Transplantation

Host: Mark Nolan Hill, MD

Guest: Arthur Matas, MD

Our system for procuring organs in the United States is based on altruism, but unfortunately, this approach continues to leave supplies short of demand, creating a shortage in transplantable organs that causes unnecessary deaths. As a means to meet the demands in other countries around the world, various forms of payment have been considered, and some are in use today. Dr. Arthur Matas, professor of surgery and director of the renal transplant service at the University of Minnesota Medical School, explains how the concept of financial incentives for organ donation could be received by the American populace and within the medical community. Toward this end, how would a large-scale clinical trial, yet to be conducted on this model, help us to evaluate our options in the United States? Dr. Mark Nolan Hill hosts.

Host: Mark Nolan Hill, MD

Guest: Arthur Matas, MD

Since the mid-1970s, all 50 states have afforded citizens an opportunity to donate their organs for transplantation after death, either by signing the back of their drivers' license or through an organ donation card. Yet our supply of organs remains woefully short of demand for transplantation. What if we took steps, as many countries around the world have, to make organ donation near-mandatory? Dr. Mark Nolan Hill welcomes Dr. Arthur Matas, professor of surgery and director of the renal transplant service at the University of Minnesota Medical School, to weigh the effects of a ‘presumed consent' program for organ donation. In which countries has this practice brought a notable increase in organ donation, and what might be the pitfalls for such a program in the United States?

Host: Mark Nolan Hill, MD

Guest: Mark Boucek, MD

For years, we have performed pediatric heart transplants following the declaration of brain death in donors. To this point, those who die of cardiovascular complications have not been considered for heart donorship. How are advances in this area forcing us to reconsider the prospect of a heart transplant after cardiocirculatory death? Host Dr. Mark Nolan Hill considers the potential ramifications of this fascinating investigation with Dr. Mark Boucek, director of pediatric cardiovascular services at Joe DiMaggio Children's Hospital in Hollywood, Florida, and the lead author of research published in the New England Journal of Medicine on three cases of pediatric heart transplantation after cardiocirculatory death. Does this successful restarting of the heart in transplant recipients suggest that the donor's heart stoppage was not irreversible?

Host: Maurice Pickard, MD

Guest: Armand Antommaria, MD, PhD

Donation of the heart after asystole leads to questions about the point at which death is irreversible. Dr. Armand Antommaria, assistant professor in the division of pediatric inpatient medicine and an adjunct assistant professor in the division of medical ethics and humanities at the University of Utah School of Medicine, discusses the ways that pediatric cardiac transplant surgery may be pushing controversial organ-retrieval strategy beyond acceptable legal, moral, and ethical boundaries. Hosted by Dr. Maurice Pickard.

Host: Mark Nolan Hill, MD

Guest: Valluvan Jeevanandam, MD

The Chicago metropolitan area is home to five adult heart transplant centers, equal to Philadelphia for the most in one city in the United States. Some say this figure is a tribute to the determination of Chicago's hospitals to collectively become a national leader in heart transplantation. Others believe this is a serious strategic gaffe. What are the key policy questions at hand? Dr. Valluvan Jeevanandam, professor of surgery and chief of cardiothoracic surgery at the University of Chicago Pritzker School of Medicine, talks with host Dr. Mark Nolan Hill about the process of developing a transplant facility at a medical institution.

Host: Mark Nolan Hill, MD

Guest: Valluvan Jeevanandam, MD

Heart transplants are among the most complex procedures in medicine. Without performing transplants on a consistent basis, it is argued that transplant teams may not be able to maintain the utmost level of precision requisite for care. In cities like Chicago, which has five transplant centers, are there factors preventing one or more of these hospitals from achieving the highest standard of care? Is there an efficient way to remedy the prospective dilemma for Chicago and other urban centers in a similar situation? Host Dr. Mark Nolan Hill considers the potential value of redundancy among these programs, and whether there is an ideal number of transplant centers for a major metropolitan area, with Dr. Valluvan Jeevanandam, professor of surgery and chief of cardiothoracic surgery at the University of Chicago Pritzker School of Medicine.

Host: Maurice Pickard, MD

Guest: Gary Becker, PhD

Dr. Gary Becker, Nobel laureate and professor of economics and sociology at the University of Chicago, joins host Dr. Maurie Pickard to discuss the connection between the gap in supply and demand in the economic market and the same gap in the organ transplant market. Dr. Becker presents a solution and answers the critics.

Host: Maurice Pickard, MD

Guest: Gary Becker, PhD

Nobel Prize recipient for Economic Science, Dr. Gary Becker, professor of economics and sociology at the University of Chicago, explains how monetary incentives would sufficiently increase the supply of organs for transplant surgery, eliminating the very long queues in the donor market. Undoubtedly the suffering of those on the waiting list would be significantly decreased, but are there costs that might not be immediately obvious? Join Dr. Becker and host Dr. Maurie Pickard for this fascinating discussion.

Host: Leslie P. Lundt, MD

Guest: Julie Salamon

We know graft-versus-host disease is a common complication in transplant patients. How can this also be happening at an institutional level? Julie Salamon's recent book, Hospital-Man, Woman, Birth, Death, Infinity Plus Red Tape, Bad Behavior, Money, God and Diversity on Steroids, offers a glimpse of her year-long journey through Maimonides Hospital in Brooklyn, New York. Ms. Salamon joins host Dr. Leslie Lundt to discuss the complex cross-cultural implications of 21st century American medicine.

Host: Maurice Pickard, MD

Guest: Benjamin Hippen, MD

Dr. Benjamin Hippen speaks about the Iranian system that allows an individual's kidney to be sold by the donor, whom we can also think of as the vendor. Examination has shown that the recipients are on a level playing field and there is no tourism or fraud. The responsibility for recruiting potential vendors becomes separated from the responsibility for approving the vendor's medical and surgical candidacy. But moral concerns in the US may have to be resolved in the future by a hybrid system that combines features of both systems.