Transplantation: Issues and Controversies

Titte Srinivas

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Jesse Schold

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We are delighted to introduce a series of articles that address select areas of controversy in kidney transplantation in this issue of ASN Kidney News. These articles, which provide provocative views on contentious topics, are authored by some of the leading thinkers in the field. One of the key driving forces behind this special edition on transplantation was to elicit thoughtful yet uninhibited information and commentary beyond what is already available at scientific meetings or in peer-reviewed journals. These articles tap into the core of some of the intellectual discourse among many academicians, industry leaders, and policymakers in the field of kidney transplantation.

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Dr. Richard Howard provides an insightful overview of increased regulatory oversight, a contentious issue facing kidney transplant centers. He points out how the increased regulatory oversight of kidney transplant performance has led many centers to question the utility of these evaluations. Dr. Howard then discusses some of the unintended consequences that may result from this oversight, in particular, the potential impact on many patients who may be deemed “too risky” to transplant.

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Dr. Curtis provides a highly provocative and sobering perspective on efforts to implement a new kidney allocation system for deceased donor organs, while Dr. Stegall discusses the merits that may be associated with changes to current policies of organ allocation. Dr. Ojo shares his experienced perspectives on changes and failures in efforts to ameliorate well-known disparities in care for renal disease patients with a focus on racial issues.

Drs. Page and Woodward present important research regarding the impact of availability of long-term financial coverage of immunosuppression medications for renal transplant recipients, an issue especially relevant in today’s economic climate. Drs. Augustine and Dharnidharka provide two perspectives on the increasing prevalence of immunosuppressive regimens without maintenance steroids in kidney transplantation. Finally, Dr. Foley discusses the important issue of potential risks to living donors and the evidence that exists concerning higher risk living donors.

And, to kick off our coverage, take a look at the data snapshots here. These visual displays address important metrics such as yearly trends in numbers of living versus deceased donors and donor type by age. This synopsis will help put many of these important issues into perspective.

Please join us online at www.asn-online.org in discussing these important issues. From May 18 to June 3, ASN will host an online forum, “Discuss and Debate” on the articles “New Kidney Allocation Policy: God Squad Resurrection. . . Or Allocating a Scarce Medical Resource?” We look forward to your comments.