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Kidneys from Black donors are more likely to be thrown away − a bioethicist explains why

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theconversation.com – Ana S. Iltis, Professor of Philosophy; Carlson Professor of University Studies; and Director, Center for Bioethics, and Society, Wake Forest University – 2024-06-25 07:35:43
Corey Mayes at his New York home on Feb. 10, 2023, after receiving a kidney transplant.
Steve Pfost/Newsday RM via Getty Images

Ana S. Iltis, Wake Forest University

As one of the leading causes of death in the U.S., kidney disease is a serious public health problem. The disease is particularly severe among Black Americans, who are three times more likely than white Americans to develop kidney failure.

While Black people constitute only 12% of the U.S. population, they account for 35% of those with kidney failure. The reason is due in part to the prevalence of diabetes and high blood pressure – the two largest contributors to kidney disease – in the Black community.

Almost 100,000 people in the U.S. are awaiting kidney transplantation. Though Black Americans are more likely to need transplants, they are also less likely to receive them.

Making matters worse, kidneys from Black donors in the U.S. are more likely to be thrown away as a result of a flawed system that erroneously considers all Black donor kidneys as more likely to stop working after a transplant than kidneys from donors of other races.

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As a scholar of bioethics, health and philosophy, I believe this flawed system raises serious ethical concerns about justice, fairness and good stewardship of a scarce resource – kidneys.

How did we get here?

The U.S. organ transplantation system rates donor kidneys using the kidney donor profile index, an algorithm that includes 10 factors, including the donor's age, height, weight and history of hypertension and diabetes.

Another factor in the algorithm is race.

Research on previous transplants shows that some kidneys donated by Black people are more likely to stop working sooner after transplantation than kidneys donated by people from other races.

This brings down the average time a transplanted kidney from a Black donor can last for a patient.

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Kidneys from Black donors are more likely to be thrown away − a bioethicist explains why
An image of a cross section of a kidney showing the major blood vessels.
Encyclopaedia Britannica/UIG Via Getty Images

As a result, kidneys donated by Black people are discarded at higher rates because the algorithm downgrades their quality based on the donor's race.

This means that some good kidneys may be wasted, raising several ethical and practical concerns.

Risk, race and genetics

Scientists have shown that races are social constructs that are poor indicators of human genetic diversity.

Using a donor's race assumed people who belong to the same socially constructed group share important biological characteristics despite evidence that there is more genetic variation within racial groups than between other racial groups. Such is the case for Black Americans.

It is possible that the explanation for observed differences in outcomes lies in genetics and not in race.

People who have two copies of certain forms or variants of the APOL1 gene are more likely to develop kidney disease.

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About 85% of people with those variants never develop kidney disease, but 15% do. Medical researchers do not yet understand what is behind this difference, but genetics is likely only part of the story. Environment and exposure to certain viruses are also possible explanations.

People who have two copies of the riskier forms of the APOL1 gene almost all have ancestors who came from Africa, especially from West and sub-Saharan Africa. In the U.S., such people typically are categorized as Black or African American.

Research on kidney transplants suggests that kidneys from donors with two copies of the higher-risk APOL1 variants fail at higher rates after transplantation. This could explain the data on Black donor kidney failure rate.

How might this practice change?

Health care professionals decide how limited resources are used and distributed. With that comes an ethical responsibility to steward resources fairly and wisely, which includes preventing unnecessary loss of transplantable kidneys.

Reducing the number of wasted kidneys is important for another reason.

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A black man raises his gown as a doctor uses a marker to  show which kidney is to be removed during surgery.
A doctor at Johns Hopkins Hospital marks which kidney to remove from a living Black donor.
Brendan Smialowski/AFP/GettyImages

Many people agree to organ donations to help others. Black donors may be disturbed to learn that their kidneys are more likely to be discarded because they came from a Black person.

This practice can further decrease the trust of Black Americans in a health care system that has a long history of mistreating Black people.

Making organ transplantation more equitable could be as simple as ignoring race when evaluating donor kidneys, as some medical researchers have proposed.

But this approach would not account for the observed difference in transplantation outcomes and could result in transplanting some kidneys that are at increased risk for early failure due to a genetic issue.

And since Black kidney recipients are more likely to receive kidneys from Black donors, this approach could perpetuate transplant disparities.

Another option that would improve public health and reduce racial health disparities is to identify the factors that lead to some kidneys donated by Black people to fail at higher rates.

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One way researchers are working to identify higher risk kidneys is using the APOLLO study, which assesses the impact of key variants on donated kidneys.

In my view, using the variant instead of race likely would decrease the number of kidneys wasted while protecting recipients from kidneys that are likely to stop working sooner after transplantation.The Conversation

Ana S. Iltis, Professor of Philosophy; Carlson Professor of University Studies; and Director, Center for Bioethics, Health and Society, Wake Forest University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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How high school athletes can safely prepare for the start of practice, and the warning signs of heat illness

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theconversation.com – Samantha Scarneo-Miller, Assistance Professor of Athletic Training, West Virginia University – 2024-07-19 07:30:16
The first two weeks of practice are hardest as the body acclimatizes.
Derek Davis/Portland Portland Press Herald via Getty Images

Samantha Scarneo-Miller, West Virginia University

High school sports teams start practices soon in what has been an extremely hot summer in much of the country. Now, before they hit the field, is the time for athletes to start slowly and safely building up strength and stamina.

Studies have found that the greatest risk of heat illness occurs in the first two weeks of team practices, while players' bodies are still getting used to the physical exertion and the heat. Being physically ready to start increasingly intense team practices can help reduce the risk.

I am an athletic trainer who specializes in catastrophic injuries and heat illnesses. Here's what everyone needs to know to help keep athletes safe in the heat.

Why should athletes restart workouts slowly?

One of the biggest risk factors for developing dangerous exertional heat illnesses is your physical fitness level. That's because how fit you are affects your heart rate and breathing, and also your ability to regulate your body temperature.

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If an athlete waits until the first day of practice to start exercising, their heart won't be able to pump blood and oxygen through the body as effectively, and the body won't be as adept at dissipating heat. As a person works out more, their body undergoes changes that improve their thermoregulation.

That's why it's important for athletes to gradually and safely ramp up their activity, ideally starting at least three weeks before team practices begin.

How high school athletes can safely prepare for the start of practice, and the warning signs of heat illness
Taking breaks – ideally in the shade – and staying hydrated can help athletes avoid heat illnesses.
Ian Spanier/ImageSource via Getty Images

There is no hard and fast rule for how much activity is right for preparing – it varies by the person and the sport.

It's important to remember not to push yourself too hard. Acclimatizing to working out in the heat takes time, so start slow and pay close attention to how your body responds.

How hot is too hot for working out outside?

Anything that is hotter than normal conditions can be risky, but it varies around the country. A hot day in Maine might be a cool day in Alabama.

If it's significantly hotter outside than you're used to, you're more likely to get a heat illness.

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To stay safe, avoid exercising outside in the hottest periods. Work out in the shade, or in the early mornings or evenings when the sun's rays aren't as hot. Wear loose clothing and light colors to dissipate and reflect as much heat as you can.

Hydration is also important, both drinking water and replenishing electrolytes lost through sweating. If your urine is light-colored, you are likely hydrated. Darker urine is a sign of dehydration.

Football teammates, without pads or helmets, take a break around coolers of water on a hot August day.
Players need to stay hydrated and start practices slowly, without heavy equipment, to allow their bodies time to acclimate to the exertion and heat.
Shawn Patrick Ouellette/Portland Portland Press Herald via Getty Images

What does acclimatization look like for teams?

Once team practices start, many states require heat acclimatization processes that gradually phase in activity, though their rules vary. Some states require 14 days of heat acclimatization. Some require six days or none. Some only require it for football.

Athletes who get a head start on acclimatization can help their bodies adapt faster and more efficiently to the heat. Regardless of what your state requires, all athletes participating in all sports should acclimatize carefully.

Heat acclimatization involves adding more strain during the workout every few days, but taking care not to add too much.

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For example, instead of starting the first day of practice with full pads and full contact in football, players might start with just the helmets for the first few days.

A line of linemen practice tackling while wearing helmets and pads.
Contact practices generate body heat, and full pads and helmets hold that heat in. More than 50 high school football players died from heat illnesses between 1996 and 2022.
AP Photo/Rogelio V. Solis

Acclimatization is also about limits: Holding practice only once a day in the beginning and capping how many hours players practice each day can help avoid putting too much strain on their bodies too fast. Coaches and athletic trainers must also keep an eye on the wet bulb global temperature – the combination of heat, humidity, radiation and wind speed – to gauge the heat risk to players and know when to limit or cancel practice.

This isn't just for football. Whether it's soccer, track and field, softball or baseball, heat illnesses do not discriminate. A Georgia basketball player died after collapsing during an outdoor workout in 2019 – she was accustomed to practicing indoors, not in the heat.

What are warning signs an athlete is overheating?

If a player starts to slow down or gets lethargic, that may be a sign that they're overheating. You might see evidence of central nervous system problems, such as confusion, irritability and being disoriented. You might see someone stumbling or trying to hold themselves up.

Most of the time, someone with exertional heatstroke will be sweating. They might have red skin and be sweating profusely. Sometimes a person with heat stress can lose consciousness, but most of the time they don't.

Illustration of an athlete shows symptoms of heat exhaustion and heat stroke
Signs of heat illness in athletes and what to do about it.
Alexander Davis for Arizona State University, Korey Stringer Institute

What should you do if someone appears to have a heat illness?

If someone appears to be suffering from heat illness, cool them down as fast as possible. Find a tub you can put the person in with water and ice. Keep their head out of the water, but cool them as fast as possible.

Immersion in a cool tub is best. If you can't find a tub, put them in a shower and put ice around them. Even a tarp can work – athletic trainers call it the taco method: Put the patient in the middle of the tarp, put some water in with ice, and hold up the sides to oscillate them slowly so you're moving the water from side to side.

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Every sports team should have access to a cooling vessel. About half the states require it. As that expands, these safety practices will likely trickle down to youth sports, too.

If a player appears to be suffering from heatstroke, cool them down and call 911. Having a comprehensive emergency action plan ensures that all personnel know how to respond.

What else can teams do to prepare?

Exertional heatstroke is a top cause of sports-related death across all levels of sports, but proper recognition and care can save lives.

Athletic trainers are vital for sports programs because they are specifically trained to recognize and manage patients suffering from exertional heatstroke and other injuries. As hot days become more common, I believe all sports programs, including high school sports programs, should have an athletic trainer on staff to keep players safe.The Conversation

Samantha Scarneo-Miller, Assistance Professor of Athletic Training, West Virginia University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Fewer bees and other pollinating insects lead to shrinking crops

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theconversation.com – Rachel Mallinger, Professor of Entomology, University of Florida – 2024-07-19 07:30:29
Insects are the primary pollinators of most flowers and crops.
Niklas_Weidner/500px via Getty Images

Rachel Mallinger, University of Florida

Many plants, from crops to carnations, cannot bear fruit or reproduce without bees, beetles, butterflies and other insects to pollinate them. But the population of insect pollinators is dropping in the U.S., due in part to pesticides, climate change, invasive plants and diminished habitats. Rachel Mallinger, assistant professor of entomology at the University of Florida, explains why these insects are in decline and how homeowners can create yards and gardens that are good for pollinators.

Rachel Mallinger discusses insect pollination.

has collaborated with SciLine to bring you highlights from the discussion that have been edited for brevity and clarity.

What kind of insects pollinate?

Rachel Mallinger: A lot of different insects pollinate. Insects visit flowers for many purposes, often for food, to get nectar or to get pollen. Sometimes they'll visit flowers to mate or to lay eggs or as refuge. Bees are the primary pollinators for a lot of plants, but flies, wasps, beetles and butterflies also play an important role.

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How ecologically critical are insect pollinators?

Mallinger: A small percentage of flowering plants are pollinated primarily by wind, but new research suggests that as much as 90% require animal pollinators. Although birds, bats and other mammals also pollinate, insects are the main pollinators for the vast majority of those plants.

Without insects and their pollination, these plants would not be able to reproduce, and we would see a dramatic decline in plant diversity and abundance. Without insect pollinators, these plants wouldn't produce the seeds and the fruit that feed many animals – including people.

Have insect pollinator populations declined?

Mallinger: Recent studies have shown pretty dramatic declines in insects generally, and this has been shown even in conservation lands. So we think that in highly developed areas, insect declines are probably even more dramatic.

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I study primarily native wild bees. Here in North America, we have between 4,000 and 5,000 species. For many species, we don't know if they're declining. Of the ones that we do have some information on, it's estimated that about half are declining and about a quarter are imperiled and potentially on the road to going extinct.

The insect pollinators that tend to be most at risk are ones that are specialists – those that require really unique, specialized food or nesting resources. Also ones that already have a limited range. For example, maybe they are found only on islands or in a small area.

Although many bee populations are in danger, there's much you can do to help.

What about the economic importance of insect pollinators?

Mallinger: Crops pollinated by animals, primarily insects, make up about one-third of our agricultural production in terms of acreage. A study in the state of Georgia found over US$360 million per year in crop pollination services provided by insects in that state alone.

What do insect pollinators need to be healthy?

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Mallinger: Aside from pollen and nectar, some insect pollinators require additional food sources. For example, butterflies in the caterpillar stage need foliage from their host plants.

Other insect pollinators, like wasps and flies, are carnivores in the larval stage, so during that time they need to eat small arthropods – like spiders and centipedes – and insects.

Beyond that, they need nesting habitat. The majority of our insect pollinators nest below ground, and so they need ground that is relatively undisturbed, bare and accessible. Other pollinators nest in woody debris, stems and reeds. And some pollinators, like butterflies, just lay their eggs on host plants.

Additionally, pollinators need environments that are free from toxins. So they need environments that are not regularly sprayed with pesticides, including insecticides.

What stressors are leading to declines in insect pollinator populations?

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Mallinger: I would say there are five main stressors.

Land use change is one. This can be the conversion of wild lands to agriculture or to development.

Climate change is another stressor. It changes the average temperature that these pollinators are experiencing and increases the chance of extreme temperatures and weather events. Hurricanes and flooding can be really detrimental and destroy the habitat for pollinators.

Third, pesticides and other chemicals in our environment that are toxic.

Invasive plants can be really detrimental for pollinators. They can take over an area and replace the native plants that pollinators depend on. That's four.

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And finally, pathogens and parasites.

All five of these stressors can interact. For example, climate change may increase the likelihood of invasive plant species, pathogens and parasites thriving. Land use change can also increase the likelihood of invasive species.

What can homeowners do to help pollinators?

Mallinger: Planting a diversity of flowering plants for pollinators is one of the best things you can do. Aim to have at least three plants flowering at any given time, and look for a diversity of flower colors and shapes. Different pollinators have different preferences. You can have flowers that are yellow, blue, purple, pink, red and white.

In terms of floral shapes, plant some flowers that are flat and are accessible for pollinators with small mouthparts. And also plant some flowers with medium-length tubes, and some with long tubes.

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Focus on native plants and try to seek out plants that might not just be the common types that you find in the big box stores. Go to native plant nurseries and seek out resources online.

Additionally, try to have nesting habitat in your garden. If the space allows, have some woody debris around for the pollinators that nest above ground. This can include things like logs, stems and reeds. Also manage your area to be as chemical-free as possible. This includes reducing pesticide use.

Keep in mind that many pollinators that nest below ground are not aggressive and are solitary. It's just one individual pollinator and her nest.

Watch the full interview to hear more.

SciLine is a free service based at the American Association for the Advancement of Science, a nonprofit that helps journalists include scientific evidence and experts in their stories.The Conversation

Rachel Mallinger, Professor of Entomology, University of Florida

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Long COVID puzzle pieces are falling into place – the picture is unsettling

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theconversation.com – Ziyad Al-Aly, Chief of Research and Development, VA St. Louis Care System. Clinical Epidemiologist, Washington University in St. Louis – 2024-07-18 18:02:37
Researchers are gaining key insights into the ways that the SARS-CoV-2 virus can lead to long COVID symptoms.
Catherine McQueen/Moment via Getty Images

Ziyad Al-Aly, Washington University in St. Louis

Since 2020, the condition known as long COVID-19 has become a widespread disability affecting the health and quality of life of millions of people across the globe and costing economies billions of dollars in reduced productivity of employees and an overall drop in the work force.

The intense scientific effort that long COVID sparked has resulted in more than 24,000 scientific publications, making it the most researched health condition in any four years of recorded human history.

Long COVID is a term that describes the constellation of long-term health effects caused by infection with the SARS-CoV-2 virus. These range from persistent respiratory symptoms, such as shortness of breath, to debilitating fatigue or brain fog that limits people's ability to work, and conditions such as heart failure and diabetes, which are known to last a lifetime.

I am a physician scientist, and I have been deeply immersed in studying long COVID since the early days of the pandemic. I have testified before the U.S. Senate as an expert witness on long COVID, have published extensively on it and was named as one of Time's 100 most influential people in health in 2024 for my research in this area.

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Over the first half of 2024, a flurry of reports and scientific papers on long COVID added clarity to this complex condition. These include, in particular, insights into how COVID-19 can still wreak havoc in many organs years after the initial viral infection, as well as emerging evidence on viral persistence and immune dysfunction that last for months or years after initial infection.

Long COVID puzzle pieces are falling into place – the picture is unsettling
Early on in the pandemic, the SARS-CoV-2 virus seemed to be primarily wreaking havoc on the lungs. But researchers quickly realized that it was affecting many organs in the body.
Uma Shankar sharma/Moment via Getty Images

How long COVID affects the body

A new study that my colleagues and I published in the New England Journal of Medicine on July 17, 2024, shows that the risk of long COVID declined over the course of the pandemic. In 2020, when the ancestral strain of SARS-CoV-2 was dominant and vaccines were not available, about 10.4% of adults who got COVID-19 developed long COVID. By early 2022, when the omicron family of variants predominated, that rate declined to 7.7% among unvaccinated adults and 3.5% of vaccinated adults. In other words, unvaccinated people were more than twice as likely to develop long COVID.

While researchers like me do not yet have concrete numbers for the current rate in mid-2024 due to the time it takes for long COVID cases to be reflected in the data, the flow of new patients into long COVID clinics has been on par with 2022.

We found that the decline was the result of two key drivers: availability of vaccines and changes in the characteristics of the virus – which made the virus less prone to cause severe acute infections and may have reduced its ability to persist in the human body long enough to cause chronic disease.

Despite the decline in risk of developing long COVID, even a 3.5% risk is substantial. New and repeat COVID-19 infections translate into millions of new long COVID cases that add to an already staggering number of people suffering from this condition.

Estimates for the first year of the pandemic suggests that at least 65 million people globally have had long COVID. Along with a group of other leading scientists, my team will soon publish updated estimates of the global burden of long COVID and its impact on the global economy through 2023.

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In addition, a major new report by the National Academies of Sciences Engineering and Medicine details all the health effects that constitute long COVID. The report was commissioned by the Social Security Administration to understand the implications of long COVID on its disability benefits.

It concludes that long COVID is a complex chronic condition that can result in more than 200 health effects across multiple body systems. These include new onset or worsening:

Long COVID can affect people across the lifespan from children to older adults and across race and ethnicity and baseline health status. Importantly, more than 90% of people with long COVID had mild COVID-19 infections.

The National Academies report also concluded that long COVID can result in the inability to return to work or school; poor quality of life; diminished ability to perform activities of daily living; and decreased physical and cognitive function for months or years after the initial infection.

The report points out that many health effects of long COVID, such as post-exertional malaise and chronic fatigue, cognitive impairment and autonomic dysfunction, are not currently captured in the Social Security Administration's Listing of Impairments, yet may significantly affect an individual's ability to participate in work or school.

Many people experience long COVID symptoms for years following initial infection.

A long road ahead

What's more, health problems resulting from COVID-19 can last years after the initial infection.

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A large study published in early 2024 showed that even people who had a mild SARS-CoV-2 infection still experienced new health problems related to COVID-19 in the third year after the initial infection.

Such findings parallel other research showing that the virus persists in various organ systems for months or years after COVID-19 infection. And research is showing that immune responses to the infection are still evident two to three years after a mild infection. Together, these studies may explain why a SARS-CoV-2 infection years ago could still cause new health problems long after the initial infection.

Important progress is also being made in understanding the pathways by which long COVID wreaks havoc on the body. Two preliminary studies from the U.S. and the Netherlands show that when researchers transfer auto-antibodies – antibodies generated by a person's immune system that are directed at their own tissues and organs – from people with long COVID into healthy mice, the animals start to experience long COVID-like symptoms such as muscle weakness and poor balance.

These studies suggest that an abnormal immune response thought to be responsible for the generation of these auto-antibodies may underlie long COVID and that removing these auto-antibodies may hold promise as potential treatments.

An ongoing threat

Despite overwhelming evidence of the wide-ranging risks of COVID-19, a great deal of messaging suggests that it is no longer a threat to the public. Although there is no empirical evidence to back this up, this misinformation has permeated the public narrative.

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The data, however, tells a different story.

COVID-19 infections continue to outnumber flu cases and lead to more hospitalization and death than the flu. COVID-19 also leads to more serious long-term health problems. Trivializing COVID-19 as an inconsequential cold or equating it with the flu does not align with reality.The Conversation

Ziyad Al-Aly, Chief of Research and Development, VA St. Louis Health Care System. Clinical Epidemiologist, Washington University in St. Louis

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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