New Transplant Patient orientation

December 14th finally came we made our trip to Murray which is a 280 mile 4 hour drive trip.  We were fortunate enough to be there for one of Lee's moms appointments and got to go out to lunch with a couple of his sisters, his mom and his brother before the start of our orientation day with the liver team.  During the orientation day we learned tons of new things.  I think the most amazing thing we learned about was the program through Intermountain Healthcare.  They transplanted the first Hepatitis C liver into a patient without Hepatitis, then gave the patient the medications to cure Hepatitis C.  They were also the leading researchers for the cure of Hepatitis C.  The program through IMC is leading the nation in transplanting Hepatitis livers, they are receiving livers from all over the united states because of this. Learning about the surgery itself was quite interesting to me being a nurse I wanted to know all the details if how they actually cross match the livers and how they sustain blood flow and all risk factors big and small.   It was interesting to know that livers are not as sensitive as other organs to be matched, for example kidneys have to have immune compatibility, for the liver the liver has to have the same blood type and body size.  If you are wondering why body size I was wondering that to, Dr. Fujita the transplant surgeon explained that livers are proportioned to the body size, so Lee being 5' 6" and about 190 pounds, if the donor was 6'10" and 300 pounds that liver would not fit into Lee's smaller frame, but if the donor was 5' and 120 that liver could go to Lee and it will amazingly grow to fit his frame.  There were several other interesting facts living in Utah we belong to a region for the allocation of organs through UNOS The United Network for Organ Sharing unos.org is their website it if full of great information.  Our UNOS region consist of California, Nevada, Arizona, New Mexico and Utah. 

If you are interested in learning about the transplant numbers here is the UNOS statistics for 2017 for our region.  https://optn.transplant.hrsa.gov/members/regions/region-5/ It looks like about half the patients on the wait list get transplanted a year.  IMC transplanted 271 patients in 2017.  That is more that one a day excluding weekends.  We also learned more about the MELD score and how it ranks you for transplant.  The score starts at 15 and the top number is 40.  Lee was a 16 at this point.  They look at listing at 15 depending on how symptomatic the patient is.   Lee was symptomatic at this point with encephalopathy and portal Hypertension.  The patients in the mid to high 30's to 40 are very sick and are commonly in the hospital or ICU it is life of death.  The patients in the mid to higher 20's are the patients that commonly receive the higher risk or Hepatitis livers.  After much discussions with Dr. Fujita and between Lee and myself he decided that if a high risk liver was offered to him he would take it so that he could get better sooner then later.  We also learned many more interesting facts about health in general.  Dr.Fujita was amazing to spend time with us and talk about general health and liver health.  One interesting thing that he did was look at Lee's palms he told up that it is common for patients with liver problems to have a pale white area in the middle of their palms and more pink to red on the outer palm. 

We also learned that the little red spidery areas on Lee's chest and back were a sign of liver disease.

(https://www.slideshare.net/karangagneja/liver-failure-31824393) This is an awesome slide show that I found containing the previous two images and a load of information about liver failure. 
The next interesting fact that we found out was about heart health, of course transplant patients have to have a good heart.  Lee does have an earlobe crease.

When we left the orientation Lee was not yet listed, there was a list of things that needed to be done before he would be evaluated for listing.  Here is the list of things to be done and the dates they were done. ( I wanted to get them all done before the end of the year.
1. Labs 22 tube to be specific done December 15th
2. See the podiatrist December 19th
3. Echo cardiogram December 19th
4. 6 minute walk test December 21st
5. Dermatologist December 21st
6. DEXA scan December 28th
7. Liver ultrasound December 29th
8. Cardiac stress test December 29th
Boy oh boy was that a crazy couple of weeks all that plus working my 3-12 hour shifts 3 Physical therapy appointments and Christmas.  Now that waiting game begins, after all the test are done and sent off to the doctors they take Lee's entire profile to and interdisciplinary meeting and determine if he is a good candidate for a liver transplant.  This is that part that will make me nuts, just sitting and waiting.