J R Thistlethwaite

University of Chicago, Chicago, Illinois, United States

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Publications (221)1105.79 Total impact

  • William F Parker · J Richard Thistlethwaite · Lainie Friedman Ross
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    ABSTRACT: Background: The new deceased donor kidney allocation algorithm uses a Kidney Donor Profile Index (KDPI) based on donor characteristics to predict graft survival and divides kidneys into 4 quality groups (ie, KDPI-A, -B, -C, and -D). Pediatric kidneys constitute 10% to 12% of deceased donor kidneys. We hypothesized that KDPI would not accurately predict pediatric donor graft survival and superior predictive models could be created. Methods: Scientific Registry of Transplant Recipients data for years 2000 to 2010 for transplants from child (<10 years) and adolescent (10-17 years inclusive) donors into first-time adult recipients were analyzed with graft failure as the principle outcome. Two novel indices, Child Donor Index (CDI) and Adolescent Donor Index (ADI), were developed using stepwise variable deletion to identify significant model covariates in a Cox Regression. Pediatric donor kidneys were then classified into the 4 quality groups based on both KDPI and CDI/ADI scores. The performance of the KDPI, CDI, and ADI models were compared with respect to the 4 quality groups defined by the new allocation system. Results: The KDPI did not effectively discriminate between quality groups (P > 0.05 for all but 1 comparison) in Kaplan-Meier survival analyses. The CDI and ADI included novel variables (eg, body mass index percentiles) and successfully discriminated between quality groups (P < 0.05 by log rank test). The Net Reclassification Index showed improvement when switching from KDPI to CDI and ADI, with values of 0.09 (P < 0.001) and 0.073 (P < 0.001), respectively. Conclusions: The KDPI does not accurately predict pediatric kidney graft survival. Alternative indices can improve allocation efficiency.
    No preview · Article · Jan 2016 · Transplantation
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    ABSTRACT: Background: OPTN policy regarding "Living Kidney Donor Informed Consent Requirements" only requires general disclosure of candidate health information to prospective living kidney donors. We examined attitudes of transplant surgeons and transplant nephrologists regarding greater disclosure. Methods: Web-based and mailed surveys to explore attitudes about disclosing potential recipient health information, health-associated behaviors, and lifestyle choices to living donors. Results: Of 397 potential participants, 111 eligible participants (28%) fully or partially responded. Respondents were split between surgeons (42%) and nephrologists (58%). While 72% believed that general disclosure did not require explicit permission, 88% believed that disclosure of specific recipient information did. Many would disclose more information if legally permissible. Over 65% thought disclosure of recipient information should not depend on the donor-recipient relationship. Virtually all supported disclosing expected 1- and 5-year graft survival and anticipated deceased donor wait-time. Sixty-six percent supported disclosing non-compliance or difficulty taking medications. Support was divided for disclosure of HIV (52%), hepatitis (49%), smoking (53%), illicit drugs (50%), alcohol (49%), and psychiatric history (44%). Conclusions: While virtually all respondents support disclosing recipient information directly relevant to graft and patient survival to prospective living donors, they are divided about sharing other recipient health, health behavior, and/or lifestyle information. This article is protected by copyright. All rights reserved.
    No preview · Article · Oct 2015 · Clinical Transplantation
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    ABSTRACT: Living donor guidelines-both national and international-either do not address or are vague about what information can be shared between prospective living donors and transplant candidates, as well as when to make such disclosures and who should make them. This study explored the attitudes of donors and recipients regarding how much information they believe should be shared. Two Email invitations were sent by the National Kidney Foundation (national headquarters) to its Email listservs, inviting members to participate in an online survey to assess the attitudes of kidney transplant stakeholders regarding the disclosure of health and health risk behavior information. From approximately 4200 unique Email addresses, 392 (9.3%) respondents completed part or all of the survey. The analyses were limited to the 236 respondents who self-identified as either donors (potential and actual, n=160) or recipients (candidates and actual, n=76). Overall, 79% (186 of 234) of respondents supported disclosure of general recipient health information that would affect post-transplant outcome to donors, and 88% (207 of 235) supported disclosure of general donor health information to recipients. Recipients and donors were also supportive of sharing donor and recipient information, particularly information relevant to graft and patient survival. There is some reticence, however, about sharing social information. The closer the relationship, the more information they are willing to share. Both donors and recipients wanted the transplant team involved in the information disclosure. Over three quarters of donors (79%) and recipients (78%) did not think the recipient had a right to know why a donor was excluded from donating. Both donors and recipients want a significant amount of health information to be disclosed. The opinions of other stakeholders need to be surveyed to determine whether a revision of current policies and practices is warranted. Copyright © 2015 by the American Society of Nephrology.
    No preview · Article · Aug 2015 · Clinical Journal of the American Society of Nephrology
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    ABSTRACT: A moral liver allocation policy must be fair. Consider a two-step, two-principle allocation system called “age–mapping”. Its first principle, equal opportunity, ensures that candidates of all ages have an equal chance of getting an organ. Its second principle, prudential lifespan equity, allocates younger donor grafts to younger candidates and older donors to older candidates in order to increase the likelihood that all recipients achieve a “full lifespan”. Data from 2476 candidates and 1371 consecutive adult liver transplants (1999-2012) were used to determine whether age mapping can reduce the gap in years of life lost (YLL) between younger and older recipients. A parametric Weibull prognostic model was developed to estimate total life-expectancy after transplantation using survival of the general population matched by sex and age as reference. Life-expectancy from birth was calculated by adding age at transplant and total life-expectancy after transplantation. In multivariate analysis, recipient age, Hepatitis C status, Model for End-stage Liver Disease (MELD) score at transplant >30 and donor age were significantly related to prognosis after surgery (P<0.05). The mean (and standard deviation) number of years of life from birth, calculated from the current allocation model, for various age groups were: recipients 18-47 years (n=340) =65.2 (3.3); 48-54 years (n=387) =72.7 (2.1); 55-60 years (n=372) =74.7 (1.7) and for recipients >60 years (n=272) =77.4 (1.4). The total number of YLL equaled 523 years. Re-distributing liver grafts, using an “age-mapping” algorithm, reduces the lifespan gap between younger and older candidates by 33% (from 12.3% to 8.3%), and achieves a 14% overall reduction of YLL (73 years) compared to baseline liver distribution. In conclusion, deliberately incorporating age into an allocation algorithm promotes fairness and increases efficiency. This article is protected by copyright. All rights reserved.
    No preview · Article · Jul 2015 · Liver Transplantation
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    ABSTRACT: Background In the US, African Americans and Whites differ in access to the deceased donor renal transplant waitlist. The extent to which racial disparities in waitlisting differ between United Network for Organ Sharing (UNOS) regions is understudied.Methods The US Renal Data System (USRDS) was linked with US Census data to examine time from dialysis initiation to wait-listing for Whites (n=188,410) and African Americans (n= 144,335) using Cox proportional hazards across 11 UNOS regions, adjusting for potentially confounding individual, neighborhood, and state characteristics.ResultsLikelihood of wait-listing varies significantly by UNOS region, overall and by race. Additionally, African Americans face significantly lower likelihood of waitlisting compared to Whites in all but two regions (1 and 6). Overall 39% of African Americans with ESRD reside in Regions 3 and 4—regions with a large racial disparity and where African Americans comprise a large proportion of the ESRD population. In these regions, the African American-White disparity is an important contributor to their overall regional disparity.Conclusions Race remains an important factor in time to transplant waitlist in the US. Race contributes to overall regional disparities; however, the importance of race varies by UNOS region.This article is protected by copyright. All rights reserved.
    Full-text · Article · Mar 2015 · Clinical Transplantation
  • Lainie Friedman Ross · J Richard Thistlethwaite

    No preview · Article · Jul 2014 · JAMA The Journal of the American Medical Association
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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.
    Full-text · Article · Jan 2014 · American Journal of Transplantation
  • 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.
    No preview · Article · Nov 2012 · Seminars in Dialysis
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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.
    Full-text · Article · Oct 2012 · CKJ: Clinical Kidney Journal
  • Lainie Friedman Ross · Walter Glannon · Lawrence J Gottlieb · J Richard Thistlethwaite
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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.
    No preview · Article · Jun 2012 · The Journal of clinical ethics
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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 . . .
    Preview · Article · Mar 2011 · New England Journal of Medicine
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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.
    Full-text · Article · Sep 2010 · Clinical Journal of the American Society of Nephrology
  • Lainie Friedman Ross · J Richard Thistlethwaite

    No preview · Article · Jun 2009 · New England Journal of Medicine
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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.
    No preview · Article · Sep 2008 · American Journal of Transplantation
  • 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.
    No preview · Article · Sep 2008 · PEDIATRICS
  • Josh W Joseph · J Richard Thistlethwaite · Michelle A Josephson · Lainie Friedman Ross
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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.
    No preview · Article · Jun 2008 · Transplantation
  • Lainie Friedman Ross · J Richard Thistlethwaite

    No preview · Article · May 2008 · American Journal of Kidney Diseases
  • Andrew Aronsohn · J. Richard Thistlethwaite · Donald M. Jensen · Lainie F. Ross

    No preview · Article · Apr 2008 · Gastroenterology
  • Chapter: Rejection
    J. Richard Thistlethwaite · David Bruce
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    ABSTRACT: The mammalian immune system is specialized for the discrimination between self and nonself. The appearance of new macromolecules (or antigens) normally signifies a threat, such as an infection or malignant tumor. In these settings, the prompt destruction of antigen-bearing cells is a valuable adaptation. Unfortunately, the same defense mechanisms are also efficiently invoked by the clinical transplantation of potentially lifesaving organs.
    No preview · Chapter · Dec 2007
  • Lainie Friedman Ross · Mark Siegler · J Richard Thistlethwaite

    No preview · Article · Nov 2007 · The Hastings Center Report

Publication Stats

8k Citations
1,105.79 Total Impact Points

Institutions

  • 1985-2015
    • University of Chicago
      • • Department of Surgery
      • • Committee on Immunology
      • • Department of Pathology
      • • Section of Nephrology
      • • Department of Medicine
      • • Department of Pediatrics
      Chicago, Illinois, United States
  • 2002
    • Massachusetts General Hospital
      • Department of Surgery
      Boston, Massachusetts, United States
  • 1988-2000
    • The University of Chicago Medical Center
      • • Department of Surgery
      • • Section of Transplantation
      Chicago, IL, United States
  • 1999
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1989-1995
    • University of Illinois at Chicago
      • • Division of Transplantation
      • • Department of Surgery (Chicago)
      Chicago, IL, United States
  • 1991
    • University of Basel
      • Department of Chemistry
      Bâle, Basel-City, Switzerland
  • 1987
    • Indianapolis Zoo
      Indianapolis, Indiana, United States