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...
Read More...
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...
Read More...
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...
Read More...
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...
Read More...
January 30, 2012 Posted by rgaston
Many of you who read this blog are already actively involved in supporting organ donation, but as we all know, the shortage of transplantable organs persists as the major limitation in our field.
On June 29, 2011, HHS and HRSA launched the Workplace Partnership for Life (WPFL) Hospital Campaign. This initiative builds on the success of existing workplace partnerships with more than 11,000 companies and organizations already participating in a broad donor awareness effort, created in 2001—the “Workplace Partnership for Life.”
AST has joined the WPFL Hospital Campaign as...
Read More...
November 23, 2011 Posted by rgaston
I don't want to get too optimistic, but our Public Policy team in Washington has assembled strong, bipartisan support for the Immunosuppression bill now introduced in both the Senate and House. With each new look at the legislation, its cost is coming down, and with a Congress sorely in need of bipartisanship, this just may be our best chance ever at ensuring access to immunosuppression for the life of the allograft. Will passage of this bill make a difference for your patients? How much does cost influence your decisions about transplant candidacy? Selection of immunosuppressive regimen...
Read More...
November 02, 2011 Posted by rgaston
We have recently become aware of pending CMS regulations regarding relationships between centers where living donor organs are recovered and centers where the organs are transplanted. This was the subject of a conference call on October 28 that was widely attended. The essence of the new regs is that the transplanting center holds at least partial responsibility for standards at the recovery center. You can access the proposal here. AST...
Read More...
October 14, 2011 Posted by rgaston
As some of you may be aware, the issue of donor-derived disease transmission has become very hot in the field. On September 21, proposed new guidelines from the Public Health Service regarding donor testing for HIV, HCV and HBV were released for public comment in the Federal register. In general, in an attempt to completely eradicate infectious risk, the guidelines propose NAT testing of essentially all donors (living and deceased) in...
Read More...
October 06, 2011 Posted by rgaston
This week in Stockholm, the 2011 Nobel Prize in Physiology and Medicine was awarded to Bruce Beutler, Jules Hoffmann, and Ralph Steinman (posthumously) for their work in defining the roles of dendritic cells and the innate immune system in immunologic responses. Even a clinician like me appreciates the significance of these discoveries, and the rapidly evolving understanding of their role in alloinjury. While working primarily in tumor immunology, these visionary scientists remind us of the interplay between the lab and the clinic; nowhere is this interplay more important than...
Read More...
October 03, 2011 Posted by rgaston
Today brought the sad news of the passing of Charles Bernard Carpenter over the weekend. Dr. Carpenter, or "Bernie" to his many friends, was a Professor at Harvard Medical School, one of the founding members of AST, and served as our 2nd President (1983-84). By my count, Bernie was directly or indirectly involved with training at least a half dozen AST past presidents and many, many past or current board members. His accomplishments over three decades at the helm of the Laboratory of Immunogenetics and Transplantation at the Brigham and Women's Hospital are legendary. Truly one of the...
Read More...
