Online Health Chat with Kareem Abu-Elmagd, MD, PhD and Julia Plescia, BSN

April 29, 2016


Description

Every 10 minutes, a new name is added to the national waiting list for various organ transplants. Do you have questions about transplantation issues or organ donation? Do you know anyone who is an organ donor or recipient? What is the role of a transplant center and organ procurement agency?


About the Speakers

Kareem Abu-Elmagd, MD, PhD, is the director of Cleveland Clinic’s Transplant Center and program director of the intestinal transplant program in the Cleveland Clinic Digestive Disease Institute. Dr. Abu-Elmagd has earned an international reputation for significant clinical and technical contributions to the fields of intestinal, liver and multivisceral transplantation.

Dr. Abu-Elmagd completed his fellowship in transplantation and residency in general surgery at University of Pittsburgh Medical Center in Pittsburgh. He is board certified in surgery. He received doctorate degrees from both Emory University School of Medicine in Atlanta and Mansoura University School of Medicine in Mansoura, Egypt. Dr. Abu-Elmagd completed a research fellowship in surgery at Emory University School of Medicine and one in pathology at Wayne State University in Detroit. He completed surgery residencies at Mansoura University Hospital and Hurghada General Hospital in Egypt. Dr. Abu-Elmagd completed medical school at Mansoura University School of Medicine.

Julia Plescia, BSN, earned her Bachelor of Science in Nursing from Ohio University in 2011. In 2006, she joined Cleveland Clinic and took on a variety of roles related to donor coordination. Last year, she became a preservation clinical manager for Lifebanc.


Let’s Chat About Organ Transplantation


Aiming for Eligibility

WaveWolf: I have a biopsy-proven diagnosis of multisystemic sarcoidosis, including severe neurological involvement. Does this prevent me from being able to donate organs or tissues such as skin and eyes? Because I am moving to a continuing care facility, I must make decisions about and provisions for my remains now. Ideally, I would like to donate what I can and leave the rest for medical study. However, medical schools want whole body donations, which I will do if I am not a candidate for donation to living recipients.

Kareem_Abu-Elmagd,_MD,_PhD: Thank you for your kindness in trying to help another human being. Your sarcoidosis should not be a problem as long as your organs are working well. I would encourage to you to be a potential donor, and the physicians and surgeons can decide on the use of your organs at the time of surgery. As a matter of fact, the use of your organs may resolve the sarcoidosis in the new recipient.

BSUgrad: I am interested in organ donation, but feel that I would not be a candidate for this. I was diagnosed with lupus in 1973, so I feel that my organs would not be suitable to donate. I am also concerned about putting this extra burden on my family at the time of my passing. I am looking forward to hearing more about the process during the health chat.

Julia_Plescia,_BSN: Thank you. With your diagnosis, you may still have the potential to help others through the gift of donation. At the time of your passing, your medical history will be reviewed to make sure you have the potential to be a donor prior to approaching your family with this option. The best advice is to let your family know now that you would be interested in being a donor should this be an option.

crystalclear: Can I donate organs if I have SLE (systemic lupus erythematosus)? Right now, the only organs that are affected are my kidneys. A recent kidney biopsy showed that I have "thin basement membrane".

Kareem_Abu-Elmagd,_MD,_PhD: Yes you can donate, as long as your organs are still functioning well.


Organ Opportunities

GrannyG: What organs can be donated while I'm alive?

Kareem_Abu-Elmagd,_MD,_PhD: You can donate one of your kidneys and part of your liver. Occasionally, a segment of the lung can be used.

ASandholm: How long are tissues from a donor viable for transplant, and what is done after that time expires?

Julia_Plescia,_BSN: Organs, tissues and eyes all have different time frames that determine viability. The viability for organs is much shorter than for tissues and eyes. If the time has expired, the tissues may be used for education and research with prior consent. If the family/donor has not consented for research/education, or if the tissue is not able to be used for research/education, the tissues would be discarded.

GrannyG: What health conditions can prevent you from becoming an organ donor?

Kareem_Abu-Elmagd,_MD,_PhD: There is no universal list of reasons to prevent you from being an organ donor. The function of each organ at the time of death will determine if your organs can be used or not. If cancer is the cause of death, the deceased's organs may not be eligible for transplant.

WaveWolf: I desire to set up organ donation ahead of my death because I have no one to oversee this at time of death. How can I find out what programs will use what is usable and give the rest to researchers? My greatest hope is to donate healthy corneas or whole eye, any organ not affected with sarcoidosis, skin for burn patients, blood vessels for those with PAD/PVD, etc., and then have my brain and spinal cord studied for any contribution that can be made to the understanding of neurosarcoidosis. One of my concerns is arranging for my body to arrive in a timely fashion to the right location. How can this be set up in advance? I live in Lancaster, Pennsylvania. Do I speak with the local medical center and try to coordinate with a medical/research center receiving donation? Do I request whole body donation or organ donation?

Julia_Plescia,_BSN: In Ohio, if you register to be an organ/tissue and eye donor prior to death, this gives consent to move forward with donation should you be a candidate at the time of your death. The candidacy of donation is not something that is done in advance, as much can change with the body that may determine whether or not you may donate upon your death. You may reach out to a local hospital to see if they have whole body donation, as this is something that can be arranged prior to death. Most whole body programs will allow for organ/tissue and eye donation to occur prior to a whole body donation.

WaveWolf: There are companies that advertise "no cost" donation programs to organ/whole body donors. They sell tissues to researchers. Are these an honorable choice? I would rather work with established medical/research institutions, but I am having trouble identifying a process to make arrangements in advance.

Julia_Plescia,_BSN: There is no cost to be an organ, tissue or eye donor through your local organ procurement organization. Organ procurement organizations also do not sell tissues. The best advice I can provide to determine what medical/research institutions have research programs is to start with your large local hospital systems that may be training/education hospitals.


Donors and Recipients

LadyA: How do you decide which patients get organs when a potential donor dies?

Kareem_Abu-Elmagd,_MD,_PhD: Patients who need organs are on a national list called UNOS (United Network for Organ Sharing). Each organ has certain regulations for distribution across the country. The government and the transplant community aim to maximize utilization of organs with better outcomes in the recipients. Overall, the organs are usually given to the sickest patients. Concerning matching, there is a battery of tests – including a blood type and HLA (human leukocyte antigen) test – that will determine the best match between the donor and the recipient.

mjd572: Please forgive me, as my question is not a medical one per se, but something that I hope brings comfort to me and others. Organ and tissue transplants are true miracles, allowing hope where there was once none. But in order for a family to feel that elation that a donor has been found, another family must experience tremendous loss and grief. My son donated his heart, kidneys, liver, pancreas, eyes, tissue and more a little more than a year ago. He was just 23. What I need to know is that before the harvesting of organs begins, is there a moment of silence or any recognition for the donor? Thank you, a grieving parent.

Julia_Plescia,_BSN: Thank you for this question, and thank you for your generous decision to give the gift of life when you lost your son. You have my condolences for your loss. Yes, we most certainly provide a moment of silence for all of our donors prior to the recovery of organs, tissues and eyes. I would like to share the moment of honor that we read:

"Today we share a common space and join in a common cause. Through the caring touch of our hearts and hands, we join our efforts to care for _______ and for all who benefit from this gift of life. For all the children, grandchildren, friends and family who are touched by what we do here today, may we remember that fresh hopes and dreams began with the gift of this one person. May we take a moment in silence now to honor the life of ________."

Thank you again for giving the gift of life.

Jer0Bear: For my transplant, do I have a choice whether an organ donor is living or deceased?

Kareem_Abu-Elmagd,_MD,_PhD: Yes you do. If you have a live donor that matches you, then the transplant physicians and surgeons will help you coordinate the transplant. If you don't have a live donor, then you'll be waiting on the UNOS list until a suitable organ from a deceased donor is available. If you need a kidney transplant and you have a live donor that does not match with you, there is a national program called Paired Kidney Donation in which the donors' organs can be switched to match (i.e., your potential donor can give the kidney to another person and their donor can give a kidney to you).

jfoggs: What happens during an initial evaluation of a living organ donor?

Kareem_Abu-Elmagd,_MD,_PhD: Once a potential living donor notifies the transplant center to inform them that they would like to be a living donor, the living donor evaluation will start. The living donor will be called to screen some medical information and will be sent to make certain that they have a compatible blood type with the intended recipient. Once initial screening is completed, appointments will be arranged to start an in-person evaluation. The living donor will need to meet with a transplant coordinator, physician team, surgical team, social work and any other personnel that are required to make a determination of whether the living donor is a candidate for the donation.

jfogg: Can I be an organ and tissue donor and also donate my body to medical science?

Julia_Plescia,_BSN: Yes, this is possible. Most whole body donation programs will work with donors and donor families to allow for organ/tissue/eye donation prior to whole body donation. Some whole body donation programs require registration for this type of donation prior to death. Some whole body programs may have restrictions on tissue donation prior to whole body donation.


Team Players

jamama: I heard the 2016 Transplant Games will be held in Cleveland, Ohio this year. What are the Transplant Games and how is Cleveland Clinic involved?

Kareem_Abu-Elmagd,_MD,_PhD: The Donate Life Transplant Games bring together recipients, living donors, donor families and health professionals to celebrate the success of transplantation; honor the lasting legacy of donors; provide hope to those who continue to wait; and promote donor registration. Cleveland Clinic is a proud sponsor of the Transplant Games and will be providing medical care for the athletes, educational sessions and events before and throughout the games from June 10 to 15, 2016. To learn more, visit clevelandclinic.org/transplantgames.

Mayba1967: How can I choose a hospital with a great transplant program? What should I look for?

Kareem_Abu-Elmagd,_MD,_PhD: You should look for transplant programs with large volume and good outcomes. Most of this information is available for the public through the UNOS and SRTR (Scientific Registry of Transplant Recipients) websites.

ksunny: What is Lifebanc's role in organ donation/transplant?

Julia_Plescia,_BSN: Lifebanc is the organ procurement organization (OPO) that coordinates the organ, tissue and eye donation process. Lifebanc is the OPO that covers the Cleveland area. OPOs throughout the country are assigned to certain areas. Lifebanc identifies potential donors and, when appropriate, will reach out to the donor registry or the next-of-kin to move forward with the donation process. Lifebanc offers organs to transplant centers that identify recipients, and will then coordinate the organ, tissue and eye recovery. We also offer bereavement services for our donor families and educate the public about the need for donation.

BSUgrad: Does the size of the hospital make a difference in the success of the organ donation? Are all hospitals equipped to follow the wishes of organ donors?

Julia_Plescia,_BSN: The size of the hospital does not make a difference in the outcome of organ donation. Larger hospitals, or hospitals that experience higher volumes of trauma, may be more familiar with caring for the organ donor. Regardless, the organ procurement organization educates all hospital staff to prepare them for the organ donation process in all donor cases.


Life After Transplant

ladyA: After a transplant, what follow-up exams and tests will I need? How often?

Kareem_Abu-Elmagd,_MD,_PhD: The follow-up after transplant is guided by the type of organ that the recipient received. Each organ dictates certain routine blood test to analyze immune suppression and the function of the organ. The major concern early after the transplant is rejection. Later, physicians will look at any side effects of immune suppression. The recipients of intestine and lung transplants need closer follow-up than those with liver, kidney and pancreas transplants. In general, patients are seen more frequently during the first few months of transplant and every six months to a year thereafter.

Jer0Bear: Are there any major lifestyle changes after having a transplant?

Kareem_Abu-Elmagd,_MD,_PhD: If you are sick and you need a transplant, your quality of life will improve significantly after transplant. There are usually no major restrictions in your lifestyle as long as the organ you received is working well. However, extra cautions may be taken to avoid infections since your immune system is compromised by anti-rejection medications.

ASandholm: What types of consequences does someone with a kidney transplant face by drinking six or more 24 oz. bottles of diet soda each day?

Kareem_Abu-Elmagd,_MD,_PhD: Drinking that much soda (even diet) is not recommended, because it can cause dehydration and affect your kidney function. Try to replace the soda you drink with water. You should consult with your transplant physician if you need further information.


Cleveland Clinic Specific

tara0281: Other than Cleveland, are there any other locations that Cleveland Clinic performs transplants?

Kareem_Abu-Elmagd,_MD,_PhD: Yes. Cleveland Clinic Florida’s Transplant Center is one of the leading institutes for heart, liver and kidney transplantation in South Florida. Florida’s center brings more than 50 years of experience in transplantation. We also have affiliated programs in West Virginia (for kidney transplants) and Indiana (for kidney and pancreas transplants).

volley5girl: Does Cleveland Clinic have a living donor program?

Kareem_Abu-Elmagd,_MD,_PhD: Yes. Cleveland Clinic has a kidney living donor program and a liver living donor program. Cleveland Clinic’s living donor liver program is the only one in Ohio performing both adult and pediatric living donor liver transplants.

In 2013, Cleveland Clinic’s kidney transplant program marked the 50th Anniversary of their first kidney transplant. Cleveland Clinic performed Ohio’s first kidney transplant in January 1963. During that same year, Cleveland Clinic also launched its pediatric kidney transplant program.

GrannyG: Does Cleveland Clinic do organ transplants for children?

Kareem_Abu-Elmagd,_MD,_PhD: Yes. Cleveland Clinic has been performing organ transplants for children since 1971 at Cleveland Clinic Children’s. Due to our world-class physicians and a multidisciplinary approach, we are capable of performing transplants in a number of specialty focused areas, such as bone, bone marrow, cornea, heart, intestine/small bowel, kidney, liver, lung and medical generics. In 2015, Cleveland Clinic performed 22 pediatric solid organ transplants.


Closing

That is all the time we have for questions today. Thank you, Dr. Abu-Elmagd and Julia Plescia, for taking time to educate us about organ transplantation.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at my.clevelandclinic.org.


For Appointments

To find a transplant specialist for your needs, contact the Cleveland Clinic Transplant Center at 216.444.2394 (or toll-free 800.223.2273, ext. 42394) or visit us at clevelandclinic.org/transplant for more information.


For More Information

Cleveland Clinic

Cleveland Clinic's Transplant Center is a national leader in transplantation, recently performing the nation’s first uterus transplant. Our program also performs bone and soft tissue transplants, bone marrow transplants, heart transplants, lung transplants, corneal transplants, kidney transplants, pancreas transplants, intestinal transplants, liver transplants and more. The recruitment of exceptional transplant specialists and scientists, combined with technical innovation and cutting-edge research, has made Cleveland Clinic one of the world's most comprehensive transplant centers. More information about the Transplant Center can be found at www.clevelandclinic.org/transplant.

Cleveland Clinic’s partnership with Lifebanc provides life-saving organs to transplant patients and a strengthened commitment to educating communities on the importance of organ donation.

Cleveland Clinic Health Information

Learn more about organ transplantation.

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