Kidney – COOPER GENERAL NEWS

Dr. Barbara Murphy, a leading nephrologist who specialized in advanced research that focused on predicting and diagnosing the outcomes of kidney transplants, died on Wednesday at Mount Sinai Hospital in Manhattan, where she had worked since 1997. She was 56.

The cause was glioblastoma, an aggressive form of brain cancer, her husband, Peter Fogarty, said.

Dr. Murphy blended a passion for research into kidney transplant immunology with her role, since 2012, as the chairwoman of the department of medicine at the Icahn School of Medicine at Mount Sinai (and its broader health system). She was the first woman named to run a department of medicine at an academic medical center in New York City.

“In baseball, they talk about five-tool players,” Dr. Dennis S. Charney, dean of the Icahn School, said by phone. “I don’t know how many tools she had, but she was a very strong administrator, a great researcher and a great mentor to many people.”

Dr. Murphy, who was from Ireland, developed her interest in kidney transplantation while attending medical school at the Royal College of Surgeons in Dublin. She was drawn especially to how it transformed patients’ lives.

“I love seeing how well patients do afterward,” she told Irish America magazine in 2016. “For all the years that I’ve been in this profession, the interaction between a living donor and a recipient in the recovery room still makes me proud to be a physician and to play a part in such a life-affirming moment.”

After being recruited to Mount Sinai in 1997, she joined other researchers in examining the role of H.I.V. in kidney disease and helped establish the viability of kidney transplants for patients with H.I.V. In a speech at the Royal College in 2018, she recalled that there had been criticism of such transplants — as if there were a “moral hierarchy when it came to donor kidneys.”

She added, “Two weeks ago, we received an email from one of our patients, thanking us on his 15th renal transplant birthday.”

More recently, Dr. Murphy’s research at her laboratory at Mount Sinai focused on the genetics and genomics of predicting the results of transplants, and on why some kidneys are rejected.

In findings reported in The Lancet in 2016, she and her collaborators said they had identified a set of 13 genes that predicted which patients would subsequently develop fibrosis, a hallmark of chronic kidney disease, and, ultimately, irreversible damage to the transplanted organ. Being able to predict which patients were at risk, they wrote, would allow for treatment to prevent fibrosis.

Her research has been licensed to two companies. One, Verici DX, which is still in validation trials in advance of commercial sales, is developing RNA signature tests to determine how a patient is responding to, and will respond to, a transplant. The other company, Renalytix, uses an algorithm guided by artificial intelligence to identify a kidney disease risk score for patients. Dr. Murphy served on the boards of both companies.

“Barbara was foundational to Verici,” Sara Barrington, the company’s chief executive, said by phone. She added, “Her lab will continue to file new discoveries out of her base research.”

Barbara Therese Murphy was born on Oct. 15, 1964, in South Dublin. Her father, John, owned an airfreight company, and her mother, Anne (Duffy) Murphy, worked with him and also designed bridal wear.

At age 4, Dr. Murphy recalled in a speech at a health care awards dinner sponsored by Irish America in 2016, she had to overcome a harsh judgment by a teacher.

“My elementary school teacher told my mother I was a dunce and I would never be anything, and what’s more she shouldn’t even try,” she said. “Fortunately, my parents persevered.”

After earning her medical degree at the Royal College in 1989, Dr. Murphy completed her residency and a nephrology fellowship at Beaumont Hospital, also in Dublin. She was also a nephrology fellow in the renal division of Brigham and Women’s Hospital in Boston, where she trained in transplant immunology.

In 1997, she was recruited to Mount Sinai as director of transplant nephrology by Dr. Paul Klotman, then the chief of the division of nephrology, who promoted her to his former position in 2003 after he had become chairman of Icahn’s department of medicine.

“She showed a lot of promise in transplant nephrology, which was emerging at the time,” Dr. Klotman, now the president of the Baylor College of Medicine in Houston, said by phone. “Over the years, she developed good leadership skills: She was very organized and task oriented.”

In the spring of 2020, Dr. Murphy, like other physicians, noticed with alarm that Covid-19 was much more than a respiratory disease. It was causing a surge in kidney failure that led to shortages of machines, supplies and personnel needed for emergency dialysis.

The number of patients needing dialysis “is orders of magnitude greater than the number of patients we normally dialyze,” she told The New York Times.

One of Mount Sinai’s responses to the pandemic that May was to open the Center for Post-Covid Care for patients recovering from the virus. At the time, Mount Sinai had treated more than 8,000 patients who had been diagnosed with Covid-19.

“Barbara was instrumental in forming the center,” Dr. Charney said, “and she was involved in the follow-up as it related to kidney disease caused by Covid.”

Dr. Murphy was given the Young Investigator Award in Basic Science from the American Society of Transplantation in 2003 and was named nephrologist of the year by the American Kidney Fund in 2011. At her death, she was president-elect of the American Society of Nephrology.

In addition to her husband, Dr. Murphy is survived by their son, Gavin; her sister, Dr. Celine Murphy, a cardiologist who works in occupational health; her brother, Dr. Kieran Murphy, an interventional neuroradiologist; and her parents.

Dr. Murphy said she had learned an indelible lesson about the need for a strong patient-doctor relationship while still in medical school.

“Scholarship alone was not enough,” she said at the Irish America award ceremony. “An example: If we had a patient with rheumatoid arthritis and we shook their hands and they winced, it didn’t matter how much we knew about the disease or how to treat it, we’d failed our exam because we hadn’t taken the patient’s overall well-being into consideration.”

HERAT, Afghanistan – In the midst of the hustle and bustle of beggars and patients outside the crowded hospital, there are sellers and buyers looking at each other suspiciously: the poor looking for money for their vital organs, and the seriously ill or their surrogate mothers looking for something to buy.

The illegal kidney business is booming in the western city of Herat, fueled by sprawling slums, poverty and endless war in the surrounding country, an entrepreneurial hospital bidding as the country’s first kidney transplant center, and officials and doctors turning a blind eye to organ trafficking.

In Afghanistan, as in most countries, the sale and purchase of organs is illegal, as is the implantation of purchased organs by doctors. However, the practice remains a worldwide problem, particularly with respect to the kidneys, as most donors can live with just one.

“These people need the money,” said Ahmed Zain Faqiri, a teacher who is looking for a kidney for his seriously ill father in front of Loqman Hakim Hospital. He was eyed uncomfortably by a young farmer, Haleem Ahmad, 21, who had heard about the kidney market and wanted to sell after his harvest failed.

The consequences will be dire for him. For the impoverished kidney vendors recovering in cold, unlit Herat apartments with peeling paint and concrete floors that have been temporarily freed from debt but are too weak to work, in pain and unable to afford medication, the deal is a portal for new misery. In one such apartment, half a sack of flour and a modest container of rice were the only food for a family with eight children last week.

Transplants are big business for Loqman Hakim Hospital. Officials boast more than 1,000 kidney transplants in five years, involving patients from across Afghanistan and the global Afghan diaspora. It offers them bargain deals at one-twentieth the cost of such procedures in the United States in a city with a seemingly endless supply of fresh organs.

When asked if the hospital made good money from the operations, Masood Ghafoori, a senior finance manager, said, “You could say that.”

The hospital takes care of the removal, transplant, and initial recovery for both patients without asking questions. Sellers say their hospital fees will be covered by the buyers and after a few days at the recovery center they will be sent home.

How the organ recipient gets the donor to agree to the procedure is not the hospital’s concern, the doctors say.

“It’s none of our business,” said Dr. Farid Ahmad Ejaz, a hospital doctor whose business card reads “Founder of Kidney Transplant in Afghanistan”.

Dr. Ejaz initially claimed that more than a dozen impoverished Herat residents lied when they told The Times that they had sold their kidneys for cash. He later admitted that “maybe” wasn’t the case. Interviews with other health officials here followed the same arc: initial denials, followed by reluctant appreciation.

“Everything has value in Afghanistan except human life,” said Dr. Mahdi Hadid, member of the Herat Provincial Council.

According to the United Nations, reports of organ sales in India date back to the 1980s, and today the practice accounts for around 10 percent of all global transplants. Iran, less than 80 miles from Herat, is the only country where kidney sales are not illegal as long as the parties are Iranian.

“There is always a gap between international guidelines and what governments do in practice,” said Asif Efrat, a faculty member at the Herzliya Interdisciplinary Center, a university in Israel, pointing out that Afghanistan compares to the countries in which it is located Organ trafficking is taking place, a new player is most productive: China, Pakistan and the Philippines. “The current international consensus is on the ban side, but governments have incentives not to follow it,” he said.

The moral scruples that keep business underground elsewhere are barely noticeable in Herat. Dr. Ejaz and health officials point out the hard logic of poverty. “The people in Afghanistan sell their sons and daughters for money. How does that compare to selling kidneys? “He asked. “We have to do this because someone is dying.”

Dr. Ejaz seemed unimpressed when he was shown the business card of a kidney broker: “In Afghanistan there are business cards with which people can murder others.”

On the fourth floor of the hospital, three in four recovering patients said they had bought their kidneys.

“I’m fine now,” said Gulabuddin, a 36-year-old imam, a kidney recipient from Kabul. “No pain at all.” He said he paid about $ 3,500 for his kidney that he bought from a “total stranger” with a $ 80 commission to the agent. He did a good deal: kidneys can cost up to $ 4,500.

“If there is approval, Islam has no problem with it,” said Gulabuddin.

Dr. Herat Province Public Health Director Abdul Hakim Tamanna acknowledged the rise of the kidney black market in Afghanistan but said there was little the government could do.

“Unfortunately, this is common in poor countries,” he said. “There is a lack of the rule of law and a lack of regulation related to this process.”

According to the World Bank, the poverty rate in Afghanistan is set to reach over 70 percent by 2020 and the country remains largely dependent on foreign aid. Domestic revenue only finances around half of the state budget. Without a substantial public safety net, healthcare is just another opportunity to take advantage of the most vulnerable people in the country.

Mir Gul Ataye, 28, regrets every second of his decision to sell his kidney deep in the maze of sandy streets in Herat’s slums. As a construction worker who made up to $ 5 a day prior to his surgery last November, he can now lift no more than 10 pounds, and hardly can.

“I am in pain and weak,” he said. “I’ve been sick and can’t control my piss.” Four children huddled in front of him on the concrete floor in the bare, unlit room. He said he supported a total of 13 family members and had around $ 4,000 in debt.

“It was difficult, but I had no choice. Nobody wants to give any part of their body to someone else, ”he said. “It was very embarrassing for me.”

Mr. Ataye received $ 3,800 for his kidney. That was almost three months ago. He’s still in debt and can’t pay his rent or electricity bill.

He said he felt “sadness, despair, anger and loneliness”. One night he was in such severe pain that he hit his head against the wall and fractured his skull.

Others around Herat gave similar reasons for selling a kidney: outstanding debts, sick parents, a marriage that would otherwise have been unaffordable.

“My father would have died if we hadn’t sold,” said Jamila Jamshidi, 25, who was sitting on the floor across from her brother Omid, 18, in a cold apartment on the outskirts of town. Both had sold their kidneys – she five years ago and he a year ago – and both were weak and in pain.

Mohammed Zaman, a tribal elder in a white turban, spoke of the irresistible attraction of Loqman Hakim’s kidney operation in a mud-walled camp just outside Herat, a vortex of sun, wind and dust filled with war refugees from other provinces. More than 20 from his village who have now been evicted from their homes had sold their kidneys.

“My people are hungry. We have no land. We can’t be shopkeepers. We don’t have any money, ”he said. “I can’t stop it.”

In a local restaurant, five brothers talked about being driven from their land in Badghis province by constant attacks by the Taliban. In Herat everyone had sold their kidneys. The youngest was 18, the oldest 32 years old.

“We had no choice,” said Abdul Samir, one of the brothers. “We had to sell. Otherwise we wouldn’t have sold a fingernail. “

Asad Timory and Kiana Hayeri contributed to the coverage.