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President's Blog

June 13, 2012 Posted by rgaston

This year’s ATC in Boston was an overwhelming success in terms of attendance and quality of presentations, but even more for the positive “buzz” regarding the future of our field that seemed to permeate almost every session. I hope many of you were able to attend our 30th Anniversary Celebration, June 4th. If you were there, you would have heard how healthy our society is after 30 years, with over 3000 members, sound financial footing, and ready to address the new challenges ahead. You could have watched Roz Mannon effortlessly assume the gavel as our new President for 2012-13....

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May 11, 2012 Posted by rgaston

ATC is fast approaching, and with it the end of my term as your President. Our goals at this time last year were to improve our use of technology (witness…the blog, making AJT accessible from our website, electronic voting) and increase collaboration with other groups interested in transplantation (ASTS, ASN, ESOT, ISHLT, et al). Our presence in Washington continues to bear fruit and expand, and we are trying to deal strategically with each of our other targeted areas: organ donation, research, membership, and education. What suggestions do you have for AST leadership as we approach...

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April 30, 2012 Posted by rgaston

On Friday, April 27, I represented AST at a Northwestern/ASTS/AST sponsored consensus conference on donor-transmitted diseases, specifically HIV, HCV, and HBV. These are the infections addressed in the recent draft Public Health Service guidelines now undergoing comprehensive revision. The discussion was vibrant, and the topic important. However, between 2007-11, a five-year period during which organs from over 39,000 donors were utilized, there were 20 proven or probable transmissions from 9 deceased donors in the United States! Transmission from living donors is even rarer (a potential...

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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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