Dorry Segev

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Dorry Segev
Dorry Segev 2021.jpg
Segev at the Web Summit in 2021
Alma mater Rice University
Johns Hopkins University
Known for Kidney transplantation

Nephrology
Transplantation

HIV-to-HIV Transplantation
Spouse Sommer Gentry
Scientific career
Fields Transplant surgery
Institutions Johns Hopkins University

Dorry L. Segev is the Marjory K. and Thomas Pozefsky Professor of Surgery at Johns Hopkins School of Medicine, professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, and associate vice chair of the Department of Surgery at Johns Hopkins Hospital. [1] [2] He has made significant contributions to the field of transplantation, including developing a mathematical model to facilitate a nationwide kidney paired donation program, both in the US and Canada. He is also known for his role in getting the HIV Organ Policy Equity Act (or HOPE Act) signed into law. [3]

Contents

Education and career

Segev earned his B.S. in electrical engineering and B.A. in computer science at Rice University in 1992. [4] [5] He obtained his M.D. at Johns Hopkins University in 1996, as well as his M.H.S. in biostatistics and Ph.D. in clinical investigation at Johns Hopkins Bloomberg School of Public Health in 2009. [6]

Both Segev and his wife, Sommer Gentry, have been featured in The Baltimore Sun , Science , Time , and The New York Times . [7] [8]

Segev is the director of the Epidemiology Research Group in Organ Transplantation at Johns Hopkins University. [9]

Incompatible kidney transplant

There are over 20,000 patients on the kidney transplant waitlist who have become highly sensitized, making finding a compatible donor extremely difficult. These patients often spend years on the kidney transplant waitlist looking for a compatible donor. In a 2016 study published in The New England Journal of Medicine , Segev and his team found that patients who received a kidney transplant from an incompatible live donor had a much higher survival benefit compared to patients who stayed on dialysis or waited for a deceased donor transplant. [10] There are over 20,000 patients on the waitlist who have become highly sensitized, meaning that they have developed antibodies human leukocyte antigens—HLAs—key components of the immune system. These findings show that moving forward with a live donor kidney transplant could be the best option for highly sensitized patients who have a healthy and willing donor. [11]

Kidney paired donation

Kidney paired donation is a form of live donation where patients with incompatible donors swap kidneys to receive a compatible kidney. [12]

The first kidney-paired donation was performed in South Korea in 1991, followed by one in Europe in 1999. [13] Sommer Gentry and Dorry Segev found that the existing matching programs were not sufficient to accommodate the scale of the transplant waitlist in the United States. Previous matching programs limited kidney-transplant patients and their families to connect with other incompatible pairs on their own. Together, Segev and Gentry devised a nationwide system to match donor-patient pairs. Based on an algorithm created by the Canadian mathematician Jack Edmonds in 1965, the system improves paired donation by ensuring the maximum number of matches while still factoring in age, location and willingness to travel. [14]

Under the direction of Segev and Robert Montgomery, Johns Hopkins completed the first five-way donor kidney swap among 10 individuals. [15]

The longest kidney-pair chain to date included 70 participants and was completed in 2014. [16]

HOPE Act and HIV positive transplantation in the U.S.

Before 2013, it was illegal to use organs from HIV+ donors for transplantation. Any organ whose donor was diagnosed with HIV would be immediately thrown out, despite them being otherwise healthy organs. [17]

In May 2010, Brian Boyarsky sought out Segev's advice after doing previous research comparing transplant programs in different countries. During his research, Boyarsky met Elmi Muller, who had been successfully transplanting organs between HIV+ donors and recipients in South Africa. [18] With that in mind, Segev and Boyarsky looked at both the Nationwide Inpatient Sample to study in-hospital deaths of HIV+ patients and the HIV Research Network, which provided granular disease-specific data, to calculate the impact of using organs from HIV+ donors on the organ transplant waitlist. Both data sources allowed Segev and Boyarsky to estimate a possible 500 to 600 HIV+ donors in the United States, whose organs were currently being discarded. [19]

After appearing on the front page of The New York Times and Boyarsky's article appearing in the American Journal of Transplantation , Segev and his mentee visited every major national transplant and AIDS advocacy group in the US. [20] Within weeks, they had every group officially supporting their campaign to legalize using organs from HIV+ donors for HIV+ recipients. In August 2011, Segev and Boyarsky sought out bipartisan support to change the existing law. California Senator Barbara Boxer (D) and Oklahoma Senator Tom Coburn (R) became the main sponsors of the bill first drafted by Segev and Boyarsky. They were later joined by congressional representatives Lois Capps (D) and Andy Harris (R) to support the bill in the House of Representatives. [18]

The HIV Organ Policy Equity Act (or HOPE Act) was introduced in the Senate on February 14, 2013. [18]

President Barack Obama signed the HOPE Act into law on November 21, 2013. [21]

With the HOPE Act, HIV positive patients on the current kidney and liver waiting lists can elect to also be open to any organs whose donors were diagnosed with HIV. This would not remove the patients from accepting non-HIV positive organs. However, it does have the potential to significantly shorten a patient's wait time on the kidney and liver deceased donor wait list. [22]

The first HIV-to-HIV transplants in the United States were performed on March 30, 2016, at Johns Hopkins University. [23]

Personal life

Segev married Sommer Gentry on October 18, 2003, in Ventura, California. [24] They now both reside in New York City. Gentry is a full professor at the US Naval Academy and contributes to multiple research projects in Segev's lab. [25] [26] [27]

Segev is an international teacher in swing dance and Lindy Hop with Gentry. [28] In 2005, Segev and Gentry started Charm City Swing, a non-profit organization in Baltimore, Maryland, that is dedicated to introducing the art of swing dance to non-dancers. [29] Charm City Swing found a permanent home at the Mobtown Ballroom in 2012. [30]

Honors and awards

Most-cited publications

Related Research Articles

<span class="mw-page-title-main">Organ donation</span> Process of voluntarily giving away organs

Organ donation is the process when a person authorizes an organ of their own to be removed and transplanted to another person, legally, either by consent while the donor is alive, through a legal authorization for deceased donation made prior to death, or for deceased donations through the authorization by the legal next of kin.

<span class="mw-page-title-main">Organ transplantation</span> Medical procedure in which an organ is removed from one body and placed in the body of a recipient

Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or organs may be transported from a donor site to another location. Organs and/or tissues that are transplanted within the same person's body are called autografts. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source.

<span class="mw-page-title-main">Transplant rejection</span> Rejection of transplanted tissue by the recipients immune system

Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after transplant.

Prior to the introduction of brain death into law in the mid to late 1970s, all organ transplants from cadaveric donors came from non-heart-beating donors (NHBDs).

<span class="mw-page-title-main">Kidney transplantation</span> Medical procedure

Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor or living-donor transplantation depending on the source of the donor organ. Living-donor kidney transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient. The first successful kidney transplant was performed in 1954 by a team including Joseph Murray, the recipient’s surgeon, and Hartwell Harrison, surgeon for the donor. Murray was awarded a Nobel Prize in Physiology or Medicine in 1990 for this and other work. In 2018, an estimated 95,479 kidney transplants were performed worldwide, 36% of which came from living donors.

<span class="mw-page-title-main">Canadian Blood Services</span>

Canadian Blood Services is a non-profit charitable organization that is independent from the Canadian government. The Canadian Blood Services was established as Canada's blood authority in all provinces and territories except for Quebec in 1998. The federal, provincial and territorial governments created the Canadian Blood Services through a memorandum of understanding. Canadian Blood Services is funded mainly through the provincial and territorial governments.

<span class="mw-page-title-main">United Network for Organ Sharing</span>

The United Network for Organ Sharing (UNOS) is a non-profit scientific and educational organization that administers the only Organ Procurement and Transplantation Network (OPTN) in the United States, established by the U.S. Congress in 1984 by Gene A. Pierce, founder of United Network for Organ Sharing. Located in Richmond, Virginia, the organization's headquarters are situated near the intersection of Interstate 95 and Interstate 64 in the Virginia BioTechnology Research Park.

Organ procurement is a surgical procedure that removes organs or tissues for reuse, typically for organ transplantation.

Organ trade is the trading of human organs, tissues, or other body products, usually for transplantation. According to the World Health Organization (WHO), organ trade is a commercial transplantation where there is a profit, or transplantations that occur outside of national medical systems. There is a global need or demand for healthy body parts for transplantation, which exceeds the numbers available.

"Harvest" is the 14th episode of the second season of the American television show Numbers. Inspired by a Christian Science Monitor article about organ tourists, people who travel to a different country to give their organs for money, and an algorithm developed in the United States, the episode features Federal Bureau of Investigation (FBI) agents and mathematicians attempting to locate a missing organ tourist before she is killed.

<span class="mw-page-title-main">Francis L. Delmonico</span>

Francis L. Delmonico, MD, FACS is a surgeon, clinical professor and health expert in the field of transplantation. He serves on numerous committees and is affiliated with various leading organizations and institutions. He is the chief medical officer of the New England Organ Bank (NEOB) and Professor of Surgery, Part-Time at Harvard Medical School in Boston, Massachusetts, where he is emeritus director of renal transplantation. He served as president of The Transplantation Society (TTS) from 2012 to 2014, an international non-profit organization based in Montreal, Canada that works with international transplantation physicians and researchers. He also served as the president of the United Network of Organ Sharing (UNOS) in 2005, which overseas the practice of organ donation and transplantation in the United States. He was appointed and still serves as an advisor to the World Health Organization in matters of organ donation and transplantation. He was appointed by Pope Francis to the Pontifical Academy of Science in 2016. In 2020, he became the recipient of the Medawar Prize of The Transplantation Society.

<span class="mw-page-title-main">Heart transplantation</span> Surgical transplant procedure

A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. As of 2018, the most common procedure is to take a functioning heart, with or without both lungs, from a recently deceased organ donor and implant it into the patient. The patient's own heart is either removed and replaced with the donor heart or, much less commonly, the recipient's diseased heart is left in place to support the donor heart.

ABO-incompatible (ABOi) transplantation is a method of allocation in organ transplantation that permits more efficient use of available organs regardless of ABO blood type, which would otherwise be unavailable due to hyperacute rejection. Primarily in use in infants and young toddlers, research is ongoing to allow for increased use of this capability in adult transplants. Normal ABO-compatibility rules may be observed for all recipients. This means that anyone may receive a transplant of a type-O organ, and consequently, type-O recipients are one of the biggest beneficiaries of ABO-incompatible transplants. While focus has been on infant heart transplants, the principles generally apply to other forms of solid organ transplantation.

Tayfun Sönmez is a Turkish-American professor of economics at Boston College. He is a Fellow of the Econometric Society and the 2008 winner of the Social Choice and Welfare Prize, which honors scholars under the age of 40 for excellent accomplishment in the area of social choice theory and welfare economics. Sönmez has made significant contributions in the areas of microeconomic theory, mechanism/market design, and game theory. His work has been featured by the U.S. National Science Foundation for its practical relevance.

<span class="mw-page-title-main">Intestine transplantation</span> Surgical replacement of the small intestine

Intestine transplantation is the surgical replacement of the small intestine for chronic and acute cases of intestinal failure. While intestinal failure can oftentimes be treated with alternative therapies such as parenteral nutrition (PN), complications such as PN-associated liver disease and short bowel syndrome may make transplantation the only viable option. One of the rarest type of organ transplantation performed, intestine transplantation is becoming increasingly prevalent as a therapeutic option due to improvements in immunosuppressive regimens, surgical technique, PN, and the clinical management of pre and post-transplant patients.

The National Kidney Registry (NKR) is a national registry in the United States listing kidney donors and recipients in need of a kidney transplant. NKR facilitates over 450 "Kidney Paired Donation" (KPD) or "Paired Exchange" transplants annually.

Kidney paired donation (KPD), or paired exchange, is an approach to living donor kidney transplantation where patients with incompatible donors swap kidneys to receive a compatible kidney. KPD is used in situations where a potential donor is incompatible. Because better donor HLA and age matching are correlated with lower lifetime mortality and longer lasting kidney transplants, many compatible pairs are also participating in swaps to find better matched kidneys. In the United States, the National Kidney Registry organizes the majority of U.S. KPD transplants, including the largest swaps. The first large swap was a 60 participant chain in 2012 that appeared on the front page of the New York Times and the second, even larger swap, included 70 participants and was completed in 2014. Other KPD programs in the U.S. include the UNOS program, which was launched in 2010 and completed its 100th KPD transplant in 2014, and the Alliance for Paired Donation.

Donor-specific antibodies (DSA) are a concept in transplantation medicine and describe the presence of antibodies specific to the Donor's HLA-Molecules. These antibodies can cause antibody-mediated rejection and are therefore considered a contraindication against transplantation in most cases. DSA are a result of B cell and plasma cell activation and bind to HLA and/or non-HLA molecules on the endothelium of the graft. They were first described in 1969 by Patel et al., who found that Transplant recipients who were positively tested for DSA using a complement-dependent cytotoxicity crossmatch assay had a higher risk of transplant rejection. DSA can either be pre-formed or can be formed as a response to the transplantion.

Sommer Elizabeth Gentry is an American mathematician who works as a professor of mathematics at the United States Naval Academy and as a research associate in surgery at the Johns Hopkins School of Medicine. Her research concerns operations research and its applications to the optimization of organ transplants, and has led to the discovery of geographic inequities in organ allocation. She is also interested in dancing, teaches swing dancing at the Naval Academy, and wrote her doctoral dissertation on the mathematics and robotics of dance.

Ernesto Pompeo Molmenti is an American transplant surgeon, scientist, and author. Currently practicing in Long Island, New York. He is Chief of Surgical Innovation and Vice-Chairman of the Department of Surgery at North Shore University Hospital / Northwell Health, and Professor of Surgery, Medicine, and Pediatrics at Zucker School of Medicine at Hofstra/Northwell. He is known for his description of the “Syndromic Incidence of Ovarian Cancer after Liver Transplantation, with Special Reference to Anteceding Breast Cancer,” and for the development of the vascular reconstruction technique that has been named "Molmenti technique".

References

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