Caitlin Whyte (Host): Have you ever wondered what it takes to be a transplant surgeon? The pressure, the skill, the immense responsibility of offering a second chance of life. Today, on In Their Words, we meet Dr. Danielle Ladie, a renowned transplant surgeon who will be guiding us through the incredible world of organ transplantation. We'll also be revisiting a story that resonated deeply with all of us, the tale of Mary Oliviera, the selfless living donor.

Dr. Ladie will share her unique perspective on Mary's journey and the profound impact of living donation. So, settle in as Dr. Ladie sheds light on the dedication, the triumphs, and the challenges faced by transplant surgeons. Join us for an episode filled with hope, human connection, and the power of medical miracles.

Danielle Ladie, MD: I'm Danielle Ladie. I am a transplant and hepatobiliary surgeon. I'm also the Vice Chair of the Department of Surgery. And I've been with the system for-- it'll be 10 years in July. I did my residency here and left for Charlottesville, Virginia for a while, and then came back to practice here in Harrisburg.

When I was very young, I knew I wanted to somehow help people in general. But I had no idea what I would be best at. So, I did some things after college. Instead of going to medical school, I worked at a nursing home, worked at a restaurant and ultimately decided to go to medical school because I knew that was the best way that I could help people. I was always fascinated by science and how medicine works especially surgery.

So, it's four years of medical school. That can be pretty challenging. After medical school, you decide what specialty in general you would like to go into, and you go into a residency program. For general surgery, it's five years, and I wasn't sure what type of surgery I wanted to practice at that time, but ultimately decided on transplant surgery.

So after the five-year general surgery residency, you do two years of a fellowship program, which concentrates on that specialty in surgery. So, I did two years of transplant surgery. It's called an Abdominal Transplant Surgery Fellowship. So, it concentrates on the abdomen and organs in the abdomen that can be transplanted. So, that means liver, pancreas and, in some cases, small bowel. So after that, then you can practice as an attending surgeon.

So, being a female surgeon in general can be challenging. I think that over half of the students graduating from medical school are currently female. But surgery has its specific challenges, and that has to do with more of a work-life balance. In transplant surgery, only about 10% of the surgeons are female. And I don't think that is a hindrance for me at all. I think that is definitely something that, while it hasn't been a hurdle, is, of course, always in the back your mind. But as a female, I can really relate to a lot of the female patients and female donors very well. I think females in general have a little bit of a softer nature and can sit down and discuss things with a patient.

Transplant is quite a scary thing. You're either donating one of your organs to somebody, which is an incredible gift, or you're receiving a gift from someone, either living or a deceased donor. And it's very sensitive and can be overwhelming.

Host: Now, we'll delve deeper with Dr. Ladie. Have you ever wondered the sheer number of transplants happening in a year? Listen in, as she provides us a sense of scale.

Danielle Ladie, MD: So, every year, there ends up being about 20,000 to 22,000 kidney transplants in general, which is not enough to cover the hundred and some thousand patients who are on the list waiting for organs. And there are about 5,000 to 6,000 living donors every year, but there's a lot of benefits to living donation.

The patients who are waiting for organs tend to get sicker and sicker as they are on dialysis. So, they may not be a candidate whenever the six years passes, and they're starting to get offers. And I say six years, because that is the average waiting time in our area for a deceased donor organ transplant. And that's someone who has passed away, who has donated their organs and has, for example, organ donor on their driver's license, and are helping people by donating their organs that way.

I've done over 500 transplants and donors, believe it or not. Last year, we did 61 transplants in total. Every year, about half of our transplants are from living donors. We tend to do anywhere from 50 to 65-ish each year. We probably have a little bit of room to grow if more people were willing to donate their kidneys.

When someone decides to donate their kidney, they go through a process that we try to make it as easy as possible for them, but we also want it to be as safe as possible. So, after their workup in the office, which is typically a two-day process, and they go through a selection process, meaning that we make sure that we're not going to change their lives by removing one of their kidneys. After that process is done, then we plan for the surgery. Typically, we've done the surgeries laparoscopically, and that means three small incisions and a short time in the hospital. But robotically, we have better visualization and this helps with the tissue damage as well and in turn helps with the recovery of the recipient and the donor. And the donor can get back to their normal lives a little bit quicker.

So, we just started this on February 6th, was our first robotic living donor. We have our next one tomorrow. And we're looking forward to developing a program using the robot to help us facilitate the donation process and make it more comfortable for the donors. The technology has tremendously improved. We started doing laparoscopic donors. They were done in Maryland first in the mid to late 90s. But technology in that regard hasn't changed much. But the robot has allowed us to have a 3D visualization and fine tuned our dissection with minimal tissue damage, which has really transcended things in terms of how how we can operate on the donors and, again, facilitate their recovery.

Host: And now, we return to the story that resonated with so many of us from our last episode, Mary Oliviera's incredible act of selflessness as a living donor. Let's go back to the beginning.

Danielle Ladie, MD: So, she came in for her donor workup. And I wasn't there for the very first time she came into our office, but I had heard a lot about her. She's well respected in the community and was doing such tremendous things for somebody that I had heard of, a recipient, a young female who really needed a kidney. This recipient was very active in the community as well and was tied down to dialysis. So, I think a lot of people don't realize that whenever your kidneys aren't working correctly, you really feel terrible, you're tired, you have a very, very limited diet. And this particular recipient was on dialysis for eight hours at least every night. So, she had to go home at a reasonable hour, hook herself up to the dialysis machine, and then come off in the morning. It's impressive that the recipient was still working, but that's quite difficult to do, and it was such a tremendous thing. I felt that Mary wanted to donate her kidney to this individual. And I met her on her next visit, and just such a giving and well spoken individual.

So, the very first item that happens is a phone call to make sure that the donor is comfortable with the process and that they know what to expect with the whole process of getting worked up to be a donor. We then get some blood work and see if the donor is a match for that recipient. A patient is not a family member or is not related whatsoever. That doesn't matter. They don't even have to be a match. They can swap their kidney, so that means that we go through a program called the NKR, which is National Kidney Registry, and we can trade organs, and the recipient still ends up with a very, very good living donor kidney. And sometimes you'll hear that referred to as a swap or a paired exchange, meaning that we may send the kidney out to another state. They'll send a kidney out to another state and that state will send the kidney to us, for example.

So, Mary was willing to do that as well, if that was necessary. She got her blood work done and then she meets with our team. And that team is quite large. It consists of a transplant nephrologist. We have a transplant coordinator who goes over everything from beginning to end with the donor. They meet with one of the transplant surgeons. They meet with a financial coordinator and they also meet with a transplant social worker. So again, quite a large team to ensure that this is right for them and that they are well prepared for the process.

The second day is typically heart testing. So, they get some imaging on their abdomen as well as an EKG on their heart. So, we can make sure that the kidney anatomy is adequate for donation as well. They're typically in the hospital for two days. Hopefully, with the robot, we'll get that down to one day. And at about three to four weeks, you feel about 80% back to normal. So, six weeks, we hope they are living their lives normally. It doesn't affect them long term if they are healthy to start with and that's why the workup is so thorough at the beginning. Their limitations after surgery are just heavy lifting and no driving initially. But after those first few weeks, they should be living their lives like normal.

Host: When asked about her feelings toward living donors, Dr. Ladie was overwhelmed with gratitude. With heartfelt sincerity, listen as Dr. Ladie expresses her profound appreciation for the selflessness and generosity displayed by individuals who choose to become living donors, that living donors embody the essence of compassion and altruism offering hope and renewed life to those in need.

Danielle Ladie, MD: It's such a tremendous honor to be involved with these people who are so selfless and willing to give their kidney to somebody else and then, to also be involved in the recipient's case where they're receiving this gift and their lives change dramatically. It is truly a life saving procedure and they go on to live their lives normally. So, this recipient was able to go to work easier and live her life normally without having all the issues that come with kidney disease and kidney failure as well. So, being involved in both of those cases is just such a tremendous opportunity to help people.

 If you're considering donating a kidney, keep in mind that it is truly a life-saving procedure, and it really changes people's lives. If you are even vaguely interested, do not hesitate to call our office and find out more information or even come in and meet with one of us. We can give you more details about the specifics of the process and discuss any questions or hesitancies that the donor specifically might have. This doesn't commit you. The donor can decide not to donate at any point in the process. It may be too overwhelming for them or their family and the recipient and donors are kept as separate patients, so the recipient will not know the donor situation.

Host: Dr. Ladie's work is nothing short of extraordinary. But with such immense responsibility, how do transplant surgeons unwind and recharge after a long day?

Danielle Ladie, MD: I think the work-life balance is very important. It's important for surgeons to be physically fit as well as mentally fit. So, I do this by hiking, getting outside and walking, and hiking in the woods, taking my dog for a walk. I think that's extremely important for anyone, especially for surgeons. This keeps us sharper and able to focus, quicker, also relieves stress in general, which any job can be stressful, but of course, surgery is can be quite stressful.

Host: Now, when we spoke to Dr. Ladie about why patients considering a living organ donation should choose UPMC, her passion for the program was truly inspiring. Let's hear what she has to say.

Danielle Ladie, MD: So, UPMC is one of the leaders in transplant across the nation. We have trusted experts in transplant throughout the system. I think it's a good choice for patients because not only do we have world-class physicians and world-class teams involved in patient care, but it also has a personalized note for patients. So, you're not just a number here. You come in and we know you by name. We know your families. We get to know some of your support systems. This can really facilitate the transplant process for a lot of patients, because it can help them through and patients feel more secure with such a a daunting process.

I think it's just important that everyone is aware what it means to be a kidney donor and how that really can save someone's life. Again, it's a few days in the hospital or less and a short period of recovery. And the donors go back to living their lives like normal. Again, it doesn't have to be a relative. It can be a neighbor, a friend, someone from church, someone from going to school together as children. Anyone really can donate their kidney as long as they're healthy enough.

Host: And that's a wrap on another inspiring episode of In Their Words. Dr. Danielle Ladie, thank you for giving us a glimpse into the remarkable world of transplant surgery, your dedication, and the countless lives you've touched. To Mary Oliveira, your selfless act of living donation continues to resonate. You are an embodiment of compassion and a true hero.

The stories of Dr. Ladie and Mary remind us that, even in the face of immense challenges, hope and human connection can truly work wonders. Thank you for joining us on this journey. If you or someone, you know, is considering organ donation, please visit donatelife.net, or turn to the incredible transplant teams at UPMC in central PA. Until next time, be kind to yourself and each other.