To facilitate the matching of internal medicine residents with nephrology fellowship training programs, nephrology first participated in the Electronic Residency Application Services (ERAS) in 2006 and the Medical Specialties Matching Program (MSMP) in 2007. MSMP—part of the larger National Residency Matching Program—is a service that pairs residents with available fellowship positions. Currently, 10 internal medicine specialties participate in MSMP (Table 6.1).
In 2011, continuing the downward trend that has plagued the nephrology fellowship match in recent years, the fewest number of residents applied for positions than in any year since the ASN first joined the MSMP (1
From boom to bust, the projections for the physician workforce in the United States reverse every 20 years. In the 1960s, experts projected a shortage of 40,000 physicians by 1975. During the 1980s and 1990s, some of the same experts predicted a surplus of up to 165,000 physicians by 2000. A few years ago, the country was expected to face a shortage of 55,000 physicians by 2020 (1). But with last year’s passage of the Affordable Care Act (ACA), which extends coverage to the uninsured, the country is now projected to need an additional 91,500 physicians by 2020
Policies governing the allocation of deceased donor organs must incorporate numerous factors, which are often very difficult to satisfy in a simultaneous manner. These policies can have a significant impact on patients’ lives, but we must carefully consider objective factors such as logistical operations and efficient resource allocation along with more subjective constructs such as equity and justice.
Perhaps an even more difficult challenge is to prospectively consider possible unanticipated changes in behavior by patients and caregivers that may arise from these policies. For certain, any changes in policy should be considered deliberately and conscientiously, with the best information available
A wide array of ethical issues comes into play regarding renal transplantation after prior solid organ transplantation. They include concerns about prevention and access. One must first understand the scope of the problem. The prevalence of chronic kidney disease (CKD) among prior non–renal organ transplant (NRTx) recipients is between 80 percent and 100 percent for those who survive three years. The more advanced stages of CKD, types IV and V, occur in 5–20 percent of patients by five years after NRTx, and they vary according to the type of transplant. CKD is lowest in heart–lung recipients and highest in intestine
In recent years, the 60- to 80-year-old age group on the kidney transplant waiting list has increased dramatically, decreasing their chances of ever receiving a kidney. Yet studies show that even those older than 70 can decrease their chance of death and increase the length of their life with a kidney transplant.
Evaluating elderly patients for a transplant should be an “exaggeration” of evaluating younger patients, said Gabriel Danovitch, medical director for the Kidney and Pancreas Transplant Program at the University of California, Los Angeles. Physicians should rule out coronary artery disease, other cardiovascular disease, and cancer. Patients should also
Kidney transplants are being performed in an era when higher-risk donor organs are being used. One could expect, given this scenario, that posttransplant renal function and graft survival would be adversely affected.
Refreshingly, recent studies show that kidney transplant function in the United States has improved in recent years, as has also graft survival.
In a study using Scientific Registry of Renal Transplant Recipients data from more than 90,000 recipients who underwent transplantation between 2003 and 2008, the estimated GFR 6 months after transplant averaged 54.3 mL/min/1.73 m2 (1). The decline in GFR between 6 and
Unrelated living donors in the United States have increased to the point where they were the most common category in 2009, most likely because of swaps and chains, said Gabriel Danovitch, medical director for the Kidney and Pancreas Transplant Program at the University of California, Los Angeles.
The total recipient pool reflects the populations undergoing dialysis; white persons form the largest category, followed by African American, Hispanic, and then Asian persons. But the donor pool reflects the demographics of the national population, meaning that African American and Hispanic individuals are overrepresented recipients and underrepresented donors. Danovitch believes that this largely
Three years ago, Garet Hil’s daughter’s kidneys failed, and he and his family entered a desperate race to find a living donor for her, including asking 100 family and friends to be tested and entering into every paired organ exchange program that existed in the United States. After several months of angst, they found that Hil’s 23-year-old nephew was a compatible match.
“We dodged the bullet, but it showed me that the United States needs a system to get all incompatible pairs into the database,” to facilitate as many matches between living donors and recipients as possible, Hil said. So
The call had come. A donor was identified for 18-year-old Tim. His path to transplantation was not the smoothest, but in many ways, it was perhaps quite typical. He had received a diagnosis of Alport syndrome at a young age. Throughout his adolescence, his engagement was poor. He had received immunosuppressive therapy for a few years, with fluctuant drug levels. He often sat through appointments without his hearing aids and would provide very little independent information.
When renal replacement therapy loomed near, his mother was intent on a pre-emptive transplant. Immediately, we had concerns about nonadherence and subsequent graft failure.
Speakers at a “Controversies in Organ Transplant Policy” session at Renal Week 2010 described a range of issues affecting both kidney donors and recipients.
Gabriel Danovitch, MD, director of the Kidney Transplant Program at UCLA, described the steps taken this year by the Declaration of Istanbul Custodian Group (DICG) to create a framework of “muscles and tendons” across the “skeleton” of the Declaration. The Declaration of Istanbul was created in 2008 by representatives of scientific and medical bodies from around the world to protect the poor and vulnerable from the negative effects of transplant tourism and organ trafficking.