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RESEARCH BRIEFS
Improved Procurement Could More than Double Availability of Transplantable OrgansLast year, fewer than 6,200 people in the United States donated organs though more than 80,000 waited for organ transplants.Even though the need for transplantable organs far outweighs the supply, the number of organs donated could be more than doubled--saving thousands of lives every year--if the procurement process were improved. These findings by researchers from HMS, Boston University, and the Institute for Healthcare Improvement appear in the summer issue of Health Care Financing Review. Although millions of people across the country are registered donors, only two percent of them annually suffer brain death and meet the other medical requirements for being a cadaveric donor. The U.S. Department of Health and Human Services (HHS) suggests that the number of actual donors may be further limited by organ procurement organizations (OPOs) that do not utilize the most efficient practices. "We needed to know if we have a supply of potential donors who can meet the demand for organs," said Edward Guadagnoli, first author on the study and an HMS associate professor of health care policy. "We didn't know until we used a statistical model to estimate that number." The researchers determined that the number is about 17,000 potential donors each year. OPOs coordinate the organ donation process and match potential donors to recipients. They also deal directly with the potential donor's family to get consent for donation. Organ donation usually comes at a difficult time for families, and the way an OPO addresses the situation can mean the difference between saving a life through transplantation and losing a potential donor. Family resistance to organ donation is the primary reason that potential donors do not donate. According to the study, OPOs have an efficiency rate of between 20 and 80 percent, with an average of about 34 percent. In other words, the country's medical industry is using only one third of the potential donors. HHS is now calling on OPOs to increase their efficiency to 75 percent, a goal that Guadagnoli says is high, but may be possible. Even with 100 percent OPO efficiency, Guadagnoli said, there still would not be enough potential donors to supply the current demand for organs. --Nicole Giese
Shifts in Training Needed to Care for Elderly PopulationAs the American population tips towards old age, more and more patients will need geriatric care. Yet most general internal medicine training programs do not offer substantial experience in geriatrics. Current curricula produce internists who may not be attuned to the needs of a burgeoning elderly population, according to researchers at HMS.In a paper published in the Oct. 7 Annals of Internal Medicine, Steven Simon, HMS assistant professor of ambulatory care and prevention at Harvard Pilgrim Health Care, and colleagues including Anne Fabiny, HMS assistant professor of medicine at Beth Israel Deaconess Medical Center, define the problems undermining cooperation between geriatricians and internists, and propose solutions. The researchers report that general internal medicine curricula lack opportunities for clinical training, research, or mentorship in geriatrics. Some programs do have informal collaborations between internal medicine and geriatrics, but most interested fellows must seek out contacts among geriatricians on their own. In many institutions, the pervading culture pits internal medicine against geriatrics as both struggle for influence and funding in departments of medicine. In addition, geriatrics is often seen as a lesser discipline, only a clinical field instead of a "real" medical field. Some current efforts aim to break down these misconceptions. The Society of General Internal Medicine (SGIM) Collaborative Centers Program has 10, two-year awards that help support institutions with innovative geriatrics training programs for internal medicine fellows. The researchers recommend that institutions offer a three-year internal medicine-geriatrics fellowship, in which students study general internal medicine and specialize in geriatrics. Fellows would spend 80 percent of their time on geriatrics research and 20 percent on clinical geriatrics. This type of dual training would be beneficial, the authors argue, because it would address the cultural problems between the two disciplines.
World Smoking Deaths in a Year Estimated at 5 MillionSmoking kills, declare warnings on cigarette packs worldwide. An article in the Sept. 13 Lancet estimates just how many people it kills: in the year 2000, smoking caused nearly 5 million premature deaths around the world.That number has been difficult to calculate based on tobacco consumption or smoking prevalence, since these factors do not take into account whether a smoker uses filters, how much tar is present in the tobacco, or how deeply a smoker inhales. For their estimate, Majid Ezzati, assistant professor of international health in the Department of Population and International Health at HSPH, and Alan Lopez of the University of Queensland, Brisbane, Australia, began by using lung cancer deaths as an indirect indicator of smoking deaths. Lung cancer is usually the result of inhaling a harmful substance like asbestos, coal dust, or smoke. In less developed countries many people heat with coal burned in poorly ventilated stoves, for example. Ezzati and Lopez corrected for this and other environmental factors for each geographic area they analyzed. After defining the number of smoking-related lung cancer deaths in an area, the researchers extrapolated this data to estimate the extent of other smoking-related deaths, such as deaths from cardiovascular disease and chronic obstructive pulmonary disease. Of the 5 million deaths in 2000, nearly 40 percent were attributed to cardiovascular disease, the main cause of smoking-related deaths. The researchers also reported that almost 80 percent of the deaths were men, and the total deaths were almost equally split between industrialized and developing countries. This equal split in mortality may not last long. Smoking continues to decrease in industrialized countries and increase in developing countries. "Smoking-related deaths will rise substantially, especially in developing countries, unless effective intervention and policies ... are implemented," Ezzati said. --Nicole Giese
Blocking Exit from Cell Seen to Stifle HIVEfforts to combat AIDS have focused on keeping HIV from entering cells, but an equally viable strategy would be to prevent the microbe from exiting. "If you can arrest that step in the life cycle, then you will block the virus from spreading," said Heinrich Gottlinger, HMS associate professor of pathology at the Dana-Farber Cancer Institute. "If it cannot leave the cell it cannot continue its replication cycle." The problem is, little is known about how HIV makes its departure. Gottlinger and his colleagues report a finding in the Sept. 19 Cell that could fill in the story. Like other retroviruses, HIV uses the host cell's proteins to make copies of itself. These copies, or virions, exit by fusing with and then budding from the cell's membrane. Researchers knew that to detach from the cell, HIV must enlist a protein from the cell's endocytic pathway, Tsg101. It now appears that the virus seizes a second protein, AIP1. At first glance it might seem an unlikely recruit. AIP1 was thought mostly to play a role in apoptosis. But it turns out the yeast homolog of AIP1 is required for the budding of cellular vesicles into mature endosomes. It also interacts with a protein lying in a complex at the core of the endocytic pathway. In fact, Gottlinger and his colleagues found that in human cells too, AIP1 partners with the ESCRIT-111 complex. Though AIP1 appears to play a less important role than Tsg101 in HIV budding, other viruses accord it a central role. Gottlinger and his colleagues found that blocking the ESCRIT-111 partners of AIP1 with dominant negative proteins resulted in a dramatic drop in budding in equine infectious anemia virus (EIAV). Even in HIV, budding was significantly inhibited by the dominant negative proteins. "I am pretty convinced that there is nothing else out there that is more inhibitory as far as proteins are concerned," said Gottlinger. "I am convinced they will block the virus if we can actually express them stably in cells. The only question is whether the cells will tolerate this. But the potency is clear."--Misia Landau |
