Why visit this Blog?

Conveying via blog useful information, including for organ donation and transplantation, as well as a social media emphasis.




Saturday, June 15, 2013

Why a cirrhotic liver needs to be replaced with a transplanted liver.


Often during conversations that transplant surgeons have with potential candidates for liver transplantation procedure, it can take a while to reach an understanding of exactly why the whole liver needs to be replaced. Particularly as this will involve major surgery along with waiting for a suitable liver from an organ donor. Also there are currently no other types of medical treatment which can reverse end stage liver disease once it is diagnosed.

With the liver being hidden from view under the right lower rib cage at the top of the abdomen as described in this British Liver Trust post, it can be hard for any individual with liver disease to know exactly what is going on. Plus many types of liver disease in the early stages do not usually lead to specific symptoms such as abdominal pain or the development of yellow jaundice.

So by the time the symptoms of chronic liver disease do occur there is often already a significant amount of liver scarring present, i.e. there is cirrhosis.  This means that the underlying disease process in the liver can already be well advanced. Cirrhosis affects the whole liver and the scarring process turns the liver from being a slightly soft triangular shaped organ into being a far harder, scarred organ with lots of nodules. This can be seen in the image below or via watching this video What is cirrhosis of the liver?  



 


Cirrhosis can also lead to other significant changes occurring within the abdomen which also tend not to be visible until this type of liver damage is well advanced. Changes like the accumulation of fluid lead to abdominal swelling and this is otherwise known as ascites. Increased pressure within certain veins in the abdomen cause a condition known as portal hypertension which can lead to major bleeding from the junction of the oesophagus with the stomach.  In advanced cirrhosis yellow jaundice and problems with kidney function may also occur. Further information on liver disease and cirrhosis can be obtained via the MedLine Plus WebMD or the American Liver Foundation sites.

Hence this is why in the advanced stages of many of the chronic liver diseases which lead to cirrhosis, liver transplantation is currently the only long lasting effective treatment, because the whole diseased liver must be replaced. As yet other therapies such as stem cells and bio engineered organs are nowhere close enough to being considered effective therapies for this condition.
If you are a patient receiving treatment for liver disease or a relative you should always check with your doctor that any information you source online is appropriate for your circumstances.


 

Thursday, January 10, 2013

Why ‘every tablet every time’ is so important for transplant recipients


No conversation about an organ transplant surgical procedure is complete without mention being made of one other important topic. That is the absolute necessity for additional medicines to be given post transplant, otherwise known as the ‘immunosuppressive medications’. So why are these types of medicines needed? Why do transplant recipients need to understand the importance of the saying “every tablet every time”?
Well it is all about the fact that our ‘immune system’ is designed to protect us by repelling anything from entering our bodies that is not made up of our own tissue. This includes bacteria, viruses and yes vital transplanted organs. A very general overview of how our immune system works can be obtained via this YouTube video.

Hence these white blood cells (lymphocytes), and other related factors need to be kept suppressed by medications as summarised in this article via  News Medical This prevents the newly transplanted organ from being ‘rejected’.

These extra medications will commence in most cases around the time that the organ transplant surgical procedure occurs. Initially quite high dosages are usually required and as a result side effects may occur, as summarised via this article from the National Kidney Foundation 


 
In order to limit the long term consequences of all of the possible side effects from these medications, many transplant recipients will ultimately be managed on the lowest dose that is possible. Hence why taking “every tablet every time” is essential. Skipping medications can allow the immune system to be triggered, which then contributes to premature loss of the vital transplanted organ. No one wants this outcome.

General information on ‘immunosuppressive medications’ can also be obtained via web sites maintained by legitimate professional organisations for e.g. eMedicine Medscape or Up to Date

NB: Immunosuppressive medication regimens do vary markedly, as there are many factors which go into the decision making as to which medications are suitable for each recipient. Hence this is why all transplant recipients if they have any concerns over their medications, need to also seek advice from their treating doctor.
 

 

Saturday, October 27, 2012

Using Social Media for information streaming in healthcare

Are you in health care and accessing social media for work purposes? Are you also comfortable with using some of the current social media platforms as tools for the streaming of information that meets your needs? If so, the following information is probably not new. However, if you do not fit in either of these two categories, then feel free to read on.

The amount of information related to health care is burgeoning whether it be in the form of facts, published scientific reports, or related to other day to day work processes. Much of this information is now sourced electronically including via the Internet. This situation has not gone unnoticed in some areas with there being an increasing realisation that somehow all of this needs to be managed. At times individuals can feel like they are "trying to drink from a fire hydrant" (Mitchell Kapoor) as pictured.



This same analogy was featured in a blog written by a medical student in Scientific American Blog-Unofficial Prognosis where the impact of this information deluge on medical students was explored.

So how can you use social media to help with your information needs regardless of where you are in the health sector? Plus why might this now be an increasingly important topic? First you need to gain familiarity with use of the most common social media platforms which include Facebook, Twitter, YouTube and Linked In (see below image). Then you need to ascertain which organizations, groups and individuals are relaying information via these platforms which can help meet your learning needs. As it turns out an increasing number of organizations are relaying important information via social media.



 


For example if you have recently joined Twitter but still feel a little unsure of how to go about finding the organizations or individuals of interest, the good news is that help is at hand. This is in the form of the Symplur hashtags project- @healthhashtags Via this Symplur web site you can find hashtags including for organizations, communities of practice(eg nursing, medicine, audiology), diseases, treatments, management and informatics. As a result of exploring the hashtags you will also be able to find relevant organizations, plus individuals on Twitter as well as their related web sites and other social media channels. As everyone has slightly different learning needs in health care, this is why it is now important that you know how to source useful information for yourself.


Finally feel free to explore, find like minded individuals and most important of all continue to learn! Also take some time to check out advice that is available on the safe use of social media platforms eg for Facebook via reputable channels including Mashable Social Media.

Tuesday, August 7, 2012

Organ Donation: Three essential 'A's.


You may notice that the postings on to this site mainly provide information on 3 topics - organ donation, organ transplantation and use of social media. So what would you say it you were told that there are important common messages contained within these topics? What does this represent? Well it comes down to three important words all beginning with ‘A’.

A is for Awareness, a term used frequently over the last 10-20 years for various campaigns promoting organ donation around the world. So do you think that having lots of ‘Awareness’ leads to higher organ donor rates? What would you say if you were told that the country with the highest organ donor rate in the world-Spain- does not run ‘awareness’ campaigns? Can you say that you or your family are truly aware of the importance of organ donation or what is involved? How about your friends or work colleagues? What steps have you taken to find out more about organ donation even though you may be ‘aware’ of its importance? This is where one other word beginning with ‘A’ becomes important.

A is for Action, a term used when individuals or organisations take steps to convert their ‘Awareness’ of a problem or issue into steps that lead to real change and hence results. Without taking action ‘Awareness’ on its own will not achieve any lasting impact. Probably the greatest example of awareness not leading to appropriate action for health is the world-wide obesity epidemic. Despite clear documentation of an increasing problem for e.g. CDC statistics, numerous campaigns via both media and professional organisations including, reports from the Institute of Medicine, the problem continues. You can view an Obesity info graphic from the Australian Science Media Centre which outlines the projected rates of obesity in that country if action is or is not taken.

So what do you need to do to take action on organ donation? Well first you need to find out the facts and there are a number of good web sites which include Organdonor.gov, United Kingdom NHS Then you need to talk to your family. You can also note your decision via your Facebook timeline if you wish. If you belong to an organisation with an interest in organ donation, then you will be combining Awareness with Action which are two essential components as depicted in order to help form a platform for leading and driving change

A is for Advocacy, a term used to signal the action being taken by individuals, groups or organisations who want change [or reform] to occur, including within the health care system and at policy level, for the barriers to organ donation to be overcome.


Three essential A's required for change

So there you have it, the 3 A’s as they relate to organ donation as depicted above, which is of enormous importance for organ transplantation. You cannot have one without the other two. As for social media, well this is now a conduit via which relevant information [for both Awareness and Action] is being relayed both by individuals and organisations with an Advocacy role. This is in order to facilitate the changes that are required in many countries to ensure that the maximum benefits of organ donation are realised.


Saturday, June 16, 2012

The Most Important Transplant Surgeon Conversation- Providing an Outline of the Transplant Surgical Procedure


The  most important conversation that a transplant surgeon needs to have with any potential recipient relates to the planned transplant surgical procedure. This involves describing what the actual procedure involves, as well as any potential problems that can occur with the surgery followed then by the expected post-operative course.

All transplant surgical procedures are considered major operative procedures and there are common elements which they all share-

a)     Making an appropriate incision either on the chest or the abdomen to gain the required access

b)    The surgical removal of the recipients own diseased organ in the case of the lungs, liver and heart in order to make space for the new organ to be transplanted. This also requires that some blood vessels and other structures need to be preserved to assist with the next phase of the surgery.

c)    Implanting the new donor organ which involves suturing a number of vessels and other pipes/structures that are specific to each type of donor organ

d)    Ensuring that any other problems such as bleeding are then dealt with

e)    Inserting drainage tubes and closing the incision

 Once the surgery is completed one of two things then happens-

1)    In the case of kidney recipients, most of the time the patient can be woken up from the anaesthetic and transferred to a ward or step-down unit for close post-operative monitoring to occur

2)    For the heart, lung and liver recipients most patients are kept asleep at the end of the surgery and transferred straight from the operating room to the intensive care unit for ongoing close monitoring. This is required until it is apparent that the patient is stabilising following the surgery and that the newly transplanted organ is functioning.

The nature of the surgery and the expected post-operative course can generate many other questions. There are some general guides available including via the Internet. In particular via the MedlinePus site in the United States-  Liver transplantation heart transplantation kidney transplantation  lung transplantation


The pieces of information that need to be put together for every transplant recipient including the last piece of information that can be obtained only during the actual transplant procedure.

However both the magnitude of the surgery as well as the range of possible complications do vary depending on both the organ being transplanted and how unwell each potential recipient is at the time of the transplant procedure -


       a) How each transplant recipient fares during the surgery and early on post operatively is   
           related to the many specific bits of information that need to be put together at the time-as 
           outlined in the above image.  


      b)  It is important to remember that the last 2 pieces of the recipient information jigsaw 
           puzzle are only able to be put together in the operating room during the actual transplant   
           surgery. For example there is no test for how much scarring may be present in the 
           abdomen in a liver recipient who has undergone previous surgery, hence this can only be 
           determined during the actual transplant surgical procedure. 


      c) Also if the combination of all of the non-surgical pieces of information were to predict an 
          unfavourable outcome in advance for a recipient, then the transplant surgery would not be 
          able to go ahead.

Hence specific advice should be sought by potential transplant patients and their relatives from the transplant programme that they are currently in contact with. There are both pluses and minuses from currently seeking health care advice only via the Internet as outlined via the following link- Mashable- what-doctors-think-about-your-online-health-searches


Image designed by Deb Verran 2012: acknowledgement Presentation magazine


Monday, April 30, 2012

Another Transplant Surgeon conversation: Waiting for an organ transplant

When a transplant surgeon is holding a conversation with a patient who requires an organ transplant, there is one topic that usually attracts more questions. It is the timing of that all important phone call that will be made to the patient with the offer of the donor organ. Can you imagine what it must be like to be listed for a transplant and waiting for that call day after day, week after week?


The conversation often goes like this-
Q: So doctor, when will I get the phone call [about the donor organ being available]?
A: You can get the call any time of the day or night, week day or weekend. So even in the middle of the night it is important to answer the phone.
Q: Why is that?
A: Well, first because the deceased organ donors can be identified at any time in the hospitals. Second, there is a need to track down all of the potential recipients of the organs from each donor, as there are time limits once the organ donation process is underway.
Q: So when I receive the call, do I need to hurry to hospital?
A: Yes, you do need to make your way to hospital reasonably quickly, but also safely. This is so you can be prepared for the surgery. If you live a long distance from hospital, special arrangements may need to be made to get you there in time.
Q: After I get to hospital, when do I know the transplant is definitely going ahead?
A: Once the organ you require has been surgically retrieved from the donor and is cleared to be suitable for transplant, you will be told. The organ often also has to be transported to the hospital as well.

Explaining what is actually involved in the process for obtaining the organ from the organ donor through to commencing the actual transplant surgical procedure is important. The journey to a transplant can be tough on potential recipients and their loved ones. Some descriptions of this journey can be obtained via the Organtransplants web site.

It takes good co-ordination for the available organs from every deceased donor to be successfully transplanted. Time is often of the essence once the organs have been surgically removed from the donor, due to limits on storage times of the organs. In many countries this co-ordination is achieved by agencies and or networks of professionals. Further information on this part of the process can be obtained via professional sources including from the United States and the United Kingdom

Some other general web sites which provide information are-
Transplant Living , OrganTransplants Understanding , United Kingdom
If you or a loved one are waiting for an organ transplant, it is best to seek advice from the professionals in the Transplant Programme that you are in contact with.

Monday, March 12, 2012

An important task for Transplant surgeons. Helping piece together the picture for every donor organ.

Transplantation involves the surgical removal of the organ(s) from a donor-who is either living or deceased- and then surgically implanting each precious organ into the designated recipient.

Do you know that there are many steps in the organ donation process that are all critical for deciding on whether or not a donor's organ(s) can go on to be transplanted? Transplant surgeons are very much involved in this process of assessing the suitability of the donor organs for transplantation.

Are you aware of instances where individuals were unable to be live kidney donors? Do you know of occasions where organ donation was not able to go ahead from a potential deceased donor (i.e.after death) in hospital, due to there being medical concerns?

Being able to assess each organ donor for their 'medical suitability' to donate one or more organs is one of the essential parts of the downstream transplant process. Although general information on organ donation is available via the Internet for eg, this website from the United States of America more specific information on the In's and out's of organ donation, may not be  easily located unless you know where to find it, eg from the United Kingdom

There are many pieces of information (see below image), that have to be obtained for each and every organ donor as to whether they are suitable to donate an organ (as a live donor) or multiple organs(after death). This whole process is like putting together a jigsaw puzzle, with the final two pieces (bottom right hand of the image), made up of what the surgeons discover at the time of the actual organ retrieval surgery. As most of the pieces of the jigsaw are put together prior to the retrieval surgery, this helps explain why not all donors proceed to the operating room. However, information obtained by surgeons during the retrieval surgery is often critical to the final decision as to whether or not a particular organ can be actually used for transplantation.

Legend- DCD: Donation after Cardio-Circulatory Death; DBD: Donation after Brain Death; NAT: Nucleic Acid Testing





Of note as rates of organ donation do vary between countries as outlined in this report from the WHO Transplant observatory particularly for deceased donors, it is important to place this information into the context of where you live. However, as you can see transplant surgeons are very much involved in the assessing of the donor organs for transplantation!
Image designed by Deb Verran 2012: acknowledgement Presentation magazine