Advances in Transplantation

Guest: Paul R. Helft, MD Host: Aaron Carroll, MD Guest: A. Joseph Tector, MD, PhD One of the most pressing problems in transplant medicine is the shortage of available organ donors to keep up with high demand. What are the ethical considerations of solving the liver shortage problem with xenotransplantation? Host Dr. Aaron Carroll welcomes Drs. Tector and Helft for the second part in a discussion of xenotransplantation. Dr. Joseph Tector directs the section of transplant surgery's xenotransplantation research program at Indiana University Health. Dr. Paul Helft is director of the Charles Warren Fairbanks Center for Medical Ethics at Indiana University Health, and is a member of the IU Health Ethics Committee and co-chair of the IU Health Ethics Consultation Subcommittee.

Guest: Paul R. Helft, MD Host: Aaron Carroll, MD Guest: A. Joseph Tector, MD, PhD The necessity for transplantation of living cells from other species, or xenotransplantation, may arise when human donors are not available, a bridge organ is needed, or animal cells can provide a unique benefit to patients. Host Dr. Aaron Carroll's guests are xenotransplantation experts Dr. Paul Helft, director of the Charles Warren Fairbanks Center for Medical Ethics at Indiana University Health, and Dr. Joseph Tector, chief of transplant surgery at Indiana University School of Medicine. What is the history of xenotransplantation? What donor species are currently the subject of the most promising research in terms of solid organ transplantation and overcoming immunologic barriers and infection? Find out which patients might be the first to benefit.

Guest: Audrey A. Krause, PhD Host: Aaron Carroll, MD Psychosocial issues arise before, during and after organ transplantation. To address these issues proactively and comprehensively, many transplant centers incorporate a psychological assessment as part of the protocol to evaluate patients for transplantation. What are the psychological criteria for inclusion or exclusion for listing? And how are psychosocial issues managed for patients both before and after surgery? Host Dr. Aaron Carroll's guest is Dr. Audrey Krause, assistant professor of clinical psychology at the Indiana University School of Medicine.

Host: Aaron Carroll, MD Guest: John M Reynolds, MD Which patients are good candidates for lung transplantation? How sick does a patient need to be to qualify? How does the transplant allocation system work? Host Dr. Aaron Caroll welcomes Dr. John M. Reynolds, medical director of Indiana University Health Lung Transplant Program, to discuss these questions and other considerations regarding potential lung transplant candidates, including the lung allocation score system, and how to assess the optimal time frame to transplant patients for the best chances to improve overall quality of life.

Host: Aaron Carroll, MD Guest: Rodrigo M. Vianna, MD Multivisceral transplant entails the transplant of nearly all the abdominal organs, with the exception of the kidneys. It is a highly unusual procedure, with only about 30-40 such surgeries occurring per year in the United States, compared to thousands of liver transplants performed annually, in only about seven transplant centers in the United States. Host Dr. Aaron Carroll welcomes Dr. Rodrigo Vianna, director of intestinal and multivisceral transplant at Indiana University Health, to discuss when multivisceral transplant can be used to treat patients with rare tumors, such as neuroendorcrine or desmoid tumors.

Guest: Patricia Scott, PhD Host: Aaron Carroll, MD Transplantation offers patients a new lease on life, but the process of waiting before and recovering after a transplant can take their toll. Host Dr. Aaron Carroll is joined by Dr. Patricia Scott, who studies occupational role transitions throughout the liver transplantation process at Indiana University, to discusses the challenges patients face and their quality of life before and after transplantation. Dr. Scott also talks about how healthcare providers can help foster a better quality of life for patients surrounding transplantation.

Guest: William Goggins, MD Host: Aaron Carroll, MD Some patients needing kidney transplants have to wait much longer than others because of their sensitization to human leukocyte antigen (HLA). How are new desensitization protocols opening the door to transplantation for these patients who were previously ineligible? Host Dr. Aaron Carroll talks to Dr. William Goggins, kidney transplant surgical director at Indiana University Health.

Host: Aaron Carroll, MD Guest: Mary Maluccio, MD, MPH While the incidence of many types of cancer in the United States has decreased in recent years, the incidence of hepatocellular carcinoma, secondary to either hepatitis B or cirrhosis, has been on the rise. And, of the treatment options including resection, ablation and transplantation, what tumor characteristics determine treatment and which patients might benefit most from liver transplant? Dr. Mary Maluccio, director of the liver oncology program at Indiana University Health, discusses the advantages of transplant, the length of time that patients generally wait to receive a donor liver and the criteria for donor organs. Hosted by Dr. Aaron Carroll.

Guest: Jonathan Fridell, MD Host: Aaron Carroll, MD Although most patients with type 1 diabetes are able to rely on insulin to effectively manage their condition, sometimes insulin is not enough. When should these patients consider pancreas and/or kidney transplant? Dr. Jonathan Fridell, surgical director of the pancreas transplant program at Indiana University Health, talks with host Dr. Aaron Carroll about the benefits of separate or simultaneous pancreas and kidney transplantation, and says that such transplants can effectively cure patients of their type 1 diabetes. Of course, not every patient with type 1 diabetes is an appropriate candidate for transplant, and sometimes the side effects of immunosuppresive drugs are serious. What are the factors that influence a patient's eligibility for pancreas and kidney transplant? If a patient already has a kidney transplant, are there any disadvantages to getting a pancreas transplant, since these patients are already on immunosuppressive medications?

Guest: Thomas C. Wozniak, MD Host: Aaron Carroll, MD Currently, 3 to 5 million people per year suffer from heart failure in the United States; one-third of these patients suffer from Class III or Class IV heart disease. Host Dr. Aaron Carroll welcomes Dr. Thomas Wozniak, surgical director of the Indiana University Health Thoracic Transplant Program. Dr. Thomas discusses the advanced heart failure patient, and who is a candidate for ventricular assist device (VAD) therapy and cardiac transplantation and considerations about timing.

Guest: Paul Kwo, MD Host: Aaron Carroll, MD Approximately three million people in the US have hepatitis C. In some cases, hepatitis C can be completely cured. However, many with the condition may be asymptomatic for decades and thus are not diagnosed until the disease has progressed into later stages. This is problematic, because when hepatitis C advances, it may cause scarring of the liver. When should liver transplant be considered for these patients? And what is the rate of recurrence and necessity for re-transplantation? Dr. Paul Kwo, medical director of the adult liver transplant program at Indiana University Health, discusses treatment options for patients with various stages of hepatitis C, as well as the evaluation process for those with advanced hepatitis C who are liver transplant candidates. Dr. Aaron Carroll hosts.

Guest: Tim Taber, MD Host: Aaron Carroll, MD Patients needing transplantation have two options--receiving an organ from a deceased donor or a living donor. In which cases might living organ donation be a viable option, and what are the advantages to this procedure? Dr. Tim Taber, medical director of the kidney and pancreas transplant program at Indiana University Health, discusses the issue of organ shortages, how organs are allocated and the process of living organ donation. Dr. Aaron Carroll hosts.