Benjamin Hippen, "Ethical challenges posed by APO L-1 screening in renal transplantation"

Benjamin Hippen, "Ethical challenges posed by APO L-1 screening in renal transplantation"
Friday, October 6, 2017 - 12:30 to 13:45

Benjamin Hippen (MD, FASN, FAST.  Clinical Professor, Department of Medicine, UNC-Chapel Hill School of Medicine.   Metrolina Nephrology Associates P.A. and the Carolinas Medical Center, Charlotte, North Carolina) presents:

"Ethical challenges posed by APO L-1 screening in renal transplantation"

Lunch workshop, Friday, Oct. 6, 2017, Cone 112, 12:30-1:45.

Free and open to the public - but please RSVP Here by Monday, October 2nd so we can order food!

 

Abstract: Chronic kidney disease (CKD) and End-Stage Renal Disease (ESRD) disproportionately affects African Americans: Though African Americans comprise 13% of the U.S. population, nearly a third of the prevalent patient population with ESRD are also African American.  Why this is the case remains an area of active research in nephrology and public health.   Recently, two distinct mutations in a gene coding for the APO-L1 protein on Chromosome 22q has been associated with higher risk for the development of CKD and ESRD.   Large population studies have shown that nearly 50% of (self-identified) African Americans carry at least one APO L-1 gene mutation, and 13% carry two mutations (thought to confer the highest risk for developing CKD/ESRD), whereas similar studies have found the prevalence of APO L-1 mutations in <1% of European (self-identified) Caucasian populations.  Even two-mutation carriers are not destined to develop CKD or ESRD, and additional social/environmental exposures which contribute to some developing disease remain an area of active study. The prospects of expanding APO L-1 genetic testing poses a number of familiar ethical and policy challenges (and hazards).  One scenario which exemplifies these hazards  is the use of APO L-1 testing in screening potential living kidney donor candidates interested in donating to a biological relative who may (or may well) have APO L-1-associated  nephropathy.    The discussion and debate over the appropriate uses (if any) of APO L-1 testing also transpires in the multivalent contexts of the history of eugenics and scientific racism, the competing ends of attempting to understand the mechanisms of disease in efforts to appropriately target effective individual- and population-level interventions to abate disease, as well as the complex, often subtle interplay between the concept of “race” as a socially constructed category, the inexorable advancement of medical knowledge, and the troubled/troubling sources of authority and responsibility in describing and adjudicating “risk” for individuals and populations.

 

Dr. Hippen appears as part of our series on "Biosurveillance," cosponsored by NC Biotech. Other speakers in the series include: