J R Thistlethwaite

University of Chicago, Chicago, Illinois, United States

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Publications (212)1033.73 Total impact

  • Lainie Friedman Ross, J Richard Thistlethwaite
    JAMA The Journal of the American Medical Association 07/2014; 312(1):94. · 30.39 Impact Factor
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    ABSTRACT: The legal concept of First Person Authorization (FPA) is based on the principle that a decision by a person with decision-making capacity should be respected even after he or she dies. Although the transplant community largely supports this concept, its implementation has not been universal. We conducted a web-based survey of all 58 OPO executive directors in the U.S. to assess OPOs’ procurement policies and practices in the context of family objections. All 58 respondents (100%) responded to our survey. All OPOs except one have an online donor registration website. Most OPOs (89%) (51 of 57 respondents) estimated that the frequency of family objecting to organ donation in cases of registered donors was < 10%. No OPOs reported the frequency to be higher than 25%. Only 50% (27 of 54) of the OPOs have a written policy on handling family objections. Approximately 80% of the OPOs reported honoring FPA. However, in the past 5 years, 20 OPOs (35%) have not yet participated in organ procurement from a registered deceased donor over family objection. Further research to identify the barriers and possible solutions to implementing FPA is warranted.
    American Journal of Transplantation 01/2014; 14(1):172-177. · 6.19 Impact Factor
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    ABSTRACT: We introduce a nonparametric survival prediction method for right-censored data. The method generates a survival curve prediction by constructing a (weighted) Kaplan-Meier estimator using the outcomes of the K most similar training observations. Each observation has an associated set of covariates, and a metric on the covariate space is used to measure similarity between observations. We apply our method to a kidney transplantation data set to generate patient-specific distributions of graft survival and to a simulated data set in which the proportional hazards assumption is explicitly violated. We compare the performance of our method with the standard Cox model and the random survival forests method. Copyright © 2012 John Wiley & Sons, Ltd.
    Statistics in Medicine 05/2013; 32(12):2062-9. · 2.04 Impact Factor
  • Lainie Friedman Ross, J. Richard Thistlethwaite
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    ABSTRACT: In this manuscript, we examine what role age can morally play in the allocation of deceased donor kidneys for transplantation into adult candidates. Our focus is on the equity concerns raised by recent proposals that give younger adults in end-stage renal disease priority to more and better deceased donor kidneys. We begin with a description of four models: the current allocation method (“baseline proposal”), the two models offered by the Kidney Transplant Committee in February 2011: a pure ±15 years age-matching model and a 20/80 proposal (http://optn.transplant.hrsa.gov/SharedContentDocuments/KidneyConceptDocument.PDF), and a new model entitled Equal Opportunity supplemented by Fair Innings (EOFI) described by Ross et al. earlier this year. We then consider the requirement of the National Organ Transplantation Act (NOTA) of 1984 that allocation policies balance efficiency and equity. The models all define efficiency as promoting graft and patient survival but use various conceptions of equity. We discuss the various conceptions of equity employed in the various models. We show that only the new proposal, EOFI, can meet the NOTA requirements using a multiprincipled equity approach to kidney allocation.
    Seminars in Dialysis 11/2012; 25(6). · 2.25 Impact Factor
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    ABSTRACT: Longer wait times for deceased donor kidney transplant have prompted newer initiatives to expedite the process. Reuse of a previously transplanted kidney might be appropriate in certain circumstances. However, one must also consider the unique issues that may arise after such transplants. We describe our experience in one such case where the donor kidney had lesions of focal and segmental glomerulosclerosis and signs of alloreactivity (positive C4d staining) prior to transplantation and the recipient developed ganciclovir-resistant cytomegalovirus (CMV) infection, which was perhaps transmitted from the donor. Despite the challenges, the allograft function remained stable 5 years after reuse.
    Clinical kidney journal. 10/2012; 5(5):434-437.
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    L F Ross, W Parker, R M Veatch, S E Gentry, J R Thistlethwaite
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    ABSTRACT: For 7 years, the Kidney Transplantation Committee of the United Network for Organ Sharing/Organ Procurement Transplantation Network has attempted to revise the kidney allocation algorithm for adults (≥18 years) in end-stage renal disease awaiting deceased donor kidney transplants. Changes to the kidney allocation system must conform to the 1984 National Organ Transplant Act (NOTA) which clearly states that allocation must take into account both efficiency (graft and person survival) and equity (fair distribution). In this article, we evaluate three allocation models: the current system, age-matching and a two-step model that we call "Equal Opportunity Supplemented by Fair Innings (EOFI)". We discuss the different conceptions of efficiency and equity employed by each model and evaluate whether EOFI could actually achieve the NOTA criteria of balancing equity and efficiency given current conditions of growing scarcity and donor-candidate age mismatch.
    American Journal of Transplantation 06/2012; 12(8):2115-24. · 6.19 Impact Factor
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    ABSTRACT: Testa and colleagues argue that evaluation for suitability for living donor surgery is rooted in paternalism in contrast with the evaluation for most operative interventions, which is rooted in the autonomy of patients. We examine two key ethical concepts that Testa and colleagues use: paternalism and autonomy, and two related ethical concepts: moral agency and shared decision making. We show that by moving the conversation from paternalism, negative autonomy, and informed consent to moral agency, relational autonomy, and shared decision making, one better understands why the arguments given by Testa and colleagues fail. We argue (1) why the hurdles that one must overcome to become a living donor are appropriate; and (2) that the similarities between living donor transplant surgery and cosmetic plastic surgery that the authors describe are inaccurate. Finally, we consider the recommendation to treat plastic surgery patients and living donors more similarly. We argue that any change should not be in the direction of becoming less protective of living donors, but more protective of cosmetic plastic surgery candidates.
    The Journal of clinical ethics 01/2012; 23(2):118-28. · 0.47 Impact Factor
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    Benjamin E Hippen, J Richard Thistlethwaite, Lainie Friedman Ross
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    ABSTRACT: The gap between the supply and demand of transplantable kidneys is growing, leaving policymakers eager to maximize the benefit of every kidney transplanted. Recently, a proposal for changing the way kidneys from deceased donors are allocated was proffered for public comment by the Kidney Committee of the Organ Procurement and Transplantation Network (OPTN).(1) Instead of continuing to use a patient's waiting time as the core determinant of allocation priority, the new system employs a "risk quantification score" called the Kidney Donor Profile Index (KDPI) combined with a calculated Estimated Post-Transplant Survival (EPTS) score in an attempt to quantify risk factors . . .
    New England Journal of Medicine 03/2011; 364(14):1285-7. · 54.42 Impact Factor
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    ABSTRACT: Influenza infection in transplant recipients is often associated with significant morbidity. Surveys were conducted in 1999 and 2009 to find out if the influenza vaccination practices in the U.S. transplant programs had changed over the past 10 years. In 1999, a survey of the 217 United Network for Organ Sharing-certified kidney and kidney-pancreas transplant centers in the U.S. was conducted regarding their influenza vaccination practice patterns. A decade later, a second similar survey of 239 transplant programs was carried out. The 2009 respondents, compared with 1999, were more likely to recommend vaccination for kidney (94.5% versus 84.4%, P = 0.02) and kidney-pancreas recipients (76.8% versus 48.5%, P < 0.001), family members of transplant recipients (52.5% versus 21.0%, P < 0.001), and medical staff caring for transplant patients (79.6% versus 40.7%, P < 0.001). Physicians and other members of the transplant team were more likely to have been vaccinated in 2009 compared with 1999 (84.2% versus 62.3% of physicians, P < 0.001 and 91.2% versus 50.3% of nonphysicians, P < 0.001). Our study suggests a greater adoption of the Centers for Disease Control and Prevention influenza vaccination guidelines by U.S. transplant programs in vaccinating solid-organ transplant recipients, close family contacts, and healthcare workers.
    Clinical Journal of the American Society of Nephrology 09/2010; 5(9):1637-41. · 5.07 Impact Factor
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    A Aronsohn, J R Thistlethwaite, D L Segev, L F Ross
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    ABSTRACT: The success of kidney and liver transplantation is hindered by a shortage of organs available for transplantation. Although currently illegal in nearly all parts of the world, a living 'donor' or 'vendor' kidney market has been proposed as a means to reduce or even end this shortage. Physician members of the American Society of Transplantation, the American Society of Transplant Surgeons and the American Association for the Study of Liver Disease were surveyed regarding organ markets for both living kidney and living liver transplantation. The survey queried respondents about their attitudes toward directed living donation, nondirected living donation, the potential legalization of living donor organ markets and the reasons for their support or opposition to organ markets. Partial or completed surveys were returned by 346 of 697 eligible respondents (50%). While virtually all supported or strongly supported directed living donation (98% and 95% for kidney and liver lobes, respectively), the vast majority disagreed or strongly disagreed with the legalization of living donor organ markets (80% for kidneys and 90% for liver lobes). Both those who support and those who oppose a legalized living donor organ market rate risk to the donor among the most important factors to justify their position.
    American Journal of Transplantation 02/2010; 10(4):931-7. · 6.19 Impact Factor
  • Lainie Friedman Ross, J Richard Thistlethwaite
    New England Journal of Medicine 06/2009; 360(22):2371; author reply 2372. · 54.42 Impact Factor
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    ABSTRACT: Although CD28 blockade results in long-term cardiac allograft survival in wildtype mice, CD28-deficient mice effectively reject heart allografts. This study compared the mechanisms of allogeneic responses in wildtype and CD28-deficient mice. Adoptive transfer of purified CD28-deficient T cells into transplanted nude mice resulted in graft rejection. However, this model demonstrated that the allogeneic T cell function was severely impaired when compared with wildtype T cells, despite similar survival kinetics. Cardiac allograft rejection depended on both CD4+ and CD8+ T cell subsets in CD28-deficient mice, whereas only CD4+ T cells were necessary in wildtype recipients. These results suggested that CD8+ T cells were more important in CD28-deficient than wildtype mice. In addition to the CD8+ T cell requirement, allograft rejection in CD28-deficient mice was dependent on a sustained presence of CD4+ T cells, whereas it only required the initial presence of CD4+ T cells in wildtype mice. Taken together, these data suggest that CD4+ T cells from CD28-deficient mice have impaired responses to alloantigen in vivo, thus requiring long-lasting cooperation with CD8+ T cell responses to facilitate graft rejection. These results may help to explain the failure to promote graft tolerance in some preclinical and clinical settings.
    American Journal of Transplantation 09/2008; 1(1):38 - 46. · 6.19 Impact Factor
  • Lainie Friedman Ross, J Richard Thistlethwaite
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    ABSTRACT: In the past half-century, solid-organ transplantation has become standard treatment for a variety of diseases in children and adults. The major limitation for all transplantation is the availability of donors, and the gap between demand and supply continues to grow despite the increase in living donors. Although rare, children do serve as living donors, and these donations raise serious ethical issues. This clinical report includes a discussion of the ethical considerations regarding minors serving as living donors, using the traditional benefit/burden calculus from the perspectives of both the donor and the recipient. The report also includes an examination of the circumstances under which a minor may morally participate as a living donor, how to minimize risks, and what the informed-consent process should entail. The American Academy of Pediatrics holds that minors can morally serve as living organ donors but only in exceptional circumstances when specific criteria are fulfilled.
    PEDIATRICS 09/2008; 122(2):454-61. · 5.30 Impact Factor
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    ABSTRACT: A United States consensus group on the live donor concluded that minors (<18 years) can ethically serve as live solid organ donors in exceptional circumstances. More recent international guidelines reject this position. Recent United Network of Organ Sharing data show that minors serve as living donors, albeit infrequently. We examined the attitudes of US physicians toward minors as living donors. Four hundred members of the American Society of Transplantation and 160 physicians from the American Academy of Pediatrics Section of Nephrology or Bioethics were surveyed. The physicians were asked whether minors should be permitted to serve as living donors and how their opinion would change depending on the twins' zygosity, age, and increased waitlist time. One hundred seventy of 436 eligible participants (39%) returned surveys. Thirty-two and 39% of respondents would permit a kidney donation between 15-year-old fraternal and identical twins, respectively (P=NS). If the wait time increased from 1 to 6 years, willingness increased to 39% and 45%, respectively (P=NS). Pediatric bioethicists were the most reluctant to prohibit minors as living donors. Approximately one-third of US physicians would permit children to serve as donors. Lengthening the wait time is associated with a trend toward greater willingness to permit minor donations. Current policies that give preferential status for a deceased donor organ to minors may help minimize donations by their minor siblings. Nontransplant physicians need education about donor risks to ensure that donations are in the best interest of pediatric donors and recipients.
    Transplantation 06/2008; 85(9):1235-9. · 3.78 Impact Factor
  • Lainie Friedman Ross, J Richard Thistlethwaite
    American Journal of Kidney Diseases 05/2008; 51(4):545-8. · 5.76 Impact Factor
  • Andrew Aronsohn, J. Richard Thistlethwaite, Donald M. Jensen, Lainie F. Ross
    Gastroenterology 04/2008; 134(4). · 12.82 Impact Factor
  • Lainie Friedman Ross, Mark Siegler, J Richard Thistlethwaite
    The Hastings Center Report 01/2007; 37(6):1 p following 48. · 1.08 Impact Factor
  • Lainie Friedman Ross, Stefanos Zenios, J Richard Thistlethwaite
    The Lancet 08/2006; 368(9532):333-7. · 39.21 Impact Factor
  • Journal of the American College of Surgeons 07/2006; 202(6):1021-4. · 4.45 Impact Factor
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    Lainie Friedman Ross, J. Richard Thistlethwaite
    American Journal of Transplantation 01/2006; 6(2):436 - 436. · 6.19 Impact Factor

Publication Stats

6k Citations
1,033.73 Total Impact Points


  • 1985–2014
    • University of Chicago
      • • Department of Pediatrics
      • • Department of Surgery
      • • Department of Medicine
      Chicago, Illinois, United States
  • 1988–2013
    • The University of Chicago Medical Center
      • • Department of Pathology
      • • Section of Transplantation
      • • Department of Surgery
      • • Department of Medicine
      Chicago, Illinois, United States
  • 2008
    • National and Kapodistrian University of Athens
      • Division of Surgery V
      Athens, Attiki, Greece
  • 1988–2004
    • University of Illinois at Chicago
      • • Department of Surgery (Chicago)
      • • Division of Transplantation
      Chicago, IL, United States
  • 2002
    • University of Tennessee
      • Department of Surgery
      Knoxville, TN, United States
  • 2001
    • Emory University
      Atlanta, Georgia, United States