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3. Re: First do no harm

Author

Yao, Jinna, primary, Lau, Howard, additional, Allen, Richard D. M., additional, Vass, Justin, additional, Vasilaras, Arthur, additional, and Pleass, Henry C., additional

Published
2022
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14. Ethical review of COVID‐19 vaccination requirements for transplant center staff and patients

Author

Kates, Olivia S., Stock, Peter G., Ison, Michael G., Allen, Richard D. M., Burra, Patrizia, Jeong, Jong Cheol, Kute, Vivek, Muller, Elmi, Nino‐Murcia, Alejandro, Wang, Haibo, and Wall, Anji

Abstract

Transplant centers seeking to increase coronavirus disease 2019 (COVID‐19) vaccine coverage may consider requiring vaccination for healthcare workers or for candidates. The authors summarize current data to inform an ethical analysis of the harms, benefits, and individual and societal impact of mandatory vaccination, concluding that vaccine requirements for healthcare workers and transplant candidates are ethically justified by beneficence, net utility, and fiduciary duty to patients and public health. Implementation strategies should mitigate concerns about respect for autonomy and transparency for both groups. We clarify how the same arguments might be applied to related questions of caregiver vaccination, allocation of other healthcare resources, and mandates for non‐COVID‐19 vaccines. Finally, we call for effort to achieve global equity in vaccination as soon as possible. An international group of authors summarizes ethical arguments on vaccine mandates in transplantation, concluding that it is ethically justifiable to require vaccination of healthcare workers and transplant candidates. Silverstein comments on page 335.

Published
2022
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17. Community preferences for the allocation and donation of organs - The PAraDOx study

Author

Howard, Kirsten, Jan, Stephen, Rose, John, Chadban, Steven, Allen, Richard D. M., Irving, Michelle, Tong, Allison, Wong, Germaine, Craig, Jonathan C., Cass, Alan, Howard, Kirsten, Jan, Stephen, Rose, John, Chadban, Steven, Allen, Richard D. M., Irving, Michelle, Tong, Allison, Wong, Germaine, Craig, Jonathan C., and Cass, Alan

Abstract

BackgroundTransplantation is the treatment of choice for people with severe organ failure. However, demand substantially exceeds supply of suitable organs; consequently many people wait months, or years to receive an organ. Reasons for the chronic shortage of deceased organ donations are unclear; there appears to be no lack of 'in principle' public support for organ donation.Methods/DesignThe PAraDOx Study examines community preferences for organ donation policy in Australia. The aims are to 1) determine which factors influence decisions by individuals to offer their organs for donation and 2) determine the criteria by which the community deems the allocation of donor organs to be fair and equitable. Qualitative and quantitative methods will be used to assess community preferences for organ donation and allocation.Focus group participants from the general community, aged between 18-80, will be purposively sampled to ensure a variety of cultural backgrounds and views on organ donation. Each focus group will include a ranking exercise using a modified nominal group technique. Focus groups of organ recipients, their families, and individuals on a transplant waiting list will also be conducted.Using the qualitative work, a discrete choice study will be designed to quantitatively assess community preferences. Discrete choice methods are based on the premise that goods and services can be described in terms of a number of separate attributes. Respondents are presented with a series of choices where levels of attributes are varied, and a mathematical function is estimated to describe numerically the value respondents attach to different options. Two community surveys will be conducted in approximately 1000 respondents each to assess community preferences for organ donation and allocation. A mixed logit model will be used; model results will be expressed as parameter estimates (β) and the odds of choosing one option over an alternative. Trade-offs between attributes wi

Published
2011

19. Surgical Morbidity of Simultaneous Kidney and Pancreas Transplantation: A Single-Centre Experience in the Tacrolimus Era

Author

Thwaites, Stephen E., primary, Lam, Vincent W. T., additional, Yao, Jinna, additional, Kable, Kathy, additional, Jenkins, Lillian, additional, Chen, Cheng, additional, Robertson, Paul, additional, Hawthorne, Wayne J., additional, Ryan, Brendan J., additional, Pleass, Henry C., additional, and Allen, Richard D. M., additional

Published
2013
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38. SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT REJECTION

Author

Hawthorne, Wayne J., primary, Allen, Richard D. M., additional, Greenberg, Merle L., additional, Grierson, Jean M., additional, Earl, Michael J., additional, Yung, Teresa, additional, Chapman, Jeremy, additional, Ekberg, Henrik, additional, and Wilson, Thomas G., additional

Published
1997
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41. Community Preferences for the Allocation &Donation of Organs - The PAraDOx Study.

Author

Howard, Kirsten, Jan, Stephen, Rose, John, Chadban, Steven, Allen, Richard D. M., Irving, Michelle, Tong, Allison, Wong, Germaine, Craig, Jonathan C., and Cass, Alan

Subjects
ORGAN donation, ORGAN donors, OLD age, SOCIAL surveys
Abstract

Background: Transplantation is the treatment of choice for people with severe organ failure. However, demand substantially exceeds supply of suitable organs; consequently many people wait months, or years to receive an organ. Reasons for the chronic shortage of deceased organ donations are unclear; there appears to be no lack of 'in principle' public support for organ donation. Methods/Design: The PAraDOx Study examines community preferences for organ donation policy in Australia. The aims are to 1) determine which factors influence decisions by individuals to offer their organs for donation and 2) determine the criteria by which the community deems the allocation of donor organs to be fair and equitable. Qualitative and quantitative methods will be used to assess community preferences for organ donation and allocation. Focus group participants from the general community, aged between 18-80, will be purposively sampled to ensure a variety of cultural backgrounds and views on organ donation. Each focus group will include a ranking exercise using a modified nominal group technique. Focus groups of organ recipients, their families, and individuals on a transplant waiting list will also be conducted. Using the qualitative work, a discrete choice study will be designed to quantitatively assess community preferences. Discrete choice methods are based on the premise that goods and services can be described in terms of a number of separate attributes. Respondents are presented with a series of choices where levels of attributes are varied, and a mathematical function is estimated to describe numerically the value respondents attach to different options. Two community surveys will be conducted in approximately 1000 respondents each to assess community preferences for organ donation and allocation. A mixed logit model will be used; model results will be expressed as parameter estimates (b) and the odds of choosing one option over an alternative. Trade-offs between attributes will also be calculated. Discussion: By providing a better understanding of current community preferences in relation to organ donation and allocation, the PAraDOx study will highlight options for firstly, increasing the rate of organ donation and secondly, allow for more transparent and equitable policies in relation to organ allocation. [ABSTRACT FROM AUTHOR]

Published
2011
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42. Colour duplex ultrasound accurately identifies focal stenoses in dysfunctional autogenous arteriovenous fistulae.

Author

CHANDRA, ABHILASH P., DIMASCIO, DELFINO, GRUENEWALD, SIMON, NANKIVELL, BRIAN, ALLEN, RICHARD D. M., and SWINNEN, JAN

Subjects
DUPLEX ultrasonography, BLOOD vessels, STENOSIS, ARTERIOVENOUS fistula, ARTERIOVENOUS anastomosis
Abstract

Aims: The aims of this study is to correlate colour duplex ultrasonography (US) with contrast fistulography for the detection of functional stenoses in the autogenous AVF (arterio-venous fistula) circuit. Methodology: Colour duplex US scans of 93 dialysis patients with dysfunctional AVF were compared with fistulograms performed within 6 weeks of the US. The AVF circuit was divided into six zones: inflow artery; anastomosis; distal vein; mid vein; proximal vein; and central vein. Colour duplex US and fistulogram images/reports were independently re-reported for stenoses in each fistula zone by two trained clinicians blinded to the outcomes. For each fistula, only zones examined by both modalities were included in the study. Kappa analysis of the results was performed to assess the accuracy of colour duplex US in the dysfunctional AVF circuit. Results: Most AVF studied were radio-cephalic (59%) or brachio-cephalic (22%). Stenoses identified within the AV circuit in order of frequency were: distal vein (41), mid vein (23), arterial (12), proximal vein (7) and anastomosis (3). The interval between US and fistulogram studies was 33 ± 29 days. Congruence of results between US and fistulograms ranged from 85% to 96%, depending on the zone examined. Kappa analysis of this US versus fistulogram data was also moderate to good, ranging from 0.72 and 0.91. Conclusions: Colour duplex US provides an accurate diagnostic assessment of a dysfunctional autogneous AVF, and is an important planning tool for subsequent open or endovascular intervention. It is particularly accurate in the peri-anastomotic area of the fistula which harbours the majority of fistula problems. [ABSTRACT FROM AUTHOR]

Published
2010
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47. Erythrocytosis after renal transplantation: Risk factors and relationship with GFR

Author

Nankivell, Brian J., Allen, Richard D. M., O'Connell, Philip J., and Chapman, Jeremy R.

Abstract

Post‐transplant erythrocytosis (PTE) has been increasingly recognized as a complication of kidney transplantation, and several risk factors have been defined. Recent evidence suggests renal function may also play a role in hematological recovery after transplantation and risk of PTE. In this study of kidney transplant recipients (n=123), simultaneous Tc99mDTPA GFR (n=710) and hemoglobin levels were compared with possible clinical determinants. The frequency histogram of post‐transplant hemoglobin was bell‐shaped and continuously distributed above and below the arbitrary definition of PTE, suggesting that PTE is not a separate disease entity. Hemoglobin reached a plateau at 12 months after transplantation and was correlated with isotopic GFR (r=0.46, p<0.001). This consistent and statistically independent relationship became prominent 3 months after transplantation. Hemoglobin was independently predicted by multivariate analysis by time after transplantation, presence of polycystic renal disease, greater serum albumin and reduced serum urea (which in turn were reflected by number of infective and rejection episodes). shorter kidney anastomosis time and a higher GFR, but not by immunosuppressive therapy. Rejection or infection episodes impaired hematological recovery. The independent determinants of GFR included hemoglobin level, kidneys from young, male donors, fewer HLA‐DR mismatches. and rejection episodes, shorter time on dialysis and greater azathioprine dose. Renal function was not altered by therapeutic phlebotomy. Determination of hemoglobin level by both donor and recipient variables supports the relevance of tubular and glomerular function in control of erythrocystosis after renal transplantation. A role for renin‐angiotensin mediation in the alteration of intraglomerular hemodynamics and erythropoietin secretion is postulated.

Published
1995
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48. CANINE PANCREAS AND KIDNEY TRANSPLANTATION FOLLOWING TOTALLYMPHOID IRRADIATION

Author

WILLIAMSON, PETER, ALLEN, RICHARD D. M., DEANE, STEPHEN A., EKBERG, HENRIK, GRIERSON, JEAN M., HAWTHORNE, WAYNE J., MEARS, DOUGLAS C., TIVER, KENNETH, LITTLE, J. MILES, and STEWART, GRAEME J.

Abstract

The effect of total-lymphoid irradiation on survival of canine pancreas and kidney allografts was studied. TLI had a marked immunosuppressive effect as measured by in vitro immune responses and reduced circulating leukocytes. Despite the changes, median graft survival times for animals treated with 800 cGy (9 days) or 1800 cGy (9.5 days) were not significantly different from untreated control animals (7 days). The addition of low-dose antithymocyte globulin (10 mg/kg/day) on post-transplant days 0, 2, 4, 6, 8, and 10 had no measurable synergistic effect. Similarly, median segmental pancreas allograft survival times after 1700–2200 cGy of TLI treatment (16.5 days) were only marginally longer than those of untreated controls (9 days). The only animal to maintain a graft for greater than 200 days was matched to the donor in mixed lymphocyte culture (MLC). This animal was able to reject a third-party skin graft after 8 days while a graft from the original donor was still surviving after 21 days when the pancreas graft failed from a chronic-type rejection. These results indicate that TLI alone or in combination with ATG will not be predictably effective as a method of prolonging allograft survival. The role of matching major histocompatibility complex antigens in TLI treatment requires clarification.

Published
1990

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