Organ donations, Part I: A patient’s story

HEALTH MATTERS

By: Dr. Gary Forester
   The liver is one of the most important organs in the body.
   As the body’s largest gland, the liver performs multiple functions such as manufacturing blood-clotting substances, processing nutrients absorbed by the small intestine and removing toxic substances from the blood. The liver also produces bile, a yellow fluid that aids in digestion. When it becomes infected, however, there can be serious and even fatal ramifications.
   Because symptoms of liver trouble may not appear until damage occurs, it is important to treat your liver well by following a nutritional, fiber-rich diet, limiting alcohol, avoiding street drugs and being sure to never mix alcohol with drugs or medications.
   Hepatitis, an inflammation of the liver, can occur in many forms (A, B, C, D, and E). It may resolve quickly (acute hepatitis) or cause long-term disease (chronic hepatitis). According to the American Liver Foundation, over 5 million Americans have hepatitis B or C, resulting in an estimated 13,000 to 15,000 deaths each year. Unfortunately, symptoms may not appear until serious liver damage has been done.


"In cases of severe liver damage, the liver must be replaced if the patient is to survive."

Gary Forester, M.D.


Director,

Liver Transplant Evaluation

and Management Service

The Medical Center at Princeton

   If you recognize any of the following symptoms, contact your doctor:
   • Yellow discoloration of the skin or eyes.
   • Abdominal swelling or pain.
   • Prolonged itching of the skin.
   • Very dark urine or pale stools.
   • Passage of bloody or tar-like stools.
   • Chronic fatigue, nausea or diminished appetite.
   To protect yourself and your loved ones, ask your doctor to test you for a hepatitis virus if you exhibit trouble signs, have received a blood transfusion prior to 1990, or if anyone in your family tests positive for the hepatitis virus. If you do not have the hepatitis B virus, you may opt to undertake a simple series of three vaccinations that will offer you long-term protection.
   In cases of severe liver damage, the liver must be replaced if the patient is to survive.
   According to The Sharing Network, a federally certified, state-approved organ procurement organization responsible for recovering organs and tissue for New Jersey residents currently awaiting transplants, the number of patients in need is greater than most people imagine. As of January, 117 New Jersey residents were awaiting liver transplants.
   One such young man is a patient at the MCP. He is in his 20s and is currently on the liver transplant list at the University of Medicine and Dentistry of New Jersey (UMDNJ) University Hospital in Newark.
   Although this patient lives at home with his mother, enjoys basketball and step dancing, has held several jobs and has completed most of the credits he needs to get a college degree, his need for a liver transplant makes him different from his peers by limiting his lifestyle. He hopes that his case can be used to educate the public about the importance of organ donations.
   About a dozen years ago, the patient was a young teenager who began to experience a lot of nosebleeds. The nosebleeds were frequent enough to warrant medical attention, and his mother took him to the MCP to have his nose cauterized. While at the hospital, the medical staff ran a series of blood tests and discovered that his blood counts were far from normal. At the time, the teen and his mother were told that further testing was required.
   He was diagnosed with auto-immune hepatitis, a serious liver disorder with life-threatening potential, and his doctors prescribed prednisone, a steroid drug used to reduce inflammation and alleviate symptoms in a variety of disorders.
   Unfortunately, prednisone can lower a patient’s resistance to infections and cause many other deleterious effects. It decreased his hepatic inflammation but further compromised his immune system. As he notes with a wry laugh, "blood cells don’t differentiate between good medicines and bad diseases." Using prednisone was a temporary fix. Soon, he learned that his liver was cirrhotic (organically deteriorating), was failing him, and that he would need a new organ.
   At the present time, the young man receives all his medical care at the MCP and awaits a phone call that may mean a liver is available. When this happens, if the liver is a suitable match, the patient will receive his transplant at UMDNJ.
   To address the needs of such area patients, the MCP has established a Liver Transplant Evaluation and Management Service. This service provides screenings and treatment for patients with end-stage liver disease who may require liver transplants, as well as follow-up treatment for patients who have already received transplants.
   It is proving invaluable to central New Jersey patients because they can receive evaluation and treatment in Princeton, close to home.
Gary Forester, M.D., is director of the Liver Transplant Evaluation and Management Service at The Medical Center at Princeton. For more information on this service, call (609) 497-4301. For more information about the liver, visit the American Liver Foundation at www.liverfoundation.org. This article was prepared in collaboration with Lorraine Seabrook.
Next Friday’s Health Matters will take a close look at organ donation, how it works and who’s affected.