I'm Dr. Thomas Fishbein, and I'm the executive director of the MedStar Georgetown Transplant
Institute. And I am the chief surgeon in charge of the Liver Transplant Program. My name is
Mary Barr. I'm a transplant nurse coordinator with the adult liver program at the MedStar
Georgetown Transplant Institute. My name is Dr. Rohit Satoskar. I'm a transplant hepatologist,
and I'm the medical director of the adult liver transplant program
at MedStar Georgetown Transplant Institute. I'm Dr. Chirag Desai. I'm a liver transplant
surgeon at MedStar Georgetown Transplant Institute. My name is Dr. Amol Rangnekar.
I'm a transplant hepatologist at MedStar Georgetown Transplant Institute. The goal
of the MedStar Georgetown Transplant Institute is to return patients with
advanced liver disease to their optimal state of health and back to a productive life.
The liver is actually the largest solid organ in the body. It weighs about one to two percent
of your body weight, so a normal adult has a liver that weighs between a kilo and two
kilograms. It's the metabolic engine of the body as well. It takes the food
substances that you absorb, processes them, and then turns them into energy. Generally,
patients who have chronic liver disease tend to develop inflammation in the liver. Over time,
that inflammation leads to scarring. And once you have a certain amount of scarring, that's what's
called cirrhosis. Not all patients who have cirrhosis necessarily need liver transplant.
But if they develop certain complications over time and get sicker, liver transplant is really
a life altering therapy. Cirrhosis is caused from excessive alcohol, use infection with viruses that
cause liver disease such as hepatitis B and hepatitis C. There are a variety of genetic
disorders that lead to liver disease such as Wilson's disease or hemochromatosis. And then
there are immune disorders similar to Crohn's disease but that attack the liver. Once patients
become sick from the cirrhosis, they can develop specific complications. Those include jaundice,
where the eyes are skin become yellow. They can have bleeding in the gastrointestinal tract. They
can develop excessive fluid retention either in the abdomen or the legs. And sometimes, they can
also develop confusion because the liver is not filtering toxins out of the blood appropriately.
When somebody's referred for a liver transplant, they come for evaluation here. And at that time,
they see multiple people like a liver transplant surgeon, medical hepatologist, social worker,
nutritionist. And for a transplant surgeon, the main thing is when they come first time
get introduced to the patient is like a three-fold. First, is whether the patient to
see what the patient requires a liver transplant or not. B is if they require liver transplant,
whether the transplant can be performed safely and meaningfully to have a good
outcome and good quality and quantity of life. And third is to make them aware about how the
transplant process takes place and then to explain them how we perform this surgery and
what are the risk and benefits involved with that. When I first meet a patient,
I want to make sure that they understand the liver transplant process. A lot of times,
it's a lot of information that they're getting at one time. So I do my best to explain to them
what's going to happen. I try to make sure that they understand that if they do have
any questions further down, they can always call their transplant nurse coordinator.
In terms of liver transplant there are various options that the hepatologist,
surgeon, and the patient will discuss and consider together. For the majority of patients,
cadaveric liver transplant or receiving a whole liver transplant from a deceased individual is
the best option. Other options include cadaveric split liver transplant, this is where we have the
ability to take a liver and split that liver to serve two people. So the liver can be transplanted
in two different people, generally a child and an adult. And the third option is living donor
transplant. And this can be done both in adults and children. Children require a smaller volume
of liver, so in general a smaller piece of liver can be given to a child in a living
donor transplant. Adults generally will require a larger portion of liver. An organ is allocated by
the federal government's contractor or UNOS who is charged with fair distribution of the organs
that come forward. Generally, when an organ becomes available, it's distributed to patients
on a waiting list on the basis of the degree of illness so the sicker patient rises to the top of
the list as they become more sick and then gets to the top and gets the next liver available.
If we receive a patient referred at a time when they are stable and their disease is
under control, we usually are able to get them transplanted from home
so they come in to the hospital when we receive an organ offer.
And then they get the transplant and generally within a week or ten days,
they're back out of the hospital and just seeing us for routine follow-ups in the clinic
Compliance is a very important part of liver transplantation. After liver transplant,
patients will be required to take a number of new medications. Some patients with liver
disease pre-transplant are used to taking a lot of medications others are not. But
the medications after transplant are required to ensure a healthy liver long term. Prior to
the patient leaving the hospital, our physicians, nurse practitioners, transplant pharmacists will
discuss all of these medications with the patient to make sure they understand what they're taking,
how to take it, and why they're taking it. The transformation a patient goes through
from chronic liver disease where they've become very ill and debilitated over time to after their
transplant is remarkable. It is a true rebirth and transformation that a patient goes through.