Summary
In this podcast episode, the host Peter Etia sits down with his former senior resident, Chris, to discuss his journey into medicine and surgery. Chris stumbled into medicine but was drawn to surgery because it provided a unique opportunity to help people in their darkest moments. He also discusses his decision to train at Johns Hopkins, citing the emphasis on mentorship and clinical excellence as reasons for his choice. Throughout their discussion, Peter praises Chris for his exceptional leadership skills and ability to maintain his humanity during the stresses of residency.
The conversation revolves around kidney transplantation, the increasing demand for kidneys due to pre-diabetes and metabolic syndrome, and the challenges faced in measuring kidney function. The benefits of living donation over deceased donation are discussed, with living donation being a critical part of kidney transplantation. The conversation also touches on the evolution of immunosuppressive regimens and the use of live donor swaps to expand the compatibility of donors and recipients. The importance of exploring options for living donation is emphasized, as it provides a smoother recovery for the donor and better long-term outcomes for the recipient.
The podcast discusses the history of organ transplantation and the development of immunosuppressive drugs that allowed for long-term organ survival. Initially, organ rejection was thought to be caused by circulating antibodies, but it was later discovered to be cellular rejection caused by T-cells. The development of drugs like cyclosporine was a game-changer that improved kidney transplant outcomes and reinvigorated other solid organ transplant programs. The majority of kidney transplant patients suffer from chronic kidney disease due to comorbid conditions like diabetes and hypertension. The potential impact of effective and durable therapy for chronic kidney disease is massive from a public health standpoint.
The context discusses the process of organ donation and transplantation. The organ procurement organization and their team facilitate the gift of transplantation from individuals who have identified themselves as organ donors or families who come forward to donate their loved one's organs. The process of declaring death is separate from the process of procuring organs, even in the case of donation after cardiac death. The need for organ donation is high, with more than a hundred thousand people waiting for various organs. The liver is the largest solid organ in the body and has a dual blood supply, making it one of the most technically demanding operations in the field of transplantation.
The liver is a complex organ with challenging anatomy and intra-hepatic structures. Liver transplantation is a difficult surgery due to the development of cirrhosis or end stages of chronic liver injury and fibrosis. Attempts at extracorporeal liver support have failed, including liver dialysis and liver transplantation with baboons. The regulation of blood glucose is a critical function of the liver, which cannot be done by a machine. Liver patients are at high risk of death without timely transplantation. The context discusses various liver diseases and their impact on liver transplant infrastructure in the United States. Hepatitis C was the predominant indication for transplant for about 20 years, until the development of direct anti-viral agents that transformed the field of hepatitis C. This has led to a precipitous drop in the number of patients needing transplant for hepatitis C. However, non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease have emerged as leading indications for liver transplant.
Overall, the podcast episode provides a deep dive into the world of organ transplantation, specifically kidney and liver transplantation. The conversation highlights the challenges of the medical profession and the importance of teamwork, accountability, and responsibility in medicine. It also emphasizes the importance of humility and recognizing opportunities to improve as a team. The podcast provides a comprehensive overview of the history and current state of organ transplantation, including the development of immunosuppressive drugs and the challenges faced in measuring kidney function. The conversation also touches on the need for more living donors and the ethical considerations surrounding organ donation.
