PRESENTED BY: Brienna Hirsch Jennifer Haiar Whitney Dunn

LIVER TRANSPLANTS PRESENTED BY: Brienna Hirsch Jennifer Haiar Whitney Dunn http://www.methodsofhealing.com/files/2010/11/tip-for-a-healthy-liver.jpg

Think about this for a moment… “On May 9, every year, someone is mourning the loss of their baby, who for some reason was called from this life way too early. On May 9, every year, we remember the Gift of Life that this family gave us when they made the difficult decision to donate their baby’s organs—and we think of their grief; yet celebrate the life and 2nd chance that was given to Brienna at the age of 19 months. If they could only see the smiles, and hear the music; and know just how grateful we are that they looked beyond their own grief to help another child. “In 1992, we didn’t know if we’d ever get to see the day our baby would graduate from High School, and tomorrow, 16 years later, on May 17, 2009, we will se her walk across the stage to get her diploma as a graduate of Washington High School (WHS)…” -Russ & Connie Hirsch (2009) Pictures provided from: Brienna Hirsch

Liver Disease Liver failure or disease occurs when the liver becomes damaged and is no longer able to function the way it should. The most common diseases of the liver are Hepatitis B and C. The liver is the second largest organ in your body. It weighs about 3 pounds. The liver processes what you eat and drink into energy and nutrients for your body, and also will remove harmful substances from your blood stream.

Hepatitis B Hepatitis B is the inflammation and swelling of the liver. It is caused by the hepatitis B virus. There are immunization injections to help prevent hepatitis B. they are given in infancy and adulthood. Hepatitis B is spread through the blood, semen, body fluids, and vaginal secretions.

Hepatitis C Hepatitis C is caused by an infection with a virus. The liver stops working as it should due to inflammation and swelling Will destroy the liver and cause cirrhosis Hepatitis C is one of the main needs for liver transplants Up to 70% of people develop chronic liver disease

Cirrhosis Inflammation and scarring damage the liver. Alcohol use and hepatitis are the main causes of cirrhosis Liver transplants are common in individuals whom develop cirrhosis.

BiliaryAtresia A rare disease of the liver that affects newborn infants Occurs in about 1 in 10,000 infants “The loss of the bile ducts that are responsible for draining bile from the liver” The liver stops working and Cirrhosis will result Liver transplants are mandatory within the first 1-2 years of life! **This is what Brienna was diagnosed with.

Signs and Symptoms of Liver Failure Pain Swelling Tenderness in the right upper quadrant Jaundice color Itching all over body Loss of appetite, fever and nausea Feeling tired Stomach pain Diarrhea Yellow eyes Weight loss Internal bleeding Dark yellow urine

Liver Failure Prevention Do not overdose on acetaminophen (Tylenol) Do not drink alcohol in access or long term Immunizations Ingestion of wild mushrooms Proper diet Do not handle blood or blood products unless professionally trained. Don’t share personal toiletry items Do not share needles Use condoms when having sex

When is Liver Transplant Needed? Chronic hepatitis B and/or C Bile duct disease Autoimmune liver disease Primary liver cancer Alcohol liver disease Fatty liver disease Currently there are more than 6,000 liver transplants every year. Success rate is high! About 7 to 8 people out of 10 live full healthy lives

Advance Directives It is always wise to have an advance directive when dealing with organ transplant and donation An advance directive provides instructions for your personal medical choices and decisions while you are in the hospital.

The Waitlist In order to undergo a liver transplant, a patient must be put on the national waiting list. The list is managed by the United Network for Organ Sharing, or UNOS.

UNOS • The United Network for Organ Sharing does the following: • Collects and manages all data that pertain to the patient waiting list. • Organ donation and matching. • Transplantation occurring on the Nation’s Organ Transplant Network, or OPTN. • UNOS developed a scoring system called the Model for End-Stage Liver Disease, or MELD. • Sickest patients are given priority for organ transplants. • Candidates age eleven and younger are placed in categories according to the Pediatric End-Stage Liver Disease, or PELD, scoring system.

MELD • MELD system involves a numerical scale: • Ranges from 6 (less ill) to 40 (gravely ill) • Used for liver transplant candidates that are twelve or older. • Gives each candidate a number based on how urgent he or she needs a liver transplant within the next three months.

MELD • The number is calculated by a formula using three routine lab test results: • Bilirubin • Measures how effectively the liver excretes bile. • INR (pro thrombin time) • Measures the liver’s ability to make blood clotting factors. • Creatinine • Measures kidney function. • Impaired kidney function is often associated with sever liver disease.

MELD Exceptions • There is only one priority exception to MELD. • This priority is referred to as Status 1. • Status 1 patients have a sudden and severe onset liver failure and a life expectancy of hours to a few days without a transplant. • Less than 1% of liver transplant candidates fall into this category.

Waitlist Statistics • Currently about 17,000 people are waiting for a liver transplant in the United States. • The median national waiting time in 2006 was 321 days. • The patient’s median wait could be longer or shorter. • The wait time depends on how sick the patient is or where they live.

Waitlist Statistics • According to UNOS about 540 children in the United States were waiting for a liver transplant in 2009: • 56 in newborn to 1 year old age group • 174 in the 1 to 5 year old age group • 127 in the 6 to 10 year old age group • 183 in the 11 to 17 year old age group

Where do transplanted organs come from? • Most transplanted livers come from deceased organ donors. • Organ donors are adults or children who have been declared brain dead. • When children receive a liver they may get a whole liver or a segment of one. • If an adult liver is available and is an appropriate match for two children, or a child and adult, on the waiting list, the donor liver can be divided into two segments. • This situation is called a split liver transplant.

Where do transplanted organs come from? • Living family members may also be able to donate a section of their liver. • This situation is called a living-related transplant. • Relatives who donate a portion of their liver can live healthy lives with the remaining segment. • The segment of the liver will eventually grow to the original size of the whole liver. • The liver is the only organ in the human body that can do this.

Other Information! Patients will be placed on a specific and detailed diet before & after the transplant After the transplant, the patients are placed on numerous anti-rejection drugs, vitamins, and other prescribed medication that they will be required to take for the rest of their life in order to prevent the body from the rejecting the liver as a “foreign object” Routine doctor appointments will also be a requirement after the transplant; eventually spreading out over longer periods of time

Liver Transplant Agencies • National Kidney Foundation • Hosts the U.S. & World Transplant Games • Similar to the Olympics with a plethora of sporting events to participate in: swimming, triathlon, tennis, bowling, cycling, etc. • Held every other year: 1 year the games are held somewhere in the U.S. and the next year the games are held somewhere else outside the U.S. • Ex: 2010 games were held in Madison, WI while the 2011 games will be held this summer in Göteborg, Sweden • For any Transplant Recipient, Donor, Families of Transplant Recipients/Donors, Doctors, Surgeons, Nurses, etc. • Divided into teams by States or Regions in U.S. Games and by Country in the World Games • Ex: Team Upper Midwest, Team Arizona, etc. for U.S. Games and Team USA for World Games

Liver Transplant Agencies • American Liver Foundation • Our mission is to facilitate, advocate and promote education, support and research for the prevention, treatment and cure of liver disease. • Provides information for the parents or families of the recipients and donors in order to help them cope with the process • Explains the Transplant process and the before and after requirements • Gives other websites to visit so that families can research the problem and the solution!

Other Liver Transplant Agencies • American Association for the Study of Liver Diseases • www.aasld.org • Hepatitis Foundation International • www.hepfi.org • National Digestive Diseases Information Clearinghouse • www.digestive.niddk.nih.gov • Organ Procurement and Transplantation Network • http://optn.transplant.hrsa.gov

REFERENCES Brand, E. (2009, September). Liver transplant program: the waiting list. Retrieved from http://www.chop.edu/service/liver-transplant-program/evaluation/liver-transplant-waiting-list.html. Smith, C. (1999). Center for liver disease and transplantation. Retrieved from http://www.livermd.org/waiting.html. National Digestive Diseases Information Clearinghouse, . (2006, July). Biliaryatresia. Retrieved from http://digestive.niddk.nih.gov/ddiseases/pubs/atresia/ National Kidney Foundation, Inc., . (2010). 2010 U.S. transplant games. Retrieved from http://www.kidney.org/news/tgames2010/index.cfm WebMD (2005-2011) Retrieved on April 10, 2011 from www.webmd.com/hepatitis WebMD (2005-2011) Retrieved on April 10, 2011 from http://www.webmd.com/a-to-z-guides/organ-transplant-overview World Transplant Games Federation, . (2011, April 19). XVII World transplant games 2011. Retrieved from http://www.wtg2011.com/Default.aspx

PRESENTED BY: Brienna Hirsch Jennifer Haiar Whitney Dunn