Dartmouth Community Medical School Director William Green addressed a packed Kellogg Auditorium at the Geisel School of Medicine on Wednesday night to introduce the third talk in DCMS's six-part spring lecture series. The theme of this year's series, "It's Personal: Medicine's Evolution Away from One Size Fits All," is a timely topic, as it is now possible to sequence the entire human genome, opening up new possibilities for personally tailored therapies and treatments, according to Green. Geisel School surgery professors David Axelrod and Christopher Simpkins spoke at Wenesday's lecture about personalized medicine and organ transplantation.
Beyond medicine, a number of legal, ethical and moral ramifications to sequencing the genome persist, Green said in an interview with The Dartmouth. Questions arise over whether everyone should know their complete sequence and who should have access to that information if it is known. These issues can also affect the doctor-patient relationship with regard to shared decision making and end-of-life considerations, according to Green.
Axelrod's lecture titled "Transplant Immunology: Are You My Brother?" centered on the history of organ transplantation and the problems surrounding the successful graft of donor organs into recipients. Axelrod said that transplantation has been documented as early as 1000 BC, but it was not until 1954 when a kidney was successfully transplanted from one living human to another that transplantation became widely viable.
"1954 makes possible the rest of my career," Axelrod said.
At that time, successful transplantation was confined to identical twins. Researchers began to develop the use of immunosuppressants to prevent rejection of newly transplanted organs in 1961, but it did not become the treatment of choice for end-stage renal disease until 1983, according to Axelrod.
Building on concepts discussed by Axelrod, Simpkins who arrived to the lecture late because he had been performing a transplant surgery addressed the issue of finding suitable donors for transplantation, or "How We Turn Non-brothers Into Brothers."
"Who you are, your genetic make-up, is integral to the success of performing this endeavor of transplantation," Simpkins said.
Simpkins said that the waiting list for kidney transplants in 2011 included 50,000 active recipients. One of the main obstacles for surgeons is finding donor matches based on blood group, HLA type a type of antigen and the patient's previous exposure to HLA through pregnancy and blood transfusions.
In the last decade, new techniques have been developed "to make a non-brother into a brother for the purposes of transplantation," according to Simpkin.
One of these techniques is kidney paired donation, in which donors and recipients of two or more mismatched pairs swap to create a match. This technique was recently in the national spotlight because of a front-page article in The New York Times, which described 30 pairs of donors and recipients coming together to successfully swap organs.
Another alternative is antibody removal, which involves separating plasma and blood cells through a process called plasmapheresis. The procedure poses a higher risk immunologically but yields considerably more benefits than remaining on kidney dialysis, according to Simpkins.
Transplant surgeons are compelled to use a highly individualized approach to each patient, as there are many tests that need to be carried out to make a potential match with a donor, according to Simpkins.
"Every one of us has a different immunological fingerprint that demands that type of testing and that type of individualized treatment," Simpkins said.
After the spring lecture series at the Geisel School of Medicine, the DCMS team plans to take the series on the road.
In fall 2011, Green expanded last year's series to a third location. Instead of repeating all six lectures at Manchester's Derryfield School, an independent coeducational high school, the team delivered three of the lectures in Manchester and the remaining three at Nashua High School South. Green intends to repeat this with this year's series.
"I think we're open to taking it to other places potentially, but no decisions have been made yet," Green said.
The DCMS public spring lecture series was founded in 1998 by physiology and medical professor Donald L. St. Germain, who ran the series for 10 years. Green said he took over the series last year and is responsible for setting its theme and organizing the individual evening sessions.
"My main job is to work on defining the speakers and asking them to participate," Green said.
The majority of speakers are staff and faculty members from Dartmouth-Hitchcock Medical Center and the Geisel School, Green said.
Thayer School of Engineering faculty members have also spoken in the series because of the "natural overlap" in the research they carry out, especially in the field of bioengineering and the creation of new body parts and joint replacements, according to Green.
Wednesday night's audience consisted mostly of local residents. Although DCMS has recently tried to encourage more undergraduate and medical students to attend the series, it is geared toward the general public, Green said.
"Largely this has been and has continued to be an audience of community members," Green said.
Along with their responsibilities to educate medical students, PhD candidates, post-doctoral fellows and residents, the Geisel School and DCMS "also have a responsibility to educate the public," Green said.
"This is one of our big mechanisms to get the word out about science and medicine and issues that arise from that," he said.
