Podcasts about Reform

Edwin Raymond, a fifteen-year veteran of the New York Police Department, sits down with Lurie Daniel Favors to discuss how he did not see a path forward for reform when working within the system.To learn more, check out Raymond's latest book, An Inconvenient Cop.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Beim Apothekertag in Düsseldorf kamen mehr als 300 Delegierte der Apothekenbranche aus allen Teilen Deutschland zusammen. Die Stimmung war bereits vor der Liveschaltung zu Gesundheitsminister Karl Lauterbach (SPD) hitzig und aufgeladen. Dies steigerte sich noch, als Lauterbach seine Pläne für das Apothekenwesen vorstellte. Web: https://www.epochtimes.de Probeabo der Epoch Times Wochenzeitung: https://bit.ly/EpochProbeabo Twitter: https://twitter.com/EpochTimesDE YouTube: https://www.youtube.com/channel/UC81ACRSbWNgmnVSK6M1p_Ug Telegram: https://t.me/epochtimesde Gettr: https://gettr.com/user/epochtimesde Facebook: https://www.facebook.com/EpochTimesWelt/ Unseren Podcast finden Sie unter anderem auch hier: iTunes: https://podcasts.apple.com/at/podcast/etdpodcast/id1496589910 Spotify: https://open.spotify.com/show/277zmVduHgYooQyFIxPH97 Unterstützen Sie unabhängigen Journalismus: Per Paypal: http://bit.ly/SpendenEpochTimesDeutsch Per Banküberweisung (Epoch Times Europe GmbH, IBAN: DE 2110 0700 2405 2550 5400, BIC/SWIFT: DEUTDEDBBER, Verwendungszweck: Spenden) Vielen Dank! (c) 2023 Epoch Times

Stand Up is a daily podcast. I book,host,edit, post and promote new episodes with brilliant guests every day. Please subscribe now for as little as 5$ and gain access to a community of over 700 awesome, curious, kind, funny, brilliant, generous souls Check out StandUpwithPete.com to learn more See JL Cauvin and I co Headlining City Winery In Pittsburgh PA on Oct 11 Spend Money on Kevin's Honey!  14 minutes Eric J. Segall graduated from Emory University, Phi Beta Kappa 27  and summa cum laude, and from Vanderbilt Law School, where he was the research editor for the Law Review and member of Order of the Coif. He clerked for the Chief Judge Charles Moye Jr. for the Northern District of Georgia, and Albert J. Henderson of the 11th Circuit Court of Appeals. After his clerkships, Segall worked for Gibson, Dunn & Crutcher and the U.S. Department of Justice, before joining the Georgia State faculty in 1991. Segall teaches federal courts and constitutional law I and II. He is the author of the books Originalism as Faith and Supreme Myths: Why the Supreme Court is not a Court and its Justices are not Judges. His articles on constitutional law have appeared in, among others, the Harvard Law Review Forum, the Stanford Law Review On Line, the UCLA Law Review, the George Washington Law Review, the Washington University Law Review, the University of Pennsylvania Journal of Constitutional Law, the Northwestern University Law Review Colloquy, and Constitutional Commentary among many others. Segall's op-eds and essays have appeared in the New York Times, the LA Times, The Atlantic, SLATE, Vox, Salon, and the Daily Beast, among others. He has appeared on CNN, Fox News, MSNBC, and France 24 and all four of Atlanta's local television stations. He has also appeared on numerous local and national radio shows. Listen and Subscribe to Eric's Podcast Supreme Myths and follow him on Tik Tok!   Watch Union Made by Jon Carroll Pete on Tik Tok Pete on YouTube  Pete on Twitter Pete On Instagram Pete Personal FB page Stand Up with Pete FB page All things Jon Carroll  Follow and Support Pete Coe

#UNSC: Reform or rupture is the choice. Judy Dempsey, Carnegie Endowment for International Peace, Editor-in-Chief: Strategic Europe, in Berlin. https://carnegieeurope.eu/strategiceurope/90606 1930 Germany

Hosts: Maura Carabello and Greg Skordas The Salt Lake Chamber is heading to Washington D.C. this week to meet with Utah's congressional delegation and discuss some of their top federal priorities, including immigration and permitting reform. Derek Miller, President and CEO of the Salt Lake Chamber and Downtown Alliance, joins the show to discuss what's to come from this meeting.See omnystudio.com/listener for privacy information.

Anna Kurzrok, managing director of market structure at Jefferies, joins Ronan and JR to dive into the nuts and bolts of U.S. equities market structure. They chat about what the SEC's market structure proposals will mean for the big institutional players and everyday traders, the trajectory of AI in trading, the fragmentation of trading venues, and what's going on with off-exchange trading. Recorded August 29, 2023.

The United Nations, founded in the aftermath of history's most destructive war, is the world's premier forum for international diplomacy. But is the UN a vestige of a bygone era? This year's session of the UN General Assembly, which today closes general debate, has been the site of much frustration over the war in Ukraine, the stalled progress of the 2030 Sustainable Development Goals, and the lack of representation for the global south.    The world has changed since the end of World War II, and as this episode's guest, Suzanne Nossel, argues, so too must the UN. Currently CEO of PEN America, Suzanne served in the UN under both the Clinton and Obama administrations as Deputy to the US Ambassador for UN Management and Reform and Deputy Assistant Secretary of State for International Organizations. Suzanne joins the Eurasia Group Foundation's Mark Hannah to reimagine the UN to better address these challenges and others. To listen to more episodes or learn more about None Of The Above, go to www.noneoftheabovepodcast.org. To learn more about the Eurasia Group Foundation, please visit www.egfound.org and subscribe to our newsletter. Suzanne Nossel currently serves as the CEO of PEN America, a leading human rights and free expression organization. Her prior career has spanned roles in both the Clinton and Obama administrations as part of the US Mission to the United Nations.

When farmer John Durfee found the body of a local factory girl hanging from a fence post on his property on the morning of December 21, 1832, he and the rest of the townspeople assumed she had died by suicide. But a cryptic note she had left among her possessions pointed the investigation in a different direction, and the ensuing murder trial captured the public imagination. Joining me now to discuss the murder of Maria Cornell and the shifting cultural milieu of New England in the 1830s is Dr. Bruce Dorsey, Professor of History at Swarthmore College and author of Murder in a Mill Town: Sex, Faith, and the Crime That Captivated a Nation.  Our theme song is Frogs Legs Rag, composed by James Scott and performed by Kevin MacLeod, licensed under Creative Commons. The mid-episode music is “Midnight,” by Aleksey Chistilin (Lexin_Music) via Pixabay; available for use under the Pixabay License. The episode image is “A very bad man - Ephraim Kingsbury Avery,” published by Henry Robinson & Company in 1833; the image is in the public domain and is available via the Library of Congress Prints and Photographs Division. Additional Sources: “Sarah Maria Cornell,” The Town & the City: Lowell before and after The Civil War, University of Massachusetts Lowell Library. “Trial of Rev. Mr. Avery ; a full report of the trial of Ephraim K. Avery, charged with the murder of Sarah Maria Cornell : before the Supreme Court of Rhode Island, at a special term in Newport, held in May, 1833 ; Avery's trial ; Additional medical testimony by Professor Channing on the part of the defendant, and Dr. William Turner, for the government,” reported by Benjamin F. Hallett, 1832, Harvard Library. “Letters of the law : the trial of E. K. Avery for the murder of Sarah M. Cornell,” by J. Barbour, Law Text Culture, 2, 1995, 118-133. “Religious Revivals and Revivalism in 1830s New England,” TeachUSHistory.org. "The Second Great Awakening and the Making of Modern America," by Kerry Irish, Faculty Publications - Department of History and Politics. 78, 2018.  “Religion and Reform,” The American Yawp. “The Mill Girls of Lowell,” National Park Service. Learn more about your ad choices. Visit megaphone.fm/adchoices

Cromwell's campaign in Ireland comes to an end, with a high cost for the New Model Army at Clonmel. Check out the podcast website or join the mailing list! Check out Pax Britannica Merch! Facebook | Twitter | Patreon | Donate For this episode, I found the following publications particularly useful: John Cunningham, ‘Politics, 1641-1660', Cambridge History of Ireland Elaine Murphy, Micheál Ó Siochrú, Jason Peacey, John Morril, eds. The Letters, Writings, and Speeches of Oliver Crmwell: Volume II, 2022. Antonia Fraser, Cromwell: Our Chief of Men David Edwards, ‘Political Change and Social Transformation, 1603-1641', Cambridge History of Ireland Ian Gentles, The English Revolution and the Wars in the Three Kingdoms, 1638-1652 John Jeremiah Cronin and Padraig Lenihan, ‘Wars of Religion, 1641-1691', Cambridge History of Ireland Patrick Little, Lord Broghill and the Cromwellian Union with Ireland and Scotland, 2004 Nick Lipscombe, The English Civil War: An Atlas and Concise History of the Wars of the Three Kingdoms, 1639-51 Micheál Ó Siochrú, (ed.) Kingdoms in Crisis: Ireland in the 1640s, 2000 Micheál Ó Siochrú, Confederate Ireland, 1642-1649, 1999 Micheál Ó Siochrú, God's Executioner: Oliver Cromwell and the Conquest of Ireland Pádraig Lenihan, Confederate Catholics at War, 1641-49, 2001 Pádraig Lenihan, 'Siege Massacres in Ireland: Drogheda in Context', in Martyn Bennett, Raymond Gillespie, and Scott Spurlock (eds), Cromwell and Ireland: New Perspectives Wheeler, James Scott, 'Ormond and Cromwell: The Struggle for Ireland', in Martyn Bennett, Raymond Gillespie, and Scott Spurlock (eds), Cromwell and Ireland: New Perspectives Martyn Bennett, ‘God's Wall of Brass: Cromwell's Generals in Ireland, 1649-1650' in Martyn Bennett, Raymond Gillespie, and Scott Spurlock (eds), Cromwell and Ireland: New Perspectives Derek Hirst, ‘Security and Reform in England's Other Nations, 1649-1658', in Michael J. Braddick. The Oxford Handbook of the English Revolution Learn more about your ad choices. Visit megaphone.fm/adchoices

 The sexual assault allegations surrounding Russell Brand have dominated the social media space for the last week and “What's Left?” decided to add our 2 cents to thoughts on all that is going on around this.  Check us out!How to Order Your “What's Left?” Shirthttps://youtu.be/nItmqkrpWHU To see all our episodes go to:What's Left? Website: https://whatsleftpodcast.com/iTunes: Spotify: Bitchute: YouTube:  LBRY: Telegram :Odysee:  Googleplaymusic: Rumble

In this episode of Energy Evolution, co-host Taylor Kuykendall interviews Eric Beightel, the executive director of the Federal Permitting Improvement Steering Council. The council was established in 2015 to improve the transparency and predictability of the federal environment review and authorization process for certain critical infrastructure projects.  Beightel discusses the challenges of permitting reform and the need for more resources, staff, and funding for agencies charged with the permitting process. He also emphasized the importance of early stakeholder engagement and community outreach to reduce the risk of litigation and improve the efficiency of the permitting process.  Energy Evolution co-hosts Dan Testa and Taylor Kuykendall are veteran journalists with broad expertise covering the energy and mining sectors. In addition, Camellia Moors and Camilla Naschert, reporters who write about mining and power issues, are correspondents for Energy Evolution and regularly contribute to the show. Subscribe to Energy Evolution on your favorite platform to catch our latest episodes!

The gerrymandered GOP Legislature continued to force its extreme and unpopular agenda down the throats of Wisconsinites. This week the groundless impeachment drive continued with a cynical embrace of a fake nonpartisan redistricting plan, yet another refusal to address the growing child care crisis, and an escalation of attacks on the UW System's Diversity, Equity, and Inclusion programs. To top it all off, Speaker Vos announced the worst possible Brewer stadium public funding plan, which once again sticks it to Milwaukee. We close with a discussion of the UAW strike and the false tension between good union jobs and fighting runaway climate change, Chicago's breakthrough on the minimum wage, and President Biden's executive order creating the Climate Corps that was stripped from his legislative plans by wannabe third party presidential candidate Sen. Joe Manchin.

Garland Nixon

AP correspondent Charles de Ledesma reports on General Assembly-EU.

Latest news from 20 September 2023, as reported in the Ukrainian media. Easy ways to support us: Subscribe to our Patreon to give monthly support https://www.patreon.com/highlightsfromukraine Send us a one-time 'thank you' tip via PayPal at: highlightsfromukraine@gmail.com Out YouTube channel: https://bit.ly/3oH111z Special thanks to our top Patreon supporters - Helena Pszczolko O'Callaghan, mattg629, krissi, Jared and Dick Warner!

Dr. Jason Altmire speaks with Justin Draeger, President and CEO of the National Association of Student Financial Aid Administrators (NASFAA), about financial aid reform and the onslaught of borrower defense claims.They delve into the recent surge of borrower defense claims and how schools nationwide are grappling with them. The conversation explores questions and concerns, such as the lack of sorting at the Department of Education and the impact of these claims on schools. Draeger also discusses NASFAA's role in advocating for reforms in federal student loan programs and the challenges in balancing the desire for forgiveness with the need for systemic changes.To learn more about Career Education Colleges & Universities, visit our website.

EPISODE 1734: In this KEEN ON show, Andrew talks to Daniel Ziblatt, co-author of TYRANNY OF THE MINORITY, about how constitutional reform can strengthen democracy in America Daniel Ziblatt is Eaton Professor of Government at Harvard University and director of the Transformations of Democracy group at Berlin's Social Science Center ( WZB Berlin Social Science Center ).  He is the author of four books, including How Democracies Die (Crown, 2018), co-authored with Steve Levitsky,  a New York Times best-seller and  described by The Economist magazine as "the most important book of the Trump era." The book has been translated into thirty languages. In 2017, he authored Conservative Parties and the Birth of Democracy (Cambridge University Press), an account of the history of democracy in Europe, which won the American Political Science Association's 2018 Woodrow Wilson Prize for the best book in government and international relations.  His first book was an analysis of 19th century state building, Structuring the State: The Formation of Italy and Germany and the Puzzle of Federalism (Princeton, 2006). His newest book co-authored with Steven Levitsky is entitled Tyranny of the Minority (Crown, 2023). The book is  published in September 2023. The book puts America's contemporary transition into a multiracial democracy in comparative and historical perspective, and shows the distinctive vulnerabilities of the U.S. constitutional order.  In 2023, Ziblatt was elected member of the American Academy for Arts and Sciences. Named as one of the "100 most connected men" by GQ magazine, Andrew Keen is amongst the world's best known broadcasters and commentators. In addition to presenting KEEN ON, he is the host of the long-running How To Fix Democracy show. He is also the author of four prescient books about digital technology: CULT OF THE AMATEUR, DIGITAL VERTIGO, THE INTERNET IS NOT THE ANSWER and HOW TO FIX THE FUTURE. Andrew lives in San Francisco, is married to Cassandra Knight, Google's VP of Litigation & Discovery, and has two grown children. Learn more about your ad choices. Visit megaphone.fm/adchoices

Many of my listeners don't know this, but I went to a private Catholic school until 8th grade before transitioning to a public high school. I had what I like to call “Catholic school RtI”, where I got extra reading help with Sister Marie (and it paid off!).I've focused a lot of my content on issues impacting the public schools, so when I connected with Tom Conroy, a Catholic school principal, I thought he'd bring an interesting perspective to the show; especially because I know that many of my listeners may be working with students who attend private schools. Tom Conroy is currently the principal of Our Lady of the Lake Catholic School in Verona, NJ. He retired from public school after 30 years and dove into the world of Catholic Education. Tom has held both teaching and administrative positions on the elementary, middle, high school, and district levels. Tom served for eight years on the New Jersey Principal and Supervisor Association/Foundation for Education Administration (NJPSA/FEA) Leadership Academy Development and Presentation Teams. Tom completed both his undergraduate and graduate work at Montclair State University.We start out by discussing some differences in private vs. public education; but transition to talking about topics that will be useful regardless of what K-12 setting you're in. In this episode, we discuss:✅Do private schools have more resources and support than public schools? ✅Why a school curriculum should be a living document and tool for communication (and not a scripted program).✅How to reform curriculum in a way that builds a culture of autonomy and how to create alignment across grade levels, buildings, and disciplines (including related service providers).✅The inner workings of successful professional learning communities (and why they help eliminate unproductive staff meetings).✅How to maintain a high level of rigor in standards and assessment protocols, without “teaching to the test” and overemphasizing standardized tools. In this episode, I mentioned the Time Tracking Journal, a strategy for improving time-management, future planning, and executive functioning during daily tasks like academic assignments or daily routines. You can learn more about the Time Tracking Journal here (https://drkarendudekbrannan.com/timejournal). You can connect with Tom on LinkedIn here(https://www.linkedin.com/in/thomas-conroy-0ab187b0/), or connect with him on the My Lady of the Lake website here (https://myoll.org/faculty-and-staff). 

"Abandon your religion of sacrifices (golden calf), and try a religion of prayer!"

#153: The City Hall leaked tape incident last year, combined with several corruption scandals involving councilmembers in the past few years, have led to this moment: There's now more momentum than ever behind some major reforms.  There are three main proposals that would significantly impact how the city is governed. They have to deal with redistricting, revamping the ethics commission and expanding the city council. BTW, did you know that the number of city council seats (15) hasn't changed in over 100 years, even though in the population of L.A. has grown sevenfold in that time? Voters have to approve those changes, but there are some steps that have to happen before Angelenos will see them on their ballots. Frank Stolze, LAist Civics and Democracy Correspondent, who recently co-wrote a guide to all this, joined us to explain.

Seattle police officer Daniel Auderer was caught joking about the death of a 23-year-old student on his own bodycam video. We discuss the subsequent outrage and debate whether the scandal could lead to meaningful changes within SPD. Our editor is Quinn Waller.If you want to advertise, please contact us realseattlenice@gmail.comIf you want to help support Seattle Nice, please review us wherever you get your podcasts.If you're still on X Twitter find us @realseattlenice Also please donate!  Our Patreon link is here. Support the show

The United States spends more money on healthcare than any other country in the world. In 2021, U.S. healthcare spending reached $4.3 trillion.Medicare, which insures seniors, is America's largest national health program, and therefore, it can and should be compared to its counterpart in other countries. So, how does the United States stack up?How do outcomes in the United States compare for patients, and what kind of comparisons can we make from the point of view of the healthcare provider? Do doctors have it better in the United States, or in other places? What lessons can we learn? Where are the most urgent areas that need reform?During the next live edition of Monitor Mondays, RACmonitor investigative reporter Edward M. Roche will examine U.S. healthcare in comparison with that of other countries, focusing on a number of dimensions, including cost, quality, outcomes, and ease of use.Broadcast segments will include these instantly recognizable features:Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Lead Story: RACmonitor investigative reporter Edward M. Roche will report the lead story on the performance scorecard for Medicare.

Boston homeowners have notoriously sharp elbows for keeping new developments -- especially big apartment buildings -- out of their neighborhoods. For decades, they've been aided by a uniquely complex zoning code that Mayor Michelle Wu now seeks to overhaul.

Does U.S. Chess need to be reformed? GM Jesse Kraai, IM Kostya Kavutskiy, and IM David Pruess talk about the ongoing problems and controversies with the USCF and whether the organization needs serious reform in today's episode of the Dojo Talks podcast. Interested in improving? Check out the Dojo Training Program: https://chessdojo.club   Chess is more than a game, it's a lifestyle. Live it with ChessDojo merch: https://www.chessdojo.club/shop  Want to support the channel? Donate here - https://streamlabs.com/chessdojolive  Follow ChessDojo here: Website: https://chessdojo.club Twitch: https://twitch.tv/chessdojolive Discord: https://discord.gg/sUUh8HD Twitter: https://twitter.com/chess_dojo Patreon: https://patreon.com/chessdojo Instagram: https://www.instagram.com/chess_dojo/ Podcast: https://chessdojotalks.podbean.com/ 0:00 Intro 2:17 Randy Bauer, Alejandro Ramirez, and US Chess Fallout  17:21 Possible US Chess Reforms 29:14 Saint Louis Chess Club, US Chess, and the Dojo 41:41 Problems in Chess Abroad

Life isn't fair. Perhaps that is why we love sports. In sports, the aspiration at least, is to even the playing field. But that endeavor in and of itself, poses many challenges. What does the inclusion of transgender athletes mean for sports? For ESPN's Katie Barnes, a journalist who covers the intersection of gender and athletics, the answers here are never simple.  Katie joins Jay to discuss the gender politics of sports at all levels of performance, as they break down in their new book, Fair Play: How Sports Shapes The Gender Debates. This conversation distills the complex and often-sensitive questions around transgender competitors, many of whom are kids who simply want to enjoy the sport they love.  See omnystudio.com/listener for privacy information.

The system for coordinating organ donations and transplants in the United States is broken, according to experts who have testified over the course of many years to Congress. In this episode, hear their testimony about what is wrong with the current system and then we'll examine the bill that aims to fix the problems. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank's online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Background Sources August 3, 2022. Senate Finance Committee. Lenny Bernstein and Todd C. Frankel. August 3, 2022. The Washington Post. February 10, 2020. Senate Finance Committee. The Bill Audio Sources July 20, 2023 Senate Committee on Finance, Subcommittee on Health Care Witnesses: LaQuayia Goldring, Patient Molly J. McCarthy, Vice Chair & Region 6 Patient Affairs Committee Representative, Organ Procurement and Transplantation Network (OPTN) Matthew Wadsworth, President and CEO, Life Connection of Ohio Raymond J. Lynch, MD, MS, FACS, Professor of Surgery and Director of Transplantation Quality and Outcomes, Penn State Health Milton S. Hershey Medical Center Donna R. Cryer, JD, Founder and CEO, Global Liver Institute Clips 30:40 Sen. Ron Wyden (D-OR): HRSA, the Health Resources Agency, is on track to begin the contract process this fall and we're just going to be working here to complement their effort. 36:30 Sen. Chuck Grassley (R-IA): In 2005, I started the investigation of the deadly failures of UNOS, the monopoly tasked with managing the US organ donation system. Since then, more than 200,000 patients have needlessly died on the organ waiting list. There's a reason that I call UNOS the fox guarding the hen house. For nearly two decades, UNOS has concealed serious problems [at] the nation's organ procurement organizations, known as OPOs, instead of working to uncover and correct the corruption. This human tragedy is even more horrific because many of these deaths were preventable. They were the result of [a] corrupt, unaccountable monopoly that operates more like a cartel than a public servant. 44:45 LaQuayia Goldring: As a toddler, at the age of three, I was diagnosed with a rare kidney cancer that took the function of my left kidney. And when I was 17, I went back into complete renal failure and I received a first kidney transplant at that time. Unfortunately, in 2015, I went back into kidney failure. And at that time, I wasn't ready for another transplant, but I didn't have a choice but to go back on dialysis. I've been waiting nine agonizing years for a transplant, dependent upon a dialysis machine five days a week, just to be able to live. I was told that I would receive a kidney transplant within three to five years. But yet I am still waiting. I am undergoing monthly surgeries just to be able to get my dialysis access to work so that I can continue to live until I get a transplant. The UNOS waitlist is not like one to 100, where everybody thinks you get a number. I'm never notified on where I stand on the list or when I will get the call. I have to depend on an algorithm to make the decision of what my fate will be. 47:55 LaQuayia Goldring: Just a few weeks ago, a donor family reached out to me to be a directed kidney donor, meaning they chose me specifically for a kidney transplant. But unfortunately, due to the errors in the UNOS technology, I was listed as inactive and this was a clerical error. And all that they told me was this was a clerical error, and they could not figure out why I was inactive. But when it came down to it, I'm actually active on the transplant list. 51:45 Molly McCarthy: The Federal monopoly contractor managing the organ donation system, UNOS, is an unmitigated failure. And its leadership spends more time attacking critics than it does taking steps to fix the system. I've seen this firsthand in my five years as a patient volunteer with the OPTN and three years ago, I stepped into the role of Vice Chair of the Patient Affairs Committee, or PAC. 53:45 Molly McCarthy: Further, I have been called by a board member telling me to stop focusing on system outage and downtime of the UNOS tech system. He told me that having downtime wasn't a big deal at all, "the donors are dead anyway." That comment speaks volumes to me about the lack of empathy and respect UNOS has for donor families. 55:00 Molly McCarthy: Congress needs to break up the UNOS monopoly by passing 1668, ensuring that HHS uses its authority to replace UNOS as its contractor. 1:00:15 Matt Wadsworth: Break up the OPTN contract and allow for competition. 1:00:40 Matt Wadsworth: I commend this committee for introducing legislation to finally break up this monopoly and I stand ready to work with you in any way possible to ensure that this bill passes. It's the only way this industry will be able to save more patients' lives. 1:02:10 Dr. Raymond Lynch: I want to differentiate between organ donation, which is the altruistic decision of the donor patient and their family, and organ procurement, which is the clinical care provided by OPO staff. This is what turns the gift of donation into the usable organs for transplant. Organ procurement is a clinical specialty. It's the last medical care that many patients will ever receive. It's reimbursed by the federal government and it's administered by OPOs that are each the only provider in the territory to which they hold federal contracts. Right now patient care delivered by OPOs is some of the least visible in American healthcare. I can't tell you how many patients were evaluated by OPO workers in the US in 2022. I can't tell you how many patients were examined, or how many families were given information about donation, or how many times an OPO worker even showed up to a hospital to do this clinical duty. This lack of information about what OPO providers actually do for patients is a root cause of the variability in rates of organ procurement around the country. My research has shown that what we call OPO performance is a measurable restriction on the supply of organs that results in the unnecessary deaths of patients with organ failure. For example, if the lowest performing OPOs from around the country had just reached the national median over a recent seven year period, there would have been 4957 more organ donors, yielding an estimated 11,707 additional organs for transplant. Because many OPOs operate in a low quality data environment and without appropriate oversight, almost 5,000 patients did not get adequate organ procurement care, and nearly 12,000 other patients did not receive life saving transplants. 1:03:55 Dr. Raymond Lynch: OPO clinical work is currently not visible, it's not benchmarkable, and it's not able to be adequately evaluated, analyzed, or compared. However, much of the hidden data about how OPOs provide care to patients is known to one entity and that entity is UNOS. 1:05:20 Dr. Raymond Lynch: We need a new network of highly skilled specialist organizations, each attending to areas of expertise in the management of the OPTN contract. 1:21:15 Sen. Marsha Blackburn (R-TN): When we look at OPTN, and look at the Securing Organ Procurement Act, the bill would strip the nonprofit requirement for the manager of the Organ Procurement and Transplantation Network, which would open the door for profiting from organ procurement and donation. And to me, this is something that I think many people really fear, especially people that are on a waitlist. And so what I would like for you to do is to address that and address those concerns. And why or why not you think the Act has it right. Dr. Raymond Lynch: Thank you, Senator. I think it's unfortunate that people would be afraid of that and it needs to be changed. Many of the patients that you referenced are waitlisted at for-profit hospitals. For-profit is a part of American healthcare. And I can tell you that our not-for-profit entity doesn't work. And there are for-profit hospitals and for-profit transplant centers that do work. So patients don't need to be afraid of that. They do need to be afraid of the status quo. 1:28:30 Sen. Ben Cardin (D-MD): Ms. Cryer, do you have any views as to why it's much lower percentage chances for a racial minority to be able to have a transplant? Donna Cryer: Yes. And it really does come down to UNOS not doing its job of overseeing the organ procurement organizations. We know from many studies that black and brown communities donate organs in the same percentage they are the population. So it is not a problem of willingness to donate. It is a problem, as Miss Goldring was starting to discuss, about UNOS not ensuring that OPOs go out into the communities, develop relationships far before that horrible decision is needed to [be] made to donate the organs of a family member. 1:56:45 Sen. Elizabeth Warren (D-MA): And among the many reforms the legislation would support HRSA's proposal to break up the OPTN monopoly contract into multiple smaller contracts, which would allow some competition and allow the best vendors in the business to manage different parts of the transplant network operation. That means hiring IT experts to do the IT. It means hiring logistics experts to do logistics, and so on. 1:57:15 Sen. Elizabeth Warren (D-MA): UNOS does not want to lose control, so they're pushing to have the government limit eligibility only to nonprofit vendors that have worked in the past on organ donation, meaning, for instance, that the IT company that is hired to run OPTNs computers systems would have had to have worked on an organ transplant network in the past and be a nonprofit. So Ms. McCarthy, the requirement UNOS wants would seem to make it so that only one organization could apply for the new contract: UNOS. 1:58:35 Sen. Elizabeth Warren (D-MA): Right now, Congress has an opportunity to root out corruption in this system, but if we don't act before the current contract expires we won't have another shot for years. August 3, 2022 Senate Committee on Finance Witnesses: Brian Shepard, CEO, United Network for Organ Sharing (UNOS) Diane Brockmeier, RN, President and CEO, Mid-America Transplant Barry Friedman, RN, Executive Director, AdventHealth Transplant Institute Calvin Henry, Region 3 Patient Affairs Committee Representative, Organ Procurement and Transplantation Network (OPTN) Jayme Locke, M.D., MPH, Director, Division of Transplantation, Heersink School of Medicine, University of Alabama at Birmingham Clips 36:15 Sen. Ron Wyden (D-OR): A 1984 law created the first computerized system to match sick patients with the organs they need. It was named the Organ Procurement and Transplantation Network. Someone needed to manage that system for the whole country, so the government sought to contract an organization to run it. UNOS was the only bidder for that first contract in 1986. The contract has come up for bid seven other times, UNOS has won all seven. Today, the network UNOS overseas is made up of nearly 400 members, including 252 transplant centers, and 57 regional organizations known as Organ Procurement Organizations, or OPOs. Each OPO is a defined geographic service network. Families sitting in a hospital room thinking about donating a loved one's organs does not have a choice of OPOs. 37:40 Sen. Ron Wyden (D-OR): Between 2010 and 2020, more than 1,100 complaints were filed by patients and families, staff, transplant centers, and others. The nature of these complaints runs the gamut. For example, in a number of cases, OPOs had failed to complete critical mandatory tests for matters like blood types, diseases, and infection. Our investigation found one patient died after being transplanted with lungs that a South Carolina OPO marked with the wrong blood type. Similar blood type errors happened elsewhere and patients developed serious illness. Some had to have organs removed after transplant. Another patient was told he would likely die within three years after an OPO in Ohio supplied him with a heart from a donor who had died of a malignant brain tumor. UNOS did not pursue any disciplinary action. In a case from Florida, another patient contracted cancer from transplanted organs and the OPO sat on the evidence for months. In total, our investigation found that between 2008 and 2015, and 249 transplant recipients developed a disease from transplanted organs. More than a quarter of them died. 38:55 Sen. Ron Wyden (D-OR): Delivering organs has been another source of life threatening errors. We found 53 such complaints between 2010 and 2020, as well as evidence that this was just the tip of the iceberg. In some cases, couriers missed a flight. In others, the organs were abandoned at airports. Some organs were never picked up. Many of these failures resulted in organs being discarded. 39:20 Sen. Ron Wyden (D-OR): It's reasonable to assume that many more errors are going unreported. Why? Because filing official complaints with UNOS appears to accomplish zero productive oversight or reform. Organ transplant professionals repeatedly told the Finance Committee that the complaint process was, and I quote here, "a black hole." Complaints went in, UNOS went quiet. In interviews with the Committee UNOS leaders have dragged their feet, dodged tough questions, and shifted responsibility onto others. investigations and disciplinary measures rarely amount to much more than a slap on the wrist. Only one time -- just once -- has UNOS recommended that an OPO lose their certification. 55:05 Diane Brockmeier: We must update the archaic technology system at UNOS. As OPOs, we are required to work with UNOS technology DonorNet every day. DonorNet is outdated, difficult to us,e and often slow to function when every minute counts. Manual entry subjects it to error and OPO and Transplant Center staff are not empowered with the right information when time is critical. I did serve in leadership roles on the OPO Committee from 2017 to 2022. Committee members and industry leaders voiced repeated requests to improve DonorNet. The consistent response was UNOS IT did not have the bandwidth to address this work. The limitations of the UNOS technology are delaying and denying transplants to patients that are dying on the waitlist. Poor technology impacts the disturbingly high kidney discard rate in the United States, where one in four kidneys never make it to a patient for transplantation. Critical time is lost due to the inefficiency of DonorNet, wasting time on offers that will not be accepted. Of course an available organ should be offered to the patient in this sequence. However, far too much of the matching, particularly on older donors and organs that are difficult to place, are left to the individual OPOs and transplant centers to find each other despite, rather than facilitated by, UNOS technology. Mid-America Transplant intentionally identifies surgeons who accept kidneys that have been repeatedly turned down many times. These are life saving options for those patients. In May of 2022, one of these patients was number 18,193 on the list. Relying on DonorNet alone, that kidney would never had been placed and the chance to save a life would have been wasted. 55:20 Diane Brockmeier: UNOS lacks urgency and accountability around identifying and remediating this preventable loss of organs, and they are not required to publicly report adverse events when patients are harmed, organs are lost, or the quality of patient care is deemed unsafe. UNOS does not require clinical training, licensure, or certification standards for OPO staff delivering critical patient care. In this environment, who's looking out for the patient? Who's being held accountable for poor patient care? No OPO has ever actually been decertified, regardless of its performance or its safety record. 57:55 Diane Brockmeier: When an OPO goes out of sequence to place an organ that would otherwise be thrown away, UNOS requires an explanation; however, when organs are recovered and discarded, you must remain silent. 58:05 Diane Brockmeier: We must remove conflicts to ensure effective governance. From 2018 to 2020, I served as a board member for the OPTN. Serving on the board of the OPTN automatically assigns membership to the UNOS board. My board experience revealed that at times UNOS actions are not aligned with its fundamental vision of a life saving transplant for everyone in need. How can you fairly represent the country's interest and a contractor's interest at the same time? 58:35 Diane Brockmeier: Board members are often kept in the dark about critical matters and are marginalized, particularly if they express views that differ from UNOS leadership. Preparatory small group calls are conducted prior to board meetings to explore voting intentions, and if the board member was not aligned with the opinion of UNOS leadership, follow up calls are initiated. Fellow board members report feeling pressured to vote in accordance with UNOS leadership. 59:10 Diane Brockmeier: To protect patients, I urge Congress and the administration to separate the OPTN functions into different contracts so that patients can be served by best-in-class vendors, to immediately separate the boards of the OPTN and OPTN contractors, and to ensure that patients are safeguarded through open data from both the OPTN and OPOs. 1:00:45 Barry Friedman: Approximately 23% of kidneys procured from deceased donors are not used and discarded, resulting in preventable deaths 1:00:55 Barry Friedman: Organ transportation is a process left to federally designated Organ Procurement Organizations, OPOs. Currently, they develop their own relationships with couriers, rely on airlines, charter flights, ground transportation, and federal agencies to facilitate transportation. In many cases, organs must connect from one flight to another, leaving airline personnel responsible for transfers. While anyone can track their Amazon or FedEx package, there is currently no consistent way of tracking these life saving organs. 1:01:45 Barry Friedman: Currently there is no requirement for OPOs to use tracking systems. 1:02:20 Barry Friedman: I also believe there's a conflict of interest related to the management of IT functions by UNOS, as the IT tools they offer transplant centers come with additional costs, despite these being essential for the safety and management of organs. 1:02:35 Barry Friedman: UNOS is not effectively screening organ donors so that they can be quickly directed to transplant programs. UNOS asks centers to voluntarily opt out of certain organs via a filtering process. As a result, OPOs waste valuable time making organ offers to centers that will never accept them. Time wasted equates to prolonged cold ischemic time and organs not placed, resulting in lost organ transplant opportunities. 1:03:10 Barry Friedman: Due to the limited expertise that UNOS has in the placement of organs, it would be best if they were no longer responsible for the development of organ placement practices. The UNOS policy making [process] lacks transparency. Currently OPTN board members concurrently serve as the board members of UNOS, which creates a conflict of interest that contributes to this lack of transparency. UNOS committees are formed in a vacuum. There is no call for nominations and no data shared with the transplant community to explain the rationale behind decisions that create policy change. 1:11:35 Dr. Jayme Locke: The most powerful thing to know about this is that every organ represents a life. We can never forget that. Imagine having a medication you need to live being thrown away simply because someone took too long to get it to you. Your life quite literally in a trash can. Organs are no different. They too have shelf lives and they are measured in hours. Discarded organs and transportation errors may sound abstract, but let me make this negligence real for you. In 2014, I received a kidney that arrived frozen, it was an ice cube you could put in your drink. The intended recipient was sensitized, meaning difficult to match. The only thing we could do was tell the waiting patient that due to the lack of transportation safeguard, the kidney had to be thrown in the trash, the final generous act of a donor in Maryland. In 2017, I received a kidney that arrived in a box that appeared to have tire marks on it. The box was squished and the container inside had been ruptured. We were lucky and were able to salvage the kidney for transplant. But why should luck even play a role? 1:12:45 Dr. Jayme Locke: In one week, I received four kidneys from four different OPOs, each with basic errors that led to the need to throw away those life saving organs. One due to a botched kidney biopsy into the kidneys collecting system, another because of a lower pole artery that had been cut during procurement that could have been fixed if someone involved had assessed the kidney for damage and flushed it before packing, but that didn't happen. Two others arrived to me blue, meaning they hadn't been flushed either. 1:13:15 Dr. Jayme Locke: Opacity at UNOS means that we have no idea how often basic mistakes happen across the country, nor can we have any confidence that anything is being done to redress such errors so they don't keep happening. 1:13:40 Dr. Jayme Locke: Women who have been pregnant, especially multiple times, are harder to match, contributing to both gender and racial disparities in access to transplant. This is a very real example of how a constrained pool of organs and high discards disproportionately hurt women and women of color, who are more likely to have multiple pregnancies. 1:14:25 Dr. Jayme Locke: Number one, immediately separate the OPTN board from any of the boards of any contractors. Number two, bring in real experts to ensure our patients are served by the best of the best in each field, separating out key functions of the OPTN, including policy, technology, and logistics. And number three, ensure that patients are safer by holding all contractors accountable through public adverse event reporting and immediate redressing of problems. 1:22:00 Sen. Chuck Grassley (R-IA): The system doesn't seem to be fair to racial minorities or people living in rural communities. So what are your efforts underway to understand the root causes and help make the system fairer to patients on the waiting list to explain the factors that result in the disparity for minorities in rural populations in the process? And how can the federal government address a problem if we have to be involved in addressing it? Dr. Jayme Locke: One of the most important things that we don't currently do is we don't actually account for disease burden in terms of examining our waiting lists. So we have no way of knowing if we're actually serving the correct people, if the correct people are actually making it to the waiting list. Disease burden is super important because it not only identifies the individuals who are in need of transplantation, but it also speaks to supply. So areas with high rates of end stage kidney disease burden, like the southeastern United States are going to have much lower supply. And those waiting lists predominantly consist of African American or Black individuals. So if you want to make a truly equitable organ system, you have to essentially get more organs to those areas where there are higher disease burdens. I think the other thing is that we have to have more focus on how we approach donor families and make sure that we have cultural competence as a part of our OPOs, and how they approach families to ensure that we're not marginalizing minority families with regard to the organ donation process. 1:30:00 Brian Shepard: The OPTN IT system that UNOS operates has 99.99% uptime. It is a highly reliable system. We are audited annually by HRSA.... Sen. Ben Cardin (D-MD): My information shows it's had 17 days down since I think 1999. That's not correct? Brian Shepard: In 23 years, yes, sir. Sen. Ben Cardin (D-MD): Okay, well, every day there's a loss of life, isn't it? Brian Shepard: That's the total amount of time over the couse of -- Sen. Ben Cardin (D-MD): I hope our national event system isn't down 17 days a year. Brian Shepard: The system has never been down for a day. And to my knowledge, and I have not been at UNOS since 1999, there's been maybe one event that was longer than an hour, and that was three hours. But the total amount of time since 1999 -- Sen. Ben Cardin (D-MD): So you're satisfied with your technology? You think you have the right technology? You're satisfied with your tracking systems now? You think everything is okay? Brian Shepard: We constantly improve our technology. We're subjected to 3 million attempts a day to hack into the patient database and we successfully repelled them all. So we are never satisfied with our technology, but we do maintain 99.99% uptime. We disagree with the USDS analysis of our systems. 1:37:25 Brian Shepard: If you're asking whether UNOS can prevent an OPO from operating or for being an OPO -- Sen. Rob Portman (R-OH: Well not prevent them, but require them to do something .You don't have the ability to require them...? Brian Shepard: The peer review process has significant persuasive authority, but all the payment authority and all the certification and decertification authority live at CMS. 1:39:00 Sen. Rob Portman (R-OH: Do you think there should be tracking of organs in transit? Brian Shepard: I think that's a very beneficial thing. UNOS provides an optional service that a quarter of OPOs use. Many OPOs also use other commercially available trackers to do that. There is not a single requirement to use a particular system. 1:41:55 Sen. Elizabeth Warren (D-MA): Mr. Shepherd, you are the CEO of UNOS. We have documented these problems and you've received more than 1000 complaints in the last decade alone. So tell me, in the 36 years that UNOS has had the contract to run our national organ system, how many times has UNOS declared its OPO Members, any OPO members, not in good standing. Brian Shepard: Two times, Senator. 1:43:20 Sen. Elizabeth Warren (D-MA): How many times has UNOS put an OPO on probation? Brian Shepard: I don't know that number off the top of my head, but it's not a large number. Sen. Elizabeth Warren (D-MA): It's not large, in fact it's three. 1:45:20 Brian Shepard: Approximately 10% of the budget of this contract is taxpayer funded. The rest of that is paid by hospitals when they list patients. 1:49:30 Sen. Todd Young (R-IN): Once an OPO is designated not in good standing, Senator Warren referred to this as toothless. It does seem toothless to me. I'll give you an opportunity, Mr. Shepherd, to disabuse me of that notion and indicate for me what penalties or sanctions are actually placed on an OPO when they are designated not in good standing. Brian Shepard: The statute does not give UNOS any authority to offer sanctions like that. The certification, decertification, payment authorities belong entirely to CMS. UNOS's statute doesn't give us the ability -- Sen. Todd Young (R-IN): So it is toothless in that sense. Brian Shepard: It is designed to be, by regulation and contract, a quality improvement process, in contrast to the oversight process operated by a federal agency. 1:51:15 Sen. Todd Young (R-IN): To what extent is UNOS currently tracking the status of all the organs in transit at any given time? Brian Shepard: UNOS does not coordinate transportation or track organs in transit. We do provide a service that OPOs can use to use GPS trackers. Some of the OPOs use ours and some use other commercially available products. Sen. Todd Young (R-IN): So why is it, and how does UNOS plan to optimize organ delivery if you don't have 100% visibility into where they are at any given time? Brian Shepard: I think that the GPS products that we offer and that other people offer are valuable, they do help in the delivery of kidneys. Only kidneys travel unaccompanied, so this is a kidney issue. But I do think that GPS trackers are valuable and I think that's why you've seen more and more OPOs use them. 1:52:50 Sen. Ron Wyden (D-OR): Mr. Shepherd has said twice, with respect to this whole question of the power to decertify an OPO, that CMS has the power to do it. UNOS also has the power to refer an OPO for decertification under the OPTN final rule. That has been done exactly once. So I just wanted it understood with respect to making sure the committee has got what's really going on with respect to decertifying OPOs. 2:00:15 Dr. Jayme Locke: Obviously people have described that we have about a 25% kidney discard, so one in four. So if you look at numbers last year, these are rough numbers, but that'd be about 8000 kidneys. And really, I think, in some ways, these are kind of a victim of an entrenched and cumbersome allocation algorithms that are very ordinal, you have to go sort of in order, when data clearly have shown that introduction of multiple simultaneous expiring offers would result in more efficient placement of kidneys and this would decrease our cold ischemia time. 2:00:50 Dr. Jayme Locke: So if you take UNOS's organ center, they have a very rigid system, for example, for finding flights and lack either an ability or interest in thinking outside the box. So, for example, if there are no direct flights from California to Birmingham, Alabama, instead of looking for a flight from San Francisco to Atlanta, understanding that a courier could then pick it up in Atlanta and drive it the two hours, they'll instead put on a flight from SFO to Atlanta and allow it to go to cargo hold overnight, where it literally is rotting, if you will, and we're putting extra time on it. Sen. Ron Wyden (D-OR): Just to make sure everybody gets this. You're saying you've seen instances of something being put in cargo hold when it is very likely to rot? Dr. Jayme Locke: That is correct. So if the kidney arrives after 10pm at the Atlanta airport, it goes to cargo hold. We discovered that and made calls to the airlines ourselves and after several calls to the airlines, of course they were mortified, not understanding that that was what was happening and actually had their manager meet our courier and we were able to get the kidney out of cargo hold, but this went on before we figured out what was happening because essentially they fly it in, it sits in cargo hold, it comes out the next morning to catch the next flight. Instead of thinking outside the box: if we just get it to Atlanta, it's drivable to Birmingham. And those hours make a difference. Sen. Ron Wyden (D-OR): That sounds way too logical for what UNOS has been up to. 2:03:05 Sen. Ron Wyden (D-OR): Miss Brockmeier, UNOS has developed this organ tracking system. Do you all use it? I'm curious what you think of it. Diane Brockmeier: Thank you for the question, Senator. We did use and participate in the beta pilot through UNOS and made the decision to not move forward using their product, and have sought a commercial alternative. Sen. Ron Wyden (D-OR): And why was that? Diane Brockmeier: Part of the issues were some service related issues, the lack of the interconnectivity that we wanted to be able to facilitate a more expedited visual tracking of where the organ was. Sen. Ron Wyden (D-OR): Was the tracking technology low quality? Diane Brockmeier: Yes, sir. 2:11:25 Sen. Ron Wyden (D-OR): All right, let's talk for a moment about the boards that are supposed to be overseeing these, because it looks to me like there's a serious conflict of interest here and I'll send this to Ms. Brockmeier, and perhaps you'd like to get to it as well, Mr. Friedman. The Organ Procurement and Transplantation Network, which is the formal title of the organ network that operates under federal contract administered by HHS, and UNOS, which is the contractor that operates the network and controls information about the network, have the same boards of directors, despite efforts by the government to separate them. That means the people who look out for the best interests of UNOS, the multimillion dollar nonprofit, are the same people who look out for the interests of the entire organ transplant network. Sure sounds like a conflict to me. 2:12:55 Diane Brockmeier: I think there should be an independent board. I think the division of the responsibilities of the board and by the inherent way that they're structured, do pose conflicts. It would be like if you had an organization that was a supporting organization, you'd want to hold it accountable for its performance. And the current structure really limits that opportunity. 2:19:50 Dr. Jayme Locke: And if you think about IT, something as simple as having a system where we can more easily put in unacceptable antigens, this was a debate for many years. So for context, we list unacceptable antigens in the system that allows us to better match kidneys so that when someone comes up on the match run, we have a high probability that there'll be a good tissue match. Well, that took forever and we couldn't really get our unacceptable antigens in, so routinely people get offered kidneys that aren't going to be a match, and you have to get through all of those before you can get to the person that they really should go to. Those are simple examples. But if we could really have transparency and accountability around those kinds of things, we could save more lives. 2:23:10 Sen. Ron Wyden (D-OR): Mr. Shepherd told Senator Warren that only 10% of UNOS funds come from taxpayer money and the rest comes from fees paid by transplant centers who add patients to the list. But the fact is, Medicare is the largest payer of the fees, for example, for kidneys. So we're talking about inefficiency, inefficiency that puts patients at risk. And certainly, taxpayer dollars are used to cover some of these practices. May 4, 2021 House Committee on Oversight and Reform, Subcommittee on Economic and Consumer Policy Witnesses: Tonya Ingram, Patient Waiting for a Transplant Dr. Dara Kass, Living Donor and Mother of Transplant Recipient LaQuayia Goldring, Patient Waiting for a Transplant Steve Miller, CEO, Association for Organ Procurement Organizations Joe Ferreira, President, Association for Organ Procurement Organizations Matt Wadsworth, President and CEO, Life Connection of Ohio Dr. Seth Karp, Director, Vanderbilt Transplant Center Donna Cryer, President and CEO, Global Liver Institute Clips 5:15 Tonya Ingram: The Organ Procurement Organization that serves Los Angeles, where I live, is failing according to the federal government. In fact, it's one of the worst in the country. One analysis showed it only recovered 31% of potential organ donors. Audits in previous years found that LA's OPO has misspent taxpayer dollars on retreats to five star hotels and Rose Bowl tickets. The CEO makes more than $900,000. Even still, the LA OPO has not lost its government contract and it has five more years to go. 30:00 Rep. Raja Krishnamoorthi (D-IL): Unusual among Medicare programs, their costs are 100% reimbursed, even costs unrelated to care. So, extravagant executive compensation and luxury perks may be passed off onto the taxpayer. 46:55 Dr. Seth Karp: We have 10 hours to get a liver from the donor to the recipient, and about one hour to sew it in. For heart, we have about six hours. Time matters. 47:55 Dr. Seth Karp: Last year, I had the opportunity to co-write a viewpoint in one of the journals of the American Medical Association with TJ Patel, former Chief Data Scientist of the United States. In that article, we provided evidence that the metrics used to judge the performance of organ procurement organizations are basically useless. Until the recent OPO Final Rule, performance was self-reported, and OPO employees admitted to having gamed the system. When threatened with decertification, one of the OPOs themselves successfully argued that because the performance data were self reported and unaudited, they failed to meet a reasonable standard and the OPO should not be held accountable. In other words for decades, the metrics supposed to measure performance didn't measure performance, and the results have been disastrous, as you have heard. 49:45 Dr. Seth Karp: Whenever I, and quite frankly most everyone else in the field, gives a talk on transplantation, we usually make two points. The first is that organ transplantation is a miracle of modern medicine. The second is the tragedy that there are not enough organs for everyone who needs one. I no longer use the second point, because I don't believe it. Based on my work, I believe that there are enough organs for patients who require hearts, lungs, and probably livers, and we can make a huge improvement in the number of kidneys available. In addition to improving OPO performance, new technologies already exist to dramatically increase the organ supply. We need a structure to drive rapid improvement in our system. 54:00 Joe Ferreira: One common misconception is that OPOs are solely responsible for the entire donation and transplantation system, when, in fact, OPOs are the intermediary entity and their success is highly dependent on collaborations with hospitals and transplant programs. At the start of the donation process, hospitals are responsible for notifying any OPO in a timely manner when a patient is on a ventilator and meets medical criteria to be an organ donor. Additionally, transplant centers must make the decision whether to accept or decline the organs offered by OPOs. 57:55 Matt Wadsworth: As geographic monopolies, OPOs are not subject to any competitive pressure to provide high service. As the only major program in all of health care 100% reimbursed for all costs, we do not face financial pressures to allocate resources intelligently. 1:02:10 Rep. Raja Krishnamoorthi (D-IL): Mr. Ferreira, I'd like to turn to you. You run the OPO called the Nevada Donor Network. I have your OPO's 2019 financial statement filed with the CMS. It appears that your OPO spent roughly $6 million in 2019 on administrative and general expenses. Interestingly, in 2019, I see your OPO spent approximately $146,000 on travel meetings and seminars alone. And your itemization of Administrative and General has an interesting line item for $576,000 for "ANG". It took me a minute but that means you have an "Administrative and General" subcategory in your "Administrative and General" category. Very vague. Now Mr. Ferreira, I was informed by Mr. Wadsworth, a former executive of yours at the Nevada Donor Network, that your OPO has season tickets to the NHL's Las Vegas Golden Knights, isn't that correct? Joe Ferreira: That is correct, Mr. Chairman. Rep. Raja Krishnamoorthi (D-IL): And you also have season tickets to the Las Vegas Raiders too, right? Joe Ferreira: That is correct. Rep. Raja Krishnamoorthi (D-IL): And according to Mr. Wadsworth and others, your OPO took a board retreat to Napa Valley in 2018. Joe Ferreira: That is correct. Rep. Raja Krishnamoorthi (D-IL): And Sonoma in 2019, right? Joe Ferreira: That is correct. Rep. Raja Krishnamoorthi (D-IL): Mr. Ferreira, what you're spending on the Raiders, the Golden Knights, Napa Valley and Sonoma have one thing in common: they have nothing to do with recovering organs. 1:10:30 Dr. Seth Karp: In 2019, there were six heart transplants that were performed using donors after circulatory determination of death. And I don't want to get into the technical aspects of that. But in 2019, that number was six. In 2020, that number was 126. This is a new technology. This is a way that we can increase the number of heart transplants done in United States dramatically. And if we think that there were 500 patients in the United States waiting for a heart in 2020, 500 patients that either died or were delisted because they were too sick, and you think in one year, using a technology, we got another 100 transplants, if we could get another 500 transplants out of that technology, we could almost eliminate deaths on the on the heart transplant waiting list. That technology exists. It exists today. But we don't have a mechanism for getting it out to everybody that could use it and it's going to run itself through the system, it's going to take too much time. 1:24:05 Rep. Andrew Clyde (R-GA): You know, I'm a little disappointed that we're discussing race as a factor in organ transplant. We're all one race in my opinion; color makes no difference to me. We're the human race. And to me, the interjection of race into this discussion is very concerning. Discrimination based on race was outlawed almost 60 years ago through the Civil Rights Act of 1964. Now, I'm not a medical doctor, and I have very little knowledge of medicine. But last year, there was an article that came out in LifeSource and it says, "Does my race and ethnicity matter in organ donation?" And so my question here is for Dr. Karp. In your experience, would you agree that a donor's organs are more likely to be a clinical match for a recipient of the same ethnicity? Could you comment on that? Is that actually a factor, or not? I mean, we're all human beings, we all, you know, have similar bodies. Dr. Seth Karp: Yes. So there definitely are certain HLA types that are more common. That is race-based. So the answer to that question is yes. Rep. Andrew Clyde (R-GA): Okay. All right. And so if you have more of one particular race, more donations of one particular race, then naturally you would have more actual matches of that particular race. Is that correct? Dr. Seth Karp: That would tend to be the case. Rep. Andrew Clyde (R-GA): Okay. All right. All right. Okay, that's just a question that I wanted to clear up here. 1:34:20 Donna Cryer: We'd like to see investments in languages that are spoken by the community. Educational resources should be, as required by law, for those with limited English proficiency. They should be in the languages spoken by the community. They should be hiring diverse staff to have those most crucial conversations with families. The data shows, and certainly experience and common sense shows as well, that having people of color approaching families of color results in more donations. Executive Producer Recommended Sources Music by Editing Production Assistance

In this episode, I am joined by Dr. Joseph Antoun, CEO & Chairman of the Board of L-Nutra and Member of the Forbes Business Development Council. He's the former CEO of Health Systems Reform, a boutique consultancy aimed at improving public health by reforming health systems, management, and delivery. Prior to that, he was Director of Health Policy at the University of Chicago, Editor in Chief of the Journal of Health Systems and Reform and head of Business Development for Eli Lilly & Co. He completed his studies in Public Policy at Harvard University, in Public Health at Johns Hopkins University, and his Doctorate in Medicine and Masters' in Medical and Biological Sciences at Saint Joseph University.   L-Nutra is the first nutra-tech company to focus on providing people the knowledge and products to live to 110 and beyond. A culmination of 25 years of research at the University of Southern California (USC) and 12 other partner universities, L-Nutra is pioneering Nutri-technologies that mimic and enhance the effects of fasting to unleash the body's natural ability to fuel and rejuvenate itself. L-Nutra's team of researchers and collaborators are leaders in the field of nutrition related to longevity and healthspan. Connect with us - Thank you for joining us today. If you could do me the honor of hitting the subscribe button, leaving a review, sharing this podcast with a friend, or tagging me on social media when you visit The Simplicity Sessions Community on Facebook or @jennpike on Instagram, I would be forever grateful. Connect with Dr. Joseph Antoun - Website: https://l-nutra.com/ Instagram: https://www.instagram.com/prolonfmd/?hl=en Facebook: https://www.facebook.com/LNutra/ Learn more about the products and supports I recommend from some of our amazing partners - St Francis Herb Farm education includes webinars, blogs and articles on important topics including the plant medicines that they create to promote women's health by targeting digestion, allergies, immune support, heart health, brain health, and sleep. I use and recommend their products and you can use the code JENNPIKE15 at checkout to save 15% off your order. Skin Essence is Canadian-founded, organic, non-GMO, and does not test on animals; this company is one that we love and have around the house. You can even talk to the company to get advice on which products may be right to try first. Save 15% off your first order with the code JENNPIKE15 and use code JENNPIKE10 to save 10% off every order after that.

After sacking Drogheda and securing the path into Ulster, Cromwell marches south towards the port town of Wexford. History doesn't repeat, but it does rhyme. Check out the podcast website or join the mailing list! Check out Pax Britannica Merch! Facebook | Twitter | Patreon | Donate For this episode, I found the following publications particularly useful: John Cunningham, ‘Politics, 1641-1660', Cambridge History of Ireland Elaine Murphy, Micheál Ó Siochrú, Jason Peacey, John Morril, eds. The Letters, Writings, and Speeches of Oliver Crmwell: Volume II, 2022. Antonia Fraser, Cromwell: Our Chief of Men David Edwards, ‘Political Change and Social Transformation, 1603-1641', Cambridge History of Ireland Ian Gentles, The English Revolution and the Wars in the Three Kingdoms, 1638-1652 John Jeremiah Cronin and Padraig Lenihan, ‘Wars of Religion, 1641-1691', Cambridge History of Ireland Patrick Little, Lord Broghill and the Cromwellian Union with Ireland and Scotland, 2004 Nick Lipscombe, The English Civil War: An Atlas and Concise History of the Wars of the Three Kingdoms, 1639-51 Micheál Ó Siochrú, (ed.) Kingdoms in Crisis: Ireland in the 1640s, 2000 Micheál Ó Siochrú, Confederate Ireland, 1642-1649, 1999 Micheál Ó Siochrú, God's Executioner: Oliver Cromwell and the Conquest of Ireland Pádraig Lenihan, Confederate Catholics at War, 1641-49, 2001 Pádraig Lenihan, 'Siege Massacres in Ireland: Drogheda in Context', in Martyn Bennett, Raymond Gillespie, and Scott Spurlock (eds), Cromwell and Ireland: New Perspectives Wheeler, James Scott, 'Ormond and Cromwell: The Struggle for Ireland', in Martyn Bennett, Raymond Gillespie, and Scott Spurlock (eds), Cromwell and Ireland: New Perspectives Martyn Bennett, ‘God's Wall of Brass: Cromwell's Generals in Ireland, 1649-1650' in Martyn Bennett, Raymond Gillespie, and Scott Spurlock (eds), Cromwell and Ireland: New Perspectives Derek Hirst, ‘Security and Reform in England's Other Nations, 1649-1658', in Michael J. Braddick. The Oxford Handbook of the English Revolution Learn more about your ad choices. Visit megaphone.fm/adchoices

 Today we take a look at 9/11 and the uncovered areas people often look at during this time of remembrance. We can still feel the effects of that event that we find resemblance in other major crises (especially the Covid “pandemic”). Check us out.Opening Clip from:https://www.corbettreport.com/911-a-conspiracy-theory/How to Order Your “What's Left?” Shirthttps://youtu.be/nItmqkrpWHU To see all our episodes go to:What's Left? Website: https://whatsleftpodcast.com/iTunes: Spotify: Bitchute: YouTube:  LBRY: Telegram :Odysee:  Googleplaymusic: Rumble

KSL's Top Story: The Salt Lake district attorney has cleared 2 Salt Lake City police officers... in the shooting of a veteran in the midst of a mental health crisis.See omnystudio.com/listener for privacy information.

Martin Luther and Lutheranism wasn't the only protestant reformation movement. In this episode we look at other reformers such as John Calvin and see how they impacted European culture. Lyndeurozone.com  Patreon If you use this podcast regularly would you please consider supporting us on Patreon for as little as a dollar a month?  The Euro Simplified Podcast has no advertising revenue and is produced by a public school teacher.  We love and appreciate our supporters on Patreon as our supporters help us meet the costs associated with the production of this free resource for students. Episodes will be released on the following schedule: Unit 1 and Unit 2 - August/September Unit 3: October Unit 4: November Unit 5: November and December Unit 6: January Unit 7: Late January & February Unit 8 : March Unit 9: April   If you have any questions you can contact Robert Lynde at Lyndeurozone.com.   Instagram: @Lyndeurozone  

Huge news from Planned Parenthood on Thursday morning, they are announcing the resumption of abortions in the state. We welcome national baseball stadium expert Neil deMause, from Field of Schemes, to discuss the on-going conspiracy of billionaire baseball owners to grab public money they don't need. We discuss lessons for Wisconsin political leaders about the critical role they play in fighting and supporting the public interest instead of well connected ultra rich owners. Robert updates the political situation in Madison, and we discusses the important role teachers unions are playing in opposing a Nevada plan to give away public money for Las Vegas MLB stadium. House leader McCarthy formally pursues a quixotic impeachment of President Biden as the MAGA wing threatens to shut down the government and overthrow McCarthy. All of Wisconsin's Republican members of Congress supported the impeachment scheme. Meanwhile Senator Tammy Baldwin was busy actually leading, visiting rural Wisconsin talking to voters about the issues they care about. Wisconsin Republicans continue to struggle to find an opponent for Baldwin other than arsonist David Clarke who this week is busy setting the national Republican Party on metaphorical fire. The Republicans in Wisconsin continue to work to funnel more money to the rich, while Donal Trump proposed a huge new corporate tax cut on top of the largest corporate tax giveaway in American history contained in the first Trump tax package.

Garland Nixon