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Traditionally, a liver used for transplant came…
Date Recorded
February 17, 2016 Health Topics (The Scope Radio)
Cancer Transcription
Interviewer: Donating your liver for a living donor liver transplant. That's next on The Scope.
Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.
Interviewer: So the problem is there are more people waiting for livers than there are deceased donors, but the solution is a procedure that allows a living person to donate part of their liver.
Dr. Robin Kim is the Executive Medical Director of the Transplant Service Line at University Utah Health Care. So a living liver donor transplant, how common is this procedure?
Dr. Kim: The living donor liver transplant between one adult to another is not commonly done in North America. Perhaps 10 to 20% of all transplant centers in North America who perform transplants in adults have the ability to do adult-to-adult living donor liver transplantation.
Interviewer: The standard way of doing a liver donation is from somebody who is deceased and then you transplant that organ.
Dr. Kim: Yes, it's a cadaveric donor who donates their whole organ or part of their whole organ after they have passed away.
Interviewer: And it's a pretty safe procedure?
Dr. Kim: Living donor liver transplant is a technically demanding procedure, but it's deemed to be very well-accepted throughout the world. Parts of Asia where it is not in their culture to donate after being deceased, they rely almost solely on live donor liver transplant. We've learned lessons from these centers, and in North America we do it very well, and we take opportunities to learn from each other, and that is what we have done at the University of Utah.
Interviewer: So what's the advantage to this type of procedure?
Dr. Kim: The great advantage of this procedure is we are able to offer life-saving transplantation to adults in a more timely fashion before these recipients get too sick or wait too long with their liver disease.
Interviewer: Plus, there are a lot more people waiting for livers and donors, so if you can add some new people to that donation pool that has to help.
Dr. Kim: That's absolutely right. The whole purpose of live donor liver transplantation is to get organs to folks who would normally not be able to get one, and thereby expand the donor pool.
Interviewer: Briefly, just kind of take me through the procedure. What happens?
Dr. Kim: In a live donor liver transplant our primary goal is to advocate for the donor. The donor must come of his or her own accord, and after a very lengthy evaluation, a lot of education for them, they deem that this is something they want to do.
Specifically, we have a person called an Independent Live Donor Advocate. The ILDA is a social worker that is tasked to make sure that they are there to protect the donor's best interests, and at any given time, if the donor doesn't feel comfortable they can stop the procedure at any given time.
Essentially, the operation is two parallel operations which occur at the same time. In that day, the donor, under a surgery, donates a part of their liver. In this case, if it's an adult-to-adult, typically it's a right side of the liver, And in a room right across the hall, in the operating room, the recipient will be prepared to receive that right side of liver, and thereby getting a good segment of liver which is sufficient for the overall function that the recipient needs. Even more importantly, the donor will have enough excellent liver for them to survive without any problems.
Interviewer: And I understand that that liver actually . . . it's the only organ that grows back in the human body.
Dr. Kim: Yeah, absolutely. The amazing thing about the adult liver is that within three months about 80 to 90% of the mass that was meant to be for that recipient will grow into place.
Interviewer: How long does it usually take for the donor to recover after the procedure?
Dr. Kim: A standard right liver operation to donate that part of the liver will require the donor to be in the hospital perhaps one week. They can likely return to work within three to four weeks, but we ask them to wait a little longer. We just want to make sure that they're fully comfortable after the surgery to embark on any activities.
Interviewer: It's pretty amazing. Really, that's not a lot of time considering that you just gave somebody else the gift of a few more years.
Dr. Kim: Yeah, and that's the incredible thing about the human body is it can heal so well.
Interviewer: How safe is this procedure for the donor?
Dr. Kim: This procedure is extremely safe. The risks of having complications, and usually they're minor, is 10%, very similar to other surgeries of equal magnitude, and in terms of mortality it's exceedingly low, far under 1%. The programs that do it throughout the country have been highly scrutinized by UNOS, that governing body which determines who can and cannot do these procedures, and they've been prescreened and only given certification once it's been determined that they are the right program with the right quality results.
Interviewer: Is there going to be a time where it's going to be more commonly practiced at other institutions?
Dr. Kim: I think that an institution has to be able to deliver and document excellent results. Then you have to have a scenario where the institution as well as the physicians and the healthcare providers all align together with a common mission to perform this fairly complex task. Once that's aligned, then we can move forward. But I have to say not a lot of programs throughout the country have that alignment.
Interviewer: Yeah, it's kind of like the perfect storm, if you will, of people that can do it, that have the expertise, the facility, they can handle it, and there's just not a lot of places like that.
Dr. Kim: Absolutely. The University of Utah, we enjoy such a luxury of having that alignment that doesn't necessarily exist in other institutions.
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Without treatment, Hepatitis C can lead to liver…
Date Recorded
March 25, 2014 Health Topics (The Scope Radio)
Family Health and Wellness Transcription
Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.
Kim: Hepatitis C virus is a liver disease that has become the forefront of health care attention and resources. The CDC has mandated that patients or baby boomers who were born from 1945-1965 should all get a single hepatitis C virus test because the preponderance of hepatitis C in that population of the United States is upwards of eight-fold or ten-fold larger just by virtue of the fact that those baby boomers were subjected to behaviors that were high risk. This mandate was brought up by the CDC in April this year. Our primary care providers are supposed to enact that mandate by testing our baby boomers once. And so this is a good time to talk about hepatitis C.
In addition, hepatitis C is a disease which research is developing huge gains in terms of managing in and so over the next few months we will see two new drugs, anti-viral drugs specifically designed to treat hepatitis C, and this is a huge difference in terms of hep C strategies that we didn't have.
Interviewer: So is it a lifestyle disease 100%? Meaning it was behaviors that caused it, meaning like needles and drug use. How does it get transferred, first of all? It transferred by a blood.
Kim: Yeah, the hepatitis C is a bloodborne pathogen. It's a virus, and once it resides, it gets access to your blood with a certain concentration and it will preferentially reside in the liver. And so hence the hepatitis portion of the virus name.
Interviewer: So hepatitis C, what are the symptoms? If I have hepatitis C am I going to notice anything?
Kim: The symptoms of hepatitis C upon first contraction may be general feelings of illness, almost like viral-type, flu-type symptoms. People do describe an upper abdominal pain on the right side, and that's likely due to the swelling that occurs when the hepatitis infects the liver. These are not necessarily common but these are things that would make you aware that something is going on. I think most people who, unless they were attune to the fact that they may have been exposed to blood, they wouldn't think too much of those types of symptoms.
Interviewer: All right. So the whole message here, there again, as a health care provider you're trying just to let people know, "You need to have this test." Is that accurate?
Kim: Absolutely. Knowing about this condition is the best way to treat it.
Interviewer: Is time of the essence in detecting hepatitis C?
Kim: Time is always important in any chronic diseases, and certainly chronic liver disease is another disease that would benefit from early detection because there are ways to decrease the end effects of hepatitis C in particular.
Interviewer: And one of the reasons somebody should be concerned about this is because-very startling statistic-85% of primary liver cancer is due to end-stage liver disease which could be caused by something like hepatitis C.
Kim: Cancer in general is a process where injury to tissues-and the liver is simply a tissue-results in the body creating unregulated growth in tumors. So hepatocellular cancer and also to a smaller degree bile duct cancer are cancers that are developed specifically in the liver in the setting of injury or cirrhosis.
If you were to contract hepatitis C on day zero about ten to fifteen years from then you will, unless you're treated, you will develop scarring of the liver or cirrhosis. From there on, we know that 85% of people over the course of 12 years will develop cancer in the liver. If detected early there are many therapies available to patients. However, if detected late, your options are far less.
Interviewer: Any final thoughts?
Kim: I think the end goal for centers like ours is to manage organ disease at all of its spectrum. So if we can in any way contribute to the early management or detection of liver disease then we're doing a service to the community. What we would like to try to avoid is folks who may be able to avoid the more rigorous and intense treatments of advanced organ failure such as cirrhosis, such as liver failure, because those are much more costly both socially to the patient and also financially to the community. If we can avoid that point that would be the ultimate goal.
Interviewer: So the old adage, an ounce of prevention is worth a pound of cure.
Kim: Absolutely.
Interviewer: Really does apply.
Announcer: We're your daily dose of science. Conversation. Medicine. This is The Scope. University of Utah Health Sciences Radio.
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