Age ≥ 56 years, male, active congestive heart failure, ascites, hypertension, preoperative creatinine > 106 mol/L, diabetes mellitus (controlled by either oral medication or insulin injections), ventilator dependence, chronic obstructive pulmonary disease, smoking, coagulation disorders, cancer, obesity, and long-term steroid use. The gene discussed is INS; the disease is obesity due to melanocortin 4 receptor deficiency.