 Hello, and thank you for joining us today. I'm Kate Egan, Nurse Coordinator for the Living Donor Liver Transplant Program at University of Maryland. I, along with my colleagues, will be discussing living donor liver transplant today. First you will hear from Dr. Sasan Sakiani, a transplant hepatologist, about the organ shortage crisis in the United States and why living donor liver transplant is so important. Thank you, Kate. Liver transplantation is a life-saving measure for many people with liver disease. Currently, we have over 12,000 people on the liver transplant list in the United States. Unfortunately, there's also big shorters of livers available for transplant. This is a chart showing the difference between a number of people waiting for a liver transplant compared to the number of patients that are actually transplanted each year. As you can see from the line at the top, there are currently about 12,000 patients added to the liver transplant list each year. While we would love to be able to transplant each one of these patients, we're limited by the number of available organs. Therefore, we're only able to transplant about 9,000 patients each year, with the majority of these patients being from deceased donors. This leaves us with over 4,000 people who are unable to receive life-saving liver transplants each year, with the majority of them subsequently falling off the list. In other words, for each 100 people getting a liver transplant, 32 will not be able to receive a liver transplant on the list. This is where living donation can make a huge difference. By performing living donor transplants, we can overcome the shortage of available donors. Another bonus of living donor transplants is that they're often better quality organs and tend to have better outcomes as a whole compared to deceased donors. In 2019, over 7,300 people were living organ donors. In addition to better quality organs, living donor transplants allow us to plan the surgery. That's the way everybody involved, including the patients, their families, and the surgical team are able to prepare well in advance for the surgery. By scheduling these surgeries, we're also able to shorten the time that patients have to wait on the transplant list, and most of these patients are able to be transplanted at much lower melt scores. Also tend to mean that patients are less sick at the time of transplant, and the healthier a patient is at the time of surgery, the shorter their hospital stays typically are. Now, you might be asking what I meant by meld score. Meld, which stands for model for end stage liver disease, is a scoring system which uses your serum sodium, bilirubin, INR, and creatinine. We'll predict how well a patient with liver disease will do over the next 90 days. We also use the score to rank patients on a liver transplant list. The score ranges from 6 to 40, and patients with lower meld scores are less likely to receive liver transplants from deceased donors. In addition, as the meld score starts getting higher, the chances of survival drop significantly. This can be seen on this graph, which shows the relationship between the meld score and the chances of being alive in three months. A meld score of six has almost 100% chance of survival, while a meld score of 40 has less than 10% survival at three months. In our area, the average meld score for deceased donors is around 30. However, as I mentioned before, living donor transplantation allows us to transplant patients at much lower meld scores. And our average meld score here in our area is around 13 for living donor transplants. So I want to discuss now the benefit of living donor liver transplantation. One of the factors that is very important as you will receive a better quality organ. As we prepare for living donor liver transplantation and assess the organ donor, we always make sure that the quality of the organs that you will get is an excellent organ that will you receive for transplantation. As a consequence, the outcomes associated with it, the survival of that organ is better. We have seen that now in our institution, but now it's also proven with data at the national level. The other thing that is important to describe that living donor liver transplantation is a scheduled surgery. You will know what day your surgery will be. The surgeon will be planning for that day. The whole thing will be present that day. And it will not happen, obviously, during the weekend. So planning and scheduling, it becomes very important because it's associated with better outcomes and better survival. You can see the comparison of the three-year survival of the institution that we are part of, UMMC, versus the national level. You can see that in our institution, we achieve better long-term results than other institution when it comes to living donor liver transplantation. This is important for you when you identify the hospital or the institution where you prefer to be transplanted. We have a team of four or five surgeons that that day are fully focusing you on the donor and make the surgery to go as smooth as we can. Going one step forward, if you look at the outcomes or the survival post-living donor liver transplantation at national level, you can see that when you compare living donor receiving an organ from a live donor versus receiving an organ from a deceased donor, the long-term survival benefit from receiving a live donor liver transplantation. This data now is very clear. And so if you need a transplant, it always will be a better option to identify some potential donors to be your organ donor. And I frequently get asked about donor safety. If the operation is safe, you ask, is my donor operation will be safe? We can tell you that we will focus long time before the surgery about the donor safety. Donor safety by far our priority. With new technology, the new MRIs, 3D and 2D images, we are pretty accurate in what we see pre-transplantation that the day that we do the operation. We have a team that focus and dedicate ourselves to donor operations, so we will put all our effort to minimize any risk of complication or any risk of dysfunctions. In terms of complication of living donor, I always say that if you get the surgery, you can have a hernia, you can have an infection. But beside of that, we sometimes see what is called jaundice, is that when the villi roving go up a little bit on the donor, and that usually lasts three or four days, and that recover by itself, and then organ dysfunction that is very rare, less than 1% of the donor present with some degree of liver dysfunction. The risk of the living donation is mainly in the first one or two weeks post donations. Once the liver grow, that usually take four to six weeks to grow to normal size, any chance of dysfunction or jaundice or complication associated with liver function go away. So this is important to know because the main risk occur in the first week, and then most of the risk go away. Potential living donors should be healthy and be between the ages of 18 to 55. Body mass index or BMI is a way to calculate body fat based on height and weight of an individual. For living donors, we would ideally like their BMI to be less than 35. Living donors also need to be blood type compatible with their recipients. A full medical evaluation will be done on any individual interested in becoming a living donor. We understand that asking someone to be a living donor for you can be an emotional and difficult conversation. Instead, a good place to start is by telling everyone you know that you need a liver transplant. Inform them that a living donor transplant is an option at University of Maryland, and your doctor says that you would do best with the living donor. Ask your friends and family to share your story by word of mouth, email, or social media. Be sure to mention that even if they don't feel comfortable being a living donor for you, they can still share your story to help you find the life saving transplant you need. Be sure to mention that even if they don't feel comfortable being a donor for you, sharing your story is an excellent way to get your word out and help you find the life saving transplant you need. Using social media or email is a great way to get your story out. In a social media post or email, be sure to include a photo or video of yourself. Explain what your life is like now, what you miss doing, but can't now because of the demands of your illness or treatment. Include what you wanna do when you get better or certain family events that you would like to participate in, like watching your kids grow up, the birth of a grandchild or the wedding of a loved one. Say that you need an organ and your doctor said a living donor is your best chance at getting transplanted quickly. Include the website where donors can register or obtain a questionnaire. Remember to update your post or email monthly. Include any health updates or progressions of your disease. Remember that it may take time for your donor to realize that they can do this for you. For further information, please visit our website. For any questions regarding living donation, please contact me, Kate Egan via phone or email.