Online Health Chat with K.V. Narayanan Menon, MD & Donna Ferchill, RN, BSN

July 20, 2017


Description

Liver transplantation is considered when the liver no longer functions adequately and the benefits of transplantation outweigh the risk of alternative modalities. There are many indications for liver transplant ranging from acute infections to long-term conditions resulting in liver failure. These conditions include chronic hepatitis, liver cancer, sclerosing cholangitis, alcoholism and many others.

A comprehensive evaluation is required to determine eligibility for transplant. Options for transplant include standard cadaveric transplant or living donor transplant, where a piece of a healthy liver from a living person is transplanted into the recipient. Living donor liver transplantation requires additional considerations and assessments, but also offers additional advantages such as avoiding prolonged waiting periods on the national donor list.

Cleveland Clinic has more than 30 years of experience in liver transplantation. Our program performs approximately 150 liver transplants per year and offers options for both adult and pediatric liver patients. Our living donor liver transplant program is the only one in the state of Ohio performing both adult and pediatric living donor liver transplants.
 
Our multidisciplinary team unites experts in all areas of liver disease to participate in the evaluation, management, treatment and follow up of liver transplant patients, as our expert hepatologists work hand-in-hand with our surgery team to manage care. Cleveland Clinic’s liver transplant program is a member of the Ohio Solid Organ Transplant Consortium (OSOTC) and the United Network for Organ Sharing (UNOS), meeting all their requirements for liver transplant. Our program is approved by Medicare for liver transplant and also has OPTN/UNOS full approval for live liver donation.


About the Speaker

K.V. Narayanan Menon, MD is the medical director of liver transplantation in the Department of Gastroenterology and Hepatology at Cleveland Clinic. Dr. Menon has completed subspecialty training in advanced endoscopy and hepatology. He is an assistant professor of medicine at Cleveland Clinic College of Medicine of Case Western Reserve University. Dr. Menon’s specialty interests include liver transplantation, liver and bile duct cancer, advanced endoscopy and advanced liver disease.
 
Donna Ferchill, RN, BSN is the clinical nurse manager for the Adult and Pediatric Liver Transplant Program and the Living Donor Liver Transplant Program at Cleveland Clinic. Donna is a current member of Liver Transplant QAPI and the Donor Advocacy Team. She is a member of NATCO and ITNS as well as an elected member of the UNOS Transplant Coordinators Committee (TCC), which she has been since 2015. She also serves on work groups within the TCC.


Let’s Chat About Liver Transplantation

Living Donor Limits

MitchScHnug: How safe is it to be a living donor? Have living donors died as a result of the donation procedure?

Donna_Ferchill,_RN,_BSN: There are risks associated with being a living donor, including a risk of death that ranges from 0.2 percent to 0.6 percent depending on the lobe that is donated. The right lobe is larger, so it carries more risk. There have been no donor deaths at Cleveland Clinic.

MitchScHnug: Does a living donor have to pay any money for the procedure?

Donna_Ferchill,_RN,_BSN: No. The living donor evaluation, surgery and post-operative care is all billed to the recipient’s insurance. There may be costs for the donor that include travel, lodging and lost wages.

Frigiamo58: What are the types of living donor transplants?

Donna_Ferchill,_RN,_BSN: At Cleveland Clinic, we perform both living liver and kidney donor transplants.

FrankD: Does being overweight affect a person’s ability to donate their liver?

Donna_Ferchill,_RN,_BSN: Yes. We require potential donors to have a BMI (body mass index) of less than 30. If it is more than 30, we will evaluate the donor but will need to do a liver biopsy to rule out a fatty liver.

Nursept214: Does making a living donation affect my future insurability? What about the recipient?
 
Donna_Ferchill,_RN,_BSN: We have the potential donor discuss this with their insurance company. This has not been an issue with our previous donors. No donors have lost their insurance. The recipient needs to have living donor liver transplant benefits on their insurance plan.


Evaluation and Operation

BettySrnick: How long does a typical liver transplant take?

Donna_Ferchill,_RN,_BSN: The surgery can last approximately eight to 12 hours.

Biliaryatresia2014: What factors should be considered when thinking about living versus cadaver donors? Is there one surgery you prefer over the other? Also, if a child has to have a liver transplant early in life, what are their chances that they will have to have another one later?

Donna_Ferchill,_RN,_BSN: When considering a living donor, the potential recipient must be evaluated and listed at our transplant center. Depending on how sick a patient is, receiving a living donor will happen faster compared to waiting on the national waiting list. As a living donor is being evaluated, the recipient remains active on the waiting list and is still eligible to receive a cadaver organ. There is a small possibility that a child will need a re-transplant for recurrent disease or rejection.

Hannah: How long does it take to be evaluated for a liver transplant?

Donna_Ferchill,_RN,_BSN: The evaluation for a liver transplant takes place over four to five days.

Biliaryatresia2014: We have already been told by Pittsburgh Children's that my grandson is not ready for a transplant. His spleen is getting bigger all the time. He has biliary atresia and is 2½ . Do they ever remove the spleen prior to liver transplant?

K.V._Narayanan_Menon,_MD.: They generally do not remove the spleen prior to liver transplantation. If you are interested in a consult at Cleveland Clinic Transplant Center, please call 216.444. 1976, option 1.

Mark45: Are liver transplant evaluations only done at the Cleveland location?

K.V._Narayanan_Menon,_MD.: Most evaluations are down at our downtown campus in Cleveland. We are, however, in the process of starting transplant clinics at our Avon location and also in Akron.

CompareTransplantCenters: If multi-listing, do you take the test results of the first transplant hospital? How long does that evaluation last?

K.V._Narayanan_Menon,_MD.: Yes. We take most of the results from the first transplant hospital, but we elect to do the most important tests here, such as cardiac stress testing. The testing generally is valid for one year and will take one to two days to complete if you decide to come to Cleveland Clinic for double listing.


Questioning Qualifications

Hannah: How long do people wait to receive a liver transplant?

K.V._Narayanan_Menon,_MD.: Livers are allocated based on patients’ MELD score. Typically, with a MELD score around 22, a patient will wait approximately six months. It also depends on the patient’s blood type.

Hannah: Can anyone receive a living donor transplant?

Donna_Ferchill,_RN,_BSN: If you are a candidate to receive a transplant at our center, then you are a candidate to receive a living donor transplant. Some patients may not qualify for a living donor transplant if they have had a transplant in the past or have anatomical problems that would preclude LDLT.

CompareTransplantCenters: How far away is it acceptable to be and still be on the transplant list? Where do most people stay if they’re from out-of-town? How long must you stay locally post-transplant?

Donna_Ferchill,_RN,_BSN: We have many patients that are listed for a liver transplant that do not live locally. Many of these patients live in another state. Once you receive a liver transplant, you are required to stay within one hour of the main hospital for approximately eight to 12 weeks. We offer transplant rates at the Intercontinental Hotel, Intercontinental Suites and our Transplant House.


Reset and Recovery

jasmine1963: When receiving a portion of the liver, how long does it take for the liver to regenerate?
 
Donna_Ferchill,_RN,_BSN: It can take approximately four to six weeks for the liver to regenerate.

Nursept214: What are some things to worry about after receiving an organ donation?

K.V._Narayanan_Menon,_MD.: In the short term, you should be careful about infections. In the long term, there is a slight increased risk of cancer, which will require surveillance.

FrankD: What is the recovery time for a liver recipient?
 
K.V._Narayanan_Menon,_MD.: Generally, they stay in the hospital for one week to 10 days. They can return to work after two to three months, depending on the type of activity. People in desk jobs can start working a few weeks following their transplant.

Sallywer1: When will I be able to drive after the transplantation?

Donna_Ferchill,_RN,_BSN: Typically, you can drive once you have stopped taking narcotics or approximately three weeks after transplant.

Stevest12: What is the recovery time for a living donor?

Donna_Ferchill,_RN,_BSN: Recovery time for a living donor is six to 12 weeks. There is a weight restriction of no lifting anything greater than 10 pounds for 12 weeks.


Life After Transplant

Nursept214: Is it safe for a women who has received a liver transplant to have a baby? What about a living donor, is it safe for the donor to have a baby?

K.V._Narayanan_Menon,_MD.: Yes. It is generally considered  safe to have babies after a liver transplant. However, it should be a planned event, working closely with a high-risk obstetrician and the transplant center. Living donors have no particular increased risk.

BettySrnick: Do recipients have to take medication for the rest of their lives?

K.V._Narayanan_Menon,_MD.: Generally, all liver transplant recipients have to take medications for the rest of their lives.

BettySrnick: Is it better to have a liver from a living donor rather than a deceased donor?

Donna_Ferchill,_RN,_BSN: Outcomes show that the survival rate is better when receiving a living donor liver transplant compared to receiving a deceased donor organ. There is national data available at www.srtr.org.

K.V._Narayanan_Menon,_MD. & Donna_Ferchill,_RN,_BSN: Thank you for participating in today's health chat. Cleveland Clinic is a Top 10 center for liver transplant. We are one of few centers in the country that performs living donor liver transplants. Our survival rate is comparable to the national average for both deceased and living donor liver transplants. If you are interested in being evaluated for a liver transplant or becoming a living donor, please contact the Transplant Office at 216.444.1976, option 1.


Closing

That is all the time we have for questions today. Thank you, Dr. Menon and Ms. Ferchill, for taking time to educate us about Liver Transplant and Organ Donation.

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 http://my.clevelandclinic.org.


For Appointments

To make an appointment with Dr. Menon or any of the other specialists in Cleveland Clinic’s Mikati Center for Liver Diseases, please call 216.444.7000, toll-free at 800.223.2273 (extension 4700) or visit us at clevelandclinic.org/liver for more information.
 
To discuss liver transplantation or living donor transplantation, call 216.444.1976, option 1, or visit clevelandclinic.org/livingdonation.

For More Information

Cleveland Clinic’s Liver Transplant Program has more than 30 years of experience and is one of the largest in the nation. Click the link below to learn more about the Liver Transplant Program.

About Cleveland Clinic
The Mikati Center for Liver Diseases, part of the Digestive Disease and Surgery Institute, offers experienced liver specialists to accurately diagnose and offer advanced treatments for all types of liver diseases. Established in 2013, the Mikati Center was made possible by a generous philanthropic gift of the Mikati family and is dedicated to sustaining and improving the lives of those with liver diseases through advances in research, innovation and education. The center unites all of the necessary specialists in one setting and helps create individualized treatment plans that are best for patients.

Cleveland Clinic’s Liver Transplant Program is an essential component of broad and medical surgical strategy to manage all patients with liver disease with the most appropriate therapy. Our Liver Transplant Program has performed more than 1,200 liver transplants since 1984 and has been recognized by outside professional groups for its growing volume and excellent patient outcomes.

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