Speaker 1: Initialize sequence.
Speaker 2: Coming to you live from Houston, Texas, home to the
Speaker 2: world's largest medical summer.
Speaker 3: In a bunch of bays. Every day we lead gremony
Speaker 3: rode Conti.
Speaker 2: After this is your Health First, the most beneficial health
Speaker 2: program on radio with doctor Joe Glotti.
Speaker 3: During the next.
Speaker 2: Hour you'll learn about health, wellness and the provention of disease.
Speaker 2: Now here's your host, doctor Joe Bellotti. Well la marvelous
Speaker 2: Sunday Evening to everybody, Doctor Joe Galotti. As usual, we're
Speaker 2: here every Sunday between just an hour between seven and
Speaker 2: eight pm Central time. And if you're traveling over the summer,
Speaker 2: don't forget. You can catch us anywhere in the globe
Speaker 2: if you go to the iHeartRadio app type in KTRH
Speaker 2: and we will be here at seven o'clock Central time.
Speaker 2: And my goal is, I say, every Sunday evening, we
Speaker 2: want to make you better consumers of healthcare. We want
Speaker 2: to raise your health IQ so that you really really
Speaker 2: understand how the body works, what that pain in your
Speaker 2: stomach means, and that you don't blow things off out
Speaker 2: of not wanting to be well, but just I hate
Speaker 2: to use the word ignorant, you're just ignorant of what
Speaker 2: a particular problem is. So that is our goal. We're
Speaker 2: going to raise your health. I q our website doctor
Speaker 2: Joegalotti dot com. You can send me a message, sign
Speaker 2: up for own newsletter. All of our social media info
Speaker 2: is there now. On the program tonight in the studio
Speaker 2: to veteran of the radio program, doctor Caroline Simon and
Speaker 2: Elie Chia. They are transplant surgeons at Houston Methodist Hospital.
Speaker 2: They are colleagues, friends of mine, co workers in the
Speaker 2: marvelous liver transplant program that we have at Euston Methodist,
Speaker 2: and they're going to discuss the robotic surgery that they do,
Speaker 2: but also in the setting of live liver donation. So
Speaker 2: when you do liver transplant, you have this idea. You
Speaker 2: get a liver from somebody that is brain dead and
Speaker 2: they donate their liver and it is recovered and planted
Speaker 2: into the recipient the person that is going to be
Speaker 2: allocated that liver. But here a healthy adult will donate
Speaker 2: half of their liver, but that has to be surgically
Speaker 2: taken out, and that is what their expertise is here.
Speaker 2: So they'd previously been on the program, but it's about
Speaker 2: a year and a half, a little bit of an
Speaker 2: update on new technology and how the program is going
Speaker 2: and what all of you need to know, So stay
Speaker 2: tuned for that. A couple of articles in the news
Speaker 2: that caught my eye. Now this one is for those
Speaker 2: that feel marijuana is completely benign. Everybody should smoke it.
Speaker 2: Why should there be laws to limit it in any way. Well,
Speaker 2: an article came out this week that is associating a
Speaker 2: link with heart attack and stroke. And the general consensus
Speaker 2: is that the general population feels that marijuana is safe.
Speaker 2: But new research that was just published showed that there's
Speaker 2: an associated risk with a associated higher risk which stroke
Speaker 2: and heart attack, including amongst young adults. So this was
Speaker 2: a study that looked at twenty four different research studies
Speaker 2: and it was published in the journal Heart, and it
Speaker 2: found that marijuana use was associated with a twofold increase
Speaker 2: in the risk of death from cardiovascular disease. Now, you
Speaker 2: have to be careful in how you analyze the data.
Speaker 2: It is not a direct correlation, but the relationship is there.
Speaker 2: But it's very tough to prove that smoking marijuana caused
Speaker 2: all of these problems. Now, what they think the problem
Speaker 2: is it is a rise in blood pressure and a
Speaker 2: rise in heart rate, as well as cardiac arrhythmia, so
Speaker 2: irregular beating of the heart, the electrical system goes a
Speaker 2: little bit berserk, and that is what they think is
Speaker 2: the culprit. Now speaking, older adults and people with underlying
Speaker 2: conditions like diabetes, high cholesterol, pre existing heart disease, they
Speaker 2: are going to be the greatest at risk. And certainly
Speaker 2: there are more older adults, a lot of baby boomers
Speaker 2: that are using marijuana, either recreationally or for some kind
Speaker 2: of medical use, and so they are definitely more at risk. Now.
Speaker 2: In twenty twenty three, about seven percent of the US
Speaker 2: adults sixty five and old are reported using marijuana within
Speaker 2: the last month, So that's a fair amount of people
Speaker 2: that are that are using it now. The other somewhat
Speaker 2: alarming part is that younger, younger adults sort of in
Speaker 2: that thirty five to forty range are coming in with
Speaker 2: heart attack, but a lot of them don't know what
Speaker 2: the signs and symptoms of a heart attack or stroke are,
Speaker 2: so they're sort of getting diagnosed a bit late. And
Speaker 2: so what do we do well, I would think certainly,
Speaker 2: if you're an older adult, you have to be very careful.
Speaker 2: Talk with your doctor if you are using marijuana. If
Speaker 2: you are younger and using marijuana, you probably need to
Speaker 2: get a good checkup to make sure you don't have highpertension,
Speaker 2: you don't have diabetes, there's no rhythmias with your heart.
Speaker 2: The amount of people that have a FIB has gone
Speaker 2: up four hundred percent in the last ten years, so
Speaker 2: there's a lot of people with underlying heart disease that
Speaker 2: may not realize it. So buyer, beware, proceed with caution.
Speaker 2: All right. With that said, we're gonna take a quick
Speaker 2: break here in the wings. Doctor Simon and doctor Chia
Speaker 2: will be here gracing our airwaves. I'm doctor Joglotti. Doctor
Speaker 2: Jogolotti dot com is our website. Stay tuned, we will back.
Speaker 2: As of this morning, they were approximately nine one hundred
Speaker 2: and twenty eight Americans waiting for a liver transplant all
Speaker 2: around the country, big cities, small cities, And that is
Speaker 2: a real challenge. And I'm very fortunate to be part
Speaker 2: of a world class liver transplant program. And in the
Speaker 2: studio today are two stars, doctor Carolyn Simon and doctor
Speaker 2: Eeli Chia. They're sort of veterans of the program and
Speaker 2: they've been begging me to come back on the program.
Speaker 2: So doctor Simon, doctor Chia, welcome and so glad you
Speaker 2: come back and share your knowledge with everybody tonight about
Speaker 2: liver transplant and more importantly robotic surgery.
Speaker 1: Thanks for inviting us, Thanks for having us back to you.
Speaker 2: Absolutely so happy. So if there are people listening that
Speaker 2: didn't catch you the first time about eighteen months ago,
Speaker 2: so really quick introduction about yourselves and your training, your
Speaker 2: background and what you do here in Houston.
Speaker 1: My name is Caroline Simon, so.
Speaker 2: Everybody knows that is Caroline. Doctaccia will be number two here.
Speaker 3: Yeah, I've been in Houston now for just over two
Speaker 3: and a half years. I was trained in kind of
Speaker 3: a mixture. My med school was done in Ireland and
Speaker 3: my residency and fellowship was done in the Northeast between
Speaker 3: Rhode Island and Boston. I specialize in hepatobilliary and pancratic surgery,
Speaker 3: how to do it open as well as robotically like
Speaker 3: you were saying, and then I also do living down
Speaker 3: a liver transplants. The recipient part.
Speaker 2: Right right Doctachia number two. This is a get your
Speaker 2: left and right speakers set here.
Speaker 4: Hi, I'm a Yilicia. I'm the director of the Robotic
Speaker 4: living don A liver transplant program at Houston Methodists.
Speaker 1: I follow.
Speaker 4: A similar path to doctor Simon. I graduated from an
Speaker 4: Irish medical school and then I did most of my
Speaker 4: training in Brown and Leahy Clinic in Massachusetts. And my
Speaker 4: passion is living down a surgery where I look after
Speaker 4: healthy patients who want to donate part of the liver
Speaker 4: to help someone on the waiting list.
Speaker 2: Right exactly. Now, we've talked about robotic surgery, and there
Speaker 2: are people sitting there saying, robotic surgery totally automated. What
Speaker 2: some something that Elon Musk is going to make is
Speaker 2: going to come and do the surgery. So don't why
Speaker 2: don't you both explain what exactly robotic surgery is.
Speaker 3: I'll take that it's basically computerized surgery allows us to
Speaker 3: perform really fine movements, really complex surgery through very very
Speaker 3: tiny incisions, you know, smaller than your finger. It is
Speaker 3: a common misconception, you know, even my mom would say that, oh,
Speaker 3: you set the robot and it just goes off in
Speaker 3: the room and right exactly, but there's no self parking,
Speaker 3: there's no self driving assist modes. Here, this is just
Speaker 3: you know, augmented to make so basically you control the robot.
Speaker 3: You control everything it does, and that's what makes it
Speaker 3: so cool.
Speaker 2: Yeah, what do you think?
Speaker 4: Yeah, it's kind of like a remote operated vehicle, except
Speaker 4: the surgeon is no longer at the bitside, but is
Speaker 4: like sitting in a console with the hand controls and
Speaker 4: foot pedals that will enable us to use different kinds
Speaker 4: of energy devices to help us with to stop bleeding
Speaker 4: or to cut through the liver, right, and there's usually
Speaker 4: a separate surgeon or a system at the bedside to
Speaker 4: help us changing instruments and any kind of like sectioning
Speaker 4: assistance that we may need.
Speaker 3: Right.
Speaker 2: So, the sense is you're in the room, you're doing
Speaker 2: the surgery, the surgeon is doing the surgery. The robot
Speaker 2: really is just a super cool tool that you are
Speaker 2: using at you know, ten feet away.
Speaker 3: Absolutely, you know, it also makes you.
Speaker 1: A slightly different surgeon.
Speaker 3: And what I mean by that is automatically, you have
Speaker 3: two right hands and two left hands, right, and so
Speaker 3: think of all the things that you could do with
Speaker 3: an extra couple of hands. Right. It also makes you
Speaker 3: automatically and be dexterous and so you could, you know,
Speaker 3: throw the same amount of sutures and cut and dissect
Speaker 3: the same way right handed or left handed and looks
Speaker 3: exactly the same.
Speaker 2: You know, you look at different and physicians and any
Speaker 2: specialty and you'd almost look at them in different eras
Speaker 2: as far as they're training. So you graduated medical school
Speaker 2: in the late nineteen seventies, and you did your training
Speaker 2: through the eighties, and here you are. What is how
Speaker 2: is the retrofitting of surgeons to pick this up? Where?
Speaker 2: And you know, we're not naming names to say this
Speaker 2: guy shouldn't be doing it or she's a disaster, but
Speaker 2: where do you think this is? Is this truly a
Speaker 2: new generation of surgeons and physicians that are getting involved
Speaker 2: in this versus the retrofitting? You know, should we really
Speaker 2: have high hopes for that?
Speaker 4: I think it goes both ways, because the current generation
Speaker 4: of junior surgeons who have graduated from official training, they
Speaker 4: are trying to pick up the robot because they're at
Speaker 4: a I guess a time in their careers where they
Speaker 4: can still pick up new technology pretty easily.
Speaker 1: So I'm one of those so.
Speaker 4: Called retrofitted surgeons because I had no exposure to robotic
Speaker 4: surgery during training, and that takes a lot of self
Speaker 4: motivation and learning, sure to kind of figure out how
Speaker 4: the device works, how the equipment will help you do
Speaker 4: the surgery and kind of operate in a very different way.
Speaker 4: One of the fallbacks of the robot is that as
Speaker 4: opposed to open surgery, you don't have any teachtile feedback.
Speaker 4: You can't feel the liver, you can't feel the tissues
Speaker 4: as you're sewing it. And that's something that someone who's
Speaker 4: learning that technology will have to figure out and takes,
Speaker 4: you know, methods like simulation training, training on cadever models,
Speaker 4: biotissue models to try and figure that out.
Speaker 2: Sure, yeah, and I would think most people don't think
Speaker 2: about that that you're actually not touching and feeling and
Speaker 2: so much of that is important when you're doing you're
Speaker 2: doing surgery. So as a retrofit in the fifteen years,
Speaker 2: how tell everybody how far the technology has come from
Speaker 2: you know, version one point oh robot that you vers
Speaker 2: first sat with, versus what you're going to be dealing
Speaker 2: with tomorrow morning.
Speaker 4: I think the first robot was mainly used by our
Speaker 4: urology colleagues and they've really pushed the development of better robots.
Speaker 4: When we first started the robotic surgery and the liver
Speaker 4: and pancreas, it was like the third generation robot, and
Speaker 4: there was still some disadvantages to the technology. But with
Speaker 4: the current fourth generation and the most recently released fifth
Speaker 4: generation robot, they've kind of overcome a lot of those
Speaker 4: difficulties and added some safety features that I think helps
Speaker 4: with a surgery like liberal panker surgery, where you know,
Speaker 4: there is a sense that you need to have better
Speaker 4: control to help with bleeding and any kind of those
Speaker 4: like fine futuring that we will need for operations in.
Speaker 2: Yeah, Caroline, what would you say is the new cool
Speaker 2: feature that you've had for the past few years compared
Speaker 2: to five ten years ago that maybe just didn't exist.
Speaker 3: I think they've made the camera a little bit more functional.
Speaker 3: You know, it's smaller, it white balance is better, right.
Speaker 3: You tend not to think about it, but you know,
Speaker 3: in a cavity, especially if it's say, you know, a
Speaker 3: certain type of pink or a certain type of red,
Speaker 3: white balancing is actually pretty important, and so that's actually
Speaker 3: gotten better. The other thing that we're able to do
Speaker 3: is we're able to inject a substance called ICG or
Speaker 3: indosyanine green. We can change the light models and have
Speaker 3: immunofluorescence kind of guide us for different parts of the surgery.
Speaker 3: It can show you blood vessels, it can show you
Speaker 3: where to cut on the liver, it can show you
Speaker 3: where the bio ducts are. And then also the instruments
Speaker 3: that we have that's gotten better too. You know, there's
Speaker 3: more joint it's more functional. Like doctor Chio was saying,
Speaker 3: the ceiling or the grip the yeah, the grip that
Speaker 3: the heating elements or the cattery elements that that's gotten
Speaker 3: better too.
Speaker 2: Yeah, you know. I would I would say that the
Speaker 2: average average person listening tonight, which I like to think
Speaker 2: they tend to be very health motivated or health conscious,
Speaker 2: really they have no idea what this looks like in there.
Speaker 2: I remember, I don't know if you were visiting I
Speaker 2: think you were visiting Houston, and you're standing there at
Speaker 2: the podium and you flip up this video and I
Speaker 2: think everybody, the chairman of Surgery was there gaping with
Speaker 2: mouth open, thinking this is really unbelievable. I went to
Speaker 2: him afterwards, this is doctor Gaber at the time, and
Speaker 2: I said this is unreal, and he said it is,
Speaker 2: it is. It really is coming a long way. So
Speaker 2: we have these topics tonight to talk about really for
Speaker 2: the average citizen to really understand what is available to them.
Speaker 2: Last word before we take a break, Doctor.
Speaker 4: Chiah Joe, I just want to say that I know
Speaker 4: the videos look pretty cool and the technique is really
Speaker 4: nice and clean, but the reason why we move into
Speaker 4: robotics is because it's actually better for a patient. Yes, right,
Speaker 4: because the incisions are smaller and the recovery faster.
Speaker 2: Yeah. Yeah, I you know, robotics has trickled down to
Speaker 2: everything and I've in some knee issues that I've been
Speaker 2: having talking to the surgeon saying, oh, yes, we could
Speaker 2: fix that robotically, and like robotically, it's we're talking about
Speaker 2: a small area. No, we're going to fix it robotically.
Speaker 2: So it's fascinating. All right, Well, we have doctor Chia
Speaker 2: and doctor Simon for the whole hour here, so don't
Speaker 2: miss anything. Doctor Joeglotti dot com is our website. You
Speaker 2: can actually message me if you have any questions. Stay tuned.
Speaker 2: We will be right back. Welcome back, everybody, playing a
Speaker 2: little Billy Joel while we're filling some time here tonight,
Speaker 2: but don't forget every Sunday night between seven and eight pm,
Speaker 2: we are here Raising your Health IQ, bringing you the
Speaker 2: best experts in health and wellness. And I'm so pleased
Speaker 2: to have doctor Carolyn Simon and Ylie Chia surgeons at
Speaker 2: Houston Methodist Hospital, part of the liver transplant program that
Speaker 2: we have there. And we are talking about both robotic surgery,
Speaker 2: but living donation, live living donation, liver transplant. I get
Speaker 2: that to live liver. When I on my Siri and
Speaker 2: I say live liver, it goes liver liver or live
Speaker 2: live and doesn't quite work all the time. But we
Speaker 2: are talking about taking a healthy life liver or part
Speaker 2: of a liver from a healthy donor and putting it
Speaker 2: into a person that is in dire need of needing
Speaker 2: a liver transplant. So, doctor Simon, what is the general
Speaker 2: concept of live liver donation? What do the people tonight
Speaker 2: need to know?
Speaker 3: The basic fact that your liver can regenerate and so
Speaker 3: if you are willing and able to donate, you know
Speaker 3: a portion of your liver you can help save someone
Speaker 3: else's life.
Speaker 2: Right, And I actually I've got the numbers here national data.
Speaker 2: So back when I broke into transplant nineteen eighty nine,
Speaker 2: there were two live liver donations done transplants, probably in kids,
Speaker 2: and then nineteen ninety was fourteen, and then twenty two
Speaker 2: into the thirties. But last year six hundred and four,
Speaker 2: six hundred and four live donor transplants. So again, it's technology,
Speaker 2: it's knowledge, it's no how from people like you, so
Speaker 2: expand on that.
Speaker 3: You know.
Speaker 2: I mentioned there are almost ten thousand people waiting for
Speaker 2: liver transplants, and despite the best of care, the technology
Speaker 2: that we offer them before transplant, we're still losing nationwide,
Speaker 2: somewhere between twelve to fifteen percent of patients waiting for
Speaker 2: a liver. They've been approved good candidates, their heart, their lungs,
Speaker 2: their kidneys, their insurance, everything is good. But yet they
Speaker 2: get too sick and they die, which is always horribly
Speaker 2: sad for everybody. But this live donor program is really
Speaker 2: a stop gap to cut that down.
Speaker 1: Yeah, So Joe.
Speaker 4: Structured so that there is prioritization of the sickest patients,
Speaker 4: patients who are about to die, and they will get
Speaker 4: offered deceased donor organs from people who did and are
Speaker 4: willing to donate their organs. The problem is there are
Speaker 4: not enough of those organs to go around to those
Speaker 4: over nine thousand people. When you have a living donor
Speaker 4: come forward, that living donor is giving a directed gift
Speaker 4: to someone on the recipient list, and the living donor
Speaker 4: is not going to care where they are on the
Speaker 4: waiting list. So what the living donor does is that
Speaker 4: they take the patient out of the queue, out of
Speaker 4: the waiting list, and donate part of their liver to them.
Speaker 4: They will get a liver transplant, and it also frees
Speaker 4: up a DC's donor organ for someone else on the
Speaker 4: waiting list who can only access DC's donor organs. So
Speaker 4: technically a living donor can save two lives right.
Speaker 2: Now, there is the sense that it has to be
Speaker 2: a relative. It is my brother, it is my sister,
Speaker 2: it is my wife, it is my husband. What's your
Speaker 2: experience been with who are these candidates that you're operating on.
Speaker 4: Well, usually the donor has some sort of emotional connection
Speaker 4: to the recipient, even though there are people who are
Speaker 4: altruistic in a sense that they have no relationship to
Speaker 4: the recipient. They just want to donate an organ to them.
Speaker 4: But most of our living donor. Donors for liver are
Speaker 4: emotionally connected to the recipients, but they don't have to
Speaker 4: be relatives. In fact, fifty percent of our living donors
Speaker 4: are friends or family of friends and friends of family, right,
Speaker 4: so sort.
Speaker 2: Of like your phone, friends and family get a discount.
Speaker 4: So the most important thing is that they have to
Speaker 4: be volunteers for this procedure.
Speaker 1: They need to understand the risk.
Speaker 4: They will get educated during the work up for limit
Speaker 4: donation and they get a very terough process of evaluation
Speaker 4: where you make sure that they are fit for major surgery.
Speaker 4: Number one and number two, their liver is fit to
Speaker 4: be donated, as it has to be split appropriately into two,
Speaker 4: with a pot that can be transplanted into recipient and
Speaker 4: the remnant that stays in the donor will regenerate as well.
Speaker 2: Right you know, Caroline, As I said this before, a
Speaker 2: lot of people don't know that much about the liver,
Speaker 2: but they know one thing it regenerates. And I would
Speaker 2: think that with what you are both doing, this is
Speaker 2: the ultimate case of regeneration. You're taking half the liver
Speaker 2: out and within weeks the liver is back to.
Speaker 3: Normal, absolutely, right, you know, you get two thirds of
Speaker 3: the growth happening within the first two months, and then
Speaker 3: kind of that exponential growth tailors off a little bit.
Speaker 3: You know, within six months to a year, you're back
Speaker 3: to full size.
Speaker 2: Yeah, how would you you've been at live donor programs
Speaker 2: up at the Late Heat Clinic. How would you say
Speaker 2: the program here at Methodist is different, sim s Oller upgrades.
Speaker 2: Where would you say you're at with that?
Speaker 4: We started living on a lover transplant in Lahay Clinic
Speaker 4: because the allocation system of Massachusetts made it very difficult
Speaker 4: for our program to get a disease donor organs. So
Speaker 4: living on a liver transplant made up about twenty percent
Speaker 4: of total transplants the Massachusetts VERSU in Houston. You know,
Speaker 4: we have a much larger, more established disease donor program
Speaker 4: at Houston Netodis, but our waiting liss is four hundred
Speaker 4: plus patients and there's still a signment number of patients
Speaker 4: on the waitings who would benefit from living on a
Speaker 4: liver transplant, which was why the leadership of our transplant
Speaker 4: program wanted to bring us here to start living on
Speaker 4: a lover transplants to help those people who have no
Speaker 4: access to the diseased donor augans.
Speaker 2: Yeah, and many many patients which the allocation the sickest patients,
Speaker 2: like you said, they are near death. Those are the
Speaker 2: ones we're transplanting. But a lot of our patients in
Speaker 2: this scoring system, they're in they're in purgatory, they are sick,
Speaker 2: they're in and out of the hospital. They're there, they
Speaker 2: can't work, they can't take care of their family. But
Speaker 2: yet they look at us and they say, get me
Speaker 2: a liver, get my husband deliver this really is that
Speaker 2: that vehicle to make all of that happen.
Speaker 3: Absolutely, you know, friends, family members, if they can, you know,
Speaker 3: put the word out that you know, my loved one
Speaker 3: needs a liver. Like you said, you know, you don't
Speaker 3: have to be related, right, you know, you just have
Speaker 3: to be a willing, healthy volunteer, get tested and you
Speaker 3: know that that's about it.
Speaker 2: Yeah. Yeah, what I want to do on the final
Speaker 2: saman the final segments coming up, we're gonna have to
Speaker 2: come and do the radio station and take it, take
Speaker 2: it another hour. I really want to get into this
Speaker 2: screening process, and a lot of it is online to
Speaker 2: start off with, as a as a weeding system to
Speaker 2: get people and just really sort of end the evening
Speaker 2: with everybody having a good sense of how this works
Speaker 2: and why it's important not only to take care of
Speaker 2: your liver, but understand how these programs and processes work.
Speaker 2: All right, final segment coming up, This is Your Health First.
Speaker 2: I'm doctor Joe Glotti here with doctor Chia and doctor
Speaker 2: Simon on Your Health First. We'll break back final segment
Speaker 2: of this week's Your Health First, every Sunday between seven
Speaker 2: and eight pm. I'm doctor Joe Galotti. Doctor Joeglotti dot
Speaker 2: Com is our website. Go there to learn more about
Speaker 2: the program, send me a message. All of our social
Speaker 2: media is there, and we are blessed to have doctor
Speaker 2: Carolyn Simon and doctor ye Lee Chia from Houston Methodist
Speaker 2: here in the studio with us. I think they're having
Speaker 2: a good time.
Speaker 1: Oh yes, absolutely, yeah, this.
Speaker 2: Is the place on Sunday night. So in the short
Speaker 2: time that we have left, the evaluation of potential donors.
Speaker 2: How is that done, doctor Chia?
Speaker 4: So they start by filling in a health questionnaire online
Speaker 4: and the team will look at the questionnaire and if
Speaker 4: we deem that they're suitable for further evaluation, they will
Speaker 4: do a set of screening labs, just basic stuff, and
Speaker 4: then if we find that those are appropriate, we will
Speaker 4: bring them in for full evaluation. That's usually to a
Speaker 4: three day process where they see all the members of
Speaker 4: the team and each one will kind of evaluate specific parts,
Speaker 4: you know, including the surgical aspect of the donation, and
Speaker 4: if they're suitable surgically, someone like you doctor Galati, will
Speaker 4: evaluate them medically and make sure they are medically stable
Speaker 4: for donation. They also see a psychiatrist, a social worker,
Speaker 4: the pharmacists, the dietitians, so everyone on the team will
Speaker 4: contribute a report that we will discuss at our multi
Speaker 4: discipline reading meeting, and then we'll decide as a committee
Speaker 4: better than doble for liber donations.
Speaker 2: Right now, in your current experience, the number of people
Speaker 2: that come forward that are weeded out, what what's your
Speaker 2: conversion rate in a sense, it's.
Speaker 1: Probably around fifty.
Speaker 2: So the fifty percent that are disqualified, doctor Simon, what
Speaker 2: what are the concerns that you have or the group has.
Speaker 3: With them, Probably that they are not medically fit to donate,
Speaker 3: you know. It usually most of the time actually boils
Speaker 3: down to either of them being very much overweight or
Speaker 3: having some version of metabolic syndrome.
Speaker 2: Right, so they're diabetic and and you know this is
Speaker 2: where we talk so much about that here, these are
Speaker 2: the circumstances where you may be sitting at home saying, oh,
Speaker 2: you know, who cares if I'm overweight twenty pounds or
Speaker 2: I've got to touch a diabetes. But that day may
Speaker 2: come where you get the call to say, say, hey,
Speaker 2: somebody you know may need to be a donor, and
Speaker 2: you get washed down. So it's a wake up call
Speaker 2: that we still need to take care.
Speaker 3: Of ourselves absolutely, and it's actually not forever, right, I mean,
Speaker 3: you know yourself, you know, like dieting, exercising, you know,
Speaker 3: you can actually change your liver from being a little
Speaker 3: bit overweight or a little bit fatty back to being
Speaker 3: a normal liver and then being able to donate.
Speaker 2: Absolutely. So with the process that somebody is approved this donor,
Speaker 2: they make the cut who's going to do the the
Speaker 2: donation surgery? Who's going to remove that liver?
Speaker 4: So I'm the donor surgeon, okay, And I always try
Speaker 4: to offer them a robotic approach, and about two thirds
Speaker 4: of our living donors actually undergo a robotic living door surgery.
Speaker 1: Right at the moment, Yeah.
Speaker 2: Now you had said robotic surgery in general is better
Speaker 2: for the patient. So compared to conventional liver surgery versus
Speaker 2: the robotic approach, what's the major take home there?
Speaker 4: Well, we are talking about small incisions the size of
Speaker 4: a pen, with the larger incision used to extract the
Speaker 4: graph being in the lower abdomen instead of a large
Speaker 4: incision in the upper abdomen that may or may not
Speaker 4: split their muscles.
Speaker 1: So it's not just.
Speaker 4: A cosmetic issue. It's also a patient comfort issue in
Speaker 4: terms of pain control after the operation, and we find
Speaker 4: that the pain control is so much better to manage
Speaker 4: with robotic surgery. And then even when they go home,
Speaker 4: our robotic donors tend to go back to work faster.
Speaker 2: Right, And again, all of this technology, we are certainly
Speaker 2: focused on the recipient and the donor, but these people
Speaker 2: talk to their community and say, I as horrible of
Speaker 2: a thing that we had to go through because a
Speaker 2: loved one was sick. This was a great experience and
Speaker 2: hopefully that can promote other people to think, maybe with
Speaker 2: my loved one or they know somebody elsewhere that's waiting
Speaker 2: for liver. Think about that live donor situation. How is
Speaker 2: the implanting that the actual transplant any different. When you
Speaker 2: have part of a liver that you're putting in to
Speaker 2: where there was a whole.
Speaker 3: Liver, the whole liver still needs to be disconnected from
Speaker 3: whatever is holding it in place. It comes out, the
Speaker 3: new liver sits very nicely in its old spot. Everything
Speaker 3: gets sewn in like with like, and then the clamps
Speaker 3: get removed and you know, the blood kind of circulates.
Speaker 2: Through it turns pink and everybody's happy.
Speaker 3: Everyone's happy, yeah.
Speaker 2: And anything special the recipient, the person getting the transplant
Speaker 2: after they've had a live donor transplant in the weeks
Speaker 2: months afterwards, any different than the full liver.
Speaker 1: No, not really.
Speaker 3: I mean, like I focus a lot on nutrition and
Speaker 3: so you know, we do have them do a high calorie,
Speaker 3: high protein diet just to enhance the graph regeneration.
Speaker 2: Okay, okay, with all your experience combined, do you ever
Speaker 2: see does this kind of a surgery a liver transplant ever?
Speaker 2: Would it ever be suited for a robotic approach or
Speaker 2: a less of an open surgery than what you know
Speaker 2: we've been doing for forty years.
Speaker 4: Actually, a very small number of centers in the world
Speaker 4: have started implanting livers robotically. I think the problem is
Speaker 4: oddly enough space because there's only so much you can
Speaker 4: inflate the abdomen, and to remove a whole liver and
Speaker 4: put a whole new liver in, it's difficult. But the
Speaker 4: best results are from a living new liver transplant program
Speaker 4: in Saudi Arabia. But you put in a partial graph
Speaker 4: through the same incision, you're making the donu a lower
Speaker 4: down on the appomen So that seems pretty feasible, but
Speaker 4: I'm not sure it is for.
Speaker 1: Everybody on the waiting list.
Speaker 4: I think we have to be super selective, and it's
Speaker 4: too early in our experience to figure out who will
Speaker 4: benefit most from me right.
Speaker 2: And and we're transplanting sicker patients, and I think that
Speaker 2: has to even as a non surgeon that has that
Speaker 2: has to calculate in there in the last few minutes here,
Speaker 2: doctor Chia and Simon organ donation at the end of
Speaker 2: the d at the end of the day, all of
Speaker 2: this technology is awesome. I truly hope that the advances continue,
Speaker 2: but we still need traditional individuals to be organ donors.
Speaker 2: For both of you, what what do you say to
Speaker 2: everybody tonight to be an organ donor. Think about it.
Speaker 4: I think it's very rewarding for a living donor to
Speaker 4: save someone else's life and to be honest, for someone
Speaker 4: a recipient who needs a liver transform because of liver cancer,
Speaker 4: you can actually save someone's life and cure cancer at
Speaker 4: the same time. So I think that's a very rewarding
Speaker 4: prospect for living donors, and of course because they're emotionally
Speaker 4: connected with the recipient. Yeah, the reward is like enhanced.
Speaker 2: Right Dutch Simon speechless, speechless. Yeah, you know, people in
Speaker 2: the community, even live donor or regular cadaver donor, there
Speaker 2: is this sense that it's not for me. It's not
Speaker 2: for me, but it really is for everybody to think about.
Speaker 2: And the lives you've all impacted is you know, if
Speaker 2: they could see that the impact, it's really tremendous.
Speaker 3: Absolutely, everyone can be a living donor. You know, everyone
Speaker 3: should think about being a living owner this, you know,
Speaker 3: like you mentioned nine thousand plus people on the wait list.
Speaker 2: Yeah, yeah, I guess the final question and we got
Speaker 2: a minute here real quick, each one of you, what's
Speaker 2: your health hack? How do you guys keep healthy? Because
Speaker 2: I think it's important for the public to hear how
Speaker 2: some high end surgeons here take care of themselves.
Speaker 1: For me is really easy. I just see my PCP
Speaker 1: every year.
Speaker 2: That's it.
Speaker 1: That's it.
Speaker 3: Okay, I watch what I eat, and you know, try
Speaker 3: and exercise a little bit more than you know what
Speaker 3: I should.
Speaker 2: All right, there you go. All right, well, thank you,
Speaker 2: thank you both for coming in, and I think you
Speaker 2: you've bought a follow up visit in here for on
Speaker 2: the radio. All right, well, I'm doctor Joe Glatti. Every Sunday,
Speaker 2: have a great Fourth of July, which is this coming Friday.
Speaker 2: I'm going to be out of town. You'll probably get
Speaker 2: a best of Maybe we'll play this episode over again,
Speaker 2: but have us say fourth of July. I'm doctor Joe Giltti.
Speaker 2: Don't forget doctor Joeglotti dot com. We'll see you next week.