Greater Good Science Center

The presenters at the Greater Good Online Institute for Health Professionals, Eve Ekman, Dacher Keltner, Jamil Zaki, Elissa Epel, and Jyothi Marbin (not shown Liz Markle). Image from  Greater Good Science Center

by George Taniwaki

A couple weekends ago, I attended the Greater Good Online Institute for Health Professionals, May 2-3, 2020. The workshop was sponsored by the Greater Good Science Center at University of California, San Francisco. I was hoping to pick up some tips on how I can improve my ability to empathize with kidney patients and their family in order to help them find a donor.

It turns out the program was focused on a completely different set of topics related to reducing stress, improving self-care, and treating patients holistically. Not helpful for my goal, but an interesting weekend nonetheless.

Key take away

If you are interested in leading a happier life and connecting to others with empathy, then the GGSC has tools to help you. They have an online magazine, a Science of Happiness podcast, and videos. In addition to having classes for health professionals, they have online courses for the workplace,  K-12 educators, and families.

After the workshop, one of the goals for participants is to commit to making one change in our lives to make us happier. A typical goal would be to regularly share with a colleague (a few times a week) three good things that you are grateful for. Reflecting on your day and picking out three good things is hard, especially during a pandemic. Striking up a conversation with a colleague simply to talk about one’s feelings is uncomfortable. But the practice sounds useful, I will endeavor to try.

Agenda and video recordings

The agenda along with links to the speaker’s video sessions are shown in the table below. After each speaker there was a breakout session (not shown) where small groups could reflect on the talk and discuss how it impacts them. Of course, you won’t be participate in the group discussion as an individual watching the YouTube recording, but perhaps you can try turning on your camera and talking to yourself.

Schedule	YouTube	Description
Sat, 8:30 – 9:00	31:00 (no sound at start)	Dacher Keltner and Eve Ekman — Welcoming remarks/grounding
Sat, 9:00 – 9:30	1:00:19	Dacher Keltner — Gratitude and Awe in Healthcare
Sat, 10:30 – 11:00	2:32:43	Jyothi Marbin — Diversity, Equity, and Inclusion in Healthcare
Sat, 12:30 – 1:00	4:31:53	Jamil Zaki — Neuroscience of Empathy in Medicine
Sun,8:30 – 9:00	28:29	Dacher Keltner and Eve Ekman — Welcoming remarks/grounding with review of themes from previous day
Sun, 9:00 – 9:30	1:0054	Liz Markle — Behavioral Health and the Community as Medicine
Sun, 10:30 – 11:00	2:29:33	Elissa Epel — Supporting Stress Resilience in Healthcare
Sun, 12:30 – 1:00	4:31:46	Eve Ekman — Emotion Awareness in Healthcare
Sun, 1:45 – 2:00	5:43:05	Eve Ekman and Dacher Keltner — Closing remarks and reflection

About the speakers

Short biographies of the six speakers are available at GGSC. Some additional speaker resources and links are shown below.

Speaker	Resource
Eve Ekman, Ph.D., MSW	Three-Day Online Immersive Emotional Balance Training in June; Atlas of Emotions Online and Eve Ekman trainings online; free Guided Meditations
Dacher Keltner, Ph.D.	Born to be Good
Jyothi Marbin, M.D.	UCSF
Jamil Zaki, Ph.D.	The War for Kindness
Elizabeth Markle, Ph.D.	Open Source Wellness, podcast conversation about Community as Medicine
Elissa Epel, Ph.D.	UCSF Resources to Support Your Mental Health During Coronavirus, The Telomere Effect

 

Find a kidney donor–Yard signs

Yard signs that worked (from Kennebec Journal, Sep 2018)

by George Taniwaki

In a July 2019 blog post, I discussed the use of billboards to help publicize your need for a kidney donor. If you can’t afford a billboard, smaller yard signs are a good alternative if you have legal access to to the right-of-way next to a busy road , specifically one with lots of slow moving traffic.

The picture at the top of this blog post shows an excellent example of an effective yard sign. They were designed and installed by Krystal Reardon, a nurse and kidney patient in Augusta, Maine. She has six yard signs, all with black text on a blue background. The signs read “I require a life-saving transplant”, “Kidney”, “Donor”, “Needed”, “Would you consider”, “Ask me how (207) 518-0000 Kidney0000@gmail.com”. The first and last signs are hand painted, while the other four signs are stenciled. Her story was carried by multiple news outlets including Kennebec Journal (Sep 2018) and People (Sep 2018).

Her signs generated a remarkable 30 responses from strangers who have offered to get tested (Fox News, Sep 2018). She received a transplant shortly thereafter. Now she is helping other kidney patients use the same technique to find their own donors. You can see her handiwork for Kenneth Edwards and Rachel LaJoie in the second row of the photographs below.

 

 

 

Seven examples of kidney campaign yard signs in the news

First row: Angela (from CTV News, Jul 2016), Dan (from WLWT, Aug 2015)

Second row: Joan (from KidneyQuest on Twitter), Kenneth and Rachel (from Press Herald, Mar 2019)

Third row: Mark (from Union Leader, May 2019), Jim (from Café Mom, Jan 2014)

Since the signs are small and most people who see it will be driving fast, you cannot put a lot of text on it. All of the yard signs have the following two features:

1. Headline or call to action – Kidney needed or donor wanted

2. Contact information – phone number, email address, or website

One option to increase awareness and to tell a longer story is to use multiple signs spaced several feet apart, like Ms Reardon did for herself and for her mentees.

Another option, which works in an area that receives plenty of snow and stays cold is to build a seven-foot snow sculpture of a kidney (see last picture in the third row) and plop your sign next to it.

Media attention

As mentioned in my blog post on billboards, another way to expand your search is to get your yard signs covered by the local newspaper or television news. All of the yard signs shown in this blog post were found on news websites.

 

Find a kidney donor–Billboards

Digital billboard by LKDN and Blip

by George Taniwaki

If you want to gain attention of people outside your social circle, you need to get your message in front of strangers. One way to do this is to use billboard advertising. Billboard advertising, also called outdoor advertising or out-of-home advertising, can be expensive. It is also impersonal. However, it can generate a lot of impressions and can generate additional word-of-mouth or news publicity.

Every form of publicity you create should have a call for action. It should include a URL, phone number, or email address. In the example billboard at the top of this blog post, note the short URL that points to the Living Kidney Donor Network and includes the patient’s first name. It’s easy to remember and the LKDN web page can contain additional information to help potential donors learn more about you and the donation process.

Do-it-yourself billboard

If you own a billboard or know someone who does, you can paint your own billboard. A do-it-yourself billboard is pretty uncommon, but I found one case (Kidney Dialysis News, Dec 2013).

Example of hand-painted billboard

Rent a static billboard

More likely, you don’t own your own billboard and so will have to rent one. The most common type of billboard is static. The image is printed on paper or canvas and will remain in the billboard until it is manually covered by a new sign.

There are two costs to consider when renting a billboard. First is the up-front costs for design and production. This can range from free to a few hundred dollars. The second is the rental fee. The rental fee will be based on the amount of traffic that passes by the billboard and the scarcity of billboard space in the area where you want to place your sign. You will want to compare the total cost per impression of a billboard versus the other activities you are employing to find a donor. For a good primer on measuring advertising and publicity effectiveness, see Real Numeracy Sep 2019.

All billboard companies provide design services. If you want to do your own design work or hire your own designer, ask the billboard company for the dimensions of their billboards. Also ask for the required resolution for artwork and what file format the artwork should be delivered in. Check if they accept RGB color PDF files or require CMYK color.

For smaller billboards, the images are printed on a 27” x 40” sheet of paper. Multiple sheets can be tiled to produce larger images. Larger billboards are usually printed on 10-foot wide sheets of canvas using a special ink jet printer. Again, larger images are created by tiling sheets.

Additional benefit of a billboard

There is another impact that a billboard can generate. Your effort could get picked up by a local TV station or newspaper where an even larger audience will see it. I found several stories about billboards used to find kidney donors on the web. A few are reproduced below along with links to the news stories they were contained in.

 

Eight examples of static billboards that got in the news

First row: Tracy (from WBIR-TV, Apr 2016), Jacob (from WKYC-TV, Apr 2019), Jessica (from WDJT-TV, Apr 2018)

Second row:  Paul (from NY Daily News, Jul 2015), Randy (from Atlanta J. Const., Oct 2017)

Third row: Joshua (from USA Today, May 2018), Mandie (from ABC News, Apr 2018), Miranda (from Daily Item, Apr 2016)

Mobile billboards

In urban areas, billboard space is limited. One option to overcome that is to put signage on the side of a truck or attach it to a trailer being towed by a truck or car or even a bicycle. This is different than putting a sign on the side of your own car or truck, which is discussed in a separate blog post (Real Numeracy, Aug 2019).

Example mobile billboard for Kidney Car, from Kidney Foundation of Canada

Rent time on a digital billboards

The latest advance in billboard advertising is digital signage. A digital billboard, like a web display ad, does not require the expense of a physically printed image. It can be placed on any billboard in the world that participates in the digital billboard network. Your ad can be displayed for any length of time on any date or day-of-week and time-of-day you desire.

Your ad will run for 10 second increments that cost between 1 cent to a dollar, depending on the amount of vehicle and pedestrian traffic expected. Most traditional billboard companies like Lamar and Clear Channel have digital options. There are also digital-only companies like Blip. (In advertising parlance each 10 second increment is called a blip.)

Donor billboard

Finally, below is an example of a billboard promoting living donation without a specific patient in mind. The billboard is sponsored by TransplantFirst Academy, an organization started by Risa Simon, the author of the book Shift your Fate.

Donor billboard from TransplantFirst Academy

 

John Oliver feuds with a cosplaying otter

Last Week Tonight featuring Chiitan, from HBO via YouTube

by George Taniwaki

This is a long story of an unusual connection between the TV host John Oliver and my father. Needless to say, the story has a weird twist at the end that even John Oliver wouldn’t expect. Bear with me as I explain.

Japan loves mascots

The tale begins in Japan, where costumed mascots are a big deal. Of course every sports  team has at least one. For instance, my favorite Japanese baseball team, the Nippon Ham Fighters has four at last count, two bears, a fox, and a squirrel. They are named Brisky,  Cubby, Polly Polaris, and Frep.

Incidentally, baseball teams in Japan are named for their sponsors, not their home city. One of the sponsors is NH Foods, formerly Nippon Ham. So the players are the Fighters of Nippon Ham. They are not Ham Fighters of Nippon. But the image of men in pinstripes wielding pig legs against their opponents is so indelible in my mind that I cannot dismiss it. But I digress.

Not the Nippon-Ham Fighter logo, from tedquarters.net

In Japan, costumed good luck symbols aren’t limited to just sports teams. In the country that invented kosupure, there are thousands of mascots, called yuru-chara. They have been created for nearly every city, school, government agency, even resorts, castles, and prisons. That’s a lot of people dressed up in hot, stuffy outfits walking around and getting punched and kicked by kids. But again I digress.

A small sampling of yuru-chara, from famous-popular.tokyo

Susaki wins the annual yuru-chara contest

Susaki-shi, population 22,000, is a small farm town located in Kochi-ken, on the southern island of Shikoku, Japan. Susaki is hard to get to. Most tourists never go there.  Yet I’ve been there twice. My father grew up on the family farm just outside town and I still have relatives living there.

There are a lot of people named Taniwaki in Susaki. But not everyone in Susaki named Taniwaki is related to me. Once, I was standing outside the train station in Susaki, and somebody behind me yelled “Taniwaki-san”. I turned around and said “hai” (which is about the only Japanese I know) and was startled to see that the person calling my name was a stranger. “How does this person know me,” I wondered.  I was relieved when I saw he was talking to someone else, not me. It was the first and only time in my life when I saw someone named Taniwaki that was not related to me. I stared at them for quite a while. Enough of that, let’s go on with the story.

Susaki, Kochi, Japan, 33°24′N 133°17′E

A vacation trip to Susaki would be the equivalent of a tourist visiting Dumas, Texas (home of the Ding Dong Daddies) or Muscatine, Iowa (made famous by Mark Twain). Both are small rural cities that have some interesting history and architecture but are off the beaten path. I’ve been to both towns and actually lived in Dumas in the summer of 1979 working for Natural Gas Pipeline Company of America (NGPL) at a natural gas field and compressor station.

One of my coworkers at NGPL donated a kidney to his brother at a time when living transplants were uncommon. He had to have one of his ribs removed, something that is rarely done today. His sacrifice for his brother is one of the events that led me to become a donor (Real Numeracy, Nov 2007). But back to Susaki.

The town has an official mascot named Shinjōkun. It is a Japanese river otter with an inverted bowl of ramen on its head (the ramen looks like curly hair). It isn’t a run of the mill, small town yura-chara, it is really popular.

Every year there is a nationwide contest called the Yura-chara Grand Prix where over a thousand mascots compete to be the most popular. In 2016, Shinjōkun beat 1,420 other entrants to be crowned the most popular yura-chara in Japan.

The new Chiitan, not like the old Chiitan

In addition to Shinjōkun, Susaki also had an ambassador of tourism, an actual Japanese river otter named Chiitan. Otters were once common in southern Japan, but are now locally extinct. Check out the YouTube video below. So kawaii!

There are not enough cute animal videos on the web, CLICK NOW!

Susaki no longer has an ambassador of tourism, having cancelled a contract with Kleeblatt, a marketing company that managed the tourism promotion account. But that doesn’t mean there is no Chiitan. That’s because Kleeblatt, which also manages the Shinjōkun yuri-chari promotions created a derivative yuri-chari called Chiitan that is an unofficial ambassador of tourism for Susaki.

The new Chiitan is a giant otter wearing a turtle as a hat. It (he?) dances, attempts and often fails to display athletic skills, frightens children, and performs random acts of violence. It’s hard to describe the appeal in words. Just watch this YouTube video.

As Chiitan says on its Twitter bio, “Chiitan is a Japanese mascot! 0-year-old fairy baby. Chiitan plays around super actively every day!”

[Update: Twitter has suspended the account for Chiitan and people are not happy, New York Times May 2019.]

Chiitan is on Twitter, Instagram and YouTube

News stories indicate that the city of Susaki and Kleeblatt are engaged in a dispute over the intellectual property rights and creative direction for Shinjōkun and Chiitan on social media, merchandise, and an upcoming animated television show (fromJapan Feb 2019).

Back in happier times, Shinjōkun the official city mascot, Chiitan the official living otter travel ambassador, and Chiitan the unofficial travel ambassador/social media darling, along with  3 official looking humans

Shinjōkun meets ChiiJohn

If you watch John Oliver’s show “Last Week Tonight” on HBO, you may have heard that he was engaged in a Twitter feud with new Chiitan. The back-and-forth resulted in Mr. Oliver finally tweeting, “I’m in a public beef with an unsanctioned Japanese otter. I needed this.”

The feud seems to have ended with Mr. Oliver creating his own yuru-chara named ChiiJohn and sending it to Susaki to meet Shinjōkun. As John Oliver says in the almost 13 minute long segment, “Anyone can make an unofficial mascot for a city in Japan. And if you don’t already know where this is headed, you’ve clearly never watched this fucking show before…”

Starting at 8:04 in the YouTube video at the top of this blog post is a short documentary entitled “The Journey of ChiiJohn.” At 9:56 into the video, ChiiJohn climbs a hill and passes through a torii as he enters a local Shintō shrine.  Inside the grounds of the shrine, the two yuru-charas finally meet and hug, something amusingly out of character for strangers in Japan to do.

My father rejects Shintoism

I’ve been to plenty of Shintō shrines, but never in Susaki. I think my father would recognize this shrine, since it is probably the largest one in town. But he probably would not want to go there. That’s because state Shintōism was associated with Japan’s imperial and expansionist policies starting after the Meiji Restoration and continuing during World War 2.

In this Dec 2012 blog post, my dad mentions his desire to avoid the ritual of visiting the local Shintō shrine before shipping off to war after being drafted. I strongly suspect the shrine in the video is the same one my father mentions. My father was stationed in Hiroshima and survived the US bombing.

I doubt my father ever visited that shrine again in his lifetime. And if he were alive today, he wouldn’t think the visit to the shrine by two yuru-charas was funny. It’s a small world, I guess. But I digress.

 

Extending preservation times for organs

by George Taniwaki

A new organ preservation method may help increase the number of transplants. It could dramatically increase the survival of patients with end stage liver or heart disease.

Background

The most common organ to be transplanted are kidneys. Part of the reason is that there are lots of patients with kidney failure waiting for a transplant. And part of the reason for that is patients with kidney failure can be placed on dialysis therapy while waiting for a donor organ. This allows them to survive several years while waiting for a donor organ. Patients requiring a replacement for failed hearts, lungs, and livers cannot wait. They must be transplanted quickly. If an organ is not available, they will die.

The other reason kidneys are the most common organ to be transplanted is that donor kidneys can be kept in ice water storage for 24 to 36 hours prior to transplant and still remain viable. This provides time to run crossmatch tests using blood samples from the donor and several possible recipients, contact the best matching patients and their surgeons, get them to the hospital, and transport the donor organ to the hospital. Hearts can only be stored about 4 hours and livers can only be stored about 12 hours. This often is not enough time to prepare for surgery and so the donor organ has to be discarded, unused.

I discuss some of these issues in earlier blog posts. For instance, see my Nov 2010 blog entry and May 2010 blog entry.

New and supercool protocol

In a paper published in Nature Medicine, Jun 2014 (subscription required), Tim Berendsen at University Medical Center in Utrecht, the Netherlands, Bote Bruinsma at Massachusetts General Hospital and Harvard Medical School, and others have developed a new protocol to supercool organs below zero (32 deg F) without freezing them. Their technique was tested on rat livers, but would likely work on human livers and would work with other organs, including kidneys. A good explanation of the process is included in a Jun 2014 press release.

Figure 1. Supercooled rat liver being perfused with new solution developed by Harvard researchers. Photo from Harvard University

Their technique involves four steps. First, the organ is placed in a vessel while an ice cold solution (usu. about 4 deg C, 39 deg F) is circulated through it, a process called perfusion. The solution contains dissolved oxygen and nutrients such as glucose that help keep the organ alive. This is already the standard procedure for perfusing organs.

What is new, is the perfusion solution and the next steps. The perfusion solution contains PEG-35kD (polyethylene glycol) and other proprietary ingredients (to be commercialized) that act as an antifreeze. This allows the solution and the liver to be carefully cooled to -6 deg C (21 deg F) in a way that avoids the formation of ice crystals that could damage the cells in the liver. The liver can remain perfused in the supercooled condition for up three days and remain viable. Then the liver is carefully warmed to above freezing and prepared for surgery as normal.

Figure 2. Chart showing temperature profile of liver using proprietary perfusion solution and supercooling protocol. Image from Nature Medicine

Extending the viable time for liver transplant from 12 hours to three days would be a huge change. It would allow many more transplants to occur, with a corresponding decrease in the number of patient deaths caused by a shortage of organs. Just as important, by allowing time for multiple crossmatch tests to be conducted, it could potentially improve the matching of organs to patients.

The next steps in the research is to try livers from larger animals and to test the protocol on other organs.

 

Fake transplant doctor scam

by George Taniwaki

I recently received two comments on this blog from what appear to be scam artists seeking to prey on desperate people who might be persuaded to buy or sell a kidney.

I didn’t bother to follow up with either person to learn more about this scam. I say scam because it is illegal to buy or sell organs in nearly every country on earth. Further, nobody will pay for your travel expenses to a developing nation to have a nephrectomy (kidney removal surgery).

Bottom line: Do not respond to messages from strangers offering you money!

The messages

The first message shown below, is short and specifically is targeted at poor people who need money.

Do you want to sell your kidney due to financial problem? If yes you are in the right place of selling your kidney for good money. contact us @ SAWAN NEELU ANGEL’s HOSPITAL Multi specialist Home, J-293,Saket, New Delhi-17 India.. Email Us now:

Very Urgent

 

Dr Ashok kumar
ASN Directo

 

The second message is a bit of a mixed bag. This scam artist starts his pitch with an offer to help poor people desperate for a chance to escape debt. But at the end of his message, makes a stab at conning kidney patients to make a down payment for a transplant.

Good day,

Do you want to buy a Kidney or you want to sell your kidney? Are you seeking for an opportunity to sell your kidney for money due to financial break down and you don’t know what to do, then contact us today and we shall offer you good amount for your Kidney. My name is Doctor Calvin Cien am a Nephrologist in UBTH clinic hospital. Our clinic is specialized in Kidney Surgery and we also deal with buying and transplantation of kidneys with a living an corresponding donor. We are located in Indian, Turkey, Nigeria, USA, Malaysia. If you are interested in selling or buying kidney’s please don’t hesitate to contact us via email.

Best Regards.
Dr. Calvin Cien.

 

For more on how comment spam is created, see this blog post:

Comment spam template (June 2014)

For more on how scams work, see the following blog posts:

The Craigslist counterfeit check scam (June 2013)

Paris scam artists (March 2011)

 

New therapy for CMV

by George Taniwaki

The human cytomegalovirus (CMV), a member of the Herpesvirus genus, is highly contagious and quite widespread. It is estimated that over two-thirds of all adults have anti-CMV antibodies in their blood and the proportion of the population exposed increases with age.

CMV infection is usually quite mild. Most people who have it don’t even know it. However, it can cause serious illness and death to those who are immunocompromised such as infants, the elderly, patients with HIV infection, and patients who have received a bone marrow or organ transplant. An excellent primer on CMV and its impact on kidney transplants in provided in the J. Amer. Soc. Nephr. Apr 2001.

Because CMV is so common, it is impossible (both mathematically and ethically) to avoid using donor kidneys that are infected, even when transplanting into a patient who tests negative for CMV antibodies.

As can be seen in the table below, the infection risk is lower for patients who test negative for CMV antibodies (possibly because they have a natural immunity to the virus). It is also lower for patients who receive a kidney from a donor who tests negative (since the kidney is less likely to carry the virus). The percentages in each group assumes random distribution of CMV among donor and patient populations.

Level of risk and (% of population)	Patient CMV- Lower risk  (33%)	Patient CMV+ Higher risk (67%)
Donor CMV- Lower risk (33%)	Lowest risk (11%)	Low risk (22%)
Donor CMV+ Higher risk (67%)	High risk (22%)	Highest risk (45%)

 

For solid organ transplant recipients, CMV is the most common serious viral infection. Medscape notes that, “CMV infection usually develops during the first few months after transplantation and is associated with clinical infectious disease (e.g., fever, pneumonia, GI ulcers, hepatitis) and acute and/or chronic graft injury and dysfunction.”

The standard procedure to prevent or treat CMV infection is to prescribe ganciclovir, sold under the trade names Cytovene and Cymevene (Roche). Like other antiviral drugs, ganciclovir disrupts the replication of viral DNA.

Unfortunately, this drug has several limitations. First, widespread use of the drug seems to be leading to increased incidence of ganciclovir-resistant CMV infection. Second, the drug can cause serious side effects including hematological (blood) effects such as granulocytopenia (low white blood count), neutropenia (low neutrophil count), anemia (low red blood count), and thrombocytopenia (low platelet count). Third, animal studies showed it to be a potential human carcinogen, teratogen, and mutagen.

Figure 1. Replication of long chain of viral DNA by CMV. Image from New Engl. J. Med.

New therapy option

A new drug to prevent or treat CMV called letermovir is currently under investigation. In the New Engl J. Med. May 2014 (subscription required), Roy Chemaly and his coauthors report that among patients receiving hematopoietic stem-cell transplants (bone marrow transplants), use of letermovir significantly reduced the incidence of CMV infection and the level of viral DNA fell as the dose increased. This means the new drug is quite effective. Just as important, it had an acceptable safety profile. Patient taking even the highest dosage  did not report greater side effects than those taking the placebo. Specifically, it showed no hematologic toxicity or nephrotoxicity (kidney damage). An excellent discussion of this breakthrough is provided in an accompanying editorial that appears in the same issue. The editorial also highlights the higher reliability and sensitivity of quantitative polymerase chain reaction (PCR) to measure viral load and predict the onset of symptoms.

Naturally, additional studies will need to be conducted to test letermovir with patients receiving a solid organ transplant. But the initial test results are promising and give hope that within this decade fewer kidney transplant patients will lose their graft or their life due to CMV infection.