James R. Rodrigue, PhD
Professor, Harvard Medical School
Vice Chair of Clinical Research, BIDMC
Aaron Fleishman, MPH
Our research seeks to answer two central questions:
“How can we reduce the gap between the number of people who need organ transplants and the availability of organs for transplantation?”
In recent years, the number of deceased organ donors has remained flat and the number of living donors has declined. In the meantime, the number of people waiting for a lifesaving organ transplant continues to rise, with over 120,000 people currently on the national transplant waiting list. Together with colleagues at BIDMC, the New England Donor Services, and several transplant programs around the country, we are developing and evaluating novel strategies to increase the rates of both living and deceased donation. These strategies address individual and systematic barriers we have identified through earlier research that are associated with lower organ donation rates.
“How can we reduce persistent race and income disparities in transplantation?”
Some minorities and low-income patients, relative to white patients and those with more financial resources, experience more kidney transplant access barriers, are more likely to have initiated dialysis at time of transplant referral, wait longer for a deceased donor transplant, are less likely to receive a live donor kidney transplant, have higher mortality rates on the waiting list, and have less optimal transplant outcomes. Since the proportion of patients on the kidney transplant waiting list is increasing for racial/ethnic minorities (while declining for whites), the shortage of deceased donor kidneys is likely to exacerbate these transplant disparities in the years ahead. We are conducting studies to better understand the precise cause of these disparities, to evaluate novel strategies for mitigating these disparities, and to examine the impact of policy changes on these disparities.
The success of our research program is due largely to the collaborative partnerships we have with federal and state governments, organ procurement organizations, and researchers from diverse professional backgrounds, including behavioral and medical sciences, public health, surgery, bioethics, nursing, and health services.
We received NIH funding to evaluate strategies to reduce racial and income disparities in live donor kidney transplantation, another Health Resources and Services Administration (HRSA) grant to evaluate a novel program to increase favorable attitudes toward vascularized composite allotransplantation and donation among military veterans, and a Patient-Centered Outcomes Research Institute (PCORI) contract to further evaluate the effectiveness of a home-based intervention to reduce racial disparity in kidney transplantation.
I co-authored several manuscripts examining outcomes in living kidney donors and the disparity-reducing benefits of the novel Transplant House Calls intervention. I accepted invitations to present our work at the European Society of Transplantation in Barcelona, and at several U.S. transplant programs, including the University of Wisconsin and Medical University of South Carolina.
I developed and implemented the FIRST Program (www.bidmcFIRST.com), a robust clinical research platform in the Department of Surgery upon which clinical research can be cultivated, nourished, and expanded.
Other recent accomplishments include:
- Continued service on NIH Study Section (Behavioral Medicine)
- Invited Participant for the Consensus Conference to Decrease Kidney Discards, sponsored by the National Kidney Foundation
- Selected to serve on two committees (Living Donor, Vascularized Composite Allograft) of the Organ Procurement and Transplantation Network
- Appointed to the Living Donor Committee of the American Society of Transplant Surgeons
- Appointed Associate Editor of Clinical Transplantation
- Inducted as a Fellow into the American Society of Transplantation
- Received the Clinician of Distinction Award from the American Society of Transplantation
Teaching, Training, and Education
I continue to provide training and mentorship to post-doctoral fellows and research assistants. Other activities include:
- Director of the department’s Clinical Scholarship Program, providing first-year residents with mentored clinical research experience
- Director of the Facilitating Innovative Research & Surgical Trials (FIRST) Program in the Department of Surgery, a clinical research platform providing guidance and mentorship to faculty, fellows, and residents
- Chair of the Department of Surgery Appointment, Re-appointments, and Promotions Committee
Selected Research Support
House calls and decision support: Increasing access to live donor transplantation; NIH, 2012-
2017; PI: James Rodrigue, PhD
Increasing donor designation rates in teenagers: Effectiveness of a driver’s education intervention; HRSA, 2014-2017; PI: James Rodrigue, PhD
Kidney paired donation: A randomized trial to increase knowledge and reduce perceived barriers; HRSA, 2015-2018; PI: James Rodrigue, PhD
House calls and peer mentorship: Increasing access to live donor transplantation; PCORI, 2017-2021; PI: James Rodrigue, PhD
Increasing VCA donation knowledge, attitudes, willingness, and designations in veterans; HRSA, 2017-2020; PI: James Rodrigue, PhD
Living donor wage reimbursement trial; NIH, 2017-2022; PI: James Rodrigue, PhD
Rodrigue JR, Fleishman A. Health insurance trends in United States living kidney donors (2004-2015). Am J Transplant 2016;16:3504-3511.
Rodrigue JR, Tomich D, Fleishman A, Glazier AK. Vascularized Composite Allograft (VCA) donation and transplantation: a survey of public attitudes in the United States. Am J Transplant 2017; 17: 2687-95.
Friedman Ross L, Rodrigue JR, Veatch RM. Ethical and logistical issues raised by the Advanced Donation Program “pay it forward” scheme. J Med Philos 2017; 42:518-36.
Rodrigue JR, Paek M, Schold JD, Pavlakis M, Mandelbrot DA. Predictors and moderators of educational interventions to increase the likelihood of potential living donors for black patients awaiting kidney transplantation. J Racial Ethn Health Disparities;In press.
Rodrigue JR, Luskin R, Nelson H, Glazier A, Henderson G, Delmonico FL. Measuring critical care providers attitudes and knowledge about controlled donation and circulatory death. Prog Transplant 2018;28(2):142-150.
Rodrigue JR, Feranil M, Lang J, Fleishman A. Readability, content analysis, and racial/ethnic diversity of online living kidney donation information. Clin Transplant 2017;e13039.