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Offline Clark

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LHSC’s kidney research goes well beyond biomedical focus

Whenever I think of medical research, I picture earnest looking people in white lab coats staring into microscopes or adding liquid to test tubes.

I apparently have a limited imagination because the Canadian Institute of Health Research lists biomedical research as only the first of four types. It also includes clinical; health system services research; and social, cultural, environmental and population health research. A lot of those other three forms of research are being carried out here in London.

On the lower level of the Westminster Tower at London Health Sciences Centre's Victoria Hospital, is the kidney clinical research unit. Its director, nephrologist and scientist Dr. Amit Garg said there are 20 to 25 people in the unit working on more than 100 studies.

It's a collaborative effort, teaming up nephrologists, epidemiologists, data base programmers, research co-ordinators who interface with patients, bio-statisticians, medical students, residents, fellows and post-doctoral fellows. Garg said the London area could be considered one of Canada's top kidney research centres.

The LHSC nephrologist says simply "transplants save lives."

The well-known procedure of daily aspirin usage reduces the risk of heart attack and stroke by 15%. In comparison, Garg said, kidney transplants reduce mortality by 75%.

He described kidney transplants as a "win-win-win" situation. After transplantation, patients live longer, have a better quality of life and incur fewer costs for the health system.

Research shows that over a five-year period, the cost savings of a transplant as opposed to dialysis is $250,000 per patient. Other research shows 80% of donated organs are working well after five years, and the average donated organ now lasts 17 years.

The Canadian Organ Replacement Registry shows the number of Canadians living with kidney disease has tripled in the last 20 years. Organ donations are not keeping up the pace.

Some of the research being carried out in London is looking at the effectiveness of Ontario's newly adopted donor registry; other research looks at changing the parameters for accepting organ donations. The previous standard of brain death has now been expanded to include cardiac death.

Garg heads up a major study of "living" organ donors, a life-long study aimed at optimizing the practice of living kidney donations. Forty per cent of all transplant activity involves living donations, 90% of those being kidneys.

Studies are also underway of systems that have been tried elsewhere. One is an Israeli practice under which if you agree to donate your organs, you move to the top of a priority list should you ever need an organ transplant yourself.

Another practice is called paired exchange. Should you be willing to donate a kidney to someone you know who needs one and find out you are not a viable match, would you consider donating the organ to someone else who has a donor who is a better match for the patient you wanted to help? The trade would mean both patients could win.

Many intensive care units in Ontario hospitals are swamped much of the time. Another area of study looks at whether doctors and medical staff whose priority is saving lives will take the time to discuss potential organ donations with patients and their families. What kind of changes would be necessary to better enable that?

Garg proudly cites major studies mounted in London, including the effects of E. coli infection during the Walkerton water tragedy under Dr. William Clark - who happens to be my brother - and the effects of alternating dialysis delivery times under Dr. Robert Lindsay.

Since 1964, the Kidney Foundation of Canada has awarded more than $100 million to support kidney-related research.

The work is serious; its impact profound. But Garg has no problem maintaining perspective. On the website of the kidney clinical research unit, his tongue-in-cheek quote says, "When it comes to nephro training, we raise the bar, except of course at renal limbo nights where it is as low as it can go."

George Clark is a London freelance writer. E-mail george.judy@rogers.com
Unrelated directed kidney donor in 2003, recipient and I both well.
618 time blood and platelet donor since 1976 and still giving!
Elected to the OPTN/UNOS Boards of Directors & Executive, Kidney Transplantation, and Ad Hoc Public Solicitation of Organ Donors Committees, 2005-2011
Proud grandpa!


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