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President's Blog

April 18, 2012 Posted by rgaston

Almost everything we do in transplantation is more tightly regulated and monitored than a decade ago. It strikes me that some of this is warranted, some maybe not. Our field, evolving after implementation of the Medicare ESRD program and development of cyclosporine, has always been more closely scrutinized than other areas of medicine. The benefits? Standardization of clinical care has improved outcomes and the burden of regulation has favored larger programs better equipped to deal with it.. Our experience should also be informative to those likely to face new stresses in dealing with...

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April 09, 2012 Posted by rgaston

The latest iteration of an ongoing debate over the propriety of compensating live organ donors is now transpiring in the pages of the AJT (12:306-12, 2012 with letters to follow). Current law in the US, the National Organ Transplant Act of 1984, outlaws “valuable consideration” in organ donation. Some defend the present scheme by decrying the impurity of introducing financial considerations into the process and noting the abuses associated with unregulated systems elsewhere. Others note that financial considerations already exist with recipients and providers all profiting from donor...

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March 28, 2012 Posted by rgaston

In 1986, my father, a radiologist, advised me not to go into transplantation; his 60’s vintage medical education taught him “that stuff never works.” By the time he passed away in the mid-90s, Dad knew better. How ironic that even now, a quarter century later, so much misinformation remains regarding what it is we do. The Dick Teresi article/book regarding “the ice-water test, beating heart cadavers” and “blurring the line between life and death” resurrected long-ago-disproven factoids and half-truths in a very public forum, forcing us all to defend the ethics and science underpinning...

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March 22, 2012 Posted by rgaston

Hearings are currently underway in the Congress regarding NIH funding for 2013. Francis Collins, NIH Director, was on The Hill Tuesday, the 20th, vigorously advocating against a proposed 8% budget cut for next year. AST, via our skilled Washington representatives and public policy committee, has already played a key role helping drum up support for additional NIH funding. We are an original signee of a letter to Congressmen Rehberg and DeLauro and Senators Harkin and Shelby from the Ad Hoc Group for Medical Research, and have signed on to a joint letter with ASN and ASPN (among other...

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March 15, 2012 Posted by rgaston

I know many of you have been disturbed by an article in Saturday’s Wall Street Journal (March 10, Life and Culture, What You Lose When You Sign That Donor Card, by Dick Teresi). Quite frankly, the article is so far outside the bounds of informed discussion regarding organ donation that it is difficult to know how to respond. A little background: Teresi is an author who writes about life and science, always provocatively. The article appeared in the book review (not OpEd) section of the WSJ, immediately preceding the launch of Teresi’s latest book earlier this week. Obviously, it was...

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March 08, 2012 Posted by rgaston

Most of us involved clinically are living with some degree of uncertainty regarding the implications of health care reform (ACA of 2010, Obamacare) on transplantation. Certainly, the exact impact remains unknown, with some positive and some negative effects likely. I would refer you to the excellent articles by Axelrod, Millman, and Abecassis (AJT 10: 2197-2207, 2010) for a flavor of what might be coming.

Thus far, in reviews of what should comprise the “essential health benefit” (EHB) to be included in all standard coverage, transplantation fares very well. Most, if not all,...

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February 28, 2012 Posted by rgaston

In discussions with many of you, it has become obvious in recent years that many transplant centers are redefining their structure away from a traditional medical/surgical model towards some integrated, multidisciplinary unit. To be involved in transplantation means we all understand the importance of “team” in making something this complex and wonderful happen for our patients. However, most academic institutions are very “siloed” in structure, with those involved in transplantation not necessarily reporting to leaders that understand transplantation. In today’s economic environment, it...

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February 22, 2012 Posted by rgaston

Last week's blog was written in anticipation of the SRTR-sponsored consensus conference on PSRs; I appreciate the responses received, including one from an old friend in a fairly prominent position who chose to reply personally. Was a very interesting meeting, with lots of open discussion and almost... but not quite... too much mathematics for me. Bottom line, SRTR, under its previous and current contractors, has produced a product unrivaled in American medicine. This was acknowledged by government, industry, and clinicians alike: our ability to collect and analyze accurate outcomes data...

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February 13, 2012 Posted by rgaston

A challenge of serving as your President is the constant whir of changing responsibilities. Last week, the NEJM article and “immuno” legislation. This week, I will be representing AST as workgroup chair in a Consensus Conference on Transplant Program Quality and Surveillance, sponsored by SRTR. This is being held in Washington, DC, with a primary focus on addressing the Program Specific Reports (PSRs). Basically, since creation a few years ago by SRTR, with availability to the public at www.srtr.org, PSRs have become very controversial. If their purpose...

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February 03, 2012 Posted by rgaston

Lack of dependable access to long-term immunosuppression is the Achilles’ Heel of American kidney transplantation. A legal remnant of now-disproven assumptions, the federal policy of discontinuing Medicare eligibility three years after a kidney transplant places thousands of recipients at risk each year, and is a major cause of graft failure. This policy also prevents countless potential recipients from even considering a transplant due to fears of financial ruin.

While AST and other groups have advocated for a rational end to this policy for years, an article published online...

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