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#having a lot of thoughts about the potential damage alejandro could do to people by literally messing with their heads
total-drama-brainrot · 4 months
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we as a fandom don't talk enough about how alejandro literally hypnotised owen. i know it was sort of ignored post ex-files but it was. a thing that happened.
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blackley1995 · 5 years
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Readings
The Invisible Image
- This particular reading was very engaging in terms of the topic discussed, especially the projects that were mentioned in this reading. It’s also very one sided in terms of the persons opinion in preferring analogue over digital. The person does make great points which reveal the person’s love for the traditional process of analogue. Quotes like ‘It was like witnessing a spell, a revelatory moment  I will never forget’ which the person is talking about the moment they first saw a photograph being developed. Having experienced this moment myself I totally agree, being someone who has been brought up in the world of digital photography and seeing an image being developed and seeing the image slowly reveal itself is fascinating and unforgettable.
- This reading also touches upon the negative points about the process of analogue. For example, ‘Investment, frustration when a roll of exposed film is lost or damaged during the developing process’. And ‘Analogue you have to wait, digital photograph is instant’. I totally agree with the second quote but the first quote represents the ups and downs of analogue which you will have to go through at certain times. Yes analogue may become more expensive than digital over a period of time but analogue needs time, patience and most importantly perseverance which is what makes the process of analogue a special and rewarding practice. This quote sums my point up perfectly ‘The wait is happiness in itself’ (Leopold Schefer).
- This reading reveals projects that have happened in the past which represent the analogue image as being the invisible image, a mystery. Which it is really, once a film roll has been processed you are still yet to fully see the images on a larger scale before the image is exposed by light onto photographic paper. For example you don’t know if they are in focus or if there are marks on the image. One project that links to this point is called’ Photograph without Positive’ created by Spanish artist Isidoro Valcarcel.
- This involved Valcarcel anonymously sending a notebook size sheet of paper to a number of people. A dark plastic envelope was stuck onto the sheet of paper and the lower part had text which was instructions. The envelope contained photo sensitive paper which had been exposed in black and white but not developed. These recipients had 4 choices which were; sending the packet to be developed, obtaining a signed photo, keeping it enclosed indefinitely without knowing what is inside or simply opening it.
If the paper was developed the image was a still life of the objects that were used to make the artwork. For me this project represents the unknown, the hidden image, the latent image, presenting limitless options for the recipients. This can’t be done with digital which makes a project like this unique. It tests peoples curiosity, some people are desperate to know what the image could be on the photographic paper.
I knew the Spice Girls
- This reading is similar to the one above. In terms of talking about the popularity with digital but also the dangers ‘Digital cameras are much simpler to use, faster, more powerful and cleaner. Traditional materials are more difficult to obtain, more expensive’. This reading is about a person who has gone into a photobooth that has a range of options and people to select to be in a picture with. This person picked the Spice Girls. What this is representing is image manipulation and the amount of options we have now. Also how easy it is now to edit and create fake images with the amount of editing software available. ‘Before printing, we can inspect it on screen and approve or reject it. If we don’t like it we delete it and try again.’ Although editing will take time to get used to, in terms of the amount of tools you can select. ‘Widespread access to computer and image processing programmes.’ He goes on to add, Digital photo booths nudges us towards photomontage and manipulation.’
- This also touches upon the fact that anyone can take a picture now, especially with phones and how advanced they are in terms of their use and image quality. It’s also quick and easy to take a picture and upload it to social media. Compared to the traditional way ‘Old booths catch us with our eyes closed.’ Although he says ‘The difference now is our degree of familiarity with these techniques and how easy they are to use.’ I partly agree with this quote, yes digital is easier than analogue in terms of a quicker process but digital cameras now have so many settings and the user guides are full of information with how to use each and every setting. 
Grace Lau (working on the uses of photographers of the Chinese in the west)
- This reading is an example of how important research is, how it influenced Lau’s work. The importance of continuous research along with a project you may be doing and certain influences you can get from looking at other photographer's work and how they might change the way you approach your project. These are all very key. ‘The research I do impacts on my work, looked at how other people address the issue means I sometimes have to shift my approach.’ 
- Lau created a book called 21st century types, this was to subvert the Victorian traditions of portraits by constructing an imagined Chinese portrait studio of the Victorian period so she could photograph contemporary ‘western types.’ Due to her research she was inspired and looking at William Sanders work changed her way of thinking slightly. His work inspired her to focus more on how her studio background could reveal more of what she had learned in her research. Sanders portraits of people of the 20th century made her choose to let her subjects to keep their tools of their trade (shopping, sunglasses, mobile phones,and biker’s helmet). When waking into the studio she encouraged them to pose with them to help point out the differences between the 19th and 21st centuries. This shows the importance of research and the potential of photographers influencing your own work, ideas and approach. 
- Key quotes, ‘The research I do impacts on my work, looked at how other people address the issue means I sometimes have to shift my approach.’ In addition, ‘ Looking at other peoples work, collecting information an ideas forces one to sharpen and focus on ones own work and ideas. Research leads the practical.’ Lau also talks about the ongoing process, ‘Constantly evaluate work as a project develops.’ This was a very insightful read as it shows the need to keep researching while you are producing a project and be open to photographers influencing your work which could work out for the better. I will be taking these quotes on board as I am producing my own project. To make sure I do initial research before my project, before shoots and after shoots to get influences and ideas from a variety of different photographers. 
 Alejandro Duran, Washed Up: Transforming a Trashed Landscape, 2010-2013
I came across photographer Alejandro Duran when trying to find a photographer that links to my way of working but I couldn’t relate to anyone but one of Duran’s projects is similar to my project, documenting plastic pollution. Duran uses plastic waste that has been washed up on Mexico’s Caribbean coast (Coast of Sian Ka’an) from 58 countries (products that were made in these countries). He creates striking colour based sculptures which combine man made and nature to raise awareness. He rearranges objects in the way waves would. For example, one of his images is of green bottles in a rock pool representing algae, another one is bottles mixed in with rocks which are the same greyish colour along with the cloudy sky. Another example is he collected toothbrushes and placed them next to tree roots, using plastic to mimic roots. This is all to reflect the infiltration of plastic into the natural environment.
This project caught my attention straight away because first of all, the colours grab your attention and the colours are the same throughout the images in some. Then you realise the issue that is trying to be shown. Showing sort of two sides, appealing colour and a very strong message being shown. I have seen a lot of plastic pollution projects but this one is different, in terms of Duran’s creativity and thought process. Creating sculptures that link with a certain location, whether it’s green bottles representing algae or bottles filling up rock pools. These sculptures are striking but still maintain the environmental issue trying to get across to viewers and the worrying scale of the current problem with plastic pollution. Hopefully this project will help me with mine in terms of my approach to this issue.
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medproish · 6 years
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UFC on FOX 29 was everything fans hoped it would be. Dustin Poirier and Justin Gaethje put on the FOTY war everyone expected it to be, producing the rare fight with high expectations that live up to those expectations. Poirier scored a minor upset when he put away Gaethje in the fourth round, but it was hardly the only awesome performance of the night. Alex Oliveira stopped one of the all-time great action fighters in the history of the sport when he disposed of Carlos Condit. Michelle Waterson and Cortney Casey put on a performance that would have been FOTN on any other card. Did I mention there was an omoplata on the card too?
As with any card, there were winners and there were losers. There were also those who don’t really fall into either category. Let’s delve into who fell into those categories.
Winners
Dustin Poirier: Easily the biggest winner of the event, Poirier appeared to be falling right into Gaethje’s long game. Instead, Poirier caught the seemingly indestructible Gaethje with a brutal left hand that sent the Colorado native stumbling and launched Poirier into title contention. The thought has long been that Poirier isn’t athletic enough to challenge the top of the division. This victory appears to have debunked that theory. Gaethje doesn’t always use all of his physical gifts to the best of his abilities, but he is a plus athlete. I got my doubts Poirier gets a title shot next, but the fact he’s in the conversation is more than anyone would have expected out of him.
Alex Oliveira: Coming off a loss to Yancy Medeiros, Oliveira needed a rebound if he wanted to maintain his reputation as an up-and-comer in the welterweight division. Sure, this contest was against Carlos Condit, but Condit hasn’t been the Natural Born Killer we all knew and loved. Well… he hadn’t been in his previous two contests. Oliveira not only got the best version of Condit we’ve seen in years, he submitted him. Only Demian Maia has been able to do that in the last decade. I would point out he made a bloody mess of Condit, but plenty of people have done that over the years. Nonetheless, Oliveira is back on track.
Antonio Carlos Junior: There has been high expectations for the man known as Shoeface ever since his appearance on TUF Brazil. He appears to finally be living up to what was expected of him. Granted, Tim Boetsch was a stylistically favorable contest for him, but ACJ did what he was supposed to do. Remember, he was supposed to do the same thing to Dan Kelly a few years ago. Dominating Boetsch the way he did may be more impressive than a win over Kelly would have been at that time.
John Moraga: There were many who weren’t sold on Moraga’s resurgence after his KO of Magomed Bibulatov. Understandable, given Moraga had never displayed that type of power. He didn’t show that power here, but his offense was as consistent as it has ever been against Wilson Reis, coming close to cinching in guillotines on the submission expert and surviving Reis’ own attempts to submit him. Moraga is unlikely to challenge for the title again, but he has reestablished himself as a top-notch gatekeeper at the least.
Brad Tavares: I know Twitter exploded with this revelation, but I’ll say one more time for everyone anyway: Tavares secured his first stoppage victory since 2011 when he stopped Phil Baroni at UFC 125. Doing so against Krzysztof Jotko – as opposed to someone like Bubba McDaniel – makes it that much sweeter. It’s hard to believe Tavares can climb much higher than he he’s currently at, but he certainly earned his shot to prove otherwise.
Gilbert Burns: For someone who has a reputation as a deadly ground game, Burns has been operating on his feet an awful lot as of late. Then again, his striking has appeared to be just as deadly, securing KO’s in his last two contests. Granted, nobody is going to call this a breakout performance given Dan Moret was making his UFC debut, but it was about as aesthetically pleasing as it gets. Here’s hoping Burns gets a step up in competition to prove his worth in his next contest.
Lauren Mueller: This is one tough chick. She took some heavy shots from Dobson, but refused to back down, continuing to march forward to deliver her nonstop brand of offense. Like with most young and inexperienced fighters, there are plenty of holes that could be exposed, but Mueller looks like she could have a real future in a division short on much name value.
Adam Wieczorek: I saw it tweeted the odds for Wieczorek securing a submission win was at +800. I can only imagine what a bookie would have given had anyone been willing to say specifically it would be an omoplata. Amazingly enough, that’s what happened as the young Pole secured just the second in UFC history. As much as I love Ben Saunders, Wieczorek’s looked a lot more painful too. It should be noted though, that was about the only positives in the fight for Wieczorek. Nonetheless, it was badass enough he ended up in this column.
Alejandro Perez: Perez dug himself a hell of a hole after the first round. Matthew Lopez took him down a couple of times and came pretty damn close to sinking in an RNC. Perez stormed back in the second with a steady stream of offense, being the aggressor rather than looking for the counter. It worked well enough he stopped Lopez on his feet, extending Perez’s unbeaten streak to six wins. Don’t think too many saw that coming….
Luke Sanders: It wasn’t a flawless performance by any means as Sanders nearly gave away the contest with inactivity, but he got the job done. In all likelihood, the performance saved his job, which is why he ends up in the winner’s column. He’ll likely need a better performance to win his next contest.
Losers
Carlos Condit: I didn’t want to put Condit here. He looked good. In fact, he looked very good up until he ate that upkick. The issue is he has now lost four in a row and is 2-7 since winning the interim title over Nick Diaz. There is no good way to spin that. In fact, we can’t spin Condit’s losses as him continually facing elite competition anymore. Oliveira is good, but he isn’t that good. Given Condit looked good enough that he can still produce some fun contests – and actually win them – I have no clue if he’ll come back for another fight. If he doesn’t, I might be fine with that.
Tim Boetsch: This wasn’t a majorly damaging loss to Boetsch. Most were expecting it. But it could be a sign that Boetsch is on a steep backslide for his career. I could be jumping the gun on that as ACJ may be a certifiable contender at this point, but it’s just as likely Boetsch is no longer the powerhouse he once was. I would have put him in the neither column, but he wasn’t competitive either.
Wilson Reis: Reis is in this column less because of his performance and more because of the final result. Reis was competitive with Moraga, even coming close to submitting the Arizona native before the bell sounded. What puts him here was this was his third consecutive loss. Granted, each of his opponents were either champions or former title contenders, but three losses is still three losses. He’ll probably come back as the man he lost to suffered a similar losing streak and was able to snap that streak. Still….
Krzysztof Jotko: Entering 2017, Jotko looked like he was a rising star in the middleweight division. He had won five straight, including a decisive win over longtime middleweight stalwart Thales Leites. Since then, he’s lost three straight. Even worse, he didn’t look like he wanted to be in the cage at all. It’s hard to find a single minute where he was winning the contest with Tavares. I don’t think he’ll be released quite yet, but it wouldn’t be a shock if he was either.
Dan Moret: Let’s be fair, Moret was thrown into the deep end. He could very well be a quality UFC competitor. The problem is Burns is a plus athlete whose striking has come into its own. Moret stood little chance coming in on short notice. By the end of the night, he was on the receiving end of a walk off KO. Nobody wants to be on the end of that.
Dhiego Lima: Somebody in the UFC front office doesn’t like Lima. His one big weakness is wrestling. Who do they match him up with? A man who only knows how to wrestle. Yushin Okami took him down in the first round and the next two rounds were wash, rinse, repeat. This is his second chance on the roster. It might be coming to an end. If I’m a betting man, the chances of getting a third chance don’t look good.
Arjan Bhullar: While I gave Wieczorek credit for his omoplata victory, Bhullar deserves as much credit – if not more – for walking into it and cinching it as tight as he could when he continued to drive forward. Sure, it was stupid – hence, Bhullar in this column – but Bhullar dominated the contest up to that point. I’d still bet he’ll be a longtime fixture in the division, but it’s clear he still needs a lot of experience.
Matthew Lopez: This loss hurts a lot. Lopez was in firm control of Perez in the first only for the narrative to completely flip in the second round. To think, Lopez was fighting Raphael Assuncao last year and could potentially be looking at a pink slip. And some of us had such high hopes for the fun scrambler….
Patrick Williams: Tough loss for Williams as his loss to Sanders was probably the best all-around performance of his UFC career. He hurt Sanders and was the more active fighter over the second half of the contest. Wasn’t enough and he’ll likely end up on the unemployment line.
Neither
Justin Gaethje: It’s impossible to ever put Gaethje in any loser’s column… at least in terms of opinion. The way he puts his health on the line is maddingly entertaining to the point MMA fans will scream “take my money!” anytime he’s on the card. But he did lose to Poirier and lost any chance of getting fast tracked back into title contention. He’s still going to be must-see-TV for the UFC as he has yet to put on a boring fight in his career. Hell, he’s likely to headline whatever card he’s put on next despite having lost his last two fights. But he did lose his last two fights and his fighting style isn’t conducive to a long career. He may not be able to get back into title contention before his body begins breaking down. Here’s hoping he can.
Israel Adesanya: There was a lot to like about Adesanya’s performance. His strikes were pinpoint once he figured out what Marvin Vettori was trying to do and showed his usual varied arsenal. However, he struggled to stop takedowns when he wasn’t against the cage… again. He came close to giving away the fight thanks to that. Plus, it was the second consecutive contest in which he started slow. That could cost him as he climbs the competitive ladder.
Marvin Vettori: I know I’m in the minority that scored in favor of Vettori – leave your nasty comments below if you wish – but I have no problem with Adesanya being scored the winner. What cost Vettori in the end was his willingness to remain on his feet with the former professional kickboxer. Given Vettori’s track record as a grappler… why? The Rafael Cordeiro protégé has progressed on the feet to the point he held his own at times – which is why he isn’t in the loser’s column — but that wasn’t smart.
Michelle Waterson: Don’t get me wrong, I love the Karate Hottie. I don’t know anyone who has a grudge against the former Invicta champion. But she didn’t deserve that victory over Cortney Casey. She got lucky the judges favored her top position as opposed to Casey’s submission attempts from the bottom. To be fair, Waterson was competitive in a contest that would have been a viable FOTN on just about any other card. I know I’ve said that, but it is an important factoid. Still, I wish the UFC would stop trying to make a star out of her. Then again, what would you expect when she’s represented by the WME-IMG agency….
Cortney Casey: It was the second fight in a row that Casey came out on the wrong end of a close contest. Unlike her contest with Felice Herrig, I thought she deserved the win this time around. She came far closer to ending the contest about four or five times than Waterson ever did. Given her exciting style, Casey isn’t in any danger of losing her job despite her 3-5 record. But her inability to take a clear cut decision over the likes of Waterson and Herrig indicates she isn’t likely to become a breakout contender in the division.
Muslim Salikhov: Sure, Salikhov ended up getting an impressive KO victory. But everything leading up to that was subpar. He was on his way to losing a decision to a short notice opponent who was once fodder for Michael Page. Not a good sign. The King of Kung Fu is an unorthodox competitor, but he may be too unorthodox for his own good.
Ricky Rainey: Rainey was competitive with Salikhov – if not winning – right up until Salikhov put him out cold. That may not sound that great, but very few were expecting the Bellator retread to be more than a body for Salikhov. Plus, he was short notice. I still don’t expect Rainey to pick up a win in his UFC run, but it doesn’t appear like it would be the shocking development most would expect it to be heading into this contest.
Shana Dobson: Dobson came out on the short end of the stick in this contest, but it wasn’t due to a lack of improvement. She put together a hell of a performance against Mueller. She just couldn’t match the nonstop offense from Mueller and there is little if any shame in that. Then again, the win was there for the taking…. Like Mueller, Dobson could end up being a mainstay in the flyweight division
Yushin Okami: I admit Okami was absolutely dominating in his performance over Lima. But he’s suffering from the same issue that got him released from the UFC in the first place: nobody enjoys watching Okami doing his thing. I get that he does what he needs to do to win and that’s a smart thing. But don’t be surprised to see Okami released after his first loss if he continues to perform in this manner.
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The Twice-Transplanted Kidney
https://healthandfitnessrecipes.com/?p=1079
Vertis Boyce got the call from her transplant surgeon last July. We have a kidney for you, Jeffrey Veale explained on the phone, but it has an unusual backstory. The kidney was first transplanted two years ago from a 17-year-old girl into a man in his early 20s, who just unexpectedly died in a car accident. Boyce would be its second recipient. Did she want it?
Boyce had by then been on dialysis for nine-and-a-half years and on the transplant list for nearly as long. “I thought, I’m 69 years old. When could I get a second chance? I really thought I wouldn’t get a kidney,” she recalls. So she said yes. Soon, she was on a plane from Las Vegas to Ronald Reagan UCLA Medical Center, where Veale performed the transplant.
Boyce took the chance because she did not want to be one of the 13 people who die waiting for a kidney transplant every day. The kidney-transplant list in the United States has 100,000 people, of whom only 17,000 will get transplants each year. In the face of this cold brutal math, doctors have tried a variety of ways to expand the pool of available organs—taking up organs from older donors as well as donors who suffered a cardiac death rather than brain death. Reusing previously transplanted organs, however, is rarely considered. “It’s just dogma,” says Veale. “It’s almost like taboo to retransplant a kidney.”
There are reasons, of course. “These kidneys have gone through multiple rounds of insults,” says Richard Formica, a nephrologist at Yale University and the secretary of the American Society of Transplantation. He ticked them off: death of the original donor, ice, reperfusion injury when the kidney is placed back in the body, immune system-suppressing drugs that can cause kidney damage, death of the second donor, ice again, reperfusion injury again. “Few kidneys would be good enough,” he says.
In this specific case, says Veale, the kidney did seem good enough. The original donor was a young, healthy teenager, and the second donor’s creatinine levels—a common measure of kidney function—were good. Once Boyce agreed to the transplant, Veale went out to recover the kidney himself.
There he ran into another challenge. When patients receive a transplant, the new kidney usually goes into the pelvis attached to the iliac blood vessels that supply the leg. (The patient’s original kidneys in the lower back usually stay put. ) Over time, scar tissue can form. To make sure he could sew the kidney into Boyce’s body, Veale took out not just the kidney but also some of the second donor’s iliac vessels. Boyce now has tissue inside her from two donors: the kidney of the 17-year-old girl as well as the iliac vessels of the young man.
It was only the second transplant reusing a kidney Veale had ever performed, and he has now done three, all at UCLA. He estimates that 30 to 40 have ever been performed in the United States. A spokesperson for United Network for Organ Sharing, the organization that matches donors to recipients in the United States, told me it does not specifically track the reuse of previously transplanted organs, so it did not have a number readily available.
A handful of case studies have documented reuse of kidney, liver and heart transplants. The published cases have been generally successful—though that may reflect a bias in what gets published. One case study followed a patient with a reused kidney who was still in “good health” 14 years later. Another case documented some complications—the second recipient became infected with an antibiotic-resistant virus from the first recipient, which ultimately went away with different drugs. “Our patient eventually had a good outcome, but it was tough,” says Pradeep Kadambi, an author of that case study. “We still think we did the right thing” in offering him a reused organ.
Case studies are not clinical trials though. “I think the thing that’s really held [reusing transplanted organs] back is it’s too infrequent and too difficult to structure a trial,” says Alejandro Lugo, who published a 10-year follow-up case study of a reused kidney in 2015. In other words, there is no good data on the outcome of these cases compared to ordinary kidney transplants. Formica, the nephrologist at Yale, put it this way: “This has never been studied to what we would hold to be scientific rigor.”
Given the small number of organ recipients compared to the general population, the number of organs that could be reused is ultimately quite small. But it illuminates larger issues that come with efforts to expand the pool of donor organs.
Transplant centers are reluctant to take organs that are imperfect for any number of reasons. The centers are tightly regulated by the federal government and can lose their status if too many of their transplants fail. “A lot of [transplant centers] are risk averse enough to not want to give it a try,” says Tom Mone, the CEO of OneLegacy, the organ procurement organization that matched the kidney to Boyce.
How to inform patients about previously transplanted organs is also not quite settled. Should they be consulted ad hoc, when an opportunity arises? Should they be asked their preference when they sign up for the list? “Doing it at the moment of the transplant, that’s not really fair. That’s my opinion,” says Formica. Patients do not have much time to decide, and the stakes of the decision can be high—even life and death. But Mone says it is not that different from decisions potential recipients already have to make—like whether to accept an organ from an older donor or wait for a younger one. “It’s a common event where people say I’d rather wait for a younger one,” he says.
For Boyce, the transplant has been life changing. She no longer needs to go to her dialysis center three times a week. She can travel, and recently, she went to her nephew’s wedding in North Carolina. “It just felt good,” she says, “I felt free.”
https://cdn.theatlantic.com/assets/media/img/mt/2018/04/1_reunion1/lead_960.jpg Credits: Original Content Source
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nancygduarteus · 6 years
Text
The Twice-Transplanted Kidney
Vertis Boyce got the call from her transplant surgeon last July. We have a kidney for you, Jeffrey Veale explained on the phone, but it has an unusual backstory. The kidney was first transplanted two years ago from a 17-year-old girl into a man in his early 20s, who just unexpectedly died in a car accident. Boyce would be its second recipient. Did she want it?
Boyce had by then been on dialysis for nine-and-a-half years and on the transplant list for nearly as long. “I thought, I’m 69 years old. When could I get a second chance? I really thought I wouldn’t get a kidney,” she recalls. So she said yes. Soon, she was on a plane from Las Vegas to Ronald Reagan UCLA Medical Center, where Veale performed the transplant.
Boyce took the chance because she did not want to be one of the 13 people who die waiting for a kidney transplant every day. The kidney-transplant list in the United States has 100,000 people, of whom only 17,000 will get transplants each year. In the face of this cold brutal math, doctors have tried a variety of ways to expand the pool of available organs—taking up organs from older donors as well as donors who suffered a cardiac death rather than brain death. Reusing previously transplanted organs, however, is rarely considered. “It’s just dogma,” says Veale. “It’s almost like taboo to retransplant a kidney.”
There are reasons, of course. “These kidneys have gone through multiple rounds of insults,” says Richard Formica, a nephrologist at Yale University and the secretary of the American Society of Transplantation. He ticked them off: death of the original donor, ice, reperfusion injury when the kidney is placed back in the body, immune system-suppressing drugs that can cause kidney damage, death of the second donor, ice again, reperfusion injury again. “Few kidneys would be good enough,” he says.
In this specific case, says Veale, the kidney did seem good enough. The original donor was a young, healthy teenager, and the second donor’s creatinine levels—a common measure of kidney function—were good. Once Boyce agreed to the transplant, Veale went out to recover the kidney himself.
There he ran into another challenge. When patients receive a transplant, the new kidney usually goes into the pelvis attached to the illiac blood vessels that supply the leg. (The patient’s original kidneys in the lower back usually stay put. ) Over time, scar tissue can form. To make sure he could sew the kidney into Boyce’s body, Veale took out not just the kidney but also some of the second donor’s illiac vessels. Boyce now has tissue inside her from two donors: the kidney of the 17-year-old girl as well as the illiac vessels of the young man.
It was only the second transplant reusing a kidney Veale had ever performed, and he has now done three, all at UCLA. He estimates that 30 to 40 have ever been performed in the United States. A spokesperson for United Network for Organ Sharing, the organization that matches donors to recipients in the United States, told me it does not specifically track the reuse of previously transplanted organs, so it did not have a number readily available.
A handful of case studies have documented reuse of kidney, liver and heart transplants. The published cases have been generally successful—though that may reflect a bias in what gets published. One case study followed a patient with a reused kidney who was still in “good health” 14 years later. Another case documented some complications—the second recipient became infected with an antibiotic-resistant virus from the first recipient, which ultimately went away with different drugs. “Our patient eventually had a good outcome, but it was tough,” says Pradeep Kadambi, an author of that case study. “We still think we did the right thing” in offering him a reused organ.
Case studies are not clinical trials though. “I think the thing that’s really held [reusing transplanted organs] back is it’s too infrequent and too difficult to structure a trial,” says Alejandro Lugo, who published a 10-year follow-up case study of a reused kidney in 2015. In other words, there is no good data on the outcome of these cases compared to ordinary kidney transplants. Formica, the nephrologist at Yale, put it this way: “This has never been studied to what we would hold to be scientific rigor.”
Given the small number of organ recipients compared to the general population, the number of organs that could be reused is ultimately quite small. But it illuminates larger issues that come with efforts to expand the pool of donor organs.
Transplant centers are reluctant to take organs that are imperfect for any number of reasons. The centers are tightly regulated by the federal government and can lose their status if too many of their transplants fail. “A lot of [transplant centers] are risk averse enough to not want to give it a try,” says Tom Mone, the CEO of OneLegacy, the organ procurement organization that matched the kidney to Boyce.
How to inform patients about previously transplanted organs is also not quite settled. Should they be consulted ad hoc, when an opportunity arises? Should they be asked their preference when they sign up for the list? “Doing it at the moment of the transplant, that’s not really fair. That’s my opinion,” says Formica. Patients do not have much time to decide, and the stakes of the decision can be high—even life and death. But Mone says it is not that different from decisions potential recipients already have to make—like whether to accept an organ from an older donor or wait for a younger one. “It’s a common event where people say I’d rather wait for a younger one,” he says.
For Boyce, the transplant has been life changing. She no longer needs to go to her dialysis center three times a week. She can travel, and recently, she went to her nephew’s wedding in North Carolina. “It just felt good,” she says, “I felt free.”
from Health News And Updates https://www.theatlantic.com/health/archive/2018/04/kidney-transplant-reuse/557657/?utm_source=feed
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ionecoffman · 6 years
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The Twice-Transplanted Kidney
Vertis Boyce got the call from her transplant surgeon last July. We have a kidney for you, Jeffrey Veale explained on the phone, but it has an unusual backstory. The kidney was first transplanted two years ago from a 17-year-old girl into a man in his early 20s, who just unexpectedly died in a car accident. Boyce would be its second recipient. Did she want it?
Boyce had by then been on dialysis for nine-and-a-half years and on the transplant list for nearly as long. “I thought, I’m 69 years old. When could I get a second chance? I really thought I wouldn’t get a kidney,” she recalls. So she said yes. Soon, she was on a plane from Las Vegas to Ronald Reagan UCLA Medical Center, where Veale performed the transplant.
Boyce took the chance because she did not want to be one of the 13 people who die waiting for a kidney transplant every day. The kidney-transplant list in the United States has 100,000 people, of whom only 17,000 will get transplants each year. In the face of this cold brutal math, doctors have tried a variety of ways to expand the pool of available organs—taking up organs from older donors as well as donors who suffered a cardiac death rather than brain death. Reusing previously transplanted organs, however, is rarely considered. “It’s just dogma,” says Veale. “It’s almost like taboo to retransplant a kidney.”
There are reasons, of course. “These kidneys have gone through multiple rounds of insults,” says Richard Formica, a nephrologist at Yale University and the secretary of the American Society of Transplantation. He ticked them off: death of the original donor, ice, reperfusion injury when the kidney is placed back in the body, immune system-suppressing drugs that can cause kidney damage, death of the second donor, ice again, reperfusion injury again. “Few kidneys would be good enough,” he says.
In this specific case, says Veale, the kidney did seem good enough. The original donor was a young, healthy teenager, and the second donor’s creatinine levels—a common measure of kidney function—were good. Once Boyce agreed to the transplant, Veale went out to recover the kidney himself.
There he ran into another challenge. When patients receive a transplant, the new kidney usually goes into the pelvis attached to the illiac blood vessels that supply the leg. (The patient’s original kidneys in the lower back usually stay put. ) Over time, scar tissue can form. To make sure he could sew the kidney into Boyce’s body, Veale took out not just the kidney but also some of the second donor’s illiac vessels. Boyce now has tissue inside her from two donors: the kidney of the 17-year-old girl as well as the illiac vessels of the young man.
It was only the second transplant reusing a kidney Veale had ever performed, and he has now done three, all at UCLA. He estimates that 30 to 40 have ever been performed in the United States. A spokesperson for United Network for Organ Sharing, the organization that matches donors to recipients in the United States, told me it does not specifically track the reuse of previously transplanted organs, so it did not have a number readily available.
A handful of case studies have documented reuse of kidney, liver and heart transplants. The published cases have been generally successful—though that may reflect a bias in what gets published. One case study followed a patient with a reused kidney who was still in “good health” 14 years later. Another case documented some complications—the second recipient became infected with an antibiotic-resistant virus from the first recipient, which ultimately went away with different drugs. “Our patient eventually had a good outcome, but it was tough,” says Pradeep Kadambi, an author of that case study. “We still think we did the right thing” in offering him a reused organ.
Case studies are not clinical trials though. “I think the thing that’s really held [reusing transplanted organs] back is it’s too infrequent and too difficult to structure a trial,” says Alejandro Lugo, who published a 10-year follow-up case study of a reused kidney in 2015. In other words, there is no good data on the outcome of these cases compared to ordinary kidney transplants. Formica, the nephrologist at Yale, put it this way: “This has never been studied to what we would hold to be scientific rigor.”
Given the small number of organ recipients compared to the general population, the number of organs that could be reused is ultimately quite small. But it illuminates larger issues that come with efforts to expand the pool of donor organs.
Transplant centers are reluctant to take organs that are imperfect for any number of reasons. The centers are tightly regulated by the federal government and can lose their status if too many of their transplants fail. “A lot of [transplant centers] are risk averse enough to not want to give it a try,” says Tom Mone, the CEO of OneLegacy, the organ procurement organization that matched the kidney to Boyce.
How to inform patients about previously transplanted organs is also not quite settled. Should they be consulted ad hoc, when an opportunity arises? Should they be asked their preference when they sign up for the list? “Doing it at the moment of the transplant, that’s not really fair. That’s my opinion,” says Formica. Patients do not have much time to decide, and the stakes of the decision can be high—even life and death. But Mone says it is not that different from decisions potential recipients already have to make—like whether to accept an organ from an older donor or wait for a younger one. “It’s a common event where people say I’d rather wait for a younger one,” he says.
For Boyce, the transplant has been life changing. She no longer needs to go to her dialysis center three times a week. She can travel, and recently, she went to her nephew’s wedding in North Carolina. “It just felt good,” she says, “I felt free.”
Article source here:The Atlantic
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