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Halsted's Hands - Beyond the Dome
Beyond the DomeDate: November 28, 2012
Director, Kidney/Pancreas Transplantation
Shands Transplant Center at the University of Florida, Gainesville
When Ken Andreoni needed to do an immunology research project as a Yale medical student, it just so happened that the most interesting project he could find was with a transplant surgeon. Andreoni soon found himself assisting with small animal research and large animal surgeries.
“Here I was a medical student, and I was helping a senior surgeon to do transplants,” he says. “That was pretty cool.”
He also enjoyed both his medical and surgical rotations, so transplant surgery was a natural fit.
During his general surgery residency at Hopkins, Andreoni says he was highly influenced by the national leadership skills of surgeons like James Burdick, then-president of the United Network for Organ Sharing (UNOS); Melville Williams, a president of many vascular and transplant associations; and former Department Director John Cameron. Andreoni is now vice president of UNOS and will serve as president of the organization from 2013 to 2014.
He recently moved from Ohio State to the University of Florida to work with Jeffrey Fair, M.D., whom he befriended at Hopkins in 1989 on his first day as a second-year resident and Fair’s first day as a surgery fellow. The two overlapped in training for seven years, taking care of transplant patients and doing many organ procurements and transplant operations together. They later worked together as transplant surgical partners from 2000 to 2008 at the University of North Carolina.
Halsted’s Hands: You formerly chaired a national kidney allocation policy committee for UNOS. What’s happening there?
Andreoni: It’s a politically and emotionally charged area. Almost 80,000 patients are waiting for kidneys and there are only 10,000 to 12,000 deceased donor kidneys available each year, so there’s no easy answer. How do you develop a medical urgency score to determine who is the sickest and most in need versus those with the highest probable survival after transplant? The kidney is a little like Rodney Dangerfield—it doesn’t get any respect. It’s not considered by many to be a life-saving organ; you can get dialysis. But kidney transplantation results in more additional years of life than all other transplants. We’re looking into better alignment—saving the right organ for the right person.
In the current proposal out for public comment, we are talking about creating a kidney donor profile index to characterize the quality of a kidney and estimate its potential function if it were transplanted. We are then considering allocating the highest quality kidneys—about 20 percent of the total—to patients with the longest estimated post-transplant survival. The remaining kidneys could be best allocated to the remaining recipients.
We’re also trying to expand our education efforts so people will be more accepting of so-called “extended criteria” kidneys from older donors or those with medical issues. Over the last 10 years, I have been in regular contact with Bob Montgomery, Dorry Segev and Sommer Gentry at Hopkins about their live-donor programs in paired kidney donation, domino transplants and finding optimized matches. We’re trying to bring some of the good things we’ve seen grow up at Hopkins to a national standard.
Halsted’s Hands: How did your Hopkins training influence how you practice medicine?
Andreoni: We all hear Dr. Cameron in our heads when we think about what to do in the middle of the night. I tell my students, “The only thing that’s important is the details.” In transplant, you need the medical details and the surgical details; that’s what leads to good outcomes.
Dr. Cameron attended every one of our Halsted Service morbidity and mortality conferences. When we sat for our boards, they seemed simple because we already had gone through these M&Ms. He prepared us not only for the boards but also our careers. He taught us to do the right thing by always putting the patient first.
Halsted’s Hands: What special memories do you have of your time here?
Andreoni: We all remember the special times spent with Dr. Cameron on Saturday mornings in his office. I was also very fortunate there were so many individuals at Hopkins with national leadership. The surgical faculty was not isolated in its own small area of the world but was actively shaping the practice of the nation.