Emergence of an Israel faith-based community organization facilitating live donor kidney transplantation.

BACKGROUND: The 2014 Consensus Conference on Best Practices in Living Kidney Donations recognized live donor kidney transplantation as the best treatment for late-stage kidney disease, yielding superior graft and patient survival, improved quality of life, fewer requirements for dialysis and increased cost-effectiveness compared to deceased donor kidney transplantation. Yet in spite of the excellent results of living kidney donation, the annual number of living kidney donors is declining in many countries, including the United States. In Israel, a non-profit organization, Matnat Chaim ("Gift of Life" in Hebrew), a faith-based initiative, has emerged as a major force for arranging living donor kidney transplantation mainly by facilitating altruistic living unrelated donor transplantation. METHODS: A retrospective review of the records of live kidney donations facilitated by the Matnat Chaim organization and referred to Israel transplant centers, since the organization's inception in 2009, was performed and compared to published data from the Israel Ministry of Health. RESULTS: Matnat Chaim has facilitated 494 live kidney donations since its founding in February 2009 until the end of 2017. Of the 124 live kidney transplants performed in 2016, 111 (90%) were shown to be altruistic and unrelated. This large number of donations was associated with a doubling of the total number of kidney transplantations, performed in Israel (data published by the Israel Ministry of Health). CONCLUSIONS: The success of an Israel community organization in the promotion of kidney transplantation may serve as a model for other religious and non-religious communities worldwide.

Becoming poor and the cutback in the demand for health services in Israel.

BACKGROUND: This paper examines whether individuals facing the threat of poverty are curtailing their consumption of various goods and services in a given order and, if among the expenditures that are cut back, there are also health expenditures. The location of individuals in this order of cutback is then used to derive the degree of their deprivation and the factors that affect the extent of this deprivation. METHODS: This order of curtailment of expenditures is obtained on the basis of an algorithm originally devised to derive the order of acquisition of durable goods. Having found the order of curtailment of expenditures on the basis of the 2003 Israel Social Survey, we then estimate an ordered logit regression whose latent dependent variable is assumed to measure the individual degree of deprivation. RESULTS: The results of this estimation show that, other things constant, the individual latent level of deprivation increases with the size of the household, first increases and then decreases with the age of the individual, is higher when the individual has children under the age of five, has a low educational level, a low income, and when he/she is separated or divorced. Finally, deprivation is found to be lower among individuals with good health. CONCLUSION: Discovering the order of curtailment of expenditures, including health expenditures, of individuals facing economic difficulties and finding the determinants of the extent of such deprivation should help policy makers focus their attention on the population subgroups that are most likely to curtail their health expenditures when facing economic difficulties.

On the cardinal measurement of health inequality when only ordinal information is available on individual health status.

This paper suggests new indices of health inequality which may be used when only ordinal information is available on individual health status. We borrow ideas from the literature on the measurement of occupational or residential segregation and show that indices of ordinal segregation which have been recently proposed may be also applied to the measurement of health inequality. We also prove that these indices satisfy four axioms introduced to measure inequality with ordered response health data so that the new indices presented in this paper are consistent with the inequality ordering proposed by Allison and Foster. We also suggest an extension of the family of indices proposed by Abul Naga and Yalcin.

Extended 21-sample needle biopsy protocol for diagnosis of prostate cancer in 1000 consecutive patients.

OBJECTIVE: To prospectively evaluate the diagnostic yield of a 21-sample ultrasound-guided needle biopsy protocol as the initial diagnostic strategy for detection of prostate cancer. MATERIALS AND METHODS: Between December 2001 and October 2005, 1000 consecutive patients underwent 21-sample needle biopsies under local anesthesia, comprising sextant biopsies, 3 additional posterolateral biopsies in each peripheral zone, 3 biopsies in each transition zone (TZ), and 3 biopsies in the midline peripheral zone. Each prostate core was numbered and analyzed separately. The patients were divided into subgroups according to the result of digital rectal examination (DRE), serum prostate-specific antigen (PSA), and prostate volume. We evaluated the cancer detection rate overall and in each subgroup. We compared the results of our biopsy protocol to those from 6-, 12-, and 18-core biopsy protocols by analyzing only those cores from our protocol that would correspond to these biopsy schemes. RESULTS: Cancer detection rates using 6 biopsy samples (sextant biopsies only), 12 samples (sextant plus lateral biopsies), 18 samples (sextant, lateral, and TZ biopsies), and 21 samples (sextant, lateral, TZ, plus midline biopsies) were 31.7%, 38.7%, 41.5%, and 42.5%, respectively. The 12-sample procedure improved the cancer detection rate by 22% compared with the 6-sample procedure (p=0.0001). The improvement in the diagnostic yield was most marked in patients with a prostate volume > or =55 ml (36.9%), in patients with normal DRE (26.6%), and in patients with PSA<4 (37.5%). The addition of TZ biopsies to a 12-biopsy scheme increased the diagnostic yield by 7.2% overall (p=0.023). Only 10 of 425 (2.3%) patients were diagnosed on the sole basis of midline biopsies. CONCLUSIONS: Patients with suspected localized prostate cancer should be offered at least 12 biopsies in the peripheral zone and far lateral peripheral zone (statistically significant). TZ biopsies have to be considered, because these biopsies improve the diagnostic yield. For patients with abnormal DRE and/or PSA> or =20 ng/ml, the 6-biopsy scheme seems sufficient (statistically), but 6 far lateral peripheral zone biopsies as well as the TZ biopsies add little incremental value (not significant). Evidence does not support the use of routine midline peripheral zone needle biopsies in the initial biopsy to enhance the detection of prostate cancer.

Watchful waiting policy in recurrent Ta G1 bladder tumors.

OBJECTIVE: To determine the outcome of a watchful waiting policy in patients suffering from small, recurrent, papillary bladder tumors. METHODS: Watchful waiting has been considered an option when a small (<10 mm) papillary, asymptomatic tumor with negative urinary cytology was found on follow-up cystoscopy in patients who had previous resection(s) of superficial, low-grade (Ta) bladder tumor(s). The watchful waiting protocol included cystoscopy and urinary cytology every 3 months for 2 years (and then every 6 months). Surveillance was stopped if the patient had developed either symptoms related to the tumor or positive cytology, or if there had been a significant alteration in tumor morphology or size. RESULTS: Thirty-eight watchful waiting periods were documented in 28 patients (mean age 67.7 years). Mean period length was 13.5 months (SD 14.4 months; range 3-60 months). Thirty periods were terminated with tumor resection. The main reasons for termination of surveillance were the appearance of additional tumors (19 patients) and excessive tumor growth (9 patients). Hematuria indicated tumor removal in only one patient. All resected tumors were stage Ta (23 were grade 1, and 7, grade 2). The rate of tumor growth during the watchful waiting period depended highly on the tumor's largest diameter at the beginning of surveillance. If the initial tumor diameter was smaller than 5 mm (32 cases), the tumor growth rate was 4+/-5.1 mm3/mo (mean+/-SD); if the initial tumor diameter was > or =5 mm (6 cases), the tumor growth rate was 870+/-1116 mm3/mo (p < 0.05). CONCLUSIONS: Small, recurrent papillary bladder tumors after resection of low-grade Ta tumor(s) pose minimal risk for the patient. A watchful waiting policy- without resection of the tumor-may be considered in these patients.