Using Social Media for Organ Transplantation

Reports indicate that the number of organ donors in the U.S. has decreased in recent years, while the number of patients in need of an organ transplant continues to grow. In 2006, there were 8,019 cadaveric organ donors and 6,732 living donors. Both figures have since decreased, and in 2008 there were only 7,990 cadaveric donors and 6,218 living donors. According to the National Kidney Foundation, 104,748 individuals in the United States are currently awaiting an organ transplant of some type, and more than 4,000 new patients are added to this figure each month. Organs from donors are matched to waiting recipients by a national computer registry called the National Organ Procurement and Transplantation Network (OPTN). In addition, close relatives and family members often undergo testing including tissue matching and blood typing to determine if they are a viable candidate for donation. Many organs, including kidneys, can be transplanted from either living or recently deceased donors, provided they have good kidney function, and low risk for certain disorders including high blood pressure and diabetes.

Transplants using kidneys from both living and cadaver donors are frequently successful, with about 94.9 percent and 97.96 percent of cadaver and living (respectively) donor kidneys still functioning after one year. In spite of the success rate, the wait to receive a transplant, which can often be several years and often requires dialysis and other physically taxing treatments, is too long for some individuals, and a number have chosen to utilize online social media to seek out possible donors. The Baltimore Sun reports that 80,000 people in the United States are currently awaiting kidney transplants, but just over 16,000 were completed last year. For individuals seeking to increase their chances of finding a donor, Annette Whinery, the coordinator of University Medical Center’s living donor program, says that it is becoming common for patients to seek out living donors on their own, often through church, work, family, and friends. Dr. Ngoc L. Thai, director of Allegheny General Hospital’s Center for Abdominal Transplantation, recently completed a transplant surgery in which the donor and recipient connected via Facebook. “It’s the way of the future,” according to Dr. Thai, who says that he expects more patients to turn to social networking websites for help finding donor matches. In addition to Facebook, some patients and their family members have turned to Craigslist and other websites to find possible donors.

Some individuals awaiting transplant and those who have recently received a transplant choose to use social networking websites to tell their story, rather than to ask others to consider donating an organ. Through blogs, Facebook, and Twitter, individuals in need of kidneys and other organs are able to keep others informed. Recent research has shown that people fighting chronic illnesses and those with serious health problems, such as those that might require an organ transplant, are using social media to find information and connect with others with similar ailments. Social networks like the Transplant Trust and Patients Like Me allow patients awaiting transplants, their families, physicians, donors, and others to connect with one another. In a recent study by Teri Browne, PhD, from the University of South Carolina in Columbia, this type of connection was shown to help patients navigate and understand the process of getting a transplant more easily.

According to Dave Bosch, spokesman for the Gift of Hope, an organ and tissue donor network, “Social media has become the way people communicate, very personally, about what’s going on in their life.” Dr. Kenneth Prager, director of clinical ethics and chairman of the Medical Ethics Committee at New York Presbyterian Hospital, notes that Internet appeals for organ donations raise a number of questions of fairness. While Dr. Prager states that “Solicitations undermine the concept of a level playing field,” which is the primary objective of the OPTN, “there is nothing illegal in advertising or using the Web for personal or health reasons. Altruistic organ donors have the legal right to designate recipients.” It is important to note, however, that the sale of kidneys and other organs is illegal, and all donations must be made without compensation.

Though the use social media to address matters related to an individual’s health may seem somewhat unusual, it is a trend that seems to be gaining in popularity. Some experts even argue that the solicitation for kidney and other organ donation on websites like matchingdonors.com, Craigslist, and Facebook may help to encourage individuals to consider donation and benefit the population of individuals in need of organs as a whole.

Discuss this and other health topics in the iCons in Medicine Forums

On Sunscreen and Skin Cancer

In 1903, Dr. Auguste Rollier opened the world’s first sun clinic at Leysin offering a place where sunlight was seen as a treatment for disease. Well into the 20^th century, tanned skin was not only an indicator of health, but was fashionable as well. In recent years, outdoor tanning as well as the use of tanning beds have drawn attention for their potentially harmful effects. Skin cancer is the most common form of cancer in the United States with nearly one million cases diagnosed each year. Though other risk factors can contribute to the development of skin cancer, one’s exposure to ultraviolet (UV) radiation can speed their progression. By making sure to apply sunscreen, wear protective clothing, and limit time spent in direct sun, individuals can decrease their likelihood of developing skin cancer.

UV rays are a type of invisible radiation that comes from the sun, tanning beds, and sunlamps. There are three kinds of UV light: UVA rays are present year round and penetrate deep into the surface of the skin, damaging the cells beneath and causing signs of aging. Though UVA radiation can contribute to skin cancer, UVB rays, which cause sunburn and tanning of the skin and are more prevalent during the summer months, are also most often responsible for the development of skin cancer. UVC rays, are blocked by the ozone layer, but would cause sunburn with only brief exposure, while prolonged exposure would be fatal. Tanning beds primarily emit UVA radiation, which is the least harmful, but a 2006 study indicated that the use of tanning beds before an individual is 30 years old is associated with a 75 percent increase in melanoma risk.

Excessive UV exposure frequently leads to erythema, or sunburn, as well as causing a darkening and thickening of the outermost layers of the skin, which differs from a sun tan. Chronic exposure to any UV radiation can cause degeneration of the cells, fibrous tissue, and blood vessels of the skin, and may eventually contribute to the development some types of skin cancer. The primary symptom of skin cancer is a mole or other growth on the skin. The “ABCD system” is frequently used to help individuals understand what to look for when determining if a skin growth is cancerous. Asymmetry, when one half of the area is different from the other; Borders, irregular edges to the growth; Color, changes in color from one area to another; and Diameter, when the growth is larger than a pencil eraser; are all indicators that a lesion should be examined by a dermatologist. Some experts also make note of the “E factor” associated with skin cancer development – the Evolution or changing of the lesion.

The two most common types of skin cancer, basal cell and squamous cell carcinomas, also called non-melanoma skin cancers, can be caused by exposure to ultraviolet (UV) light. Though they are often curable, the process of surgical removal can be painful and disfiguring. According to a survey from the American Society for Dermatological Surgery (ASDS), there was a 10 percent increase in the number of surgical procedures related to skin cancer between 2007 and 2009. Melanomas are often malignant and are a more dangerous form of cancer, and 65 to 90 percent of them are caused by UV exposure.

To reduce an individual’s risk of developing skin cancer, experts recommend a number of measures that can be taken, including limiting the amount of time spent outdoors, particularly between 10AM and 4PM when UV exposure is highest in the continental United States. In addition, though it does not completely eliminate an individual’s risk of developing skin cancer, the use of sunscreen can help to decrease the risk. According to a U.S. sunscreen study conducted by Neutrogena, only 18 percent of American adults use sunscreen regularly, and only 48 percent of those reapply sunscreen when needed. Though the American Academy of Dermatology (AAD) suggests that consumers apply enough sunscreen to fill a shot glass, according to Jeffery Dover, president of the ASDS, consumers often do not apply enough for the products to be effective. The AAD reports that individuals frequently do not use enough sunscreen to adequately protect them from UV rays, and suggests the use of products with a sun protection factor (SPF) of at least 15 year round and 30 in the summer. SPF refers to the ability of a product to block UV radiation from reaching the skin, however the amount of protection does not increase proportionally with the SPF number and layering multiple SPFs does not result in protection equal to their sum. In order to ensure that sunscreens are most effective, they should be applied at least 20 minutes prior to sun exposure and only products stating that they provide UVA/UVB or “broad spectrum coverage” should be used.

In order to increase the use of sunscreen, public health officials have begun seeking new ways of increasing sun safety awareness. In one study, researchers found that using text messages to remind individuals to apply sunscreen when going outside, and reapply it following swimming or exercise increased its use. Sun protection has also advanced beyond the standard lotions, creams, and sprays, and now also includes clothing treated to provide UV protection. Most recently, a 10 percent tax was implemented on the use of indoor tanning services, underscoring the fact that even indoor tanning can be hazardous. With these new measures in place and continued improvements in sun protection technologies, researchers hope that it may be possible to prevent some skin cancers from developing.

Discuss this and other health-related topics in the iCons in Medicine forums

Follow iCons in Medicine on Twitter for daily Global Health and Health IT updates

On Drug Resistance

As the distribution of medications worldwide advances, individuals gain access to improved treatment options. Among the medications most frequently distributed are antibiotics. Though expanded access to medicines is “clearly desirable,” it can also create “challenges in preserving the efficacy of these drugs.” A recent report from the Center for Global Development (CGD) indicates that antibiotic distribution programs put in place by the World Health Organization, government agencies, and other groups may be contributing to the increased incidence of drug-resistant bacteria. According to Nancy Birdsall, the president of the CGD, “Drug resistance is a serious problem that doesn’t get serious attention.”

Antibiotics and antimicrobial agents are the most effective means of combating infectious disease. However, as a class of drugs, antibiotics are unique in that once an antibiotic is utilized, the bacteria it is intended to fight begin to develop a resistance and the effectiveness of the medication is diminished. According to British researchers who analyzed 24 previous studies, the excessive prescription and use of antibiotics for coughs and flu-like illnesses leads to antibiotic resistance. Studies indicate that the overuse of medications, inconsistent drug quality, and other factors hasten the adaptation of resistance to given antibiotic and antimicrobial agents.

This increased resistance to commonly used antibiotics can result in “superbugs,” such as methicillin-resistant Staphylococcus aureas (MRSA), which is the cause of more than 50 percent of staph infections in US hospitals. Additionally, in the developing world, drug-resistant strains of malaria, tuberculosis, HIV/AIDS, and other diseases are the cause of death for millions of children each year. According to Céire Costello Research Associate at the University of Bristol, “there are some concerns that some common infections are becoming increasingly difficult to treat.” This is seen with increasing frequency in many remote and medically underserved areas of the world where medication dispersal programs are especially prevalent. Reports indicate that 60 to 80 percent of dysentery cases among children in Latin America are “resistant to the drugs recommended to treat it.”

By retaining the medications available now and developing new drugs, experts hope to be able to continue combat bacterial infections effectively. Because of the lengthy development and testing process associated with creating new medications for mass consumption, it is critical to ensure that drug resistance is minimized as much as possible. By urging providers to keep track of which antibiotics they prescribe and how frequently, it may by possible to help slow the rate of drug resistance. It is also essential for clinicians and individuals worldwide, particularly in the developing world, to be aware of the importance of not over prescribing or over using antibiotics.

Discuss this and other health-related topics in the iCons in Medicine forums

Using SMS for Healthcare

Over 4.1 billion cell phones are in use globally, and they are quickly becoming a part of the “digital life” for many.Reports indicate that individuals worldwide now use Internet-based and mobile technologies to find health-related information more frequently than ever before. Although cell phones are more common than computers in some areas of sub-Saharan Africa, it is important to note that they are frequently low-cost models with less features as opposed to high-tech smartphones, so mobile web-based information and applications may not be available.



As a means of delivering health-related information in remote areas, many clinics and organizations have begun to utilize short message service (SMS) technology. SMS or “texting” is a mature technology that is supported worldwide on all cellular network operators, through which messages of up to 160 characters can be delivered to a user’s cell phone. In regions where “personal computer technology” may not be available, it is possible to better ensure the delivery of health-related information through the use of basic cell phones and SMS technology. Over the past few years, SMS-based systems have been put in place throughout the developing world to combat diseases like malaria, provide medical and health information, and support rescue and relief efforts following natural disasters.

In regions where malaria is prevalent, SMS systems, such as the “SMS for Life” program currently in use in Africa, have been implemented to deliver information about the availability of treatment and medications. This program allows the inventory of anti-malarial medications at healthcare facilities throughout Africa, particularly in remote areas, to be tracked by clinics and aid organizations to improve distribution rates. Similar programs which allow physicians to monitor their patients at a distance have been put into practice for other diseases, including a program to ensure the provision of quality care to patients with HIV/AIDS in Kenya. This type of patient-monitoring SMS program has also been instituted to allow healthcare workers in Rwanda to monitor pregnant patients remotely, provide basic health and well-being information to patients throughout Africa, and provide clinic location information to patients in India.

SMS systems have also been established following natural disasters, such as the earthquake that struck Haiti on January 12, 2010. A number of relief organizations set up SMS shortcodes, which assisted individuals searching for friends and family members. Shortcodes are set numbers – usually only five digits long - used to quickly and easily gather messages for delivery. Additionally, SMS messaging and shortcodes allowed for a simplified donation process to a number of aid organizations providing assistance in Haiti.

Although mobile applications, smartphones, and other cutting edge technologies have provided enormous advancements in healthcare, high-tech solutions are not always appropriate for worldwide use. In settings where reliable Internet connectivity may not be available and where basic cell phones are the norm, SMS-based systems allow for the distribution of health-related information to a wider audience.

Discuss this and other Health IT topics in the iCons in Medicine Forums

HIV/AIDS Worldwide

Worldwide, an estimated 33.4 million people are currently living with HIV, and a recent WHO report indicates that 68 percent of these individuals live in sub-Saharan Africa. Though HIV is prevalent in the developing world, infection rates in the United States continue to be a major health concern. Reports indicate that at the end of 2006, an estimated 1.1 million people were living with HIV in the U.S. and these figures have continued to grow. Though education, testing, and treatment efforts have increased worldwide, ensuring that all individuals with HIV are aware of their status and have access to life-saving medications, remains an enormous challenge.

The human immunodeficiency virus (HIV) was first recognized in 1981. The virus destroys specific cells that are imperative to the functioning of an individual’s immune system known as CD4+ T cells. An individual’s HIV status can be determined by administering an antibody test, which detects the substances that the body produces in response to HIV infection. If an individual with HIV does not receive treatment, their condition will progress to the point at which they will be diagnosed as having acquired immune deficiency syndrome (AIDS). A healthy individual has a CD4 count of more than 500 cells per cubic millimeter (mm3) of blood, but when an individual’s CD4 count is below 200 mm3, they are diagnosed as having AIDS.

Though anyone can contract HIV, there are certain behaviors known to increase the risk, including promiscuous and/or unprotected sexual contact, using intravenous drugs, homosexual intercourse, and sexual intercourse with individuals who have been incarcerated. According to Carla Bruni-Sarkozy, wife of the President of France and Global Fund’s Ambassador for Protecting Women and Children Against AIDS, children born to mothers with HIV are also at an increased risk, and over 400,000 babies are born with HIV each year. New study findings also suggest that the risk of female-to-male transmission of HIV doubles during pregnancy, but the reason for this increase has not yet been identified. Individuals with HIV can suppress the virus and stop its progression through the use of antiretroviral therapy (ART), which consists of the use of at least three antiretroviral (ARV) medications. Reports indicate that the United States now supports more than 2.5 million individuals receiving ART, the WHO estimates that at least 9.7 million people, primarily in low- and middle-income nations, are in need of these lifesaving medications.

In the hopes of identifying more effective treatment options, research is ongoing to explore how HIV infection progresses in the body. Though it is no longer used following the eradication of smallpox, experts have found that the smallpox vaccine may interfere with how HIV replicates. Additionally, tests have been conducted using experimental vaginal gels containing antiretroviral elements, and they have been seen to reduce transmission of a virus closely related to HIV in monkeys. Researchers have also identified a bacterium found in the human throat which secretes a toxin that has been found to enable antibodies to destroy viral particles in the blood.

Though promising, it remains to be seen if this research will yield any substantial advancement towards finding a cure for HIV. Until a cure is found, expanding existing treatment options and ensuring the provision of testing and education programs are essential to shunting the spread of the virus.

Discuss this and other public health topics in the iCons in Medicine Forums

Innovative Appropriate Technologies

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

Discuss this and other topics in the iCons in Medicine Forums

On Malaria Worldwide

Nearly half the world’s population – roughly 3.3 billion people – are at risk of contracting malaria. Though individuals in Latin America, the Middle East, and Europe are among those most often affected by the disease, the Centers for Disease Control and Prevention reports that 98 percent of global malaria deaths occur in 35 countries - 30 of them in sub-Saharan Africa and five in Asia. Every year there are nearly 250 million cases and an average of one million deaths due to malaria. Reports show that in 2008, an estimated 863,000 people died from malaria infection, indicating some improvement in diagnosis and treatment outcomes. Transmission is possible to any individual, however some groups are at an increased risk. These include young children who have not yet developed full immunity, pregnant women whose immunity has been decreased by pregnancy, international travelers who lack immunity, and individuals with HIV/AIDS or others with compromised immune systems.

Malaria is a preventable and curable acute febrile illness caused by the bite of Anopheles mosquitoes which have been infected with Plasmodium parasites. The long lifespan of the Anopheles species found in Africa contributes to the disease’s prevalence in the region, and experts note that more than 85 percent of the world’s malaria deaths occur in Africa. Symptoms are usually seen seven days after the infective mosquito bite, and include fever, headache, chills, and vomiting. If diagnosed quickly, malaria can be treated using artemisinin-based combination therapy (ACT), however if treatment is not initiated, malaria can progress and lead to severe anemia, respiratory distress, or death.

In countries where malaria is endemic, access to diagnostic tools and medications may be limited. Less than 15 percent of these individuals are able to begin treatment within 24 hours of the onset of fever, which is when treatment must be started. Malaria diagnosis relies on either microscopy or rapid test procedures to allow healthcare providers to quickly determine if patients have the disease and require treatment. The Malaria Product Testing Evaluation Programme recently completed an assessment of 29 rapid diagnostic tests and found that 16 of them met the minimum performance criteria set by the WHO. According to Robert Newman, the director of the WHO’s Global Malaria Programme, using rapid tests allows healthcare providers to “test people who cannot access diagnosis based on microscopy in remote, rural areas where the majority of malaria occurs” and thus improves treatment outcomes.

In addition to improved testing, global efforts are underway to control malaria by eliminating the mosquitoes that transmit the disease. During the past decade, the distribution of treated bed nets has increased rapidly in 11 African nations, helping to reduce infection rates. Reports indicate that in 2008, 31 percent of African homes had insecticide-treated nets (ITNs), compared with 17 percent in 2006. Through the use of ITNs, as well as spraying of homes with insecticide chemicals, 10 African nations reduced the number of cases of malaria by at least 50 percent between 2000 and 2008.

Though there is no vaccine for malaria, more effective prevention measures, diagnostic tests, and medications can help to improve treatment outcomes for those affected. Government agencies, including the World Bank, and other groups, such as Roll Back Malaria global partnership, have made efforts to increase global awareness about malaria. By utilizing social media and online tools it has been possible to improve the effectiveness of outreach and fundraising for efforts which may help to eradicate malaria worldwide.

Discuss this and other global health topics in the iCons in Medicine Forums

Find out about iCons in Medicine’s efforts to collect donations of mobility aids for Haiti