Transplantation of the liver has become more common within the last two decades.
This successful and effective surgery is a major, lifesaving operation typically done in the hands of an experienced liver transplant team.
After patients complete the evaluation and the team places them on the organ waiting list, they have the opportunity to meet with their surgeon to review the surgical procedure, including the risks and benefits of the operation and of transplant medications.
Dr. Manish Thapar is here to help answer questions about liver health and liver transplant.
Liver Transplant: The Importance of Liver Donations
From the Show: Lourdes Health Talk
Summary:
Air Date: 2/1/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): The liver is the largest solid organ in the body and the second most commonly transplanted major organ after the kidney. My guest today is Dr. Manish Thapar. He is Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology and the Medical Director of the Lourdes Liver Transplant Program at Lourdes Health System. Welcome to the show, Dr. Thapar. Tell us first: what is the role of the liver?
Dr. Manish Thapar (Guest): Thank you for having me, Melanie. The liver, as you mentioned, is one of the largest organs in the body and it has a variety of roles in the normal state of health where it helps detoxify the various chemicals that are produced. It also has a role in synthesizing hormones and plays a major role in energy metabolism and also in metabolizing drugs that we take, i.e., medications.
Melanie: What can generally go wrong with the liver? What are some of the causes of liver issues and liver problems?
Dr. Thapar: The liver can be affected in a lot of different causes or etiologies. Generally, if you are looking at liver disease, the question that is first raised is, “Is this acute or is this chronic?” If it is acute liver disease, in most cases with support therapy, it is self-limited. The liver does have a remarkable capacity to regenerate itself. However, when diseases become chronic such as chronic Hepatitis C or long-term chronic alcohol use or fatty liver to name a few, that’s when the liver undergoes repeated injury and it leads to a stage of cirrhosis where liver tissue is essentially replaced by scar tissue with regenerating nodules. That’s when people run into trouble with their liver disease on a long term basis and that’s where they end up needed services for transplant, etc.
Melanie: Are there some symptoms of cirrhosis or fatty liver or liver disease, other than Hepatitis C? Are there some symptoms that people would notice that would signal that they need to go see a specialist?
Dr. Thapar: Most of the time, when patients are affected with liver disease, they are asymptomatic. It is usually picked up on routine bloodwork that they have in their primary care physician’s office. By the time that you really develop symptoms, it’s usually well advanced. So, the general recommendation is if you have a history of exposure to blood or a baby boomer, you should be screened for Hepatitis C. Patients who have a history of close contact with Hepatitis B, patients should be screened for Hepatitis B and vaccinated. Symptoms in late stages of liver disease when they develop could be yellowness of your eyes or itching or patients may present as throwing up blood and then, rarely, they may develop cancer of the liver. Like I said, by the time they develop symptoms it’s usually far along in the disease and really those are not the things you should be looking for.
Melanie: If you determine that somebody needs a liver transplant, what determines which patients will get one? What’s involved in liver transplantation?
Dr. Thapar: It’s a team approach and, as the listeners probably know, it’s not a minor procedure. It involves evaluation looking at the patient’s heart, making sure they can withstand the surgery, looking at their lungs. We look at what the indication for transplant is. Most programs around the country require a period of abstinence from alcohol and then, obviously, we look at the insurance coverage to make sure the patients have an ability to pay for the medications post-transplant. Social support is important and we want to make sure that somebody is there driving you to appointments after transplant and that you have a stable living situation at home. Those are the things and, ultimately, it is a team decision where the surgeons, the physicians, the case workers, the social workers, and the coordinators sit and talk and get input from various providers and specialties and then decide whether this person is an appropriate candidate for transplant. That’s how the process works, usually.
Melanie: Dr. Thapar, people hear transplantation and they think about cadaver and donor and that sort of thing but livers can be a living donor. Explain a little bit about living donor and what you want to know about becoming an organ donor, specifically the liver.
Dr. Thapar: A liver transplant is a little bit different than kidney transplants because most of the liver transplants in this country are from deceased donors or DCD. That means somebody who is donating an organ before they pass away. That’s how that organ is offered within the region and for patients who are on the waitlist. A very small percentage of liver transplants in this country are living donation where one of your family members and friends can donate a part of their liver to a person who is need for a transplant. Like I said, that is in the order of single digits – almost 4-5% percent. It’s done less commonly here than in other parts of the world. There are many historical reasons for it. Needless to say, that’s certainly an option but the majority of transplants are from deceased donors.
Melanie: How do you get on the transplant list and is there a shortage of liver donations in the country? Is this a long wait for those in need?
Dr. Thapar: There is. There is a big shortage of livers in the country and we are constantly trying to raise awareness to patients and their family members to be organ donors. It is estimated about 1/3 of the patients on the liver transplant list actually die every year waiting for an organ. Even if you are put on a liver transplant list at a transplant center, that doesn’t mean you are going to get a transplant right away. Most of the time you end up waiting for months. It varies a little bit from your region and on your blood group but you end up waiting for months for an offer for a liver. The key is to increase awareness and to sign up to be a donor. In most states, you can sign up at the time of your registration for your driver’s license. You can do that and certainly, if that is in your advanced directives, your family members--you should talk to them and tell them this is what you would like to do. That can certainly be approached at that time.
Melanie: It’s so important that our listeners sign up for organ donation on their driver’s license and make their wishes known. That’s also so important. Tell us about Our Lady of Lourdes Medical Center Liver Transplantation Program and what’s going on there. What are you doing that’s really exciting?
Dr. Thapar: We are one of two centers in all of New Jersey. We serve the whole of South Jersey. The other center is in Newark at the University Hospital. The area we serve is the southern part of the state and the program has been running for almost 15 years. We are rebuilding the program and trying to establish ourselves as a premier program in this area.
Melanie: That’s so exciting and just tell us what people can expect in these last few minutes and why they should look to Lourdes for their care.
Dr. Thapar: If you need to be evaluated for a transplant, it usually starts by you being evaluated by one of the hepatologists in our practice – myself and there are two additional hepatologists in the clinic. In the initial evaluation in the clinic, we present you to the transplant selection committee where everybody discusses and looks at various parts of your medical history. At that point, you are brought in for an evaluation where you initially sign a consent to be evaluated which is a little bit different than a consent for transplant. This is just allowing us and giving us permission to start the evaluation process which I mentioned looks at your heart, your lungs, etc. Once all that information is gathered, we discuss, again, as a committee and then, when you are put on the list, you actually get a letter saying you are made active on the transplant list.
Melanie: Thank you so much. It’s really great information and our listeners, if they want more information about the liver transplantation program at Lourdes, they can go to LourdesNet.org. That’s LourdesNet.org and look up the Expanding Liver Transplant Program in collaboration with Thomas Jefferson University Hospital. You’re listening to Lourdes HealthTalk. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): The liver is the largest solid organ in the body and the second most commonly transplanted major organ after the kidney. My guest today is Dr. Manish Thapar. He is Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology and the Medical Director of the Lourdes Liver Transplant Program at Lourdes Health System. Welcome to the show, Dr. Thapar. Tell us first: what is the role of the liver?
Dr. Manish Thapar (Guest): Thank you for having me, Melanie. The liver, as you mentioned, is one of the largest organs in the body and it has a variety of roles in the normal state of health where it helps detoxify the various chemicals that are produced. It also has a role in synthesizing hormones and plays a major role in energy metabolism and also in metabolizing drugs that we take, i.e., medications.
Melanie: What can generally go wrong with the liver? What are some of the causes of liver issues and liver problems?
Dr. Thapar: The liver can be affected in a lot of different causes or etiologies. Generally, if you are looking at liver disease, the question that is first raised is, “Is this acute or is this chronic?” If it is acute liver disease, in most cases with support therapy, it is self-limited. The liver does have a remarkable capacity to regenerate itself. However, when diseases become chronic such as chronic Hepatitis C or long-term chronic alcohol use or fatty liver to name a few, that’s when the liver undergoes repeated injury and it leads to a stage of cirrhosis where liver tissue is essentially replaced by scar tissue with regenerating nodules. That’s when people run into trouble with their liver disease on a long term basis and that’s where they end up needed services for transplant, etc.
Melanie: Are there some symptoms of cirrhosis or fatty liver or liver disease, other than Hepatitis C? Are there some symptoms that people would notice that would signal that they need to go see a specialist?
Dr. Thapar: Most of the time, when patients are affected with liver disease, they are asymptomatic. It is usually picked up on routine bloodwork that they have in their primary care physician’s office. By the time that you really develop symptoms, it’s usually well advanced. So, the general recommendation is if you have a history of exposure to blood or a baby boomer, you should be screened for Hepatitis C. Patients who have a history of close contact with Hepatitis B, patients should be screened for Hepatitis B and vaccinated. Symptoms in late stages of liver disease when they develop could be yellowness of your eyes or itching or patients may present as throwing up blood and then, rarely, they may develop cancer of the liver. Like I said, by the time they develop symptoms it’s usually far along in the disease and really those are not the things you should be looking for.
Melanie: If you determine that somebody needs a liver transplant, what determines which patients will get one? What’s involved in liver transplantation?
Dr. Thapar: It’s a team approach and, as the listeners probably know, it’s not a minor procedure. It involves evaluation looking at the patient’s heart, making sure they can withstand the surgery, looking at their lungs. We look at what the indication for transplant is. Most programs around the country require a period of abstinence from alcohol and then, obviously, we look at the insurance coverage to make sure the patients have an ability to pay for the medications post-transplant. Social support is important and we want to make sure that somebody is there driving you to appointments after transplant and that you have a stable living situation at home. Those are the things and, ultimately, it is a team decision where the surgeons, the physicians, the case workers, the social workers, and the coordinators sit and talk and get input from various providers and specialties and then decide whether this person is an appropriate candidate for transplant. That’s how the process works, usually.
Melanie: Dr. Thapar, people hear transplantation and they think about cadaver and donor and that sort of thing but livers can be a living donor. Explain a little bit about living donor and what you want to know about becoming an organ donor, specifically the liver.
Dr. Thapar: A liver transplant is a little bit different than kidney transplants because most of the liver transplants in this country are from deceased donors or DCD. That means somebody who is donating an organ before they pass away. That’s how that organ is offered within the region and for patients who are on the waitlist. A very small percentage of liver transplants in this country are living donation where one of your family members and friends can donate a part of their liver to a person who is need for a transplant. Like I said, that is in the order of single digits – almost 4-5% percent. It’s done less commonly here than in other parts of the world. There are many historical reasons for it. Needless to say, that’s certainly an option but the majority of transplants are from deceased donors.
Melanie: How do you get on the transplant list and is there a shortage of liver donations in the country? Is this a long wait for those in need?
Dr. Thapar: There is. There is a big shortage of livers in the country and we are constantly trying to raise awareness to patients and their family members to be organ donors. It is estimated about 1/3 of the patients on the liver transplant list actually die every year waiting for an organ. Even if you are put on a liver transplant list at a transplant center, that doesn’t mean you are going to get a transplant right away. Most of the time you end up waiting for months. It varies a little bit from your region and on your blood group but you end up waiting for months for an offer for a liver. The key is to increase awareness and to sign up to be a donor. In most states, you can sign up at the time of your registration for your driver’s license. You can do that and certainly, if that is in your advanced directives, your family members--you should talk to them and tell them this is what you would like to do. That can certainly be approached at that time.
Melanie: It’s so important that our listeners sign up for organ donation on their driver’s license and make their wishes known. That’s also so important. Tell us about Our Lady of Lourdes Medical Center Liver Transplantation Program and what’s going on there. What are you doing that’s really exciting?
Dr. Thapar: We are one of two centers in all of New Jersey. We serve the whole of South Jersey. The other center is in Newark at the University Hospital. The area we serve is the southern part of the state and the program has been running for almost 15 years. We are rebuilding the program and trying to establish ourselves as a premier program in this area.
Melanie: That’s so exciting and just tell us what people can expect in these last few minutes and why they should look to Lourdes for their care.
Dr. Thapar: If you need to be evaluated for a transplant, it usually starts by you being evaluated by one of the hepatologists in our practice – myself and there are two additional hepatologists in the clinic. In the initial evaluation in the clinic, we present you to the transplant selection committee where everybody discusses and looks at various parts of your medical history. At that point, you are brought in for an evaluation where you initially sign a consent to be evaluated which is a little bit different than a consent for transplant. This is just allowing us and giving us permission to start the evaluation process which I mentioned looks at your heart, your lungs, etc. Once all that information is gathered, we discuss, again, as a committee and then, when you are put on the list, you actually get a letter saying you are made active on the transplant list.
Melanie: Thank you so much. It’s really great information and our listeners, if they want more information about the liver transplantation program at Lourdes, they can go to LourdesNet.org. That’s LourdesNet.org and look up the Expanding Liver Transplant Program in collaboration with Thomas Jefferson University Hospital. You’re listening to Lourdes HealthTalk. This is Melanie Cole. Thanks so much for listening.
