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Patient Education: Living Donor Liver Transplantation

hi I'm Cody Hashimoto the director of

living donor liver transplantation at

Cleveland Clinic I believe many of you

are not familiar with living donor liver

transplantation so the core of this

video to help you understand the

importance of living donor liver

transplantation and also to explain the

differences between living donor liver

transplantation and this is the donor

liver transplantation in the next few

slides I will be explaining why we need

living donor liver transplantation

because of donor shortage we don't have

enough deceased donors to transplant all

patients in the United States for

example in 2016 approximately 14,000

people were waiting for liver

transplantation but only 8,000 patients

received liver transplantation and

unfortunately many patients died or

became to seek before transplantation in

deceased donor liver transplantation a

new liver will come from a donor

suffering from brain death or cardiac

death on the transplant waiting list the

priority to receive a deceased donor

liver transplant will be determined by

your marital score therefore your

waiting time is potentially long and you

may be come to seek before

transplantation in the last 10 years

Murdo score to receive a deceased donor

liver transplantation at Cleveland

Clinic has been rising in 2018

the average marital score to receive a

transplant was around 28 which means

when you Murdo score is greater than 25

you have a good chance to receive a

liver transplantation however when you

merge those codes

less than 20 you are unlikely to receive

a transplant from a deceased donor and

potentially you have to wait until

you're married or Squa increases even

your middle score is low you may suffer

from major complications over your liver

failure you may have a situs which is a

fluid buildup in your abdomen you may

also have confusion or mental status

change due to high ammonia to reduce

ammonia in your blood you may be taking

lactose you may also have enlarged veins

in your esophagus and stomach which

increase the risk of catastrophic

bleeding even you suffer from these

life-threatening complications of your

liver disease they do not increase your

maltose score from 2012 to 2016 more

than 1000 patients were listed for liver

transplantation at Cleveland Clinic this

slide shows the risk of mortality on the

waiting list based on marrow score

during this time period as you can see

many patients did not make it to

transplant regardless of Metascore

importantly about 20% of patients died

or became too sick even middle score was

less than 15 living donor liver

transplantation is a potential solution

for this problem in living donor liver

transplantation a new liver will come

from a healthy person this can be your

family friend or someone you have never

met in living donor liver

transplantation marrow score does not

determine the priority for transplant

because a liver from your living donor

directory comes to you importantly

because waiting time is usually short

you can receive a transplant while you

are in a relatively good shape however

healthy living donors have to undergo a

major surgery

because the Libra is a unique organ that

can regenerate partial liver can work as

a unit and grow back to its original

size left-lateral segment which is about

15 to 25% of the whole liver is usually

used for small children for adult

patients we usually take left robe or

right robe which is 30 to 40 percent or

60 to 70 percent of the liver the

decision for graft type will be

determined based on your medical

condition and size of the donor liver in

addition to shorter waiting time and

timely transplant before you become too

sick there are more benefits in living

donor liver transplantation generally a

liver from a living donor lasts longer

than a liver from a deceased donor

because this is an elective surgery your

transplant can be scheduled on a

convenient day for both you and your

donor this slide shows a result from

American multicenter study called a 2

all study group if you have a potential

living donors you have better survival

chance regardless of your marital score

compared to waiting for deceased donor

liver transplantation living donor liver

transplantation can help you receive

life-saving transplant before you get to

the point where a transplant is no

longer the option for you who can be a

living donor living donor must have

unselfish desire to save someone's life

paying someone to obtain a transplant

organ is illegal there must be no

financial gain for living donation blood

type has to be compatible or identical

for example if you have a blood type a

your living donor has to have blood type

a or all

in extreme circumstances incompatible

blood type can be considered donor age

has to be between 18 and 55 when a

recipient with small child donor age can

go up to 60 a donor has to be mentally

and physically healthy without major

illnesses including liver diseases there

are significant risks on living donors

because living donation is a major

surgery we need to understand there are

real risks during and after surgery

there are a potential risks of bleeding

pain by leak infection blood clot and

incisional hernia importantly liver

failure and death can happen on living

donors because donor safety is our top

priority we conduct comprehensive living

donor evaluation before transplantation

although the majority of living donors

have no complications it is very

important to understand that there is a

risk of serious complications on living

donors what do you expect to see in

living donor recovery after surgery do

not stay in surgical ICU overnight

donors usually stay in hospital about

four to six days after this church

donors usually return to daily

activities in about four weeks and

return to work in two to three months it

is important to understand why living

donor liver transplantation has not been

done more commonly usually patients feel

uncomfortable to ask someone to be a

living donor your physicians may have

told you that your marital score is too

low to have a liver transplantation

however as I show you in this

even your metalloids law you have a

significant risk of death or becoming

too sick on the waiting list if you have

an earlier access to a living donor

rather than waiting for this is the

donor you have a better chance to do

well

please remember the longer you wait the

more you suffer it is a real challenge

to find a living donor it is very

important to start having conversation

with your family and friends early on so

that you can share your story in the

early stage of your disease you can also

ask someone around you to spread your

story then you can share your story with

someone you have never met social media

could be a very effective way to do so

once people know how sick you are and

what help you need things may start

going forward please don't give up

living donor liver transplantation is

not just an alternative but something

you may want to consider as an important

option to save your life living donor

liver transplantation can help you

receive a life-saving liver transplant

before you get to the point where the

transplant is no longer the option for

you for more information please visit

our website or contact us we are more

than happy to help you whenever you need

thank you for staying with me today I

hope this video helps you understand the

importance of living donor liver

transplantation in your care