Report From a Multidisciplinary Symposium on the Future of Living Kidney Donor Transplantation.

Virtually all clinicians agree that living donor renal transplantation is the optimal treatment for permanent loss of kidney function. Yet, living donor kidney transplantation has not grown in the United States for more than 2 decades. A virtual symposium gathered experts to examine this shortcoming and to stimulate and clarify issues salient to improving living donation. The ethical principles of rewarding kidney donors and the limits of altruism as the exclusive compelling stimulus for donation were emphasized. Concepts that donor incentives could save up to 40 000 lives annually and considerable taxpayer dollars were examined, and survey data confirmed voter support for donor compensation. Objections to rewarding donors were also presented. Living donor kidney exchanges and limited numbers of deceased donor kidneys were reviewed. Discussants found consensus that attempts to increase living donation should include removing artificial barriers in donor evaluation, expansion of living donor chains, affirming the safety of live kidney donation, and assurance that donors incur no expense. If the current legal and practice standards persist, living kidney donation will fail to achieve its true potential to save lives.

The Pest Hospital: Memory, Vaccines, and Serum Therapy in Kansas City.

A medical narrative from a woman in her 90s describes her childhood bout with diphtheria in Kansas City, Missouri, apparently immediately after vaccination, her confinement in the "pest hospital," and her treatment with what she understood as a blood transfusion from a donor who was found through a radio appeal. In this essay, we trace the narrative back to the institutions, medical practices, and historical context, examining both the underlying history of medical practice and scientific understanding that is reflected in her experience and also the contexts of that history, including racial and religious attitudes.

Child welfare system interventions on behalf of children and families: Highlighting the role of court appointed special advocates.

Nearly three-quarters of a million children are victims of abuse and neglect in the United States every year. This article describes the scope of the problem and explains how the child welfare system intervenes, including how cases are reported, how Child Protective Services (CPS) assesses the risk, how CPS determines when in-home services are appropriate or if a child should be removed from the home, how ongoing cases are managed, and the options for permanency for children in the system. The article also explains how the Family Court system operates as the decision-maker in child abuse and neglect cases and discusses the various models of legal representation provided to child victims, depending on the jurisdiction in which they live. The authors document how outcomes for child victims of abuse and neglect are greatly improved when their representation includes the appointment of a Court Appointed Special Advocate (CASA Volunteer) to advocate for their best interests. The history of the CASA model is outlined, and the structure of the current program, which includes over 76,000 volunteers in nearly 1000 local programs in 49 states, is described. This article explains the CASA methodology and how this intervention improves outcomes for abused and neglected children. The authors argue that greater public and private support would provide more local CASA agencies with the resources to recruit, train, and support more CASA Volunteers to help more child victims of abuse and neglect.