Category: Transplantation

Financial Status a Barrier to Organ Transplantation But Not Donation.

It is easier to give than to receive in the transplant world.

organ donationIn a comment added to a recent article about the current financial status of Catholic Health Initiatives (the parent company of KentuckyOne Health) it was alleged that Jewish Hospital in Louisville did not accept Medicaid patients for organ transplantation. Because of the seriousness of this allegation, I was reluctant to allow it to stand without further comment. I therefore did some research and elicited comments from involved parties. The results trouble me and highlight yet another major example of the disparity of access to health care in our inherently unfair non-system, dividing Americans as it does by socio-economic status. In the case of transplantation, the operational result is particularly ugly, because the weight of government regulation and community has given us a morally indefensible result analogous to the rich stealing organs from the poor. I call this an example of the “Reverse Robin Hood” nature of America’s National Health System! Neither Jewish Hospital nor UofL are responsible for this situation, but have benefited from it. Continue reading “Financial Status a Barrier to Organ Transplantation But Not Donation.”

UofL Hires New Director for Bone Marrow Transplant Program.

One program or two?

I had not planned on writing quite so soon about bone marrow transplantation, but in doing my background work on U.S. News & World Report’s designation of the James Graham Brown Cancer Center as a regional high-performing cancer program, I learned that the Center has just recruited a new director for their bone marrow transplant program. Dr. William Tse is an experienced clinician and academician, was recruited from West Virginia University, and will begin in Louisville in early November. This was a fast, high-priority recruitment for the University of Louisville and the Brown Cancer Center following the loss of several clinical and research faculty faculty to the University of Kentucky, and a requirement for a minimal number of specifically-trained physicians to retain essential accreditation. Bone marrow transplantation, part of the growing field of cellular or stem-cell therapy, currently plays important part in the treatment of leukemia and other malignant diseases, and of inherited genetic disorders. Cellular therapy comprises a prominent part of the University’s commercial research portfolio.

Things looking up?
I had the opportunity to speak with one of the program’s current physicians who is optimistic about the future of the program. Although I was not given the updated procedure numbers for the two programs, I am told that they are on the way back up, as are are the numbers of clinical research protocols planned. Here is a chart updated with numbers of bone marrow transplants in 2013 as reported to the state. Continue reading “UofL Hires New Director for Bone Marrow Transplant Program.”

Crunch Time for UofL Bone Marrow Transplantation Program.

bmt-ky-1999-2012For the 30 years in which I have been associated with the University of Louisville, it’s bone marrow transplantation program has been a feather in its cap and that of the James G. Brown Cancer Center. The University of Louisville Hospital holds the Certificate of Need (CON) for adult bone marrow transplantation in Louisville – one of the tiny handful of programs that other local hospitals could not take away or did not want. Therefore I was concerned when I began to hear of doctors-lounge gossip that the program was going through a difficult patch. Unfortunately, a review of publicly available information validates my concern. Continue reading “Crunch Time for UofL Bone Marrow Transplantation Program.”

Does Donating a Kidney Increase the Risk of Kidney Failure For a Living Donor?

How good are we doctors in conveying the concept of risk to our patients and our community?

I recently met someone who donated a kidney to a person who was not a relative. My impression was that the recipient was previously a stranger, but I did not press that issue. I was overwhelmed by the staggering generosity of that gift. I am embarrassed to say that I do not know how I would respond if I were asked to donate.

Shortly afterwards in the impossibly large volume of medical journals that crosses the desk of even a retired physician, and proving the hypothesis that a person only sees what they are prepared to find, I noticed a research paper estimating the risk of kidney failure in a donor following the removal of one of the normal pair. The risk does not appear to be zero. I want to use that paper as a base to continue writing about conveying the results of medical studies and of risk to the public.

Why did Mother Nature Give Us Two Kidneys?
In medical school, and in common public wisdom, it is universally recited that we only need one of our two kidneys to live. That is true. As it happens though, there is little or no information about whether we would live as long or as well! It is known that as people age, there is an expected gradual decline in kidney function. It happens sooner and faster in people with hypertension, diabetes, and so on. It is reasonable to speculate that if starting out from a half-normal position, that a single remaining kidney might run out of steam sooner without it’s helpmate. The best way to definitively settle the matter would be to randomly divide in half a group of people who had committed to donate, only allow one group to do so, and then follow the lives of both groups to see if the donors develop kidney failure more frequently than the donor wanna-bees. I do not see that experiment happening, but the information would be relevant to a person deciding whether or not to donate. Continue reading “Does Donating a Kidney Increase the Risk of Kidney Failure For a Living Donor?”