RESEARCH & EDUCATION
RESEARCH & EDUCATION
CTI DIRECTOR SPEAKS TO NATIONAL ACADEMIES COMMITTEE
In July 2021 , UAB Comprehensive Transplant Institute Director Jayme Locke , MD , MPH , participated in a public listening session conducted by the National Academies of Sciences , Engineering , and Medicine Committee on Deceased Donor Organ Procurement and Allocation . The committee hearing was focused on creating a fairer and more equitable organ allocation system by recommending certain actions to the U . S . Department of Health and Human Services ( HHS ), which oversees the system .
A February 2022 report on the hearing recommends addressing racial and other disparities , reducing nonuse of donated organs , reducing or eliminating variation in the performance of transplant centers and organ procurement organizations , and helping ensure unity in goals , policies , and processes .
Within 12 months , HHS should eliminate race from clinical equations used in allocating organs , the report recommends . The report also considered geographic disparities , urging that patients be added to the organ waiting list on a national , continuous basis rather than by regional geographic location . Other recommendations call for HHS to reach an annual volume of 50,000 transplanted organs by 2026 – that figure was about 41,350 in 2021 – and reduce nonuse rates for donated kidneys to 5 % or less , from 20 % currently .
“ We have to make our processes more nimble ,” Dr . Locke told the committee . “ I think everyone in this system , no matter who we represent , is extremely well-intentioned . But when we get it wrong , we have to own it and do better .”
UAB STUDYING HCV + KIDNEY DONATIONS
The UAB Comprehensive Transplant Institute ( CTI ) is making increasing use of organs from donors who are hepatitis C-positive ( HCV +), thanks to curative treatments for the virus developed last decade . A new , multicenter study led in part by UAB Nephrologist Shikha Mehta , MD , and involving six other U . S . medical centers seeks to more thoroughly evaluate the process and help overcome the stigma that continues to surround the use of HCV + kidneys .
The CTI has performed over 60 kidney transplants from HCV + donors since completing its first in November 2019 . The CTI also has transplanted HCV + hearts and livers in HCV-negative patients , and the procedure is now available for all organs . Up until several years ago , most HCV + donor organs went discarded , though some are used in recipients – with informed consent – who also are HCV + and in patients who do not have the virus but are willing to accept the organ despite its viral status . The practice has accelerated with the unfortunate rise in drug overdose deaths , which often affect younger people with comparatively healthy organs .
The study is titled , “ A trial of transplanting Hepatitis C-viremic kidneys into Hepatitis C-Negative kidney recipients ” ( THINKER-NEXT ). The study ’ s goals include validating several single-center studies , providing evidence to help expand insurance coverage for such transplants , and evaluating the informed consent process .
“ The overarching goal of this study is to demonstrate the safety and efficacy of utilizing HCV-viremic kidneys for transplantation in HCVnegative patients with end-stage kidney disease ,” says Dr . Mehta , principal investigator for the study at UAB . “ We hope to address critical knowledge gaps about utilizing HCV-viremic kidneys , such as the impact on renal function and the possibility of another infection . We add 35,000 patients with end-stage kidney disease to the kidney waitlist annually and transplant about 16,000 patients every year , but 8,000 patients either die or become too sick for transplant and are removed from the waitlist . One of the key barriers to transplantation is the shortage of organs , so we hope this study will reduce the discard of transplantable kidneys and create wider acceptance for utilizing these organs , among both providers and patients .”
18 UAB CTI Report