Financial toxicity in living donor liver transplantation: A call to action for financial neutrality.

After 2 decades of limited growth, living donor liver transplant (LDLT) has been increasingly accepted as a promising solution to the growing organ shortage in the US. With experience, LDLT offers superior graft and patient survival with low rates of rejection. However, not all waitlisted patients have equal access to LDLT, with financial toxicity representing a substantial barrier. Potential living liver donors face indirect, direct, and opportunity costs associated with donation as well as insurance-based discrimination and variable employer leave policies. There are multiple potential national, local, and patient-centered solutions to address some of the cost-related issues associated with living LDLT. These include standardization of employer leave policies, creation of federal and state-led tax relief programs, optimization of National Living Donor Assistance Center use, engagement of independent living donor advocates, creation of financial toolkits, and encouragement of recipient or donor-led fundraising. In this piece, members of the North American Living Liver Donation Group, a consortium of 37 LDLT programs, explore these financial challenges and discuss solutions to achieve financial neutrality, where individuals can donate free from financial constraints or gains. As a community, it is imperative that we confront factors driving financial toxicity to improve equity and access to LDLT.

Four novel alkyl 2-cyanoacylate monomers and their use in latent fingermark detection by mid-infrared spectral imaging.

Four novel alkyl 2-cyanoacrylate monomers (alkyl=1-cyanoethyl, 2-cyanoethyl, trideuteromethyl and pentadeuteroethyl) have been tested for their ability to develop latent fingermarks that can then be visualized using mid-infrared spectral (chemical) imaging. Each of the four monomers was chosen for its potential to produce a strong, isolated infrared spectral band in its corresponding polymer (to provide spectral contrast against most backgrounds), as well as for its potential ability to be fumed onto fingermarks in the manner of conventional ethyl 2-cyanoacrylate (superglue). With the exception of the 2-cyanoethyl 2-cyanoacrylate, which had to be fumed under reduced pressure, all of the monomers were found to be sufficiently volatile to be fumed in a conventional fuming cabinet. All four monomers polymerized selectively on fingermark ridges on a variety of non-porous and semi-porous surfaces, leading to excellent development of the fingermarks. Unfortunately, although high quality mid-infrared spectral images of the fingermarks could be formed for all of the polymers at various frequencies, the new CN or CD stretching vibrations did not give rise to strong enough absorption intensities for good contrast on difficult backgrounds such as polymer banknotes. However, in the 1-cyanoethyl 2-cyanoacrylate polymer, the presence of the additional nitrile group had the unintended but desirable effect of shifting the strong CO absorption to higher frequencies, moving it away from interfering banknote absorptions. This enabled fingermark contrast to be achieved even against the intaglio printing on the banknotes.