New Procedure Allows Kidney Transplants from Any Donor | Hacker News Reader

New Procedure Allows Kidney Transplants from Any Donor

nytimes.com

158 pointsesturk35 comments

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.

Thanks for being a donor, much appreciated by those who were given a new life and their families.

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...

I can imagine this is a problem for many potential donors. As a software dev, I was on vacation for three weeks. Of course, I mainly sit and type while I work and have unlimited vacation.

But I can definitely see this being a problem for those who are not as fortunate in their work.

I scheduled mine over the holidays, and it worked out very nicely. Additionally, it meant I was around my family for any necessary support during recovery. All in all, it was very smooth.

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

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.

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?

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...

Just curious, is their similar restrictions to donating organs as there is to donating blood? Such as homosexuality?

It probably varies by country, but no. The blood donor restrictions (which also include travel, tattoos etc) are far more "blunt" due to the low levels of interaction with the donor and so on.

Donating organs as a live donor is a process including full medical records, batteries of tests and long interactions with medical professionals.

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.

This, along with the new cataracts surgery that no longer requires an artificial lens be inserted (the cataract is removed, and stem cells are used to grow a new lens within your body), makes it feel like there is such velocity in biomedical research right now. Exciting times!

It sure beats all those articles that end with "We should see clinical trials within five years", meaning it's going to be decades before it hits the clinic.

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).

Article says you could theoretically do it with lungs and liver, but it's less necessary because you don't have much antibody response to the specific organs (versus, say, the "normal" immune response you will always have from transplanted tissue).

Bone marrow transplant is a totally different situation since the new bone marrow has the immune system of the donor. This leads to the bone marrow rejecting the recipient, rather than the other way around. Called graft vs. host disease.

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/...

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

Very nice video. Thanks

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?

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.

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.

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.

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

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

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.

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.

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).

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!

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."

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.

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.

You mean an organ registry? That exists already.

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.

Reply on news.ycombinator.com