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Melanie Cole (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed, so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole and today we're discussing living donor liver transplantation. Joining me is Dr. Benjamin Samstein. He's the Chief of Liver Transplantation and Hepatobiliary Surgery in the Department of Surgery at New York Presbyterian, Weill Cornell Medicine, and an Associate Professor of Surgery at Weill Cornell Medicine.

He's also the Surgical Director of the Living Donor Liver Transplant Program at NYP. Dr. Samstein, it's a pleasure to have you join us today. Tell us a little bit about liver transplant and what are some conditions that can break down liver function.

Benjamin Samstein, M.D. (Guest): So liver disease comes from many different conditions. So, some conditions are auto-immune conditions, where the body, attacks parts of theliver, either the liver cells or the bile ducts of the liver, which are tubes that drain bile which is produced by the liver. So, there are conditions called PSC, primary sclerosing cholangitis, or autoimmune hepatitis, which cause severe liver disease.

Other conditions which can lead to severe liver disease are conditions due to exposures. So, one of the most common conditions is a condition in which fat in the liver leads to injury of the liver, a condition called non-alcoholic fatty liver disease. There is alcoholic liver disease, which can also, cause cirrhosis as well as viral hepatitis conditions like hepatitis C and B, which can all injure the liver, ultimately causing liver disease.

Host: Well, thank you for that comprehensive answer. So, when does liver disease become a transplant conversation with a patient Dr. Samstein? What does that conversation look like?

Dr. Samstein: So, most patients who have liver disease present with fluid in their abdomen. There are a number of really concerning things that can really bother patients about severe liver disease. And some patients learn about their liver disease at an early stage just from blood tests, but when it presents as symptoms, the most common symptom is that people feel fluid building up in their belly or in their legs, fluid in their belly is called ascites.

What can also happen is the liver, which helps process toxins, if it's not working well or starting to fail, it can fail to process toxins and people can notice that their brain isn't functioning well, something we call hepatic encephalopathy. And, the third scenario in which people notice that they have severe liver disease is the liver is scarred and blood can't get back to the heart through the liver the way it normally does. And it goes through kind of alternate mechanisms, dilated veins called varices, and those can bleed typically within the GI tract or in the intestinal tract leading to either vomiting blood, or passing blood per rectum.

Host: So, I'd like you to explain something for the listeners, because we've heard about living donor versus deceased donor transplants over the years. Can you tell us a little bit about the difference? Just tell us what they are.

Dr. Samstein: So, there's about eight to 9,000 liver transplants performed in the United States every year. A small portion of them use a living donor, and a deceased donor transplant is generally speaking when we use a whole organ from someone who has died. The, organ is usually removed from the donor, stored for several hours, transported to the recipient hospital, and then while the recipient is having their liver removed, then the deceased donor transplant occurs. In a living donor transplant, usually the living donor is done simultaneously at the same hospital. So, the living donor undergoes surgery, has a portion of their liver removed and is immediately placed into the recipient.

One of the advantages of living donor liver transplant is that it can be performed at the ideal time for the recipient. Basically before the recipient gets too sick, when the symptoms have just begun to affect the quality of life, but are not so severe that the patient finds themselves really on the edge of death.

Host: Well it certainly would seem more ideal. Who's usually the person that gives a part of their organ dr. Samstein?

Dr. Samstein: Most of the people who are the donor for liver transplant are people who know the recipient. So, most common scenario is an immediate family member, a sibling, a child, or a parent, but, the person who donates only needs to have the same blood type as the recipient.

There are some other matching and perhaps we can talk about that, but, the matching is less complicated than in kidney transplant. And so, you don't need to be genetically similar. You can be a spouse, you can be a friend, you can be a cousin. And in fact, at New York Presbyterian Weill Cornell, we do, do a transplant from people who don't know each other.

Host: That's so interesting. I bet so many people did not know that really blood match is the most important of the aspects of this. So, if someone is living, not near Weill Cornell, if they're by a hospital where they're told that living donation is not an option for them, what would you like them to know?

Dr. Samstein: So, almost everybody who is a candidate for liver transplant is a candidate for living donor. Living donor transplant centers, centers who have experience, are only a small portion of the centers that perform liver transplant. If you've been told you're a candidate for a liver transplant, you are likely a candidate for a living donor, and you may not need to wait for a deceased donor, you may be able to get a living donor more expeditiously. So, one of the things you can do is you can reach out to us. We can review your records. We can help you decide if you're a candidate for liver transplant. And, many times, we can begin the process, even of the evaluation through Telemedicine.

Host: That's so interesting. So, now tell us a little bit about the procedure itself, Dr. Samstein. Can it be performed laparoscopically? Tell us about the donor surgery and the transplant surgery. How does that all work? Does it happen at the same time? Just tell us about it.

Dr. Samstein: Liver transplant for the recipient, is performed through an open incision, usually a fairly big incision so that the entire diseased liver can be removed and the new liver can be sewn in, carefully. What we call the donor surgery, the donor hepatectomy can be performed laparoscopically. And in fact, at New York Presbyterian Weill Cornell, we've been doing laparoscopic donor surgery, for live donors, for more than 10 years. And so the operations are generally done simultaneously. The donor goes in just a few minutes before the recipient. They go off to sleep.

We put a camera in their belly, take a look and make sure confirming everything as determined by the preoperative workup. And then we begin the division of the liver using laparoscopic instruments. We divide the liver depending on the amount of liver that needs to be removed.

And take it out, using typically an incision in the lower abdomen, which is less painful and leads to a faster recovery. It's then immediately flushed with preservation solution and brought to the recipient where it's sewn in, in a very coordinated fashion.

Host: Isn't that amazing, what you can do now today? So, it must be very exciting to be in your field, Dr. Samstein. I think one of the questions that many people who might want to be donors have, is there a cost for the donor? Is it their insurance? And are there resources to help with any costs that might be incurred?

Dr. Samstein: So, that's a great question. And one of the things that those of us who are in the field of organ transplantation are really passionate about is trying to make this a financially neutral experience for the donor. So, a couple things I want to point out. First of all, recipient's insurance covers the cost of the surgery and the hospitalization.

So, it is important that there's no cost for the hospitalization, the workup or the surgery. In addition, there is a national program to reimburse donors for the cost of travel, dependent care, childcare or elder care, during the evaluation and during the surgery, and there is reimbursement for lost wages if the person donating, will have a decrease in income. There's a national program that reimburses donors for lost wages. In addition, some states have a tax credit for a donation so that people can have reduced taxes as well. So, there's a variety of mechanisms that are really aimed at trying to reduce the costs that donors might need to put out. S that this is essentially a financially neutral process.

Host: Well, that's really encouraging to hear that there are resources. Tell us a little bit about the psychological effect of donation on the donor. How do you address that and tell us about recovery and what life is like for both the recipient and the donor. What advice do you give them afterwards? Lifestyle changes, that sort of thing.

Dr. Samstein: You know, one of the things I often tell donors is that many donors feel like they were prepared for incisional pain. They were prepared for aspects of the donation that are described in detail. But one of the things that they describe somewhat unexpected to them was the emotional ups and downs of the process. It's a very intense process, donating. And so some of it is, both feeling the excitement of saving a life, but at the same time, feeling, the ebb of the emotions as one goes through it. The departure from the hospital and then watching the recipient, go through their own recovery process can be very intense.

All of the donors are evaluated and supported by both a social worker at our hospital. They also see a psychiatrist if they are deemed to need it. We'll often have them engage with a therapist locally, to provide support, afterwards so there are a good deal of resources to help donors, both before the operation, as well as after.

Host: It's such an interesting topic. As we wrap up Dr. Samstein, what would you like listeners to know about living donor transplantation for liver transplant and what you're doing there at Weill Cornell Medicine that is so exciting?

Dr. Samstein: When you are diagnosed with advanced liver disease, it's can be very, very frightening. The idea that you might die before you get the therapy you need and that you have to wait until you're sick can be paralyzing with fear about sickness. And I think that it's important to understand that the vast majority of people who are candidates for a transplant can have a living donor and do not need to wait. The average time, once you are listed for a liver transplant to completion of your living donor liver transplant is less than 90 days. So, you do not need to wait a long period of time on a list in order to have a transplant. So, I think that's an important thing. In addition, while the operation for donors, is a serious operation, it often can be performed laparoscopically and the recovery for donors, on average, when performed laparoscopically is in the range of about a month to a month and a half, which means that, for many people, they can be back to their life, living a normal life with essentially, minimal changes, no changes to their diet or other things after just a few weeks,

Host: Wow. What an informative episode this was. Dr. Samstein, thank you so much for joining us and sharing your incredible expertise today. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download subscribe, rate, and review Back to Health on Apple podcasts, Spotify and Google podcast. For more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids' Health Cast. I'm Melanie Cole.