House, Senate Put Forth Legislation to Renew Funding, Bolster Nation's Bone Marrow and Umbilical Cord Program

/PRNewswire/ -- The National Marrow Donor Program® (NMDP) today applauded the introduction of the "Stem Cell Therapeutic and Research Reauthorization Act of 2010." Sens. Orrin Hatch (R-UT), Christopher Dodd (D-CT), Richard Burr (R-NC), Jack Reed (D-RI), John Ensign (R-NV), and Al Franken (D-MN) introduced the act in the U.S. Senate as S. 3751 on Thursday, Aug. 5. Last evening, Reps. C.W. Bill Young (R-FL) and Doris Matsui (D-CA) introduced the companion legislation, (H.R. 6081), in the House. This legislation seeks to reauthorize the C.W. Bill Young Cell Transplantation Program (National Program) and the National Cord Blood Inventory (NCBI). These programs must be reauthorized before the NCBI sunsets.

Last year 12,000 patients searched the national registry, publicly known as the Be The Match Registry®, for a marrow donor or umbilical cord blood unit. Congressional support of the National Program and the NCBI is critical to ensure all patients have access to transplant.

"I am pleased with the introduction of this legislation and continued bipartisan support," said Jeffrey W. Chell, M.D., chief executive officer of the NMDP. "The reauthorization will provide us with the opportunity to continue our efforts to increase the number of adult donors and umbilical cord blood units available through the National Program."

Since its inception in the mid-1980s, the NMDP has operated the National Program awarded via a competitive bid process administered by the Health Services Resources Administration (HSRA). Every day, the National Program helps thousands of patients with leukemia, certain lymphomas, and other life-threatening diseases find a matching donor or umbilical cord blood unit. For many of these patients, a transplant may be the best or only hope for a cure. To date, the NMDP has facilitated more than 40,000 transplants. This accomplishment would not have been possible without the ongoing, sustained support of Congress and its efforts to increase unrelated marrow and cord blood transplants in the United States.

The proposed legislation demonstrates the continued federal commitment to these programs and recognizes the importance of providing patients and physicians with a single point of access to marrow and cord blood units that can be used for transplant. It also addresses the importance of building a diverse registry of marrow donors and cord blood units. Additionally, the legislation includes modifications necessary to continue the successful work of these programs.

The NMDP applauds the hard work and dedication of Congress to produce a bipartisan and fiscally responsible bill that will assist the NMDP in advancing its life-saving mission. The NMDP looks forward to working with Congress, and its network partners in the transplant community including, physicians, cord blood banks, donors, patients, and their families, to gain additional support for continued success of cellular transplantation.

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Hopkins Transplant Surgeons Remove Healthy Kidney Through Donor's Vagina

In what is believed to be a first-ever procedure, surgeons at Johns Hopkins have successfully removed a healthy donor kidney through a small incision in the back of the donor’s vagina.

“The kidney was successfully removed and transplanted into the donor’s niece, and both patients are doing fine,” says Robert Montgomery, M.D., Ph.D., chief of the transplant division at Johns Hopkins University School of Medicine who led the team that performed the historic operation.

The transvaginal donor kidney extraction, performed Jan. 29 on a 48-year-old woman from Lexington Park, Md., eliminated the need for a 5-to-6-inch abdominal incision and left only three pea-size scars on her abdomen, one of which is hidden in her navel.

Transvaginal kidney removals have been done previously to remove cancerous or nonfunctioning kidneys that endanger a patient’s health, but not for healthy kidney donation. Because transplant donor nephrectomies are the most common kidney removal surgery — 6,000 a year just in the United States — this approach could have a tremendous impact on people’s willingness to donate by offering more surgical options,” says Montgomery.

“Since the first laparoscopic donor nephrectomy was performed at Johns Hopkins in 1995, surgeons have been troubled by the need to make a relatively large incision in the patient’s abdomen after completing the nephrectomy to extract the donor kidney. “That incision is thought to significantly add to the patient’s pain, hospitalization and convalescence,” says Montgomery. “Removing the kidney through a natural opening should hasten the patient’s recovery and provide a better cosmetic result.”

Both laparoscopies and transvaginal operations are enabled by wandlike cameras and tools inserted through small incisions. In the transvaginal nephrectomy, two wandlike tools pass through small incisions in the abdomen and a third flexible tool housing a camera is placed in the navel.

Video images displayed on monitors guide surgeons’ movements. Once the kidney is cut from its attachments to the abdominal wall and arteries and veins are stapled shut, surgeons place the kidney in a plastic bag inserted through an incision in the vaginal wall and pull it out through the vaginal opening with a string attached to the bag.

Montgomery says the surgery took about three and a half hours, roughly the same as a traditional laparoscopic procedure.

The Jan. 29 operation is one of a family of new surgical procedures called natural orifice translumenal endoscopic surgeries (NOTES) that use a natural body opening to remove organs and tissue, according to Anthony Kalloo, M.D., the director of the Division of Gastroenterology at Johns Hopkins University School of Medicine and the pioneer of NOTES. The most common openings used are the mouth, anus and vagina.

Since 2004, successful NOTES in humans have removed diseased gallbladders and appendixes through the mouth, and gallbladders, kidneys and appendixes through the vagina.

Recently, Kalloo says, some medical experts have called for more studies to compare the safety and effectiveness of NOTES against traditional laparoscopies, which also leave very small scars, have been in use for many years, and are proven to be safer and less painful for patients than older “open” abdominal procedures. He supports more studies.

But, he adds, “natural orifice translumenal endoscopic surgery is the final frontier to explore in making surgery scarless, less painful and for obese patients, much safer.” An organ donor, in particular, is most deserving of a scar-free, minimally invasive and pain-free procedure.”

Additional surgeons from Johns Hopkins University School of Medicine who participated in the procedure were Mohamad E. Allaf, M.D., assistant professor in the departments of Urology and Biomedical Engineering and director of minimally invasive and robotic surgery; Andy Singer, M.D., Ph.D., assistant professor in the Division of Transplant Surgery; and Wen Shen, M.D., M.P.H., assistant professor in the Department of Gynecology and Obstetrics.

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Transplantation of Kidneys from Black Cardiac-Death Donors Provide Black Recipients with the Best Long-Term Survival

Contrary to prevailing assumptions, Johns Hopkins researchers have shown that kidneys recovered from black donors who died from cardiac death offer the best survival rate for black recipients of a deceased-donor kidney.

This discovery, released online this week and appearing in the October 2008 issue of the Journal of the American Society of Nephrology, challenges the long-held belief that kidneys from white brain-death donors offers the best deceased-donor transplant survival rate for either black or white recipients.

“Our findings indicate that increased use of kidneys from cardiac-death donors could help reduce the organ shortage and improve outcomes for black kidney transplant recipients,” says lead author Jayme Locke, M.D., M.P.H., of the Department of Surgery at Johns Hopkins.

Locke and a team of Johns Hopkins researchers examined the outcomes of more than 25,000 black adults who received a deceased-donor kidney transplant between 1993 and 2006.

Results showed that black recipients who received a kidney from a black cardiac-death donor had a 70 percent reduction in the risk of kidney loss and a 59 percent reduction in risk for death when compared to black recipients who received a kidney from a white brain-death donor.

“Our data is consistent with the previous observation that black recipients seem to do better with kidneys from white brain-death donors than they do with kidneys from black brain-death donors or white cardiac-death donors, however, the fact that black recipients have the best outcomes with kidneys from black cardiac-death donors is significant,” says co-lead author Daniel Warren, Ph.D., of the Department of Surgery at Johns Hopkins.

He says that the exact mechanisms responsible for racial differences in outcomes after kidney transplantation are not known, however, the results suggest that the genetic background of the donor and recipient likely have a significant impact on long-term outcomes.

“We believe that an improved understanding of the molecular consequences of cardiac and brain death is critical to improving outcomes for all kidney transplant recipients and warrants further investigation,” he added.

There are currently more than 70,000 Americans waiting for kidney transplants. Only about 600 deceased-donor kidneys donated after cardiac death are currently used for transplantation versus 7,000 donated after brain death.

This discrepancy is due in part to the belief that kidneys that are exposed to cardiac death generally suffer more damage than kidneys that are exposed to brain death.

“Our results show this is not always true, and that is significant news for all patients waiting for a kidney,” says Locke.

Other researchers who worked on this study from Johns Hopkins include Robert Montgomery, M.D., Ph.D.; Andrew Cameron, M.D.; Joseph Melancon, M.D.; Dorry Segev, M.D.; Andrew Singer, M.D., Ph.D.; Christopher Simpkins, M.D., M.P.H.; Andrea Zachary, Ph.D.; Francesca Dominici, Ph.D.; Mary Leffell, Ph.D.; and Deborah McRann, B.S.N.