod Ha-met because it enhances the respect for the deceased since it allows the donor to fulfill the mitzvah of Pikuach Nefesh. Donating organs is therefore an honor to the deceased. In addition, the transplanted tissue will ultimately be buried with the recipient, so the burial would not be an issue even if it were overridden by Pikuach Nefesh. Finally, Pikuach Nefesh is even more important to donors since they are thereby saving the lives of both the recipient and any potential living donor whose life might be at a slight risk due to the surgery involved in donating organs. Because of the organ shortage, the Conservative movement’s Committee on Jewish Law and Standards ruled in 1995 that organ donation is an obligation because not doing so would be murder to the potential recipient and endangers the lives of living donors.

Besides Pikuach Nefesh, Hesed is another reason supporting organ donation. Hesed, acts of kindness, are not mandatory, but we are commanded to “walk in God’s ways” and this would include helping those in need. Such progress has been made in transplants in the past fifty years that they are now acceptable therapeutic options instead of experimental procedures, and therefore Hesed, in addition to Pikuach Nefesh, is more ensured. In 1954, the first kidney was successfully transplanted followed by a liver in 1967, a heart in 1968, a lung in 1983, and a pancreas in 1996. New genetic engineering techniques will soon enhance the immune system’s ability to accept alien organs and immunosuppressant drugs. In 1998, 21,000 transplants took place including kidneys, livers, hearts, pancreases, and bone marrow. Success is now measured in terms of years and quality of life following transplant instead of survival of the surgery. When organ transplantation was still very experimental and endangered life, Jewish law restricted it much more; however, with all this recent progress in organ transplantation and with the organ shortage, donated organs are sure to be an act of Hesed as well as Pikuach Nefesh.

In addition to following God through acts of Hesed, we must practice Kiddush Ha-Shem, sanctifying God’s name, by acting in a way to honor God and the Jewish people. With the current organ shortage (In 1998, according to Lamm’s book The Jewish Way in Death and Mourning, 4,855 people died waiting for donors, most of whom were cadaveric donors. Every sixteen minutes on average, one more person joins the 63,000 on the waiting list of the United Network for Organ Sharing), Jewish organ donations would make the Jews look more honorable, and it would therefore sanctify God’s name. On the other hand, if Jews were to refuse to donate organs, this would look bad for God and the Jewish people, and a forbidden Hillul Ha-Shem, desecrating God’s name. In fact, this is exactly what is happening now, and that is one of the many reasons that rabbinical authorities permit and even encourage organ donations: As Dorff explains in his book Matters of Life and Death, while 60% of the general population are willing to donate organs, only 5% of Orthodox Jews are, and the statistics are similar for other Jewish denominations. As a result of Israel accepting far more organs than they provide, Israel has been banned from Europe’s transplant network Eurotransplant. Israel’s exclusion from Eurotransplant not only is a huge Hillul Ha-Shem, but it also increases the shortage in Israel of organs for people on the long waiting list for transplants.

Even with the commandments of Pikuach Nefesh, Kiddush Ha-Shem, and Hesed which take place in organ donation, it is not given a complete authorization. There should be an advance directive saying that the deceased wishes to donate his or her organs. If no advance directive is made, however, it can be assumed that the deceased would be honored to be given the opportunity to perform Pikuach Nefesh. In addition, the most restrictive Orthodox rabbis require that there be a specific patient Lefaneinu, “before us,” who would otherwise die or lose an entire physical faculty. This means that if the potential recipient can see with one eye, they would not permit a corneal transplant. These rabbis would also reject donations to organ banks because there would be no particular known patient who would be served immediately by the donation. Most Jewish authorities agree, however, that a donation is justified to improve impaired vision, and that a donation to an organ bank is justified as long as there is enough demand for that particular organ that it can be safely assumed the donated organ will eventually be used.

The final restriction placed on organ donation concerns how death is defined. In some cases the line between life and death is hazy, so it needs a precise definition. Some rabbis go by the respiration test of placing a feather under the nostrils and seeing if it moves; they consider death to be defined as respiratory arrest. Others claim that respiratory arrest is only considered death because it is a reliable sign of cardiac arrest, which is the true definition of death. Since an organ donor must be dead according to Jewish law, the moment when organs can be collected is debated. In addition, Jewish law states that we must wait before we assume that a person is dead since they may simply be unconscious or in some other state resembling death. However, waiting would obstruct organ donation since the heart must be collected immediately, and the heart must be beating to keep the other tissues alive. This problem was solved by sphygmomanometers and electrocardiograms, which can measure breath and heartbeat and remove the need for waiting. The issue of donating a heart is further complicated, however, if a person whose heart is beating is considered alive, yet the heart must be beating to collect organs. So how can it be that the Chief Rabbinate of Israel approved heart transplants in 1998?

The answer is progress in medicine and more advanced ways of diagnosing death being developed. Instead of using a feather or trying The answer is progress in medicine and more advanced ways of diagnosing death being developed. Instead of using a feather or trying to hear a heartbeat, a flat electroencephalogram is used to declare someone officially dead. If someone has a flat electroencephalogram, that person is and forever will by unable to breathe or pump his or her heart himself or herself. Almost all Jewish authorities agree that a flat encephalogram can be used to determine death. It indicates the cessation of spontaneous brain activity and qualifies the patient as being brainstem-dead instead of heart-dead or breathing-dead. Brainstem-dead should not be confused with brain-dead, however, which is the cessation of higher cerebral functions like intellect and memory that are lost in Alzheimer’s or a vegetative state – in such cases the patient is considered alive and organ donations are therefore not permitted. Going by the heart-death definition would make less sense because a decapitated animal’s heart still beats for a short while, and because the heart can beat even without a body as long as it is nourished. Both The Conservative and Reform movements accepted electroencephalograms (since they indicate the cessation of brain activity) as the moment of death, and the Orthodox chief rabbinate followed suit twenty years later, as did the Rabbinical Council of America in 1991. Since brainstem death was approved and is the major rabbinic opinion (although some rabbis reject this halachic decision), heart transplants and organ transplants can take place.

However, there are other impediments to organ donations besides rabbinical concerns: donors often have misconceptions about the process and cost of donating organs, and sometimes other psychological factors come into play. Donors sometimes wrongly believe that the donor’s body will be mutilated and the funeral will be delayed a long time. On the contrary, the body is sewn up quickly, and the funeral can occur without much delay. In addition, closed caskets would prevent any surgery from being noticed. Secondly, some donors assume that they must pay to donate organs. The truth is that the recipient (or their insurance) pays for the organ transplant, not the donor. Other donors believe that if their doctors know that they have agreed to donate organs, the doctors would not try as vigilantly to keep them alive. This too is a myth since the physician team for the organ transplant is entirely separate from the physician team that would normally care for the patient, to serve this exact purpose. Still other potential donors are hesitant due to an aversion to even contemplate death, let alone things that would happen afterwards. People also tend to imagine donating organs as though they would be conscious when the donation would take place, and they imagine what the surgery would feel like for them although they would have to be brainstem-dead and therefore could not feel it.he body for three days after the death, during which the soul hovers over the grave. Even for the first twelve months, while the body disintegrates, the soul has a fleeting connection with the body, during which it comes and goes to and from the body. Finally, there are spirits who live on after death in bodily form. If the soul comes to the body, one might be uneasy with the idea of the body “not being complete.”

Incompleteness of the body is also an issue to people when they contemplate resurrection; they believe that in order to be resurrected in one piece, they must be buriedIncompleteness of the body is also an issue to people when they contemplate resurrection; they believe that in order to be resurrected in one piece, they must be buried in one piece. Two main arguments contradict this thought. First, organs which are not donated simply disintegrate in the ground (unless the body is preserved, which is forbidden). Secondly, if God could make the world from nothing, it should be relatively easy for God to make something from something that once existed but just decomposed. When resurrection comes, Jews will be resurrected regardless of parts missing or even whole bodies missing. Maimonides further explains that people should not even consider a bodily resurrection since resurrection is of the soul, not the body, since the world to come will have no bodily functions of eating, drinking, anointing, or sexual intercourse. Regardless of ones beliefs about resurrection, however, the overriding rule is again Pikuach Nefesh: saving a life immediately is far more important than beliefs about what lies ahead.

But what if donating organs is not saving any life at all? What about donating one’s body to science? As long as the body parts are preserved to bury, the deceased’s (and his or her family’s) wishes are respected, and the family can return to their lives even without the psychological closure of an immediate burial, most rabbinical authorities permit donating one’s body to science for the same reason as they permit organ donation. It is considered Kibud Ha-Met, not as Nivul Ha-met, since dissection, necessary to train physicians, facilitates the performing of Pikuach Nefesh, which is a great honor. Also, it is Hillul Ha-Shem for Jews not to do it and Kiddush Ha-Shem for Jews to do it, unless there is already ample supply of bodies to dissect, in which case Jewish donations are unnecessary and therefore unjustified. Some orthodox rabbis, however, again reject donating a body to science as a justifying reason, since there is no specific patient who is to gain from the donation.

Another question that is brought up concerning organ donation is whether the donor can be paid. Even the United States is hesitant to condone such a practice, although Pennsylvania does allow payment of renewable tissues such as blood, hair, and semen. While the United States does not favor such practice because vulnerable populations could be abused and exploited (while not being able to afford organs which they may need), Jewish law does not favor such practice because the body belongs to God, and we cannot sell what is not ours. The Halachic Organ Donor Society in New York City, whose mission is to spread information about Jewish legal matters and rabbinic beliefs about organ donation, helps Jews donate organs in accordance with their specific halachik beliefs. They try to raise awareness about the importance of organ donation and to combat the myth that organ donation is contrary to Jewish law.

There are numerous reasons for Jews to become organ donors; most reasons against that choice are simply misconceptions. Jews should consult their own rabbi to discuss the issue of organ donation. Most rabbis agree, however, that it is our responsibility as Jews to honor God’s name and to save lives by giving the gift of life even after are lives have terminated through the act of organ donation. As Mishnah Sanhedrin 4:6 says, “Whoever saves one life, it is as if he saved the entire world.”

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Wednesday, August 27, 2008

Chronology of organ transplantation

MedHunters.com has posted an excellent article on the history of organ transplantation. Here's are some excerpts from their lists:

  • 1901-1903: Discovery of ABO Blood Groups: Viennese physician Karl Landsteiner points out that adverse reactions that occur when humans receive blood from animals may also occur when humans receive blood from other humans. His suggestions receive little attention until 1909, when he classifies the human blood into the A, B, AB, and O groups and shows that catastrophic reactions can occur when a person receives blood from a different group. Compatibility is later found to be not only a requirement for transfusion but for transplantation. In 1930, Landsteiner wins the Nobel Prize in Physiology or Medicine "for his discovery of human blood groups."

  • 1952: First Kidney Transplant: Dr. Hamburger and his team transplant the first human kidney. The kidney is taken from female traffic accident victim and transplanted into her son. The kidney initially functions well, until it is rejected 22 days later.

  • 1954: First Successful Live Donor Kidney Transplant: Drs. Joseph E. Murray, Hartwell Harrison, David Hume, and John Merril perform the first successful kidney transplant at Peter Bent Brigham Hospital (now Brigham & Women's Hospital>) in Boston. The transplant is from Ronald Herrick into his identical twin Richard. Richard Herrick lives for another eight years. Murray becomes one of the co-winners of the 1990 Nobel Prize in Physiology or Medicine along with E.D. Thomas "for their discoveries concerning organ and cell transplantation in the treatment of human disease."

  • 1955: First Heart Valve Transplants: Dr. Gordon Murray of Toronto, Ontario, uses the main aortic valve of a male automobile accident victim to perform the world's first heart valve transplant on a patient with a severely leaking aortic valve. The transplanted valve functioned well for over eight years.

  • 1967: First Successful Liver Transplant: Dr. Thomas E. Starzl of the University of Colorado in Denver performs the first successful liver transplant. The liver functions for 13 months.

  • 1967: First Successful Heart Transplant: Dr. Christiaan Barnard, at Groote Schur Hospital in Cape Town, South Africa, transplants the heart of an 18-year-old female car accident victim into Louis Washkansky. He dies 18 days later of pneumonia.

  • March 9, 1981: First Successful Heart-Lung Transplant: Dr. Bruce Reitz of Stanford University in California, performs the first successful heart-double lung transplant on 45-year-old Mary D. Golke, who had been diagnosed with primary pulmonary hypertension. Cyclosporine is experimentally used to combat rejection. Golke passed away in May 1986. Golke co-authored a book about her experiences, called I'll Take Tomorrow.

  • 1983: Cyclosporine Approved for Use: The US FDA approves Cyclosporine, an immunosuppressant drug isolated from a fungus. Cyclosporine revolutionizes organ transplantation because it selectively suppresses the transplant recipient's immune system, allowing the patient to tolerate the grafted organ but preventing routine infections. Cyclosporine was first shown as an immunosuppressive agent by Swiss physician Jean Borel in 1977.

  • 1983: First Successful Single Lung Transplant: Dr. Joel Cooper of the Toronto Lung Transplant Group, Toronto General Hospital (now part of the University Health Network), performs a single lung transplant on 58-year-old Tom Hall, who suffers from pulmonary fibrosis. Hall lives for more than six years before dying of kidney failure.

  • 1986: First Successful Double Lung Transplant: Dr. Joel Cooper of the Toronto Lung Transplant Group, Toronto General Hospital (now part of the University Health Network), performs a double lung transplant on Ann Harrison, who suffers from emphysema. Harrison lives until 2001, when she dies of a brain aneurysm.

The listings are quite comprehensive, starting with skin grafts in 400 BCE. There are also links to individual timelines for Bone Marrow Transplants, Heart/Lung transplants, Immunology, Kidney Transplants, Pancreas & Liver transplants and a separate link for other & unusual transplants.

I highly recommend the MedHunters site for anyone interested in the history of transplantation.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Tuesday, August 26, 2008

Donors recover faster with new organ removal method

News Release, Jimmy Ryals, UHS Public Relations
Published: August 25, 2008


GREENVILLE, N.C. – For all the lifesaving potential they offer, organ transplants can be painful experiences for donors.

A typical nephrectomy, or kidney removal, brings a new life for the recipient but several days in the hospital and up to 12 weeks of recovery time for the donor.

By introducing a less invasive organ removal method to eastern North Carolina, a Greenville surgeon is making the life-saving sacrifice less scarring for organ donors.

On July 1, Dr. Jonathan Taylor of Eastern Urological Associates led a team performing the first laparoscopic kidney removal for transplant ever at Pitt County Memorial Hospital.

Taylor, who worked with Dr. Gregg Murphy, said the laparoscopic procedure fits with a trend toward less invasive treatments. It has several advantages over a traditional, open nephrectomy:

  • Less scarring – The laparoscopic procedure requires a pair of small abdominal incisions, rather than the 6- to 10-inch cut that comes with open kidney removal.

  • Shorter hospital stays – Laparoscopic patients leave the hospital one to two days after surgery.

  • Faster recovery – Laparoscopic patients can return to work within a couple of weeks, compared to eight to 12 weeks for open nephrectomy patients.

It all adds up to a swift return to normalcy, the chief benefit of laparoscopic kidney removal, Taylor said.

“These patients use very little in the way of pain medications in the hospital or at home, so the recovery is much, much faster,” he said.

A speedier recovery made the laparoscopic procedure appealing to Pink Hill resident Tonna Segall, Taylor’s July 1 patient. Segall left PCMH one day after donating a kidney to her father. By her second day at home, she was controlling pain with over-the-counter medicine. Segal was pain-free after a week and a half, and back to work Aug. 1.

“I was glad we did it that way, so I could get back to work quicker,” she said. “I’m not the sort of person that stays at home much. I love to be on the go, working.”

UHS includes Bertie Memorial Hospital, Chowan Hospital, Duplin General Hospital, Heritage Hospital, Outer Banks Hospital, Pitt County Memorial Hospital, Roanoke-Chowan Hospital and physician practices and is affiliated with the Brody School of Medicine at East Carolina University.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Monday, August 25, 2008

Philippines NBI raises alarm on child-organ trafficking

I found this news report very disturbing and shocking. Merv.

From ABS CBN News:

The National Bureau of Investigation alerted the public on Sunday over the rampant smuggling of human organs in the Philippines. The NBI said smugglers are now targeting childen who are kidnapped and taken abroad where their organs are sold to foreign nationals.

The human smugglers, whose usual buyers are Middle Eastern nationals, allegedly abduct children and house them somewhere in Mindanao.

Lawyer Ferdinand Lavin of the NBI's Human Trafficking Division said the victims are provided with vitamin supplements to keep their internal organs healthy. He said the victims will then be transported outside the country to undergo surgery for organ transplants.

"Children are being kidnapped and they are housed somewhere in the south, then they will be transported outside the country for organ sale," the official said.

He said that the selling of human organs has become uncontrollable. He cited instances when parents themselves give their children to organ smugglers in exchange for money.

"We have an increasing trend. It’s no longer a person-to-person transaction, it also advertised in the Internet,” Lavin said.

Lavin said that aside from children, Filipinas seeking domestic jobs abroad are sometimes duped by their recruiters for slavery and prostitution. With a report from Ron Gagalac, ABS-CBN News

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Sunday, August 24, 2008

Rising Tide of Obesity in America Continues Unabated

Obesity

"An estimated two-thirds of the entire U.S. adult population is overweight or obese, and an estimated 23 million children fall into one of the two categories."

What does obesity have to do with organ transplantation? you may say. It could lead to heart disease requiring a heart transplant, kidney disease requiring a kidney transplant or liver disease requiring a liver transplant. And the list goes on and on. For a list & photos of 9 types of diseases caused by obesity click here.

From medpage TODAY:

By Emily P. Walker, Washington Correspondent, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

WASHINGTON, Aug. 20 -- Despite efforts to stem the surge of obesity in America, the problem worsened in much of the country last year.

So found the Trust for America's Health, which reported that adult obesity rates increased in 37 states and no single state managed to slim down its total percentage of overweight people.

Nine more states joined the ranks of those with 25% of its citizens classified as obese, bringing the total to 28, reported Jeffrey Levi, Ph.D., and colleagues.

The fifth annual F as in Fat: How Obesity Policies are Failing in America report concluded that although many promising policies have emerged to promote physical activity and good nutrition in communities, "they are not being adopted or implemented at levels needed to turn around this health crisis.

im Marks, M.D., a senior vice president of the Robert Wood Johnson Foundation, a partner in the report, said that "with each and every year we see more and more evidence that our nation's obesity epidemic continues to gain speed and destructive force."

Eleven of the 15 states with the highest obesity rates are in the south, whereas the northeastern and western states continued to have the lowest obesity rates.

The report named Mississippi the most obese state, followed by West Virginia, Alabama, Louisiana and South Carolina. The leanest states were Colorado, Hawaii, Connecticut, Massachusetts and Vermont. Colorado was the only state where less than 20% of its population was obese -- not far behind at 18.4%.

An estimated two-thirds of the entire U.S. adult population is overweight or obese, and an estimated 23 million children fall into one of the two categories. The report did not measure obesity rates of children.

Alongside the rise in obesity, type 2 diabetes rates grew last year. According to the report, four states now have diabetes rates that are above 10%, and all 10 states with the highest rates of diabetes and hypertension are in the south.

According to the report:

  • Adult rates for type 2 diabetes have grown from 5.2% in 1980 to more than 8% now. Approximately 20 million Americans have type 2 diabetes, and another 54 million more have pre-diabetes, putting them at high risk for developing diabetes.

  • After years of declines in heart disease and hypertension through the development of new medical treatments and drugs, these problems are experiencing a resurgence. One in four Americans has some form of heart disease, and one in three Americans has high blood pressure.

  • Obesity and overweight are contributing factors to over 20 chronic diseases, including some cancers, arthritis, and even Alzheimer's disease and dementia.

  • Increasing evidence shows that maternal obesity adds major complications during pregnancy, putting babies at increased risk for preterm birth and infant mortality.

  • Obese children and teenagers are developing diseases that were formerly only seen in adults. For instance, approximately 176,500 individuals under the age of 20 have type 2 diabetes, and two million adolescents ages 12 to 19 have pre-diabetes. Obese and overweight children are more likely to become overweight, and obese adults are on a track for poor health throughout their adult lives.

  • Overall, this generation of children could be the first to have shorter, less healthy lives than their parents.


The culprits for the rising obesity rates are the usual suspects-eating more and exercising less, said Dr. Marks.

While the calorie-exercise equation is easy to grasp, the economic and political factors that feed into overeating prove more nuanced, he said.

For instance, the dearth of grocery stores in poor neighborhoods drives people living in those areas to buy calorie-laden packaged food from convenience stores. Seven of the 10 states with the highest obesity rates are also in the top 10 for highest poverty rates.

The researchers also blamed illogical diet and fitness policies on driving the epidemic.

For instance, despite all 50 states and the District of Columbia having laws about physical education and activity in schools, only four states have any penalties for not complying.

Researchers said that Medicaid programs in 10 states do not cover nutrition assessment and counseling for overweight and obese kids, while 20 states don't cover assessment and consultation for overweight and obese adults.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Saturday, August 23, 2008

Fears over organ transplant ban

From Religious Intelligence:

By: Roberto Sanchez Guevara.

A decision by the Egyptian Doctors' Union to ban organ transplants between Christians and Muslims has raised fears that it will encourage greater sectarian tension.

"All Egyptian have the same blood, and if the reason for the measure is to prohibit trafficking in organs, we reject it because it can also occur between faithful of the same religion," said a spokesmen for the Coptic Church. The Church thinks the decision of the Union is ‘very grave’ because it may lead to other steps such as "banning blood donations between Christians and Muslims or prevent a doctor to examine a patient of a different religion."

The spokesman expressed fears for what the decision could do in hospitals and for relations between Christians and Muslims. The Coptic Church represents 10 per cent of the population of Egypt.

Under the new instructions from the Union -- almost dominated by the Islamist group the Muslim Brotherhood -- organ donation between Christians and Muslims is also banned. Any doctor who violates the rule and allow such operations will be questioned and punished by the Union.

"Everything is to protect poor Muslims from rich Christians: they buy their bodies and vice versa," said the director of the Doctors' Union, Hamdi El Sayed. The ban aims to "prevent any attempt to deceive the sick and steal their organs, especially if it occurs between Christians and Muslims, in this case because it opens the door to a crisis between the two communities” he said.

However, for some leaders of the Muslim institution of al-Azhar, the most prestigious in the Arab world, the new measure will encourage more religious tension.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Friday, August 22, 2008

Civitan Club provides affordable housing for lung transplant patients

NOTE: THE FACILITY MENTIONED BELOW NO LONGER EXISTS: FOR POSSIBLE FINANCIAL ASSISTANCE WITH HOUSING IN ONTARIO PLEASE CONTACT ANN MCGUIRE: annmcguire@rogers.com or Telephone 416-233-3614.

The Toronto Lung Transplant Civitan Club's major community service project has been to raise enough money to acquire affordable accommodation for out-of-town patients who must live near Toronto General Hospital (Ontario, Canada) while waiting for a lung transplant. Some patients wait for months or years before they get the call for their "Gift of Life". - (read the CBC News Report about the plight of Marilyn MacKay of Nova Scotia who has spent her life savings, over $20,000, waiting in Toronto since August, 2007 for her lung transplant).

I am very happy to report that the Civitan Club's dreams have finally been realized. Linda Lycett and her group have my heartfelt congratulations. I'll let Linda, double-lung recipient, tell the story in her own words:

"Hi Merv
After all these years of fundraising and ripping out our hair, I am happy to let you know that the condo units have finally come to fruition, and we will be housing patients by mid-September.

They are located a block and a half north of #7 Highway on Kipling Avenue in Woodbridge. We got the keys this weekend, and will be going out next week to pick out all the furnishings. We were extemely lucky to have 8 twin beds donated by Kingsdown Bedding and a substantial gift card from Hudson's Bay Company. (We decided on twin beds because the support person is not always a spouse).

Some of the other clubs and the patients have donated dishes, microwaves, etc. and we have also had some very generous monetary donations that we will be able to put directly into the rest of the furnishings. We are going to put a large TV in the living room and one in each bedroom. The common area - kitchen, living room and dining room will be shared, but they will have their own bedrooms and washrooms, running down each side. There is also a laundry room and large balcony in each unit.

This has been very exciting, and although it seems to have been a long time coming and an unbelievable amount of organization and work, it is finally becoming a reality.

Ursula Dignard, the Social Worker with the Lung Transplant Group has been giving patients my name and number to call regarding Rental Applications and we have two couples ready now who are waiting to move in. If you are aware of any patients who are in the process of moving to Toronto and looking for reasonable accommodation, please feel free to have them call me* and I will send them out an application. The rent will be $675.00 and this will include all utilities - hydro, telephone, internet, etc. *(e-mail me for Linda's contact info - Merv.)

If you need any more information, please feel free to get in touch with me at any time, but I thought with your wide range of contacts and patients, you may be able to pass this on for us.
Linda Lycett."

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Thursday, August 21, 2008

Nova Scotia considers additional funding for out of province transplant patients

From The Chronicle Herald, Halifax, N.S., Canada:

By The Canadian Press


Nova Scotia is considering what it can do to help defer the costs of patients waiting out of province for procedures such as lung transplants, the province's health minister said Thursday.

Chris d'Entremont confirmed the options included looking at additional funding for such things as living expenses.

"We're looking at the numbers right now," d'Entremont told reporters outside the weekly cabinet meeting.

He said a review was underway to determine where money could be found to fund what would be a "drastic policy change" that could cost tens of millions of dollars.

The minister said with thousands of Nova Scotians having to go outside the province for surgeries and treatments tough decisions would have to be made if more help is offered.

"Are we going to cover airline tickets, the hotels or the extended long stays like a double lung transplant recipient? We need to really look at that and really have an idea of what kind of costs and what other programs we're going to maybe have to put on hold in order to cover it."

D'Entremont said that he wasn't sure how long such a review would take, but added that if more help where to become available it wouldn't be in the immediate future.

"We're not ruling it out, but we're taking our time to look at it correctly," he said. "It would probably have to be in another budget year because it is a large item."

Nova Scotia currently pays for operations and medical costs for patients waiting for lung transplants, but only Newfoundland and Labrador covers other items such as travel and accommodations.

The program in that province provides up to $2,200 per month towards a patient's living expenses as well as money to cover air travel so spouses can visit.

Nova Scotia has been feeling heat over the issue after media reports about a double lung transplant patient from Cape Breton who maintains she may have to return home without her operation because of high living expenses in Toronto. (read the CBC News Report about the plight of Marilyn MacKay who has spent her life savings, over $20,000, waiting in Toronto since August, 2007 for her lung transplant)

D'Entremont said the province was continuing to explore ways to help patients through various associations and community fundraising initiatives.

Read a follow-up article in the Aug. 22 issue of The ChronicleHerald.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Wednesday, August 20, 2008

Brief intermission

I'll be away for a few days and will resume regular posts this coming weekend. Meanwhile, please browse previous articles and links. Thanks, Merv.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Tuesday, August 19, 2008

Quebec's transplant stand lacks heart

From The Gazette, Montreal, Canada:

Quebec is within its rights to opt out of the newly announced plan to reorganize Canada's organ-donation system. Health falls under provincial jurisdiction, and if the provincial government wants to put jurisdiction before other considerations, legally it's on solid ground.

But jurisdiction should not be the guiding principle when it comes to patient care. What's best for the patient should be. Quebec should therefore provide very compelling reasons for opting out of an honest attempt to build a cohesive, collaborative pan-Canadian organization for organ donation and transplantation.

No such explanation is in sight - beyond saying that since it runs its own blood supply, it should handle organ donations and transplants the same way, alone. But Héma Québec, the blood agency, was Quebec's response to the tainted blood scandal, a set of unique circumstances that don't apply to the question of a transplant agency.

Defenders of Quebec exceptionalism argue that because the real problem is a chronic shortage of donated organs, reorganizing a dysfunctional system isn't going to work.

But one of Canada's foremost transplant surgeons, Phil Halloran, has long argued that centralizing Canada's fragmented system will improve the system's ability to deliver. In a TV interview last year Halloran, who is also editor of the American Journal of Transplantation, criticized the fact that Canada's organ transplant system is organized by province. Halloran said as many as 1,200 Canadians a year were dying because they could not get the life-saving organs they needed.

"It's quite a balkanized system and some parts of it in some regions are probably not functioning the way they should be functioning," he added, calling for a central body to promote organ donations, establish standards, collect data and distribute organs.

Quebec ought to be part of this effort. There is a great deal of room for improvement across the country, including in Quebec. By year's end 2007, there were 4,195 Canadians waiting for organ transplants. (More than 1,000 Quebecers were waiting in 2006, even though our current donor rate - 17.9 per million for deceased donations - compares favourably with the Canadian average of 13.5.)

Nothing Quebec says it can do on its own - co-ordinate with other provinces, prioritize its waiting list, encourage people to sign donation cards - couldn't be done better as part of a larger organization.

We want to believe that politics is not playing a role here, but in the absence of any compelling reason to pull out, that's all that's left. What a waste.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Saturday, August 16, 2008

Horseback Charity Ride for children

I always have a soft spot in my heart for initiatives that help provide financial support for organ transplant patients. It's my pleasure to promote Phil and Patty Dawson's efforts to help kids with their medical expenses.

From WTVQ, Lexington, KY:


They are a couple on a mission to help America's children and they are doing it by horseback.

Phil Dawson and his wife Patty were in Lexington Friday. It's the latest stop on their "Ride America" tour.

The couple has taken turns riding their horses Jet and Billy since May 1st, when they left a state park in Idaho on their way to a state park in Richmond, Virginia.

It's a journey of nearly three thousand miles all to raise awareness and money for children who suffer from long term illnesses.

"Those waiting on heart transplants, organ transplants and these are the kids that don't get as much funding to take care of their financial needs, you know their medical finances," says Phil Dawson.

The Dawson's plan to reach Richmond, Virginia sometime in October.

If you want more information about their trip or want to donate money to their cause: American Fundraisers.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Friday, August 15, 2008

Infant Heart Transplants Raise Questions on Criteria for Death

From Bloomberg.com:

By Nicole Ostrow

Aug. 14 (Bloomberg) -- Doctors have reignited a debate over when an organ donor should be declared dead after a study reported on the first three known successful cardiac transplants from infants who were pronounced dead after their hearts stopped.

The research, published by the New England Journal of Medicine, reported on transplants from babies whose hearts had stopped after life support was removed. Infant donor hearts usually are removed only after the child is considered brain dead, which has limited the number of hearts available for infant transplant.

About one-fourth of babies needing heart transplants die before organs become available. The finding that a heart that irreversibly ceases to beat in one infant can be restarted and give new life to another raises ethical and medical questions about donor death, doctors said in three commentaries in the journal. The U.S. now has 44 infants awaiting heart transplants.

The findings ``open the door'' to heart transplantation following cardiac death, wrote Robert Veatch, a professor of medical ethics at Georgetown University in Washington, in a commentary in the journal accompanying the study. They also raise the question: ``When can death be pronounced on the basis of loss of heart function?'' he wrote.

A declaration of cardiac death requires that the cessation of function of the heart and circulatory system be irreversible. To ensure a viable heart from a cardiac death donor, procurers of organs try to minimize the time from when a heart stops to when death is pronounced. Death usually isn't pronounced for at least two to five minutes after the heart stops, the journal article said.

Current data suggests that cardiac arrest becomes irreversible in 60 seconds or less, according to a 2000 report by the Institute of Medicine.

Speed is Critical

In the transplant study, the time between cardiac death and pronouncement of death for one infant was 3 minutes. For two other donors, it was 1.25 minutes. Physicians not involved in the care of the heart recipients, with the consent of the babies parents, decided to end mechanical life support that had been keeping the infants alive, the article said.

The three transplants were done at the Denver Children's Hospital from 2004 to 2007. All three recipients are still alive, according to the study.

``The fact that the children did reasonably well suggests that this could be a viable technique if people wish to use it,'' said Jeffrey Drazen, editor in chief of the New England Journal of Medicine, in an Aug. 12 telephone interview. The study ``raises significant issues concerning the use of organs in the setting of both the pediatric and even the adult intensive care,'' he said.

The commentary authors called for review of current transplant rules.

Defining Death

``It may ultimately be deemed acceptable to amend either the dead donor rule or the brain-based definition of death,'' Veatch said in his commentary. ``But whether or not any such legal changes come to pass, any successfully transplanted heart cannot have come from a person who was declared dead on the basis of irreversible stoppage of the heart.''

Robert Truog, professor of medical ethics at Harvard University and author of one of the commentaries, said it was wrong to conclude from the study that doctors are ``doing something unethical.''

``We sort of set ourselves up for people to believe that the dead donor rule is a fundamental and inviolable principle that we need to follow in the ethics of organ transplantation,'' Truog said. ``The worrisome thing that people might take away from the study is that doctors are doing something unethical in order to increase the number of organs for transplantation. That would be the wrong conclusion.''

Irreversible Heart Death

Mark Boucek, the study's lead author and director of cardiovascular services at Joe DiMaggio Children's Hospital in Hollywood, Florida, said cardiac death of the donors was irreversible because parents had decided they didn't want the children to be resuscitated.

The hearts were restarted in other babies because there was nothing wrong with the organ in the donors, Boucek said.

``It's simplistic to say that a heart that can't work in one individual can't work in another individual. It depends on the environment that the heart is working in,'' Boucek said in an Aug. 12 telephone interview.

More than 6,000 children have received transplanted hearts from donors who were declared brain dead over 25 years, according to the study. Children who need a heart face higher risk of dying while awaiting a transplant than kids waiting for other organs, the researchers said.

Three-Year Study

Over the three-year study, 12 potential donors who died from cardiocirculatory causes were identified. If their hearts had been used, the number of transplants at Denver Children's Hospital would have increased 70 percent during that time, the study said. During those years, one pediatric heart donor was declared brain dead. No other newborns' hearts could be harvested under traditional criteria at the hospital, according to the study.

``It's terribly frustrating to lose a child while awaiting transplant,'' said Boucek. ``I'm hopeful that the study will make it possible for children or at least infants to have more donor organs and for more children to have the opportunity at life.''

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Thursday, August 14, 2008

Specialist blasts 'inadequate' organ donor proposal for Canada

From The Globe & Mail:

By ANDRÉ PICARD

The plan to revamp Canada's organ donation system is "pitifully inadequate" and a "national disgrace" says one of the world's leading transplant specialists.

Phil Halloran, editor-in-chief of the American Journal of Transplantation, said the new system - which was announced on Tuesday by provincial health ministers - was designed by bureaucrats without adequate consultation from the public or transplant specialists.

"People are dying because of the inadequacy of our current transplant system so why aren't we reaching out to find the best solution? Why is this being done secretly in the smoke-filled backrooms?" Dr. Halloran said yesterday in an interview from Sydney, where he is attending the World Transplant Congress.

He is also critical of the fact that Canadian Blood Services has been charged with overseeing a national transplant system and that a stand-alone agency was not created, as is the case in Australia, Britain and the U.S.

"Imagine if they asked a bunch of transplant people to run the blood transfusion system. That would be laughable," said Dr. Halloran, who is also director of the Alberta Transplant Applied Genomics Centre in Edmonton.

He added that the $35-million investment in revamping the organ donor system is paltry.

By contrast, Britain recently invested the equivalent of $200-million and Australia $150-million.

"This is a joke. But it's not a joke for the Canadians who are dying," he said.

Lori West, an internationally renowned pediatric cardiac surgeon and president of the Canadian Society of Transplantation, said she shares some of those concerns, but prefers to see the announcement as a big improvement over what currently exists and the foundation for building a new system.

"This is clearly a major step forward toward providing comprehensive organ transplant services to Canadians," she said in an interview from Sydney.

Dr. West added that a consultative meeting planned for September should focus on looking beyond the bureaucratic structures and determining how the organ donation and transplantation system can be improved coast to coast.

"A nationally cohesive approach is crucial," she said.

Graham Sher, CEO of Canadian Blood Services, anticipated some of the criticism. "There are questions - and appropriately so - about what this new system will be," he said.

Dr. Sher said CBS has expertise in information technology and in managing the complex system required to collect and deliver blood to hospitals around the country, functions that are similar to those required for a good organ donation and transplant system.

"We don't see blood and organs as similar products because they're not. But there is a service delivery model in place that can be taken advantage of to improve the organ donor system," he said.

"This is in no way, shape or form a power grab," Dr. Sher said.

The starting point of the new system will be the creation of new electronic registries to facilitate the sharing of organs between provinces and to make it easier for individuals to donate. CBS will also launch education campaigns to promote organ donation and undertake other initiatives, but only after consultations with provincial transplant agencies, transplant specialists and patients, he said.

Bill Barrable, executive director of B.C. Transplant, said CBS has the potential to vastly improve the organ donor system in Canada by complementing and co-ordinating the work of provincial transplant agencies.

But it is essential for CBS to remain focused on specific tasks and to be "clear and transparent" with the public, transplant surgeons and provincial agencies alike, he said.

At the end of 2007, there were 4,195 Canadians awaiting organ transplants, according to the Canadian Organ Replacement Register. By contrast, only 2,188 transplants were performed during the last year.

A report prepared last year by Dr. Halloran estimated that as many as 1,200 Canadians a year were dying because of bureaucratic shortcomings and mismanagement in the organ donor system.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Wednesday, August 13, 2008

At Least Half Of All Kidney Transplant Recipients Benefit From Drug Level Testing To Prevent Organ Rejection

From Medical News Today:

Data presented at the 22nd International Congress of The Transplantation Society provides further direction to transplant doctors to test the immunosuppression drug levels of patients who are most at risk of rejecting their transplanted organ. The data, a follow-up analysis of the FDCC* study of 901 kidney transplant recipients, shows that the active component in CellCept, mycophenolic acid (MPA), should be measured in 'at risk'patients.

"By measuring the dependable levels of MPA we identified that patients with less than 30mg*h/l were more likely to reject their organ in the first month after transplantation and this trend was even more pronounced in 'at risk' patients," commented Dr. Teun van Gelder, Internist-Nephrologist, Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands. "Therapeutic drug monitoring (TDM), as the measure is known, allows doctors to alter the dose of CellCept and deliver the optimal immunosuppression needed to prevent rejection. We're now seeing an increased interest and acceptance of TDM in clinical practice to ensure more transplants are successful," he added.

Immunosuppressive therapy is life-sustaining and lifelong for most transplant patients. Finding the best possible balance between providing sufficient immunosuppression to prevent rejection whilst minimising the side effects associated with the use of more toxic anti-rejection drugs, such as calcineurin inhibitors (CNIs) and steroids, is a key goal in transplant medicine.

The introduction of CellCept containing regimens has allowed doctors to reduce the dosage of these more toxic drugs, but some patients may need higher doses of CellCept to prevent organ rejection.

Annually, it is estimated that 70,000 transplants are carried out world-wide, but over 130,000 people are currently on the transplant waiting list. This underscores the importance of preventing any unnecessary loss of a transplanted organ.**

'At risk' patients are generally considered to have:

  • Delayed function of the transplanted organ

  • Second or third transplantation

  • Raised levels (>15%) of naturally circulating defence antibodies, which play a role in initiating rejection

  • Low donor/recipient compatibility

*The FDCC study findings are supported by the results of two similar trials investigating low-dose CNI or CNI-free CellCept based regimens. The OptiCept trial found that a reduced level of CNI with a therapeutic monitored dose of CellCept is not inferior to that of a fixed-dose of CellCept and the standard-dose of CNI. The Spare the Nephron study showed that a CellCept-based regimen in combination with sirolimus is associated with improved renal function when compared with the CellCept-based regimen in combination with CNIs; this improvement was seen without increasing the risk of acute rejection.

Read the complete article for information on the studies and the role of Roche in transplantation.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Tuesday, August 12, 2008

Canadian organ donation and transplantation streamlined in new national system

From CNW:

Patient/donor registries and $35 million in new funding will save lives


OTTAWA, Aug. 12 /CNW Telbec/ - Federal, provincial and territorial ministries of health announced today a combined investment of $35 million over the next five years to create an integrated national system to significantly improve organ donation and transplantation in Canada.

Under the new funding arrangement, the Canadian Council for Donation and Transplantation (CCDT) has merged with Canadian Blood Services, which has expanded its mandate and operations beyond blood services and into organ and tissue donation and transplantation.

Provinces and territories, except Québec, will provide half the total funding, and jurisdictions will collaborate with Canadian Blood Services in the creation of three priority national registries to more quickly match patients and donors across Canada.

"National and provincial registries are critical tools for clinicians and patients. These investments mean we will be able to offer hope and save more lives," said Alberta Minister of Health and Wellness Ron Liepert, on behalf of the provinces and territories.

"Health Canada is pleased to have financially supported the excellent work of the CCDT over the last six years. This work has served to identify key priorities and solutions for improving the coordination of organ and tissue donation and transplantation across Canada, and to bring us to this new juncture," said Tony Clement, Federal Minister of Health.

Health Canada's support to Canadian Blood Services ($3.58 million per year for five years) is targeted for public education and awareness, support for leading clinical practices and system performance improvement, and the development of a strategic plan.

"Canadian Blood Services takes seriously our new responsibilities for donation and transplantation in Canada, and will work closely with organ and tissue stakeholders in moving the work of the CCDT to action," said Dr. Graham Sher, Chief Executive Officer of Canadian Blood Services.

Ministers of health strongly encourage all Canadians to consider organ and tissue donation and discuss their wishes with family. Canadians from diverse communities can make the life saving choice to become organ donors.

About Canadian Blood Services

Canadian Blood Services is a national, not-for-profit charitable organization that manages the blood supply in all provinces and territories outside of Quebec and oversees the country's OneMatch Stem Cell and Marrow Network. A dedicated team of about 4,600 staff and 17,000 volunteers enable us to operate 41 permanent collection sites and more than 20,000 donor clinics annually. Canadian Blood Services is a non-governmental organization, howeverthe Provincial and Territorial Ministers of Health provide operationalfunding, and the federal government, through Health Canada, is responsible forregulating the blood system. For more information, please visit our Web site.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Monday, August 11, 2008

First U.S. patient to receive new heart device doing well at University of Michigan

From: University of Michigan Health System:

National trial aims to help heart failure patients survive until transplant, and may offer lower clot risk and less blood damage than earlier heart devices

ANN ARBOR, Mich. — Anthony Shannon made history on July 30. That’s when he became the first person in the United States to receive a new type of experimental and very high-tech heart-assist device. Called a DuraHeart, it was implanted in his chest, and connected to his failing heart, to help pump his blood and keep him alive.

Shannon, a 62-year-old from Livonia, Mich., is doing well less than one week after the operation, which was performed by a team led by surgeon Francis Pagani, M.D., Ph.D. at the University of Michigan Cardiovascular Center. Shannon is the former director of homeland security and emergency management for Wayne County, Mich., and holds a Ph.D, in public administration.

The DuraHeart, made by an Ann Arbor, Mich.-based company called Terumo Heart Inc., uses advanced magnetic-levitation technology. This “maglev” approach, as it is called, means that a crucial, constantly revolving part within the hockey puck-sized implanted device never touches the walls of the pumping chamber.

Instead, it levitates in the middle, suspended in a magnetic field and pushing blood along. The battery-powered device pushes blood from the heart to the body, taking over most of the function of the left side of a severely weakened heart.

As a result, DuraHeart may cause less damage to blood cells and be less likely to allow dangerous blood clots to form, compared with other heart-assisting devices that use mechanical pumps. It has already been used in 70 patients in Europe, where it received approval for commercial use in 2007 after a clinical trial.

Now, heart failure patients at U-M and other centers across the U.S. will have the opportunity to volunteer for a clinical trial of the DuraHeart, which is being co-led by Pagani and by Yoshifumi Naka, M.D., Ph.D., from Columbia Presbyterian Hospital in New York. U-M is the national training center for the trial, which is funded by Terumo Heart, and teams from Columbia and the University of Louisville have already traveled to Ann Arbor to learn how to implant the device.

“The DuraHeart gives us a new, third-generation option for patients with advanced heart failure who need help to allow them to survive until they can receive a heart transplant,” says Pagani, who leads the U-M Center for Circulatory Support.

He has led other national clinical trials of heart-assist devices, including the HeartMate II, which in April received approval from the U.S. Food and Drug Administration after a clinical trial. U-M now offers heart failure patients nearly a dozen different options to support their heart function, including heart transplants.

“This trial will test the DuraHeart’s potential to overcome some of the issues that have been seen with other devices, including hemolysis caused by shear stress on red blood cells, and clotting risk caused by blood that does not circulate rapidly enough from all areas of the chamber,” Pagani explains. “It also remains to be seen if this device offers superior durability, which might make it useful as a destination therapy that could remove the need for a heart transplant.”

Shannon, whose heart has been weakening for nearly 20 years after a heart attack and clogged arteries damaged part of his heart muscle, is one of 5.3 million Americans with heart failure.

Although not all heart failure patients are candidates for a heart-assist device or a heart transplant, tens of thousands could be. At any given time, as many as 4,000 Americans are on the waiting list for a heart transplant, but only 2,100 people receive new hearts in the U.S. each year because of a shortage of suitable donor organs. Hundreds of people each year die while waiting for a heart.

In the past 20 years, many devices have been developed to help the heart pump. Most have been left-ventricular assist devices or systems, sometimes referred to as LVADs or LVASs. But others have assisted the right side of the heart or both sides – collectively, such devices are called VADs.

The therapy has become common enough that hospitals can now apply for accreditation as certified VAD centers, an indication of their experience in implanting the devices and taking care of patients before and after they receive their device. This spring, U-M became one of the first few such accredited VAD centers in the nation.

The DuraHeart was invented and developed by a team led by Chisato Nojiri, M.D., Ph.D., the chief executive officer of Terumo Heart. More than a decade of research and development has led to this clinical trial and the trial in Europe, as well as a trial in Japan that may begin later this year. Pagani serves as an unpaid consultant to Terumo Heart.

The clinical trial will enroll 140 patients in a prospective, non-randomized fashion, and up to 40 hospitals may eventually take part. All of the devices are being made in Ann Arbor at Terumo Heart.

To implant a DuraHeart device, the surgeon diverts blood flow from the ailing left ventricle of the heart into a titanium tube that leads into the pumping chamber. The magnetically levitating impeller, a flat magnetic disc, acts as a paddlewheel, turning constantly as it is magnetically attracted to the turning motor within the pump housing. This pushes blood into a flexible artificial blood vessel, which is connected to the large blood vessel called the ascending aorta.

By assisting the weak left ventricle, which is the heart chamber most commonly affected by heart failure, the DuraHeart allows the heart muscle to rest. It also provides better blood flow to the body, brain and organs than a weak heart ever could – which helps patients prepare for the arduous surgery of a heart transplant.

Devices such as the HeartMate II and its predecessor HeartMate XVE, and potentially the DuraHeart, may become substitutes for heart transplants over time. They may allow patients to live for years with help from the device, or to recover enough heart function that they no longer need either a device or a transplant. The HeartMate XVE is already approved for this type of “destination” use, and the HeartMate II is currently in a clinical trial for this purpose.

The DuraHeart may hold the same potential, says Pagani, but first it must be tested as a bridge to transplantation. With Anthony Shannon as the pioneer, that test has now begun.

For information on the U-M Cardiovascular Center, visit umcvc.org or call 1-888-287-1082. For more on the DuraHeart trial, visit this page.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Sunday, August 10, 2008

Young transplant recipient competes in Dream Walk

From chealth.canoe.ca:

By Aedan Helmer
Thomas Quinet politely declines an interview request, passing the phone to his father Marc, while his mom navigates Hwy. 401's dense thicket of weekend traffic.

The 11-year-old can be forgiven.

He needs to grab some well-deserved rest between competing in the Canadian Transplant Games in Windsor, and this morning's Dream Walk for the Starlight Starbright Children's Foundation.

The last time Thomas took part in the walk, which sets out from Dow's Lake at 10:45 this morning, he was wheelchair-bound.

Suffering from chronic cystic fibrosis, Thomas needed every ounce of strength he could muster to complete the 5 km route.

Then, in October, his dream was realized.

He became a successful recipient of a double lung transplant at SickKids Hospital in Toronto.

Today, he will come full circle with Starlight Starbright, shedding his wheelchair and striking out along the course on his own two feet.

He has become a vocal spokesman for the foundation, as well as for organ awareness and for the Cystic Fibrosis Foundation.

ROLE MODEL

He's become a role model for hundreds of kids along the way, and his courage has become an inspiration to his father.

"It's really given us a unique perspective, and we've really helped to support each other," said Marc Quinet.

Last year, Marc found himself in the hospital, diagnosed with advanced melanoma.

He didn't have to look far to find the courage he needed.

"Because Thomas had exposed us so much to the hospital environment, I wasn't at all intimidated, and he helped me a lot through the process," said Marc.

"He's been a tremendous personal inspiration and he's a real inspiration to other kids as well."

Much has changed for Thomas and the Quinet family since last year's Starlight Walk.

"Before, we couldn't go anywhere without having a portable wheelchair on board, and it was basically because he was zapped," said Marc.

"(Today), he won't be complaining about being tired so much as he'll complain about being sore -- he's played a lot of sports this week."

Thomas will proudly display the medals he won at this year's Transplant Games. He won gold in his age category in badminton, and collected two bronze medals in table tennis and five-pin bowling.

"If he feels tired, then that's his limit. But if he feels okay, he's free to push on," said Marc.

"He's only limited by as much as he feels he is."

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Saturday, August 09, 2008

Irish double-lung transplant teen back on the farm

From Independent.ie:

By Louise Hogan
SAVING the hay may be a chore, but it's the sort of work teenager Paul Minchin would scarcely have been able to dream of doing a year ago.

It's just over 12 months since the 19-year-old from Bagenalstown, Co Carlow made history by becoming the first cystic-fibrosis patient in Ireland to undergo a double-lung transplant.

The young farmer has enjoyed his time since the vital operation by immersing himself in life on his family's farm.

The first anniversary of his five-hour operation in the Mater Hospital passed by in a flurry of activity on the farm as they rapidly cut, baled and stored the hay.

"I was nearly too busy to celebrate," he laughed, but there are still plans for a night out with some old school friends.

Paul has been in "great form" in the year since the operation in which he was provided with two new lungs, but he admits that the recovery has been gradual.

A year ago, he would not have been able to work outside on the farm -- with his diminishing condition he had started to use a breathing apparatus 24 hours a day.

But now Paul says he also has another ambition he hopes to fulfil next year -- a return to the hurling pitch alongside his brothers who play for the Ballinkillen senior team.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

Friday, August 08, 2008

Treatment may reduce organ recipients' need for drugs

From CTV News:

Scientists have developed a new treatment for organ transplant patients that may eliminate the need for long-term drug therapy to stop their bodies from rejecting the new organ.

German researchers have found that a cocktail of infection-fighting white blood cells from the transplant recipient and cells from the donor reduced or eradicated the need for immune-suppressing drugs.

In the study, researchers injected the cocktail of the transplant acceptance-inducing cells (TAICs) into organ recipients prior to or after the transplant procedure.

The findings are published in the August edition of the journal Transplant International.

The researchers said that transplant recipients have always been required to take a number of drugs to prevent their immune systems from rejecting the new organ.

However, those drugs don't always prevent rejection of the organ over a long-term period, and they can cause severe side effects.

"That is why our use of transplant acceptance-inducing cells (TAICs) in kidney transplant patients is such an exciting development, as it could eventually offer patients who have had transplant surgery a much higher quality of life, free from complex drug regimes," lead study author Dr. James A. Hutchinson, from the University of Schleswig-Holstein in Kiel, Germany, said in a statement.

"Although our use of TAICs is still in the preliminary stages, the results of our clinical trials on 17 kidney transplant patients are promising."

The study had two phases.

In the first phase, researchers gave 12 kidney transplant patients TAICs as well as conventional drug therapy to reduce the likelihood of organ rejection after their surgery.

Ten of the 12 patients were weaned off the conventional drugs over an eight-week period, with six of them being weaned down to tacrolimus monotherapy, a low-dose drug regime that has fewer side effects.

In the second phase, five kidney transplant patients received TAICs before their operations.

One of the patients went eight months without any conventional anti-rejection drugs, while three others were weaned to the tacrolimus montherapy.

The patients in both phases did not report any major side effects.

"Our research clearly shows that infusing TAICs into patients before they have a kidney transplant, or after the procedure has been carried out, is a practical and safe clinical option," Hutchinson said.

"Although this procedure is still being developed and refined, it poses an exciting possibility for clinicians and patients alike."

(Read a related article about a U.S. study in ScienceDaily)

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation