
New Procedure Allows Kidney Transplants from Any Donor - esturk
http://www.nytimes.com/2016/03/10/health/kidney-transplant-desensitization-immune-system.html?&moduleDetail=section-news-4&action=click&contentCollection=U.S.&region=Footer&module=MoreInSection&version=WhatsNext&contentID=WhatsNext&pgtype=article
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scrabble
I was an anonymous living donor who kicked off a donation chain. I don't think
it's a big deal. Recovery sucked for a couple weeks, but when you consider the
benefit alongside the developments occurring in medicine all the time, it's
almost nothing.

This is fantastic news. People should not need to die while being stuck on a
waiting list. Super happy to see this news today.

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than
It's so amazing that it works! (Donor here as well.) I would love to see the
support system expanded. Even with the recipient's insurance footing the bill
for the surgery, there's still a significant burden on donors to be able to
provide the time off to do the transplant in many cases.

I'm starting with my own state to help find ways to lower that threshold for
potential donors here: [https://www.change.org/p/minnesota-state-house-give-
minnesot...](https://www.change.org/p/minnesota-state-house-give-minnesota-
living-organ-donors-a-guaranteed-week-of-paid-time-off)

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rewqfdsa
How about just paying people for their organs? Let the market work. Is that
really such a bad idea?

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nostrebored
There's a reason you can't sell your kidneys...

Poor people are the most likely to be exploited and the most likely to use
their donated organs. It's been shown that empirically economically
incentivising organ donation crowds out altruistic organ donation, a non
negligible source of supply and that those who donate for money do not
experience a long term economic benefit but do experience long term health
consequences.

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rewqfdsa
So what? That's up to them. People who buy organs are paying a fair price. Why
do you want to infantalize poor people by denying them the opportunity to
participate in the market?

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nostrebored
By ignoring the reality of the situation you create a demand for people to
cause severe risks to their health for short term problems, preying on the
least educated group of people who have a severe information asymmetry... You
also crowd out an altruistic source as it no longer becomes a societal issue
but rather an economic one.

You also create an unnecessary class problem as middle and upper class people
have access to organs, but not poor people who are the actual source of
supply...

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esturk
The procedure is called 'Desensitization' where they filter out the existing
antibodies in the patient's blood, and then infused external antibodies for
protection while the body regenerates new ones. Then the strange part is the
new antibodies are less likely to attack the donated organs which results in
more available donors for patients.

The procedure is $30k, but in the long run is cheaper than $70k for dialysis
every year. The life expectancy appears to be longer than using cadaver
organs.

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simcop2387
That's really neat, does the procedure work with other organs too? I think
something similar happens with bone marrow transplants when they kill all of
the original marrow too doesn't it (not by design but by the nature of what
you're doing).

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esturk
Yes there is a similar procedure for marrow transplants. It is called
'Haploidentical Transplant' where you only need a half match for marrow
transplants which opens the door to parents and children as donors.

The procedure requires a 'rebooting' of the immune system which is analogous
to the "remove then let it regenerate" approach mentioned in the kidney
procedure. I guess the insight comes from the immune system changing to
accomodate new organs after it reboots. Its a really interesting area of
research.

[http://www.hopkinsmedicine.org/kimmel_cancer_center/centers/...](http://www.hopkinsmedicine.org/kimmel_cancer_center/centers/bone_marrow_transplant/haploidentical_transplantation.html)

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spenuke
The Dr. Segev mentioned in the article is an awesome guy. His wife Dr. Sommer
Gentry is an operations research professor, and they worked together on this
stuff.

Here's a fun and educational video they did on the math behind transplant
matching. If you are interested in integer programming or real world
combinatorics, check it out:

[https://www.youtube.com/watch?v=ttMQECKQ3DQ](https://www.youtube.com/watch?v=ttMQECKQ3DQ)

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elviejo
Very nice video. Thanks

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ars
I wonder if the person looses all acquired immunity - for example do they need
to be revaccinated for childhood illnesses?

Just a shot in the dark: Would this help autoimmune illnesses?

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rcthompson
No, immune memory is provided by memory T cells and B cells. Losing all your
antibodies but nothing else would only leave you temporarily immune-
compromised until your body has a chance to replenish its supply.

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ars
That what I _would_ have thought. Except something is happening here that
causes things to be different.

Simply filtering out antibodies _should_ not have any effect on organ
rejection, since the antibodies are just regenerated, yet for some reason it
does.

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rcthompson
The immune system has mechanisms to rein in self-reactive immune cells (look
up anergy). My guess, in broad strokes, is that the immune response in the
absence of antibodies results in a sufficiently weak immune response that the
cells that _do_ react are flagged as "false positives" and become anergized.
Then when the antibodies return later, tolerance has already been induced
among the T-cell population, so the B-cells don't get activated, and the
immune response remains low persistently.

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ars
So that would mean 'yes' it might help with auto-immune disorders. (But no to
childhood vaccines.)

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rcthompson
Possibly, but it would depend a lot on the specifics.

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ars
Maybe I'll get in touch with the researches and ask if they might be willing
to study it.

Edit: I sent them an email asking.

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rcthompson
The problem with the autoimmune case, though, is that the immune system has
already raised and activated specific T-cells and B-cells against itself. In
contrast, your immune system can't possibly have specific defenses against a
new graft, only general defenses. It's possible that this technique only
prevents the formation of immune memory on initial exposure to a foreign
antigen but cannot erase that memory once it is formed.

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dnautics
Interesting. Dr Dorry Segev is a personal acquaintance! He also was involved
in getting congressional approval for HIV+ -> HIV+ transplants (which were
technically illegal till recently).

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jordigh
I just finished reading Parasite Eve. While the horror aspects of the novel
are questionable, I found it was a very interesting way to learn about kidney
transplants and mitochondrias. I had no idea, for example, that even with a
compatible donor the recipients have to take immunosupressants for the rest of
their lives and are always at risk of rejecting the organ.

So, it's really amazing to hear that this could be a thing of the past!

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xuhu
What's the difference between the 62.9 and the 43.9 groups mentioned in the
article ? They're both "on the waiting list".

"After eight years, 76.5 percent of those who received an incompatible kidney
were still alive, compared with 62.9 percent who remained on the waiting list
or received a deceased donor kidney and 43.9 percent who remained on the
waiting list but never got a transplant."

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blisterpeanuts
More people survived after getting the immunity suppression treatment and a
kidney transplant than those who only got a transplant. More of both groups
survived than did those who never got a transplant.

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andrewfromx
sounds like a new website that matches, those people in society that truly
want to give a kidney to a stranger for nothing but alturistic reasons, and
people who need kidneys would work. Like ebay for kidneys but less crass than
that. You could really market it just right to apeal to everyone's good side,
be an angle etc.

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nommm-nommm
You mean an organ registry? That exists already.

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andrewfromx
yeah but this new thing where anyone can donate to anyone is very new. A whole
new take on the organ registry "industry" could make a big profit.

