On Organ Donation

November 29, 2011

As of October 2011, a reported 112,178 patients in the U.S. were awaiting organ donations and every 11 minutes another individual is added to the waiting list. Though an average of 75 people per day receive organ transplants daily and more than 86 million people in the U.S. are registered as donors, a critical shortage of organs remains. Increasing information about the importance of donation could help to encourage new donors and save lives.

Organs and tissues including heart, kidneys, liver, lungs, skin, and corneas can all be donated and transplanted. According to experts, the organs and tissue from a single donor could help as many as 50 recipients. There are no age restrictions for donors, and depending on the type of donation, organs may come from a deceased or living donor. Current data indicates that as of October 7, 2011 there had been 113,693 living donors and 143,662 deceased donors since the tracking of organ donation was initiated.

Any individual is eligible to register as an organ donor, though the process for registering varies by state. If an individual who was not a registered donor dies due to massive trauma to the brain or is declared brain dead and cannot be revived, the individual’s family members must authorize the donation of the individual’s organs. Only organs with blood and oxygen flowing through them at the time of donation are viable for transplant, and each must be transplanted within hours to help prevent rejection by the recipient. When organs become available, they must tissue and blood typed to identify the appropriate individual on the transplant waiting list who is a match, as well as ensuring that they are the appropriate size for the recipient.

The recovery of organs for transplant is performed by a team of surgeons, nurses, and the transplant coordinator in the operating room where the donor received care. Just prior to removal, each organ is flushed free of blood and then placed in a sterile container for transportation to the recipient’s transplant center. Organs must be transplanted quickly – hearts and lungs within four hours, livers within 12-18, and kidneys within 24-48 hours of removal from the donor.

The risks associated with receiving an organ transplant are outweighed by the benefits as individuals receiving transplants are those who would not be able to survive without them. Though all organ recipients must take anti-rejection drugs following transplant, reports indicate that 15 percent still suffer some rejection in the first year. In addition, though the Centers for Disease Control and Prevention (CDC) reports that though the risk of disease transmission from donated organs is rather small, between 2007 and 2010 more than 200 cases of suspected transmission were investigated. To increase the safety of organ transplants, the CDC has drafted new guidelines for advanced organ testing which would screen for hepatitis B and C as well as HIV.

In 2010, 28,665 organ transplants were performed, but reports indicate that as many as 6,000 Americans die each year while waiting for a transplant. By encouraging individuals to consider registering as donors, it may be possible to save thousands of lives each year.

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Ensuring Accessibility During Natural Disasters

September 12, 2011

Reports indicate that individuals with disabilities are disproportionately affected by natural disasters and emergency situations, due in large part to a lack of adequate planning. Available facilities are frequently inaccessible or are ill equipped to accommodate the needs associated with certain disabilities, therefore, by including individuals with disabilities in all stages of the disaster management process, particularly during the planning and preparation phases, the effectiveness of disaster responses can be greatly improved.

An estimated half a billion people – 10 percent of the world population – experiences some form of impairment or disability. Following recent natural disasters including Hurricane Katrina, studies have found that the regions affected by these disasters are frequently not prepared to evacuate, shelter, transport, or meet the medical needs of individuals with disabilities. In addition, the shelters, transportation services, and emergency communications and information broadcasts available in many regions are often not accessible.

By learning from problems identified following natural disasters, regarding the needs of individuals with disabilities, emergency response initiatives can be modified to ensure that the needs of people with and without disabilities are met. According to experts, all individuals, regardless of their disability status, should prepare for potential disaster situations by having a store of food and water on hand to last a minimum of three days. In addition, it is recommended that individuals with disabilities have a supply of items related to their specific needs – which may include eyeglasses, hearing aides, a laminated communication board, or medications – for at least seven days. FEMA, which recently launched a disaster preparedness app, notes that individuals with certain types of disabilities may need to take additional steps to prepare for and receive assistance following natural disasters. It is suggested that individuals with disabilities establish a network of friends, family, and neighbors who may be able to assist them in the event of an emergency.

While natural disasters affect everyone within a given region, individuals with disabilities may face barriers that can cause additional issues. A number of government agencies, including the Department of Health and Human Services (HHS) have put measures in place to help mitigate the barriers faced by individuals with disabilities in emergency situations. Ensuring the inclusion of individuals with disabilities and their representatives in strategic planning efforts and the provision of information in accessible formats before, during, and following natural disasters are among HHS’s chief concerns. In addition, the UN Convention on the Rights of Persons with Disabilities and other international policy initiatives aim to ensure that humanitarian responses to natural disasters are inclusive of the needs of individuals with disabilities.

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Click here to read the International Disability Rights Monitor (IDRM) report on Disability and Early Tsunami Relief Efforts in India, Indonesia and Thailand

Vote and Spread the Word!

December 2, 2010

for the Center for International Rehabilitation’s submission
to the Pepsi Refresh Project

Access to rehabilitative services and prostheses are lacking in many regions.
Your vote will help the CIR continue to address the needs of amputees in these areas with its techniques to create and provide cost-effective prosthetics to amputees without access to rehabilitative care, allowing them to more fully participate in society.

You can place your vote by clicking the link below

Provide Cost-Effective Prosthetic Care in Underserved Midwestern Areas

or by texting

104494 to “Pepsi” (73774)

You can vote once a day from now until January 1, 2011.

Please vote today and everyday and help spread the word!

Thank you for your support!

Innovative Appropriate Technologies

May 17, 2010

Some high-tech healthcare devices can be created inexpensively and may be beneficial worldwide. Devices which utilize local resources, often referred to as Appropriate Technologies, are especially valuable as they often make use of the skills of local craftsmen and rely on readily available materials. According to Danielle Zurovcik, student researcher at MIT, these devices have the potential to greatly improve care in clinics that “don’t have power, don’t have a lot of supplies.”

Using automobile parts, including headlights, an HVAC, and tires, which are common in even remote regions of the world, researchers have created an incubator in the hopes of decreasing infant mortality rates. By using car parts, researchers were able to create a device that could be fabricated and repaired by auto mechanics and others with limited or no training building or repairing medical equipment. In addition, the prototype incubator uses electricity, but also has a motorcycle battery to provide power if it is not available.

Low-cost diagnostic and treatment devices have also been developed to allow for access to these services in areas where they might otherwise be limited. Undergraduate students at Rice University have developed a centrifuge that can be constructed using a salad spinner and other common plastic items. Like conventional centrifuges, it is able to separate blood samples in only 10 minutes. These samples can then be used to test for anemia, as well as tuberculosis, malaria, and HIV/AIDS. Another simple device was created by students at MIT to help speed the healing process of wounds. The small molded plastic pump can be used to apply suction to a wound, helping to keep the draw away bacteria and wound clean, as well as allowing it to heal more quickly.

Medical devices and aids for individuals with disabilities have also been conceived for use in areas with limited resources. In many areas, low vision is a tremendous problem, affecting literacy and employment rates. In spite of the great need, eyeglasses and the personnel needed to properly fit them, are frequently not available. To address this need, Oxford University professor Josh Silver devised a solution: eyeglasses with fluid filled sacs inside the lenses, whereby the amount of fluid can be adjusted by the user to change the power of the lens. Simple, low-cost devices have also been created to allow individuals with disabilities to communicate with care givers. The Communication Board was developed by the Center for International Rehabilitation’s (CIR) Yeongchi Wu, MD in the early 1980s using only a sheet of paper and pen. The simple and low-cost device can also be used in nursing homes or intensive care units.

Innovative Appropriate Technologies which utilize local resources can help improve the quality and availability of healthcare worldwide. There is often a stigma attached to lower-cost and lower-tech devices, as more expensive can be perceived as better, however their use in the developed and developing world may prove beneficial in reducing overall healthcare costs.

Vote for the Communication Board on Instructables – May 23-30, 2010

Vote for the Communication Board - May 24-30th

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Amputation and Prostheses in Haiti

February 8, 2010

As government agencies and non-governmental organizations flood Haiti to provide relief support, many are finding a lack of even the most basic medical equipment and supplies. Even before January 12th, Haiti’s healthcare system was unable to fully support the needs of the Haitian population which included 800,000 individuals with disabilities, and life-saving medications were in short supply but high demand. While outbreaks of tuberculosis, HIV, and cholera are the current major public health concerns, insuring the provision of rehabilitation services to the estimated 200,000 (some reports indicate 250,000) individuals who have undergone amputations as a result of the earthquake are especially pressing. This figure includes not only the 2-3,000 individuals who have had amputations of major bones as well as the thousands more who have fingers or toes amputated (per personal correspondence with Al Ingersoll, CP; Healing Hands for Haiti).

Without proper medical equipment and often in unsterile conditions, physicians providing care in Haiti since the earthquake struck have had to amputate the limbs of individuals who otherwise would die. The social stigma attached to individuals with disabilities in Haiti and other developing nations has led some Haitians to leave gangrene infections untreated, as they would rather die that face the prospect of living without an arm or leg. In addition to possible infection at wound sites, individuals who have suffered “crush injuries” or rhabdomyolysis are at risk developing kidney failure when the crushed muscle ruptures. Studies indicate that between four and 33 percent of patients with rhabdomyolysis develop kidney failure, but amputation of the affected limb has the potential to save the patient’s life. In order to perform these amputations, CNN reports that some surgeons have had to use “civil war medicine” – amputating limbs with saws and other instruments, often without anesthesia. Some estimates indicate that as many as 95 percent of Haitians who suffered crushing injuries in the earthquake will undergo amputation.

Haiti’s hospitals sustained considerable damage and what remains of the Haitian healthcare system has been overwhelmed by the demand of those in need of medical services. To fill this gap, clinics run both by local hospital staff and international aid organizations have been setup in tents outside the devastated buildings. Reports indicate that surgeons at University Hospital, Port-au-Prince’s largest hospital, performed approximately 225 amputations within the first few days following the earthquake. Though statistics are not available yet for the number of new amputees, Mirta Roses, director of the Pan American Health Organization, has indicated that some hospitals have reported performing as many as 30 amputation surgeries per day. Limitations of space, medical personnel, and other resources have forced many makeshift Haitian surgical wards to discharge individuals after amputations are completed, overloading what remains intact of Haiti’s fragile hospital system with patients in need of post-operative care. To assist further assist these individuals, organizations like Healing Hands for Haiti, Handicapped International, and Doctors Without Borders are making efforts to provide surgical and post-operative care following amputation. Additionally, Global Relief Technologies has introduced a system that allows for critical information about patients to be collected and uploaded to a PDA so that this information can be shared with other aid organizations to ensure high-quality care for all amputees.

In addition to the importance of post-operative care, individuals who have undergone amputation are in need of prostheses, but the devices commonly used in the developed world may not be best suited for use in Haiti. An average prosthesis can cost between $4,000 to $6,000 and in the United States a new amputee could expect to undergo a minimum of four fittings a year for the life of the prosthesis to ensure that the device is comfortable – in Haiti this is simply outside the realm of possibilities. Low-cost, high-quality devices developed by non-profit organizations, including the Center for International Rehabilitation (CIR) and Legs for All may be applicable for use in Haiti. Developed specifically for use in areas with limited resources, the Center for International Rehabilitation’s CIR Casting System could allow for the rapid fitting of Haitian amputees. Unlike traditional plaster-based prosthetic fabrication methods, the CIR Casting System uses a fabric bag filled with polystyrene beads and allows for the fabrication of prostheses in a fast, simple, and low-cost manner. A final prosthesis can be fabricated in less than two hours during a single clinical visit, compared with at least two clinical visits using traditional plaster-based methods. In addition to the development of this innovative fabrication method, the CIR conducts blended distance learning initiatives that combine online training with hands-on workshops to familiarize local technicians with the fabrication method. Since 2008, following trainings in Thailand and India, over 2,500 individuals have been fitted using the system and it has been widely accepted in these regions. However, as Jeffrey Bigelow, resident neurologist at Yale University who completed a survey of the needs of Haitian amputees for Healing Hands for Haiti in 2004, notes,  it is important to recognize that even when using this type of appropriate technology, “devices need to be skillfully made or they’re just too painful to wear.”

Dr. Steven R. Flanagan, medical director of the Rusk Institute of Rehabilitation Medicine at NYU Langone Medical Center, noted that even in the best of circumstances, when an amputation site can be properly cared for, it can take four to six months for a traumatic amputation to heal completely. Even before they can be fitted, many of Haiti’s new amputees will require counseling to come to terms with their new lives as a part of Haiti’s generation of amputees.

Specialty physicians who wish to offer teleconsultation support to disaster-relief workers in Haiti, Health professionals who wish to provide volunteer support on the ground in Haiti, and U.S. healthcare institutions that are willing to provide services to victims of the earthquake who are airlifted to this country for urgent medical or rehabilitation care can register through iCons in Medicine.

Find out more about The Center for International Rehabilitation and the CIR’s innovative prosthetic technologies

Appropriate Technologies

December 7, 2009

The primary goal of the iCons in Medicine program is to create a community of healthcare professionals, enabled by appropriate technology to build bridges and forge connections across geographic, social, cultural, and ideological boundaries to make high-quality medical knowledge available wherever medicine is practiced. Appropriate technology is not necessarily items that are high-tech or low-tech, and may not be commercial off-the-shelf items. Rather, appropriate technologies are those that best combine suitability to the task at hand with compatibility with the technological, cultural, and economic framework of the region where they are deployed. Groups of researchers, universities, and not-for-profit and for-profit companies have all begun making strides to create healthcare tools that can be utilized in areas that may lack trained medical staff, resources, and/or reliable Internet connectivity, as well as other regions worldwide.

Health IT advancements and web-based tools offer an opportunity for physicians and healthcare workers to use technology in ways that previously were not available. Mobile applications for iPhones are gaining popularity among healthcare providers in the developed world. The BBC reports that, per Manhattan Research, 64 percent of U.S. doctors currently own a smartphone, and this figure is expected to rise to 81 percent by 2012. Most popular smartphone-based apps are available for the iPhone, among these tools are those that allow for collaboration between healthcare providers working in country, and remote consulting physicians. Among these are the iStetho Adapter and iStethoscope Pro app, developed by RidRx, which allow for audio information to be captured via a stethoscope modified for use with the adapter to be translated into sound spectrograms.

For some physicians in the United States and other areas of the developed world, high-tech solutions provide an opportunity to provide the best quality of care. Dr. Dinesh Patel, iCons in Medicine Member and Chief of Arthroscopic Surgery at Massachusetts General Hospital, finds that in his practice, new imaging and lens technologies have had the greatest impact. Technologies, which are “constantly evolving as high-tech experts bring new ideas,” bring cost reductions and improved health outcomes, as well as reducing complications and insurance costs, according to Dr. Patel. President of the American Telemedicine Center Corp., Dr. Gildred Colon Vega, also utilizes computer-based solutions in her practice at the San Juan Health Centre. Dr. Colon has found that an electronic medical record technology known as Web (based) Disease Management Electronic Medical Record (WebDMEMR) has been especially useful for storing clinical trial information.

Areas of the developing world are also making use of many of these high-tech solutions, including smartphones, and computer-based and mobile applications. The lack of trained staff have led physicians at one eye hospital in India to employ the use of mobile technology to improve its reach in rural and semi-urban areas. By training individuals in rural areas to take retinal images that are then sent to doctors’ iPhones at the hospital in Bangalore, providers are better able to ensure that infants are treated quickly if Retinaopathy of Prematurity (ROP – a potentially blinding condition) is detected.

Life-saving solutions are also being created specifically for use in the developing world, both by researchers in more developed regions and healthcare providers working in-country. These appropriate technologies are often designed with an eye towards sustainability, and make use of the skills of local craftsmen with readily available materials. Diagnostic technology is one area that holds great promise for creating technologies that are both highly effective and inexpensive, and that will provide a global benefit. Additionally, prosthetic and wheelchair fabrication techniques, such as those developed by the Center for International Rehabilitation (CIR) provide low-cost alternatives to standard prosthetic and orthotic devices that can be used in areas where resources or highly-trained personnel may not be available.

These technologies, initially conceived for use in medically underserved and post-conflict areas, also have the potential to impact healthcare in the developed world. The World Health Organization (WHO) reports that chronic disease is now the major cause of death and disability worldwide. With issues like cardiovascular disease, diabetes, and obesity, as well as pandemic outbreaks of H1N1 and HIV/AIDS, the development and utilization of globally appropriate solutions is surely practical. Hector Casanova, CP and Yeongchi Wu, MD, both iCons in Medicine Members, have noted the importance of exploring these technologies as possible alternative treatment options to help lower healthcare costs while maintaining a high quality of care. To this end, many technologies that have been conceived for use in the developing world are now being applied in the United States as well in a process known as “reverse innovation.” Companies like General Electric have created technologies in emerging markets and then bringing them to more developed regions.

Through “reverse innovations” and the application of appropriate technologies conceived in the developed world for the developing world or for global application, healthcare worldwide can be improved. By utilizing appropriate technologies that best combine the task at hand with the technological, cultural, and economic framework of the region where they are deployed, connections can be forged to make high-quality medical knowledge available around the globe.

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