What To Know About Organ Donation

Podcast Transcript

Scott Steele: Butts & Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end-to-end.

Hi again everybody and welcome to another episode of Butts & Guts. I'm your host Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. Today I'm very pleased to have Dr. Charles Miller who is Cleveland Clinic's Enterprise Director of Transplantation. We're going to talk a little bit about what to know about organ donation. Charlie, thanks for joining us on Butts & Guts.

Charles Miller: Well, thanks, Scott, a pleasure to be here.

Scott Steele: So as all of my listeners know out there that we always like to start with a little bit of background about you. So tell us a little about yourself, where you're from, where'd you train and how did you come to the point that you're here at the Cleveland Clinic.

Charles Miller: I had all of my medical training in New York at Mt. Sinai Hospital, Mt. Sinai Medical School, Mt. Sinai Hospital where I became ... a unit where I did a surgical residency in a vascular surgery fellowship and then I couldn't decide what to do with my life and Mt. Sinai made me offer I couldn't refuse and sent me to Pittsburgh for a year to learn how to do liver transplantation.

So I came back after about a year in 1986 and did the first liver transplant in New York and got a program going there for about I guess a decade and a half and then we built a really nice thing. We made a transplant institute. And then I got an offer from the Cleveland Clinic that I couldn't turn down. So I came to the Cleveland Clinic to build up the liver transplant program here and then ultimately the entire enterprise across all the sites in Cleveland, Florida and Abu Dhabi.

Scott Steele: Well I can honestly say that we are a much better organization because of that decision so thank you for that. So let's start very high level and I would just like to recommend to all of our listeners, go take a look at one of our previous episodes on one of our Butts & Guts podcasts with Dr. Anil Vaidya for more information on this topic.

But really, when is transplant recommended or required for that aspect and what types of organ transplants are there? What can we actually transplant?

Charles Miller: Well, we can transplant a lot of things, Scott, and basically transplantation is the last vestige of care for patients with end stage organ failure. So if you have end stage kidney failure, you're on dialysis, you have can have a kidney transplant. You have end stage cirrhosis or liver failure, a liver transplant. If you have heart failure or a heart transplant or an LVAD now, a left ventricular assist device, and on and on.

The routine solid organ transplants are heart, lung, liver, pancreas, kidney, intestine or multi-visceral and now we're doing also something called vascularized composite allografts, which consists of uterine transplant for people that ... mostly people who were born without uteri so they can have babies and limb transplants and face transplants. So those are the vascular composite allografts. We do the entire spectrum at the Cleveland Clinic.

Scott Steele: So I know this depends on the type of organ but just in general can you give a rough ballpark for how many transplants are done or needed a year in the U.S. and are there enough donors out there to meet the demand?

Charles Miller: So we do I think 50,000 or 60,000 kidney transplants a year but the waiting list is twice or three times that. About 8,000 or 9,000 liver transplants, but again the list is twice that. It's the same for every organ. The demand far exceeds the supply and so there's not enough. And so for some of the organs we can use living donors for kidneys and livers but for other ones you really have to rely on donors ... for organs from deceased donors who die basically from brain death or sometimes from very, very concurrent cardiac death.

Scott Steele: So I know there's probably a bucket of reasons for things but what are some generalized reasons why there's a shortage of organs to donate? Is it a problem that people ... I mean, I always see the license plates that have a sticker, donate for life, or you see that the old licenses that would say check if you're an organ donor. Do people really actually look at those type of things? Why is there a shortage out there?

Charles Miller: For years and years there was no organized way of identifying yourself to be an organ donor. Now that's better. In Ohio, you can check something on your license. It goes into a database and so people could actually know what your wishes were. Now if you don't have wishes and we rely on the family then the family has to make that decision for you and that can be complicated for certain families. It's always good to make a decision, talk about it with your family and then check your organ donor card or check the donor registries.

I think the other thing is you're a victim of your own success. As transplants for all these organs have achieved very high levels of success the demand has grown and it's been hard to keep the supply up with the demand. There are organ procurement organizations across this country, about 70 of them, and I think in general they work very hard but they're always playing catch up. So it's a difficult thing and I'm not ... and I think the national structure of the organ procurement organizations could be more robust, less punitive and more supportive. That's a complex question.

Scott Steele: Yeah, I'm sure it is. Just in very basic terms for those who don't know or have a little bit, maybe they already have their license, how does one register to be an organ donor?

Charles Miller: Oh, so really in Ohio when you go to sign up for your driver's license they will ask you, "Do you want to be an organ donor?" There's a place to check right there. Now, it's very important for the people that are asking the questions to have some knowledge and they've become more knowledgeable across the board.

There are also numbers of national websites where you can just make your designation known and you can always go ... most importantly, Scott, every community in this country is associated with an organ procurement organization. Here in Cleveland it's called Life Bank. You can always call your organ procurement organization and they will guide you through the process and be happy to do it.

Scott Steele: So are there restrictions to being an organ donor, for example if I'd had a history of cancer or could it be things like health or your age or race or gender? I mean, are there restrictions that go about this?

Charles Miller: Well, there are really very few, to be honest with you. Obviously, if you have severe end stage cancer that would be problematic. If you have a severe sepsis or infection that would be problematic. Age is very relative and some organs like the liver don't age as some of the other organs do. So there are age criteria but they're somewhat loose and it's more physiologic than chronologic.

I think the most important thing is you can be an organ donor and then a group of experts will decide whether or not you're a general organ donor or if any of the organs could be used. So sometimes you can only use the liver and the kidneys, let’s say. But other times maybe in younger you can use the heart, the lungs, the kidneys, the liver, the pancreas, everything.

Scott Steele: So a little segment we like to call Truth or Myth. So truth-

Charles Miller: What's it called?

Scott Steele: Truth or Myth.

Charles Miller: Okay.

Scott Steele: So Truth or Myth: only certain type of organs can be donated from a living person and others require the donor to be deceased?

Charles Miller: Truth. So you can donate one of your two kidneys, easily if you're alive, if you're a living donor and you can donate half of your liver if you're a living donor. If you're a heart donor you really can't. You can donate a small portion of one your lungs but it's very, very uncommon and you can donate your uterus once you're finished using it. And so a lot of women have donated their uterus to their daughters who were born without them. Fascinating-

Scott Steele: [crosstalk 00:08:49] That's very interesting. So second Truth or Myth, if I donate an organ I will have health problems in the future.

Charles Miller: It is the principle to take an organ or a part of an organ from a live donor trying to best ensure that is not true. You can never be 100% but the idea is to choose healthy people that will ... the liver will regenerate their liver to full function very quickly or in the kidney, one kidney will suffice. Those are two basic things so the answer should be no 99.9% of the time.

Scott Steele: So looking ahead, I know this is a complex field that just really brings home basic science or translational science to the bedside and pharmacology and the immunology, it's incredibly fascinating but what is on the horizon as far as research in organ transplantation that is essentially going to have better outcomes ... As you said we've had some wonderful successes. We've been able to expand the field for what we donate and receive but what do you feel is on the horizon or what's the hot topics right now?

Charles Miller: So one of the things in the supply and demand equation you asked about before, there are no perfect guidelines for what a good organ is and so sometimes people will not use the organs because they're worried that it may not work well on the recipient and so one of the things that we're doing is that we're developing profusion techniques which we're using in the liver and the lung that allow for organ resuscitation.

The organ is taken out, put on a blood pump and then pumped with oxygenated [profusa 00:10:32] for a while. We can actually make the organs better and then transplant them. So a lot of organs that would have been discarded can now be used safely and that increases the supply. So that's a big area of research.

I think making living donors safer and safer to answer the question of patient safety, that's key and I know that you just had a podcast with Dr. Vaidya. You just said. I'll bet he spoke something about stem cells and transplantation and inhibiting inflammation. I'm not sure he did but that's an area he's very, very interested in and we're interested in at the clinic. There have been some amazing early successes in turning around rejection using stem cell therapy.

Scott Steele: So for those who listen, I always like to get our guests a little bit to know them better so a couple of quick hitters to round up. First of all, what is your favorite food?

Charles Miller: My favorite food?

Scott Steele: Yeah.

Charles Miller: I think it's chicken.

Scott Steele: Any particular style of chicken or just chicken in general?

Charles Miller: Have you ever had beer can chicken?

Scott Steele: Yeah, [crosstalk 00:11:43] it's good stuff. Yeah, absolutely. What is your favorite sport?

Charles Miller: My favorite viewer sport is basketball.

Scott Steele: What about sport to play?

Charles Miller: I have two favorites, kayaking and bike riding.

Scott Steele: Fantastic and then what is the last non-medical book that you've read?

Charles Miller: Actually I'm in the middle of reading David McCullough's Truman right now. But I read a lot and that's what I'm in the middle of right now. But I love good novels. I love history too.

Scott Steele: That's fantastic. So tell our listeners, what is one thing that you like about here in northeast Ohio and Cleveland?

Charles Miller: I think I like the people. New York was action packed but this is a place for families and friends and it's really a friendly place to live. It's really, really nice.

Scott Steele: Well, I echo that. So how about some final take on messages regarding organ transplantation for our listeners?

Charles Miller: So organ transplantation is safe if you need it. It is a field of medicine and social study where it's the most human equation, where humans give organs to humans, done by humans. If you haven't, please sign your organ donor card today, call your OPO, they'll help you. If everybody does that, there'll be plenty to go around.

Scott Steele: That's great stuff. And so for more information on Cleveland Clinic's transplant center or to get more information on becoming a living donor please visit clevelandclinic.org/transplant. That's clevelandclinic.org/T-R-A-N-S-P-L-A-N-T. You can also call our transplant center at 216-444-2394. That's 216-444-2394.

As you've heard me say, remember it's always important for you and your family to continue to receive medical care, the appropriate check ups and screenings and be rest assured here at the Cleveland Clinic we're taking all of the necessary precautions to sterilize our facilities and protect our patients and caregivers.

So Dr. Miller, thanks so much for joining us on Butts & Guts.

Charles Miller: Thank you, Scott, pleasure.

Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts & Guts.