Selected Podcast
What Goes Into a Liver Transplant and the Importance of Organ Donation
Organ donation can save lives. Dr. Marlon Levy, Chair of the Division of Transplant Surgery and Director of the Hume-Lee Transplant Center, discusses liver transplants and organ donation.
Featured Speaker:
Learn more about Marlon Levy, MD, FACS
Marlon Levy, MD, FACS
Dr. Levy joined the VCU faculty in 2015. He is the former chief of staff for Baylor All Saints Medical Center. Dr. Levy is active with UNOS and sits on their Board of Directors and Executive Committee. He is also a member of numerous national and international professional organizations including the American Society for Transplant Surgeons, American Society of Transplantation, The Transplantation Society, American College of Surgeons, International Pancreas and Islet Transplant Association and American Surgical Association. Dr. Levy was named a "Top Doc" by Richmond magazine in 2016 and made the Dallas Top Docs list for many years before moving to Richmond in 2015.Learn more about Marlon Levy, MD, FACS
Transcription:
What Goes Into a Liver Transplant and the Importance of Organ Donation
Alyne Ellis (Host): October is liver cancer and liver awareness month. To commemorate, we’ll learn more about this vital organ. The VCU Health Hume-Lee Transplant Center is unsurpassed in providing state-of-the-art care to patients needing a liver transplant. This is Healthy with VCU Health. I’m Alyne Ellis. Joining me to talk about why Hume-Lee is so successful at these surgeries is Dr. Marlon Levy, the Director of the Hume-Lee Transplant Center. So, Dr. Levy what are the many causes that lead to an organ transplant?
Marlon Levy, MD, FACS (Guest): Well I can give you a short list. The fundamentals are that transplant teams recommend transplant when it’s felt that the existing liver, you know the one that patients have, is not going to lead to long-term survival for them. So, that can come from any number of illnesses including hepatitis C that leads to cirrhosis, including liver cancers, including diseases such as sclerosing cholangitis or biliary cirrhosis, including in some cases, long-term alcohol use. But the fundamentals are that when the data tells us that patients are more likely to survive with a new liver than with the one that they have; then that’s when teams would recommend essentially swapping the livers our or what we call a transplant.
Host: So, this place has a real history of innovation, and it’s my understanding that VCU Health Hume-Lee Transplant Center has really positioned itself to treat complex patients with liver issues and liver donation issues.
Dr. Levy: It really has. So, we’re one of the oldest transplant centers in the world established by our namesake, David Hume, in the late 1950s. We started with kidney transplant because that was state-of-the-art over 60 years ago, and then when the technology evolved, liver transplants became a reality; then of course we became part of that as well. And we’ve recently refocused our efforts on liver transplantation to include live liver donation, to include some sophisticated, very futuristic ways of preserving the liver between the donor and the recipient, so that the liver is as healthy as possible when we do the transplant.
Host: And I understand you are one of the few in the nation to do bile duct cancer liver issues and deal with that?
Dr. Levy: We are. Bile duct cancer in our world, in our community, in transplant, the transplants for bile duct cancer has waxed and waned over the years. There was initially enthusiasm and then the results weren’t that good so then centers would not transplant for a while for bile duct cancer. But then under some strict protocols of radiation therapy, chemotherapy and very close surveillance, I think the community moved us slowly back towards it. And we, I think, are at the forefront of a few centers in the United States where that’s our approach. We have a multidisciplinary team that looks very closely at patients with bile duct cancer and when it seems that a best outcome is going to be with liver transplant; then that’s what we do.
Host: And you also do quite a bit of research on liver transplantation.
Dr. Levy: We do. We have active labs in liver preservation, in how to resuscitate a liver after it’s gone into shock; we have active investigators looking at liver cancer and what are some of the molecular markers of cancer and how do we get to a more precise diagnosis about whether a cancer is going to have a good prognosis or a bad prognosis.
Host: So, this summer, you all reinvigorated the living liver transplant program. Can you talk about that a little please?
Dr. Levy: We did. So, in the United States, the vast majority of transplants are from deceased organ donors – people who have died whose loved ones have donated their organs. In other parts of the world, that technology is not as developed and so, live organ donation in which we take part of a liver from a healthy person and transplant it into the patient whose liver is ill is much more common elsewhere, in India, in Turkey, in Korea, for example. That’s a technology that I think is catching up in the United States to the rest of the world. It’s been around in America for quite some time, but the volumes have not been high for a number of good but complex reasons.
With the shortage of donor livers; I think many of us in the transplant world realize that to get people transplanted to save lives, we have to be able to do live liver donation as well.
Host: And so this summer, when you guys reinvigorated the program, what specifically changes in some ways did you make?
Dr. Levy: Well we imported expertise, actually. We brought some surgeons who had experience with hundreds of cases in other countries and brought them here and made sure that of course they had all the right credentials to practice in Virginia and in America and really asked them to apply what they had learned elsewhere and to apply that technology to our teams here in Richmond.
Host: So, tell me why it’s so important to have a live living donor.
Dr. Levy: Well the fundamentals are I think sadly that lots of folks who get on liver transplant waiting lists will die while they are waiting because they run out of time. There are simply not enough donor livers to go around from deceased organ donors. And in Virginia, for example, the chances of living to the point where you get a transplant once you’ve been placed on a wait list is only about 80%. So, one in five, or 20%, of the patients on the wait lists in Virginia will die before they can even get to transplant because of the shortage of donor organs.
There are various ways we can tackle that. We can try to improve the care of the patient who has a failed liver and see if we can limp them along, if you will, until they can get transplanted, or we can look to other sources of liver including live donor liver transplants.
Host: And who can donate a living liver?
Dr. Levy: Fundamentally, any healthy person. So, by healthy we mean somebody with no cancer, no diabetes, no heart disease, no kidney disease, high blood pressure is okay so long as it’s well-controlled. It’s typically a relative, not necessarily a blood relative. It can be a spouse but typically somebody who has strong emotional connections to the recipient and who feels the need to help them in this very unselfish way.
Host: And how long does it take the person who is donating a part of their liver to recover usually?
Dr. Levy: The length of stay in the hospital is fairly brief. It’s typically about five days or so maybe a little bit more or maybe a little bit less. I think that on average, folks are back to feeling pretty good after three to four weeks and back to pretty unrestricted physical activity after six to eight weeks. Everybody recovers at slightly different pace, but I think those are good guidelines.
Host: And their liver regenerates, right? It grows back to the regular size again?
Dr. Levy: The liver is an amazing organ. It regenerates very quickly typically within three to four weeks; the liver is back to its original size, which is remarkable.
Host: So, this summer, it is my understanding that you guys had a father and son that did a living donation and that was one of the first that you had done in quite a while.
Dr. Levy: We did. That worked out very well for both of them, and we were just pleased as could be for them.
Host: And can you tell me just a little bit more about that particular process?
Dr. Levy: By and large, I would say that their recovery went as expected. But they have been in our clinic now for several months and are really doing quite well. So, it’s been a good experience for them.
Host: Part of that reason is because you have such a patient-centered approach to this procedure?
Dr. Levy: We’re pretty obsessive. I think all centers in America who do live donor liver transplants, I think would say that they are pretty obsessive about safety first and making sure that there’s no shortcuts and that all the I’s are dotted, and the t’s are crossed. That’s absolutely right.
Host: And that includes in addition to everything else, emotional counseling for the patient and the donor?
Dr. Levy: Absolutely. Emotional counseling after the surgery and emotional screening ahead of the surgery to make sure that there’s nothing hidden, no secondary gain that we can identify, no coercion either on the part of the donor or the recipient. So, there’s a pretty thorough vetting process not just on the medical side but also on the psychological side and the social side.
Host: So, what else have I missed that you’d like to add about liver donations and live liver donations in particular?
Dr. Levy: Well I don’t think you’ve missed anything, but it’s a complex story. It’s an amazing gift for people to step forward and say yes go ahead and take out a piece of my liver even though they are a perfectly healthy individual and ostensibly not an operation that they need to undertake. There are some risks involved and so one has to go in eyes wide open. It’s major surgery and I would never want to give the impression that it’s to be taken lightly.
Host: But for someone suffering from cancer, this is a lifesaving procedure.
Dr. Levy: Yes. For the recipient, it’s transformational, obviously. It saves their life. Many donors find it transformational and find that it gives them really new insight and new appreciation for what we all go through. So, I think it’s important all around.
Host: Well thank you very much for letting us understand this procedure more. It’s a pleasure to talk to you.
Dr. Levy: Well thanks so much for your interest, Alyne. I really appreciate it.
Host: Dr. Marlon Levy is the Chair of the Division of Transplant Surgery and the Director of the Hume-Lee Transplant Center. For additional information about the Hume-Lee Transplant Center, visit www.vcuhealth.org. To listen to other podcasts from VCU Health, visit vcuhealth.org/podcast. This is Healthy with VCU Health. I’m Alyne Ellis. Thanks for listening.
What Goes Into a Liver Transplant and the Importance of Organ Donation
Alyne Ellis (Host): October is liver cancer and liver awareness month. To commemorate, we’ll learn more about this vital organ. The VCU Health Hume-Lee Transplant Center is unsurpassed in providing state-of-the-art care to patients needing a liver transplant. This is Healthy with VCU Health. I’m Alyne Ellis. Joining me to talk about why Hume-Lee is so successful at these surgeries is Dr. Marlon Levy, the Director of the Hume-Lee Transplant Center. So, Dr. Levy what are the many causes that lead to an organ transplant?
Marlon Levy, MD, FACS (Guest): Well I can give you a short list. The fundamentals are that transplant teams recommend transplant when it’s felt that the existing liver, you know the one that patients have, is not going to lead to long-term survival for them. So, that can come from any number of illnesses including hepatitis C that leads to cirrhosis, including liver cancers, including diseases such as sclerosing cholangitis or biliary cirrhosis, including in some cases, long-term alcohol use. But the fundamentals are that when the data tells us that patients are more likely to survive with a new liver than with the one that they have; then that’s when teams would recommend essentially swapping the livers our or what we call a transplant.
Host: So, this place has a real history of innovation, and it’s my understanding that VCU Health Hume-Lee Transplant Center has really positioned itself to treat complex patients with liver issues and liver donation issues.
Dr. Levy: It really has. So, we’re one of the oldest transplant centers in the world established by our namesake, David Hume, in the late 1950s. We started with kidney transplant because that was state-of-the-art over 60 years ago, and then when the technology evolved, liver transplants became a reality; then of course we became part of that as well. And we’ve recently refocused our efforts on liver transplantation to include live liver donation, to include some sophisticated, very futuristic ways of preserving the liver between the donor and the recipient, so that the liver is as healthy as possible when we do the transplant.
Host: And I understand you are one of the few in the nation to do bile duct cancer liver issues and deal with that?
Dr. Levy: We are. Bile duct cancer in our world, in our community, in transplant, the transplants for bile duct cancer has waxed and waned over the years. There was initially enthusiasm and then the results weren’t that good so then centers would not transplant for a while for bile duct cancer. But then under some strict protocols of radiation therapy, chemotherapy and very close surveillance, I think the community moved us slowly back towards it. And we, I think, are at the forefront of a few centers in the United States where that’s our approach. We have a multidisciplinary team that looks very closely at patients with bile duct cancer and when it seems that a best outcome is going to be with liver transplant; then that’s what we do.
Host: And you also do quite a bit of research on liver transplantation.
Dr. Levy: We do. We have active labs in liver preservation, in how to resuscitate a liver after it’s gone into shock; we have active investigators looking at liver cancer and what are some of the molecular markers of cancer and how do we get to a more precise diagnosis about whether a cancer is going to have a good prognosis or a bad prognosis.
Host: So, this summer, you all reinvigorated the living liver transplant program. Can you talk about that a little please?
Dr. Levy: We did. So, in the United States, the vast majority of transplants are from deceased organ donors – people who have died whose loved ones have donated their organs. In other parts of the world, that technology is not as developed and so, live organ donation in which we take part of a liver from a healthy person and transplant it into the patient whose liver is ill is much more common elsewhere, in India, in Turkey, in Korea, for example. That’s a technology that I think is catching up in the United States to the rest of the world. It’s been around in America for quite some time, but the volumes have not been high for a number of good but complex reasons.
With the shortage of donor livers; I think many of us in the transplant world realize that to get people transplanted to save lives, we have to be able to do live liver donation as well.
Host: And so this summer, when you guys reinvigorated the program, what specifically changes in some ways did you make?
Dr. Levy: Well we imported expertise, actually. We brought some surgeons who had experience with hundreds of cases in other countries and brought them here and made sure that of course they had all the right credentials to practice in Virginia and in America and really asked them to apply what they had learned elsewhere and to apply that technology to our teams here in Richmond.
Host: So, tell me why it’s so important to have a live living donor.
Dr. Levy: Well the fundamentals are I think sadly that lots of folks who get on liver transplant waiting lists will die while they are waiting because they run out of time. There are simply not enough donor livers to go around from deceased organ donors. And in Virginia, for example, the chances of living to the point where you get a transplant once you’ve been placed on a wait list is only about 80%. So, one in five, or 20%, of the patients on the wait lists in Virginia will die before they can even get to transplant because of the shortage of donor organs.
There are various ways we can tackle that. We can try to improve the care of the patient who has a failed liver and see if we can limp them along, if you will, until they can get transplanted, or we can look to other sources of liver including live donor liver transplants.
Host: And who can donate a living liver?
Dr. Levy: Fundamentally, any healthy person. So, by healthy we mean somebody with no cancer, no diabetes, no heart disease, no kidney disease, high blood pressure is okay so long as it’s well-controlled. It’s typically a relative, not necessarily a blood relative. It can be a spouse but typically somebody who has strong emotional connections to the recipient and who feels the need to help them in this very unselfish way.
Host: And how long does it take the person who is donating a part of their liver to recover usually?
Dr. Levy: The length of stay in the hospital is fairly brief. It’s typically about five days or so maybe a little bit more or maybe a little bit less. I think that on average, folks are back to feeling pretty good after three to four weeks and back to pretty unrestricted physical activity after six to eight weeks. Everybody recovers at slightly different pace, but I think those are good guidelines.
Host: And their liver regenerates, right? It grows back to the regular size again?
Dr. Levy: The liver is an amazing organ. It regenerates very quickly typically within three to four weeks; the liver is back to its original size, which is remarkable.
Host: So, this summer, it is my understanding that you guys had a father and son that did a living donation and that was one of the first that you had done in quite a while.
Dr. Levy: We did. That worked out very well for both of them, and we were just pleased as could be for them.
Host: And can you tell me just a little bit more about that particular process?
Dr. Levy: By and large, I would say that their recovery went as expected. But they have been in our clinic now for several months and are really doing quite well. So, it’s been a good experience for them.
Host: Part of that reason is because you have such a patient-centered approach to this procedure?
Dr. Levy: We’re pretty obsessive. I think all centers in America who do live donor liver transplants, I think would say that they are pretty obsessive about safety first and making sure that there’s no shortcuts and that all the I’s are dotted, and the t’s are crossed. That’s absolutely right.
Host: And that includes in addition to everything else, emotional counseling for the patient and the donor?
Dr. Levy: Absolutely. Emotional counseling after the surgery and emotional screening ahead of the surgery to make sure that there’s nothing hidden, no secondary gain that we can identify, no coercion either on the part of the donor or the recipient. So, there’s a pretty thorough vetting process not just on the medical side but also on the psychological side and the social side.
Host: So, what else have I missed that you’d like to add about liver donations and live liver donations in particular?
Dr. Levy: Well I don’t think you’ve missed anything, but it’s a complex story. It’s an amazing gift for people to step forward and say yes go ahead and take out a piece of my liver even though they are a perfectly healthy individual and ostensibly not an operation that they need to undertake. There are some risks involved and so one has to go in eyes wide open. It’s major surgery and I would never want to give the impression that it’s to be taken lightly.
Host: But for someone suffering from cancer, this is a lifesaving procedure.
Dr. Levy: Yes. For the recipient, it’s transformational, obviously. It saves their life. Many donors find it transformational and find that it gives them really new insight and new appreciation for what we all go through. So, I think it’s important all around.
Host: Well thank you very much for letting us understand this procedure more. It’s a pleasure to talk to you.
Dr. Levy: Well thanks so much for your interest, Alyne. I really appreciate it.
Host: Dr. Marlon Levy is the Chair of the Division of Transplant Surgery and the Director of the Hume-Lee Transplant Center. For additional information about the Hume-Lee Transplant Center, visit www.vcuhealth.org. To listen to other podcasts from VCU Health, visit vcuhealth.org/podcast. This is Healthy with VCU Health. I’m Alyne Ellis. Thanks for listening.