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Press releases Friday 13 June 2008

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(1) One in ten adults has a non-earlobe piercing
(2) What's wrong with selling kidneys?
(3) One patient's account of becoming a live kidney donor
(4) Radical reform is needed to stop the "inhumane" practice of transplant tourism
(5) Less hype and more research needed into new “superbug”, say experts

(1) One in ten adults has a non-earlobe piercing
(Body Piercing in England: a survey of piercing at sites other than the ear-lobe)
www.bmj.com/cgi/content/full/bmj.39580.497176.25

One in ten adults in England have had a piercing somewhere other than their ear lobe, with a quarter experiencing complications, and one in 100 piercings resulting in a hospital admission, according to a study published on bmj.com today.

The study, carried out by public health doctors from the Health Protection Agency and the London School of Hygiene and Tropical Medicine, also found that women are three times more likely than men to have a body piercing and the most popular piercing site is the navel.

Over ten thousand people (10,503) aged 16 and over took part in the survey. These are the first published estimates of the proportion of the English population with non earlobe piercings and the rate of complications after having a piercing.

Piercing is more common among women than men, with nearly half the women (46.2%) surveyed aged 16-24 years having a body piercing. Of all the piercings in the survey a navel piercing was the most popular (33%), followed by nose (19%), ear (13%), tongue (9%), nipple (9%), eyebrow (8%), lip (4%) and genital (2%).

The type of piercing also varied by gender with nipple piercing being the most popular among men but one of the least popular among women, while navel piercing was by far the most popular in women but was rare in men. Genital piercing, while uncommon, was found to be twice as popular among men as women.

As well as being more likely to have a piercing, people aged 16-24 years were also more likely to suffer from complications, with almost a third (31%) reporting problems and one in seven (15.2%) seeking professional help.

Four out of five (80%) piercings were performed in specialist piercing shops, with the researchers saying a "worrying" one in ten (9%) tongue piercings were performed by non-specialists. In every anatomical site, including the tongue and genital areas, they found a number of people who said they had performed the piercing themselves or they'd had it done by a friend or relative.

The most common problems with piercings were swelling, infection and bleeding, with tongue piercings being the most likely to cause problems - almost half resulted in complications. Serious complications were significantly more likely to occur if the piercing had been performed by a non-specialist.

The researchers say the clear trend in piercing by age group in both sexes confirms that piercing is a fairly recent phenomenon and add, if its popularity continues, it could "place a significant burden on health services for many years."

Contacts:
Louise Brown, Health Protection Agency, Centre for Infections Press Office , London, UK
Email: louise.brown@hpa.org.uk

(2) What's wrong with selling kidneys?
(Head to Head: Should we pay donors to increase the supply of organs for transplantation?)
Yes:
www.bmj.com/cgi/content/short/336/7657/1342
No:
www.bmj.com/cgi/content/short/336/7657/1343

Doctors in this week's BMJ debate the issue of selling kidneys.

A regulated system of compensation for living donors may be the solution to the growing shortage of kidneys for transplantation, writes Arthur Matas, Professor of Surgery at the University of Minnesota.

In many areas of the United States the average wait for a transplant from a deceased donor is five years, but in some parts it is as long 10 years. Because of this the annual death rate for suitable transplant candidates has risen from 6.3% in 2001 to 8.1% in 2005.

Current unregulated systems in developing countries only benefit the rich, and provide no long term donor follow-up, or protection for either buyer or seller, he says.

In contrast, Matas argues, a regulated compensation system in the Western world would increase the number of available organs. Such a system would provide strict control and limit harm by allowing every candidate an opportunity for transplant, full donor evaluation, informed consent, long term health follow-up, with payment managed by the government or insurance companies, and the banning of any other commercialisation.

We already compensate people for sperm, ova, surrogate motherhood, and loss of body parts in court cases without any loss of dignity or humanity. Similarly, Matas concludes that we should allow a trial of compensation for living donation to learn if we can increase the number of kidneys while protecting the dignity and humanity of the donors.

But Jeremy Chapman, from the Centre for Transplant and Renal Research in Sydney, argues that this could reduce the supply of all organs.

He believes that the idea of the regulated market is a myth, which could have devastating consequences on the less easily regulated environments of Asia and Africa.

According to Chapman, selling organs does not help lift people out of poverty. In India and Pakistan people sell their kidneys to pay off debts, but they continue to live below the poverty line, and recent data show that 86% report deteriorating health after organ removal.

In addition, he asks, which family member would donate if the government is willing to pay for a kidney? Many would prefer a stranger rather than a family member to take the risk. What's more, if a kidney is worth money before death, then rather than donating, families may demand money for all sorts of organs after death.

The reality of regulated organ purchase will be a reduction in organ donation, and the destruction of kidney, heart, lung, liver, and pancreas transplantation, he concludes.

Contact:
Yes: Arthur Matas, Department of Surgery, University of Minnesota, Minneapolis, USA
Email: matas001@umn.edu
No: Jeremy Chapman, Centre for Transplant and Renal Research, University of Sydney, Westmead, Australia
Email: jeremy_chapman@wsahs.nsw.gov.au

(3) One patient's account of becoming a live kidney donor
(A Patient's Journey: Becoming a live kidney donor)
www.bmj.com/cgi/content/short/336/7657/1374

Hospitals need to make the process of live donation easier for potential donors, says a patient in this week's BMJ.

Annabel Ferriman, an editor at the BMJ, gives a frank first person account of her journey through the "protracted" and sometimes "frustrating" process of becoming a live kidney donor to her friend, Ray, who had been suffering from polycystic kidney disease for eight years.

Although overall a positive experience, she describes how 16 months of tests, some of which had to be repeated after her notes went missing, and some unnecessary delays, at times left her "seething with rage".

In one instance, she describes how after turning up for the results of tests on a liver lesion, she waited for 90 minutes only to be told that they were still unsure about the nature of the lesion and that she would have to return a week later.

Thankfully the lesion was benign and during the final stages progress was swift, she recalls. The operation was performed laparoscopically and her recovery was fast and she has had no adverse effects. Ray took a little longer to recuperate, but is doing well and is also back at work.

Because of the shortage of cadaver organs and the higher success rates with living organ transplants, the Royal Free Hospital, where she had the operation, is keen to expand its programme. But, she says, her experience has left her "wondering if it has the capacity to do so."

"I am recounting the tale partly to encourage other people to consider kidney donation, but also in the hope that hospitals might make the path for donors a little easier", she concludes.

"Annabel's helpful account describes a process that we recognise [in this instance] was extended", says Dr Bimbi Fernando, one of Annabel's transplant surgeons from the Royal Free Hospital, in an accompanying article. This was due in part to the difficulties of managing her unexpected liver abnormality, but it was compounded by some administrative delays.

Over the past 12 months, he explains, the trust has made substantial changes and investment in the transplant process, and the average time it takes from the beginning of donor testing to the transplant operation has fallen from 200 days to 116 days.

Contacts:
Annabel Ferriman, BMA House, British Medical Journal, London, UK
Email: aferriamn@bmj.com
Philippa Hutchinson, Head of Communications, Royal Free Hampstead NHS Trust, London, UK
Email: philippa.hutchinson@royalfree.nhs.uk

(4) Radical reform is needed to stop the "inhumane" practice of transplant tourism
(Personal View: Commercial transplantation in Pakistan)
www.bmj.com/cgi/content/short/336/7657/1378
(Personal View: Let’s wave goodbye to “transplant tourism”)
www.bmj.com/cgi/content/short/336/7657/1377

The UK government must bring in presumed consent to organ donation or allow a controlled donor compensation programme for unrelated live donors, in order to bring the "inhumane" practice of transplant tourism from the UK to an end, claims a doctor in this week's BMJ.

Professor Maqsood Noorani, former transplant surgeon at The Barts and The London NHS Trust in London, writes about his first hand experience as part of a transplant team trying to save the lives of British patients who have suffered complications after buying a kidney from a live donor in Pakistan.

In the world's poor countries including Pakistan, organs come mainly from live unrelated donors. It is claimed they are voluntary donations, says Noorani, but in reality most are sold by the desperately poor and transplanted into the rich. This exploits not only the poor but also women, who, according to Noorani's professional experience, constitute 95% of related live donors. In the male dominated society of Pakistan these women often have no say over what happens to them.

The trade in kidneys has become a lucrative business in Pakistan where private hospitals advertise their services in newspapers and on the internet. More needs to be done to bring it under control and stop donors and recipients dying, he claims.

He believes that Pakistan cannot simply change to a system like the UK where donation is made after death because this would encourage a black market in cadaver organs with people being killed for their organs. Instead, governments of rich countries should put pressure on Pakistan to discourage these patients from travelling for organ transplants, and become self-sufficient themselves by introducing a presumed consent or controlled donor compensation system, he concludes.

It is the phrase "transplant tourism" that trivialises the act, writes Professor Leigh Turner from McGill University in Canada.

Commercial transplantation carries huge risks for the organ recipients, he says. Inadequate screening and testing has resulted in cases of HIV, hepatitis, malaria and tuberculosis. Recipients also often receive substandard surgical care, wound management and immunosuppressant regimens. Sellers are also vulnerable to harm from, for example, coercive organ brokers and organised crime networks.

In India, Pakistan, and the Philippines, most donors receive less than $2000. The only winners are the organ brokers and transplant surgeons who can charge recipients more than $80 000.

Transplant tourism should be recognised for the reality it is, says Turner, by referring to it as "cross border organ transplantation", "commercial organ transplantation" or "organ trafficking".

(5) Less hype and more research needed into new "superbug", say experts
(Editorial: The emergence of Stenotrophomonas maltophilia)
www.bmj.com/cgi/content/short/336/7657/1322

Recent tabloid hype over the "newly emerging superbug", Stenotrophomonas maltophilia, is misplaced, say experts in this week's issue of the BMJ.

Headlines about S maltophilia including "no antibiotics can stop it" and "rising death toll in hospitals" are unfounded, write Georgia Duckworth and Alan Johnson, from the Health Protection Agency's Centre for Infections in London. In fact, they say, S maltophilia infections are relatively rare compared to infections caused by other species of viruses and bacteria such as Staphylococcus aureus (MRSA).

Despite recent concerns, S maltophilia accounts for less than 1% of all bloodstream infections in England and Wales. Data from the Health Protection Agency in 2007 shows that in England, 4918 cases of bloodstream infection were caused by MRSA compared with 671 by S maltophilia, while Clostridium difficle caused over 50 000 cases of gastrointestinal infections.

Indeed, S maltophilia infections are uncommon in previously healthy patients, are not easily spread, and are usually treatable, say the authors, in contrast to MRSA and C difficile which can be difficult to treat and have epidemic potential.

The authors suggest that the organism is, in reality, more deserving of the "opportunist" rather than the "superbug" label.

They point out that because it is relatively uncommon and treatable, it is unlikely that large scale interventions will be aimed specifically at S maltophilia, but interventions such as improved hospital hygiene and antibiotic stewardship will help prevent its spread and the emergence of multi-resistance.

"We hope that this new knowledge of the organism's biology will help allay these [recent] concerns by being used to improve diagnostic tests, identify new drug targets, or even develop a vaccine", conclude the authors.

Contact:
Press office, Health Protection Agency Centre for Infections, London, U
Email: cfipressoffice@hpa.org.uk

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