Recipes for Health - Tomatoes Pack a Nutritional Punch

Unfortunately, the high-lycopene tomatoes I found at the supermarket did not taste as sweet as the tomatoes I buy at the farmers’ market. No matter how red a tomato is, if it was picked to be shipped to a faraway supermarket, then it was picked too soon.

In many of this week’s recipes I’m using a technique that may be new to some of you. Rather than peeling, seeding and dicing the tomatoes, I grate them on the large holes of a box grater. This is a technique I learned in Greece; it’s used throughout the Mediterranean. Cut the tomatoes in half, squeeze out the seeds if instructed to do so, and rub the cut side against the grater. Don’t worry, the skin is tough and you won’t scrape your hands. When you feel the holes of the grater against the inside of the tomato skin, you’re done. It goes quickly, and it’s a nifty time-saver.

Pasta With Salsa Crudo and Green Beans

You can make this uncooked grated tomato sauce while you’re waiting for the water to boil for the green beans andpasta. Choose a type of noodle that will catch the sauce, such as orecchiette, penne, fusilli or farfalle.

3/4 pound ripe, locally grown tomatoes

1 to 2 garlic cloves, green shoots removed, finely chopped or pureed

Salt and freshly ground pepper to taste

1 teaspoon balsamic or sherry vinegar

1 tablespoon extra virgin olive oil

6 ounces green beans, trimmed

3/4 pound orecchiette, penne, farfalle or fusilli

2 tablespoons slivered basil leaves

1/4 cup (1 ounce) freshly grated Parmesan, pecorino, orricotta salatafor serving

1.Begin heating a large pot of water. Cut the tomatoes in half across the equator, and grate on the large holes of a box grater into a wide bowl. Stir in the garlic, salt and pepper, vinegar and olive oil.

2.When the water comes to a boil, salt generously and add the green beans. Parboil four minutes. Transfer to a bowl of cold water, then drain and dry on paper towels. Keep the water in the pot boiling for the pasta. Cut the beans into 2-inch lengths, and add to the bowl with the tomatoes.

3.Cook the pasta in the boiling water until al dente. Follow the timing instructions on the package but check the pasta about one minute sooner than the suggested cooking time. When it’s done, drain and toss with the tomato mixture, basil and cheese.

Yield:Serves four.

Advance preparation:You can make the tomato sauce several hours before you cook the beans and the pasta.

Nutritional information per serving:397calories; 6 grams fat; 2 gramssaturated fat; 4 milligramscholesterol; 70 gramscarbohydrates; 4 gramsdietary fiber; 89 milligrams sodium (does not include salt added during preparation); 14 grams protein

Martha Rose Shulman can be reached atmartha-rose-shulman.com.

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What to Tell Alzheimer’s Patients After a Trial Goes Awry

So when Eli Lillyannounced last weekthat its promising Alzheimer’s drug was making patients worse and that it was halting two large clinical trials, it seemed likely that Dr. Ross would hear from family members of his patients. Are other experimental Alzheimer’s drugs safe? they might ask. Should they get their family members out of those Alzheimer’s studies?

Not a single family member called. And Dr. Ross is not sure why.

If a study of an experimentalbreast cancerdrug was ended because it made thecancergrow and spread, women in other breast cancer studies of similar drugs would be calling their doctors and asking what to do.

But Alzheimer’s is different.“It may reflect the incredible desperation surrounding Alzheimer’s disease,” said Baruch Brody, director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine.

There is no treatment and no way to prevent Alzheimer’s. It is a leading cause of death, ravaging patients and their families.“Possibly, the overworked caregiver has precious little time to listen to news or read a paper,” Dr. Ross said.

Whatever the reason, the silence of Alzheimer’s family members gives rise to an ethical question. Do families now need extra protection or warnings about the Lilly experience when they sign up Alzheimer’s patients for studies?

There are no easy answers, ethicists and drug companies say, in part because it is not known what went wrong with the Lilly drug.

When patients enter studies or, in the case of patients with Alzheimer’s, when caregivers sign them up for studies, they or their caregivers sign an informed consent document. The forms are reviewed by ethics panels known as institutional review boards.

When the federal government conducts studies, it makes the consent forms public. Drug companies, though, generally insist that their forms be confidential. Investigators conducting studies for companies and institutional review boards must agree not to distribute the forms.

But every form contains a statement that warns patients that a drug might not help, said Angela Bowen of the Western Institutional Review Board, a private group which does ethical reviews of research on human subjects, including studies of Alzheimer drugs. The forms say a clinical trial is aimed at helping future patients. It is not a treatment for a disease.

The forms also say“there may be side effects that are not known at this time” and“your condition may not get better or may get worse during this study.”

It is often difficult to convey those ideas, said Dr. John Ennever, Western’s vice president for medical affairs.“We realize drugs can cause side effects and that sometimes they don’t work but we don’t think they can make conditions worse,” he said.

“We are dealing with humans who have hopes and aspirations,” he added.“The whole idea of research is a difficult concept. We all forget that if we knew the answer we wouldn’t be doing the research.”

The Lilly drug disabled an enzyme needed to make a protein, beta amyloid, that accumulates in plaques in the brains of people with Alzheimer’s disease. Other companies are testing different drugs that disable that enzyme, gamma secretase.

Researchers at other companies like Elan and Bristol-Myers Squibb said the Lilly drug, among the first of the gamma secretase inhibitors, took a sledgehammer to the enzyme. As a result, it probably affected levels of many other proteins besides beta amyloid. They say gamma secretase inhibitors now under development are much more selective and may be much safer.

Elan is one of those companies with a newer-generation gamma secretase inhibitor, and its chief scientific officer, Dr. Dale Schenk, said he did not think it necessary to emphasize the Lilly drug result to people taking his company’s drug.

“To be fair, this is the first anti-amyloid drug that has demonstrated a negative effect,” Dr. Schenk said.“I’m not worried about the class.”

Ted Yanock, Elan’s head of global research, agreed. Telling people taking the Elan drug about the Lilly results“would almost be misleading,” he said.

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Book Review - Book of Days - Personal Essays - By Emily Fox Gordon

Her memoir of that experience,“Mockingbird Years: A Life In and Out of Therapy,”published in 2000, was praised by critics and won her fans for its unflinching honesty and aseptic prose, free from the maudlin melodrama that has suffused so many recent memoirs. Her second memoir,“Are You Happy? A Childhood Remembered,”published in 2006— again to some critical success— described her 1950s childhood, deeply enmeshed in the lives of her alcoholic mother and auto­cratic father, yet simultaneously estranged from them. (A 2009 novel, a satire set in academia, received mixed reviews.)

So readers might be eager for“Book of Days,” in which Gordon explores her preferred form— not memoir, but personal essay— nor does it hurt thatPhillip Lopate,il miglior fabbroof the art, gives his rousing approval in the introduction.

Many of the essays, including the one that prompted the book“Mockingbird Years,” have been previously published, but not all. She writes with a stringent delicacy about sickness and marriage in“Fantastic Voyage,” one of the more polished pieces in the collection. Her husband’s routinecolonoscopyfills her with a curious mortal dread, inspiring both waiting-­roomanxiety— what if he has some terriblecancer?— and then an egocentric reverie: Will she get to play the part of the martyred caretaker? How will she face the“dire glamour” of a life-changing diagnosis?

(The sickness-as-glamour leitmotif runs through Gordon’s work. She writes in the essay“Mockingbird Years” that going to Austen Riggs as a teenager would not only make her college-bound friend jealous but was“the fulfillment of an adolescent fantasy. The status of mental patient would invest me with significance.”)

In“Fantastic Voyage,” she writes, tartly and honestly, that she is deeply envious of her husband’s organized mind, his promptly scheduled medical exams and command over the minutiae of life she can never seem to control.“He was the one who had made himself pure and ready, while last night’s furtively eaten supper of leftovers rotted invisibly in my own unexamined colon. He was the one who would walk into the waters ofanesthesiathis morning; he was the one who would emerge on the other side while I remained in this anteroom, fully dressed and conscious, a fugitive from medical justice.” The fantastic voyage, of course, is not the colonoscopy but their 30-year marriage, which she describes as combative but sustainable:“We’re like two boxers who have fought so many rounds together that we’ve decided to forgo the late ones in favor of an extended, exhausted clinch.” It’s a funny and brutal moment of self-recognition.

Gordon dissects female friendship, femininity and feminism, and the changing state of marriage, in“The Most Responsible Girl.” Sometimes the writing is fresh and amusingly self-lacerating— she writes of getting into“male-pattern trouble”— and sometimes it’s distressingly academic. Marriage has changed over the last few decades, certainly, but I am not sure if writing that“the hierarchical rolebound form which found its origins in the division of labor has now been replaced by the companionate egalitarian dyad” is the most inviting way to put it.

In“Here Again,” Gordon describes her 25th or so visit to a meeting of the American Philosophical Association, as companion to her husband. (He is George Sher, a former chairman of the philosophy department atRice University.) Anyone who has spent time at an academic conference recognizes this scene: having to spend“a bleary interval at avegansteam-table restaurant where I sat opposite a graduate student who spoke at length about her five-year plan to penetrate the upper echelons of the administration at some northwestern Florida university.” Some of her best passages linger on mortality. She describes the shock of seeing people only once a year, who have“tumbled abruptly into a new category of age.” One elderly visitor at the convention is so brittle her colleagues, upon greeting her, will not actually touch her, but give air kisses and pretend pats around her shoulders, offering an“airy substitute for human contact: the idea of an embrace.”

But Gordon meanders. Sitting in on a colloquium about mental disorders— something she knows a bit about— she throws up her hands and writes that she is helpless to form a coherent narrative:“Instead, I’ll simply transcribe my notes.” Sample:“Visual system is modular. Mind is not. Central nonmodular STUFF WE CARE ABOUT.” This makes for a page of— well, calling it filler seems a bit forgiving. Isn’t her mandate as an essayist to take the stuff of life and form a narrative, a thought, a juicy little bit for the reader? I felt neglected by these dreary excursions into her notebook.

The title essay is a strange kind of apologia for her previous work, a description of how she was lured by New York publishing types into writing memoirs instead of collections of personal essays. A New York editor with“a voice like sun-­softened caramel” called her after reading the essay“Mockingbird Years” in a literary journal.“His voice evoked a feeling I hadn’t had in many, many years— the sense of submitting, with token resistance, to a stranger’s seduction.” He seduced, an agent was hired, an auction conducted, and Gordon suffered misgivings as she wrote the book, believing she had made a Faustian pact with the publisher.

Gordon raises the flag of cultural fatigue against the memoir and questions the essential honesty of memoir-writing.“I regret having written‘Mockingbird Years’— the memoir, that is, not the essay. Perhaps I should say I regret its dishonesty.” The dishonesty inherent in memoir, she argues, is that an entire life cannot be contained in one book, and so the writer is forced to follow only one story line: Me and drugs, me and my dysfunctional family, me and mydepression, me and myeating disorder.

The publishers forced her, she writes, to create a narrative arc to bolster her original personal essay— and that necessitated that her book become not the full story of her life but what Lopate suggests in his introduction is the predictable contemporary memoir, a by-now threadbare template of dissolution, struggle and (cue sunlight parting the clouds) requisite redemption.“Preferably,” Lopate writes, the story should be“one revolving around addiction, abuse, poverty or some other nasty problem whose overcoming will yield the desired triumph-of-the-human-spirit results.” Lopate writes that Gordon“tells ruefully the tale of how she was seduced, not once but twice, to write and publish memoirs, instead of being allowed to bring out a collection of personal essays.” This all sounds a bitungrateful. I can practically hear the rooms full of M.F.A. students shrieking, Please don’t throw me in the brier patch! Please, we want a phone call from that editor with the voice like sun-softened caramel!

No one will take Gordon to task as a writer for her memoir-regret. She didn’t actually make anything up; she told no outright lies.“It was no sin against literature to write as if the story of my life in therapy had been the story of my life,” she writes.“But I think it may have amounted to a sin against myself, or a sin against my life, or— more accurately yet— a sin against the true story of my life, the one I can never tell and never know.” But no memoirist worth his madeleine could possibly pack an entire life’s worth of meaning into anything less than a seven-­volume work. I’m not sure I could read seven volumes about Gordon’s life. But a few­essays? Yes.

Alex Kuczynski is the author of“Beauty Junkies: Inside Our $15 Billion Obsession With Cosmetic Surgery.”

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U.S. Inaction Lets Look-Alike Tubes Kill Patients

But in a mistake that stemmed from years of lax federal oversight of medical devices, the hospital mixed up the tubes. Instead of snaking a tube through Ms. Rodgers’s nose and into her stomach, the nurse instead coupled the liquid-food bag to a tube that entered a vein.

Putting such food directly into the bloodstream is like pouring concrete down a drain. Ms. Rodgers was soon in agony.

“When I walked into her hospital room, she said,‘Mom, I’m so scared,’ ” her mother, Glenda Rodgers, recalled. They soon learned that the baby had died.

“And she said,‘Oh, Mom, she’s dead.’ And I said,‘I know, but now we have to take care of you,’ ” the mother recalled. And then Robin Rodgers— 24 years old and already the mother of a 3-year-old boy— died on July 18, 2006, as well. (She lived in a small Kansas town, but because of a legal settlement with the hospital, her mother would not identify it.)

Their deaths were among hundreds of deaths or serious injuries that researchers have traced to tube mix-ups. But no one knows the real toll, because this kind of mistake, like medication errors in general, is rarely reported. A2006 surveyofhospitalsfound that 16 percent had experienced a feeding tube mix-up.

Experts and standards groups have advocated since 1996 that tubes for different functions be made incompatible— just as different nozzles at gas stations prevent drivers from using the wrong fuel.

But action has been delayed by resistance from the medical-device industry and an approval process at theFood and Drug Administrationthat can discourage safety-related changes.

Hospitals, tube manufacturers, regulators and standards groups all point fingers at one another to explain the delay.

Hospitalized patients often have an array of clear plastic tubing sticking out of their bodies to deliver or extract medicine, nutrition, fluids, gases or blood to veins, arteries, stomachs, skin, lungs or bladders.

Much of the tubing is interchangeable, and with nurses connecting and disconnecting dozens each day, mix-ups happen— sometimes with deadly consequences.

“Nurses should not have to work in an environment where it is even possible to make that kind of mistake,” said Nancy Pratt, a senior vice president at Sharp HealthCare in San Diego who is a vocal advocate for changing the system.“The nuclear power and airline industries would never tolerate a situation where a simple misconnection could lead to a death.”

Tubes intended to inflate blood-pressure cuffs have been connected to intravenous lines, leading to deadly air embolisms. Intravenous fluids have been connected to tubes intended to deliver oxygen, leading to suffocation. And in 2006 Julie Thao, a nurse at St. Mary’s Hospital in Madison, Wis., mistakenly put a spinal anesthetic into a vein, killing 16-year-old Jasmine Gant, who was giving birth.

Ms. Thao, who had worked two eight-hour shifts the day before, was charged with felony neglect. She pleaded no contest to two misdemeanor charges. But experts say such mistakes are possible only because epidural bags are compatible with tubes that deliver medicine intravenously.

“This is a deadly design failure in health care,” said Debora Simmons, aregistered nurseat theUniversity of TexasHealth Science Center who studies medical errors.“Everybody has put out alerts about this, but nothing has happened from a regulatory standpoint.”

An international standards group is seeking consensus on specific designs on how tubes for different bodily functions should differ, but the group has been laboring for years and its complete recommendations will take years more. Some manufacturers have used color-coding to distinguish tubes for different functions, but with each manufacturer using a different color scheme, the colors have in some cases added to the confusion.

An Alarm Is Raised

Advocates in California got legislation passed in 2008 that would have mandated that feeding tubes no longer be compatible with tubes that go into the skin or veins by 2011. But in 2009, AdvaMed, the manufacturers’ trade association, successfully pushed legislation to delay the bill’s effects until 2013 and 2014 or until the international standards group reaches a decision.

In the meantime, F.D.A. reviewers have begun to question whether feeding tubes that could mistakenly be connected to intravenous tubes should be declared fundamentally unsafe.

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Moose Offer Trail of Clues on Arthritis

But now the moose of Isle Royale have something to say— well, their bones do. Many of the moose, it turns out, havearthritis. And scientists believe their condition’s origin can help explain humanosteoarthritis— by far the most common type of arthritis, affecting one of every seven adults 25 and older and becoming increasingly prevalent.

The arthritic Bullwinkles got that way because of poornutritionearly in life, an extraordinary 50-year research project has discovered. That could mean, scientists say, that some people’s arthritis can be linked in part to nutritional deficits, in the womb and possibly throughout childhood.

Themoose conclusionbolsters a small but growing body of research connecting early development to chronic conditions like osteoarthritis, which currently affects 27 million Americans, up from 21 million in 1990.

Osteoarthritis’s exact cause remains unknown, but it is generally thought to stem from aging and wear and tear on joints, exacerbated for some by genes. Overweight or obese people have greater arthritis risk, usually attributed to the load their joints carry, and the number of cases is increasing as people live longer and weigh more.

But the moose work, along with some human research, suggests arthritis’s origins are more complex, probably influenced by early exposures to nutrients and other factors while our bodies are developing. Evenobesity’s link to arthritis probably goes beyond extra pounds, experts say, to include the impact on the body of eating the wrong things.

Nutrients, experts say, might influence composition or shape of bones, joints or cartilage. Nutrition might also affect hormones, the likelihood of later inflammation or oxidative stress, even how a genetic predisposition for arthritis is expressed or suppressed.

“It makes perfect sense,” saidDr. Joanne Jordan, director of the Thurston Arthritis Research Center at theUniversity of North Carolina.“Osteoarthritis starts way before the person knows it, way before their knee hurts or their hand hurts. It’s very clear that we’re going to have to start looking back” at“things in the early life course.”

Such research could lead to nutritional steps people can take to protect against osteoarthritis, a condition that is often painful or debilitating, and according tofederal data, costs billions of dollars annually in knee and hip replacements alone.

“It would be helpful to know if we want to make sure pregnant moms are taking certainvitaminsor if you need to supplement with such and such nutrition,” saidDr. David Felson, an arthritis expert atBoston UniversitySchool of Medicine.“The moose guy is right in that we probably should study weight or some other nutritional factor almost throughadolescencewhen the bones or joints have stopped forming.”

The“moose guy” isRolf Peterson, a Michigan Technological University scientist on theIsle Royale project, which began in 1958 and is reportedly the longest-running predator-prey study.

For half the year, Dr. Peterson and his colleagues are the only humans allowed on the 45-mile-long island, part of a national park. They stay in yurts, a log cabin or a wood-stove-heated lodge, navigate the wilderness without roads or cars, and share a single staticky phone line. They analyze everything from wolves’ moose-hunting strategies to moose feces. Collecting bones of more than 4,000 moose, they noticed that out of 1,200 carcasses they analyzed, more than half had arthritis, virtually identical to the human kind. It usually attacked the hip and instantly made the moose vulnerable.

“Arthritis is a death sentence around here— you need all four legs,” Dr. Peterson said.“Wolves pick them off so quickly that you don’t even see them limping.”

What is more, the arthritic moose were often small, measured by the length of the metatarsal bone in the foot. Small metatarsals indicate poor early nutrition, and scientists determined that the arthritic moose were born during times when food was scarce, so their mothers could not produce enough milk.

Dr. Peterson said if the arthritis were caused by excess wear and tear on the moose’s joints, that would have meant that times of food scarcity occurred when the moose were already grown, since the extra wear would have happened to moose walking farther to find edible plants. But the arthritic moose had had plentiful food as adults.

For people, several historical cases may suggest a nutritional link. Bones of 16th-century American Indians in Florida and Georgia showed significant increases in osteoarthritis after Spanish missionaries arrived and tribes adopted farming, increasing their workload but also shifting their diet from fish and wild plants to corn, which“lacks a couple of essential amino acids and is iron deficient,” said Clark Larsen, anOhio State Universityanthropologist collaborating with Dr. Peterson. Many children and young adults were smaller and died earlier, Dr. Larsen said, and similar patterns occurred when an earlier American Indian population in the Midwest began farming maize.

British scientists studying people born in the 1940sfoundlow birth weight (indicating poor prenatal nutrition) linked to osteoarthritis in the men’s hands, Dr. Felson said. AndDr. David Barker, a British expert onhow nutrition and early development influence cardiac and other conditions, said“studies of people in utero during the Great Chinese Famine” of the late 1950s found that“40, 50 years later, those people have got disabilities.”

Overeating can be as problematic as undereating.Dr. Lisa A. Fortier, a large-animal orthopedist atCornell University’s College of Veterinary Medicine, said she saw“abnormal joint and tendon development from excessive nutrition” in horses overfed“in utero or in the postnatal life,” probably ingesting“too much of the wrong type of sugar that may cause levels of inflammation.”

Dr. Peter Bales, an orthopedic surgeon affiliated withUniversity of California, Davis, Medical Center, who has written about nutrition and arthritis, sees similar problems in overweight patients. He said the causes were not as“simplistic” as“carrying more weight around,” but might involve nutritional imbalances that could hurt joints and erode cartilage. Much is unknown about nutrition’s relevance. Isle Royale moose, for example, also seem to have genetic predispositions for arthritis, suggesting that nutrition might be amplifying or jump-starting the genes.

“Genes are not Stalinist dictators,” said Dr. Barker, now at Oregon Health and Science University.“What they do, how they’re expressed, is conditional on the rest of the body. The human being is a product of a general recipe, and the specific nutrients you get or don’t get.”

Studying nutrition in people is much more complicated than in moose. Dr. Peterson said the early moosehood developmental window occurred in utero through 28 months, but humans’ developmental time frame lasted into the teens. Some experts say prenatal nutrition is most critical; others see roles for nutrients after birth and beyond.

“Up until the growth plates close, which is through adolescence and even early adulthood, the effects of nutrition are magnified,” saidDr. Constance R. Chu, director of the Cartilage Restoration Center at theUniversity of Pittsburgh, who said nutrients might affect the number of healthy cells in cartilage and its thickness.“But in my opinion, it’s relevant throughout life.”

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Recipes for Health - Lasagna With Spinach and Cottage Cheese

1 1/2 cups low-fat or nonfat cottage cheese

2 1/2 cupsfresh tomato sauceorsimple marinara saucemade with cannedtomatoes

12 ounces baby spinach, or 1 generous bunch spinach (about 12 ounces), stemmed and washed

Salt and freshly ground pepper

1/2 pound no-boil lasagna noodles

1/2 cup freshly grated Parmesan (2 ounces)

2 tablespoons bread crumbs

1 tablespoon extra virgin olive oil

1.Preheat the oven to 375 degrees. Oil a 2-quart baking dish or lasagna dish. Bring a large pot of water to a boil.

2.Place the cottage cheese in a food processor fitted with the steel blade, and blend until smooth. Add 1/2 cup of the tomato sauce, and blend until smooth. Scrape into a bowl.

3.Wash the spinach, and wilt in a large frying pan over high heat in the water left on the leaves after washing. Transfer to a colander, rinse briefly and squeeze out excess water. Chop fine (by hand or in a food processor), then stir the spinach into the cottage cheese. Season to taste with salt and pepper.

4.When the water comes to a boil, salt generously and add enough lasagna noodles to cover the surface of the baking dish (for my rectangular dish, that’s three lasagna noodles). Boil just until thepastais flexible, about two or three minutes for no-boil lasagna. Using tongs, remove the pasta from the water, and drain on a clean dish towel. Spread a thin layer of tomato sauce on the bottom of the baking dish, and top with a layer of noodles. Top the noodles with a third of the cottage cheese mixture. Use a spatula to spread it evenly over the noodles. Top with 1/2 cup of the tomato sauce, and spread in an even layer. Sprinkle on 2 tablespoons of the Parmesan.

5.Repeat these layers two more times, using up the cottage cheese/spinach mixture but retaining tomato sauce and Parmesan for the top layer. Cook one more batch of lasagna noodles, and top with the remaining tomato sauce and Parmesan. Sprinkle on the bread crumbs, and drizzle on the olive oil. Cover tightly with foil, place in the oven and bake for 30 minutes until bubbling. If you wish to brown the top, uncover and continue to bake until the top just begins to color, about five minutes. Remove from the heat, allow to sit for five to 10 minutes, and serve.

Yield:Serves six.

Advance preparation:The lasagna can be assembled up to a day ahead of time, covered with plastic and refrigerated. Replace the plastic with foil before baking. It can also be frozen for up to a month.

Nutritional information per serving(using 2 percent low-fat cottage cheese): 320calories; 9 grams fat; 2 gramssaturated fat; 12 milligramscholesterol; 42 gramscarbohydrates; 5 gramsdietary fiber; 360 milligrams sodium (does not include salt added during preparation); 18 grams protein

Nutritional information per serving(using fat-free cottage cheese): 311 calories; 8 grams fat; 2 grams saturated fat; 8 milligrams cholesterol; 44 grams carbohydrates; 5 grams dietary fiber; 389 milligrams sodium (does not include salt added during preparation); 18 grams protein

Martha Rose Shulman can be reached atmartha-rose-shulman.com.

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Personal Health - Few Rules for Donors, but Many Wait for Organs

Just ask Stacey Oglesby of Lockwood, Mo., whose 15-year-old daughter, Colbey, died in a car accident in 2001. Colbey had told her mother that when she got her driver’s license, she was going to sign up to be an organ donor. So when hospital personnel asked about organ donation, Ms. Oglesby said,“we had nohesitancy.”

Seven people got Colbey’s organs. Her lungs went to Valerie Vandervort, a 29-year-old Oklahoma woman withcystic fibrosis. In the nine years since, Ms. Vandervort has run three 5K races, hiked a mountain, danced at her sister’s wedding, doted on her nieces and nephews, and won medals in swimming at the 2010 National Kidney Foundation United States Transplant Games.

Ms. Oglesby also befriended the recipient of Colbey’s heart, Judy Kaufman of Chesterfield, Mo., who was near death withcongestive heart failure. When they met, Ms. Oglesby took a stethoscope to listen to the beat of her daughter’s heart.

Ms. Oglesby, who speaks often about Colbey’s legacy, said she has inspired others to become potential organ donors. If not for donating her daughter’s organs and connecting to the recipients, she said,“it would have been hard to get through the grief.”

A Widespread Need

At any given time in the United States, more than 100,000 people are waiting for donor organs, more than 10 times as many as become available. Some die waiting; others get sicker and sicker, sometimes too ill to survive when a suitable organ finally becomes available.

In addition to kidneys, heart, lungs, liver, pancreas and intestines, donations can include tissues like corneas, skin, heart valves, bone, veins, cartilage, middle ear, tendons and ligaments that can be stored in tissue banks and used when needed.

Most donations come from people who die suddenly, usually from an accident, a gunshot or a brief illness that resulted in brain death. (A small but growing number of donations follow cardiac death.) Some adults indicate their wish to be donors by signing the back of their driver’s license or a donor card or simply telling their next of kin. For minors, hospital personnel often ask the distraught parents if they would consider donating their child’s organs.

But when 6-year-old Katie Coolican died in 1983 from an undiagnosed heart malformation, it was her mother, Maggie, a nurse, who asked about donating the child’s organs—“to make some sense of it all,” Ms. Coolican, of East Hampton, Conn., said in an interview.

“We were willing to donate anything,” she added,“but at the time all they could use were Katie’s corneas and kidneys.”

Likewise for Julie Schlueter of Winsted, Minn., whose daughter, Missy, 10, died of acerebral hemorrhagein 1992: donating the girl’s organs meant her loss was not in vain.

Missy’s liver and one kidney went to a man who four years later won a silver medal in the Summer Olympics in Atlanta; he sent the medal to the Schlueters to thank them for enabling him to live. Two toddlers, one from Italy and the other from Colorado, got Missy’s heart valves. And an Iowa woman, then 47, got her other kidney and is still doing well 18 years later.

Rose D’Acquisto of St. Paul said that donating all her husband’s usable organs“has led to things I’d never imagined.”

Her husband, Tony, died in 1996 at age 35 when an undiagnosedbrain tumorhemorrhaged and left him in an irreversiblecoma. Ms. D’Acquisto said the recipient of his liver— an Indiana man near death with a rareliver disease— had now been married more than 30 years and has three grown children.

And the Minnesota farmer who got one of Tony’s kidneys got his life back; he had spent three years traveling three hours a day three times a week fordialysis.

Ms. D’Acquisto, now remarried, says she continues to write and speak about organ donation as love’s greatest gift. Along with Ms. Schlueter, she was among more than 7,000 people who attended the Transplant Games last month in Madison, Wis.

When Katie Coolican died, there was no follow-up care for families who donate the organs of their loved ones. After a few years of struggling with grief, her mother wrote about her experience in The American Journal of Nursing and began speaking about organ donation all over the country.

She went back to school, got a master’s degree and wrote a booklet,“For Those Who Give and Grieve,” that was published by the National Kidney Foundation. (The foundation also publishes a quarterly newsletter with that title, edited by Ms. D’Acquisto.)

“Katie’s had a wonderful legacy that continues to this day,” Ms. Coolican said. In 1992 she founded the National Donor Family Council for the kidney foundation to help grieving families that donate loved ones’ organs and tissues. The two-year follow-up program she created for families has become a model for organ donation programs throughout the country.

(To read more“gift of life” stories about organ donation, see the Web siteorg/gift/index.html.)

Who Is Eligible to Give?

Do not rule yourself out as a potential donor because you think you may be too ill or too old. Only a few circumstances, like pervasive infection or activecancer, absolutely preclude organ donation, and there is no age limit. People in their 80s and 90s have been successful donors of certain tissues, as have newborns. But for anyone under 18, a parent or guardian must approve the donation.

Even if a person dies after an illness that precludes organ donation, or if too much time elapsed after death for organs to be viable, there is still the opportunity of whole-body donation to a medical college, where the body can be used in research or to help students learn anatomy.

While it is best to register one’s interest in whole-body donation with a medical school in advance of death, after death it is up to the next of kin to make it happen. You no longer own your body after you die. If this is something you would want for yourself, discuss it with your spouse and children, who must agree with your wishes.

Most religions support organ donation as a charitable act, although some may not condone whole-body donation. Check the Web sitewww.organdonor.govand click on“Religious Views on Donation” for guidance.

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