Thinkin' about being Rickis hero?

No, that's not an "A+" for saying yes... Ricki's finally found out her blood type and it is "A Positive" Whoo hoo!! No pressure here ~ but if you feel compelled to look into being Ricki's hero... We're just making it a little easier for you. Below is the information on being a living donor. And remember... Living donation is a gift that only a few are able or willing to give, but almost everyone can still be a HERO and live on by going to www.donatelife.net and by sharing your wishes to be an organ donor with your loved ones! Live Life *then* Give Life.

Live Donor Liver Transplant

Click here to learn more about Live Donor Liver Transplants Feature: World's First Adult-to-Adult Live Donor Liver Transplant Without a Blood Transfusion FAQs: Donor and Recipient | The Operation Espanol: Trasplante de Higado con Donante Vivo | Cuestionario Live Donor Transplant Evaluation Forms: English | Spanish Live donor liver transplantation (LDLT) is a procedure in which a living person donates a portion of his or her liver to another. The feasibility of LDLT was first demonstrated in the United States in 1989. The recipient was a child, who received a segment of his mother's liver. Since that time, LDLT for children has enjoyed wide success and many pediatric programs use this technique. In the pediatric experience, survival of both the recipient and the transplanted liver (graft) at 1 year is about 90%. Donor complications have been very few. A rising population of adult patients awaiting liver transplantation has led to the application of LDLT for adult patients, and the preliminary results have been very encouraging. Only a handful of centers in this country perform the procedure. The transplant team from USC has been performing LDLT at the Children's Hospital of Los Angeles (CHLA) for some time with excellent results. This USC team also performed the first adult-to-adult LDLT in Southern California, and the world's first adult-to-adult LDLT without blood transfusion. Encouraged by these results, we now offer this option as standard treatment in adults who have suitable donors.

Donor and Recipient

Basic facts regarding the Recipient:

• Patients being considered for LDLT are those who are candidates to receive a cadaveric liver (liver from non-living, unrelated individual) based on the severity of their liver disease and its complications. These patients are placed on the liver transplant waiting list and will not be denied a donor liver if it becomes available prior to LDLT. Thus, failure to find a suitable donor for LDLT will not jeopardize the recipient's chances of receiving a cadaveric liver
• Patients considered for LDLT will be followed by the same USC liver transplant team who will manage all complications of liver disease with a view to optimizing the patient's condition prior to liver transplant.

Basic facts regarding the donor:

• The donor could either be a relative (close or distant) or even be unrelated.
• The blood type of the donor should be the same as the recipient's.
• The donor should be in good physical and mental health.
• The decision to be a donor should be made after careful consideration of facts and knowledge of the procedures, the risks and complications.
• There should be no evidence of financial gain arising out of the donation.
• The donor must be relatively close in size (or larger) than the recipient.

What constitutes a good donor?

A good donor is someone who is in good physical and mental health, older than the age of 18 and free from:

• HIV infection
• Known viral hepatitis
• Active alcoholism with frequent and heavy alcohol intake
• Psychiatric illness under treatment
• History of malignancy
• Heart and lung disease requiring medications
• Diabetes mellitus of greater than 7 years duration

What is the process for evaluating a donor?

• The potential donor will be asked to complete a questionnaire that includes attaching a copy of his or her blood type (to confirm whether this is compatible with the recipient).
• If the blood type is compatible with that of the recipient and the details on the questionnaire indicate suitability, the donor is evaluated by an internist (liver specialist or hepatologist) who will obtain additional history, perform a physical examination and administer appropriate blood and urine tests.
  BLOOD TYPE COMPATIBILITY CHART

  Blood Type Can receive liver from: Generally can donate a liver to: O O O, A, B, AB A A, O A, AB B B, O B, AB AB O, A, B, AB AB

• If the physical examination and tests confirm that the donor is suitable and the donor's size (height/weight compared to that of the recipient) is appropriate, a CT scan will be arranged to calculate the volume of liver that will permit a successful outcome. [Prior to having the CT scan the donor must notify the team of any allergies to iodine or radioiodinated contrast.]
• At this stage, the potential donor will also be interviewed by a social worker from our team. Under some circumstances, a psychiatric evaluation may be appropriate.
• When complete, the medical and social details of the evaluation are discussed at a conference by the transplant team members.A decision regarding the suitability of the donor will be made at that time. This decision will be communicated to the donor by one of the team members (usually the transplant coordinator). If not selected, physician team members can be contacted for explanation. [All information concerning the donor is kept in strict confidence.]

The Operation

Where does the transplant occur?

• All adult liver transplants are performed at the USC University Hospital.
• Pediatric liver transplants are performed in conjunction with Children's Hospital Los Angeles.

When does the transplant occur?

• The transplant is scheduled at a mutually convenient time for the donor and recipient. In the case of the latter, the team members will decide the optimal time based on condition of the recipient and control of complications. For example, if the recipient develops a sudden fever, the procedure will be delayed until the cause is found and potential infection controlled.
• The advantage of LDLT is that the procedure can be timed in such a way as to perform the procedure on both the donor and recipient when both are in the best possible condition.

How is the operation performed?

• After all of the medical issues have been settled and the donor-recipient match-up is completed, a date is selected for the operation.
• Two teams perform the donor and recipient operations simultaneously.
• As the diseased liver is removed from the recipient by one team, approximately half of the donor's normal liver is removed by the other team.
• Once the donor operation is completed, both surgical teams complete the transplant by attaching the half-liver into the recipient.
• The donor operation usually takes about 5 hours and the recipient operation about 10 hours.
• Both half-livers (of donor and recipient) grow to be full sized in 6-8 weeks.

What is the post-operative period like for the donor?

• Prior to the transplant procedure, the donor will receive a detailed description of the procedure and will have an opportunity to discuss the potential risks or side effects of the operation.
• The donor is usually in the intensive care unit for about 24 hours and in the hospital for 5-7 days. Most patients are up and out of bed (with assistance) by the second or third postoperative day. It is usually necessary to stay off work and usual home activities for a month full time and 2 to 4 weeks part time, depending on the rapidity of the recovery.

BACKGROUND: Liver transplantation is currently the standard of care for patients with end stage liver disease. However due to the cadaveric organ shortage, live donor liver transplantation (LDLT), has been recently introduced as a potential solution. We analyzed and support our initial experience with this procedure at USC. MATERIAL AND METHODS: From September 1998 until July 2000, a total of 27 patients underwent LDLT at USC University Hospital and Los Angeles Children's Hospital. There were 12 children with the median age of 10 months (4-114) and 15 adults with the median age of 56 years (35-65). The most common indication for transplantation was biliary atresia for children and hepatitis C for adults. RESULTS: All donors did well postoperatively; the median postoperative stay was five days (5-7) for left lateral segmentectomy and seven days (4-12) for lobar donation. None of the donors required blood transfusion, re-operation or postoperative invasive procedure. However, five of them (18%) experienced minor complications. The survival rate in pediatric patients was 100% and only one graft was lost at nine months due to rejection. Two adult recipients died in the postoperative period, one from graft non-function and one from necrotizing fascitis. 37% of adult recipients experienced postoperative complications, mainly related to biliary reconstruction. Also 26% of the recipients underwent reoperation for some of these complications.

Love your liver (and remember... You can't buy love)

There must be FIFTEEN WAYS TO LOVE YOUR LIVER

1. Put the six-pack back, Jack
Half of all the alcohol consumed in America is consumed by only ten percent of the population. One in three adult Americans is a heavy drinker, with a sufficient liquor habit to be indistinguishable from an alcoholic. Such behavior wrecks livers.

Cirrhosis
Cirrhosis of the liver is a rather rare disease, except among alcoholics... who make it the seventh leading cause of death in the U.S.! And it is 4th or 5th, in large cities among adult men. It usually takes a half quart of whiskey daily for ten years to abuse the liver to the point of cirrhosis.

The fibrous tissue that replaces normal liver in cirrhosis causes decreased liver function. Of course this leads to fluid buildup, jaundice and perhaps cancer of the liver. Cirrhosis is fairly easy to arrest by stopping alcohol. But cure is difficult and generally considered impossible. Well, as they say in the Marines, the difficult we do immediately; the impossible takes a little longer.

Reversing cirrhosis is reduced to being merely very difficult if you employ the Gerson program (referenced below) and very high doses of vitamin C and B-complex vitamins. Corticosteroids (such as Prednisone) are commonly tried but the side effects are undesirable, and the drug is probably ineffective.

Prevention is the way to go: stop drinking. Sure, as W. C. Fields said, "It's easy to give up drinking; I've done it a thousand times.' But consider this: Fields, the highest paid comic of his time, who drank over a quart of hard liquor a day, was dead at age 66. That's not so funny.

2. Avoid the virus, Iris
Hepatitis
Acute viral hepatitis, or "infectious hepatitis" is now called hepatitis A. "Chronic," "long incubation," "serum," and "posttransfusion" are now called type B. Non-A non-B may be more than one agent. All respond remarkably well to very large doses of vitamin C, the B-complex vitamins and the Gerson therapy, described below.

3. Take a lot more "C," Lee
Vincent Zannoni at the University of Michigan Medical School has shown that vitamin C protects the liver. Even doses as low as 500 milligrams daily helps prevent fatty buildup and cirrhosis. 5,000 mg of vitamin C per day appears to actually flush fats from the liver. (Ritter, M. "Study Says Vitamin C Could Cut Liver Damage," Associated Press, October 11, 1986) And vitamin C over 50,000 mg/day (not a misprint) results in patients feeling better in just a few days, and actually eliminates jaundice in under a week. (Cathcart, Robert F. III (1981) The method of determining proper doses of vitamin C for the treatment of disease by titrating to bowel tolerance. Journal of Orthomolecular Psychiatry. 10:125-132.) Frederick Klenner, MD, found that such huge doses of vitamin C had his patients recovered and back to work in under a week. (Klenner, Frederick R. (1971) Observations on the dose of administration of ascorbic acid when employed beyond the range of a vitamin in human pathology. Journal of Applied Nutrition. 23(3 and 4), pp 61-68, Winter.) These and additional references are found in the highly-recommended book by Melvyn Werbach, M.D. (1988) Nutritional Influences on Illness. New Canaan, CT: Keats Publishing.

Immediate and detailed information on vitamin C dosage and administration, written by medical doctors, will be found at

http://www.doctoryourself.com/titration.html
http://www.doctoryourself.com/ortho_c.html
http://www.doctoryourself.com/klenner_table.html
http://www.doctoryourself.com/klennerpaper.html

4. Don't trust in a shot, Dot
Even if you choose to vaccinate, it is immeasurably reassuring to remember this: Dr. Klenner showed that very large doses of vitamin C (between 500 to 900 mg per kilogram body weight per day) can cure hepatitis in as little as two to four days (Smith, L. H., ed. Clinical Guide to the Use of Vitamin C, Life Science Press, Tacoma Washington, 1988, pp 22-23).

5. Take vitamin B, Dee
Especially vitamin B-12, which significantly reduces jaundice, anorexia, serum bilirubin, and recovery time. (Jain, A.S.C., Mukerji, D. P (1960) Observations on the therapeutic value of intravenous B-12 in infective hepatitis. Journal of the Indian Medical Association. 35:502-5; also Campbell, R. E. and Pruitt, F.W. (1952) Vitamin B-12 in the treatment of viral hepatitis. American Journal of Medical Science, 224:252) B-12 is most effective if administered by injection, which your doctor can easily arrange. If injection is not an option, there is an intra-nasal gel that improves absorption. B-12 is non-prescription, utterly non-toxic, and has no contraindications and no negative side effects.

6. Eat veggies and greens, Gene
The fiber and abundant nutrients in vegetables are a sure way to improve the health of practically any organ you can name, especially the liver. Vegetables are esentially fat-free. And, they are rich in the B-vitamin folic acid. (Folic, like in foliage. Neat, huh?) Folate has been shown to help shorten the recovery time for viral hepatitis. (Campbell, R. E. and Pruitt, F. W. (1955) The effect of vitamin B-12 and folic acid in the treatment of viral hepatitis. American Journal of Medical Science, 229:8)

7. Eat your food raw, Paw
Or at least as much of it as you can. Max Gerson, M.D. believed that cancer in general is a disease of the liver even if occurring elsewhere in the body. Gerson's nutritional therapy is a raw-foods protocol that is often very effective against cancer, as well as lesser diseases. Cancer in the liver itself is often due to environmental toxins, such as dry-cleaning fluids. I have personally seen a terminal liver cancer case (and the patient had indeed been a dry cleaner for many years) vastly improved with the Gerson program. Full dietary details are provided in his book A Cancer Therapy: Results of 50 Cases.

8. Get off the drugs, Doug
Illegal drugs of all sorts (and not a few prescription drugs as well) are rough on the liver. This includes anabolic steroids. The liver is the main chemical detoxification center for your entire body. Don't push it; quit now before your liver quits on you.

9. Eat less fat, Matt
The liver is the largest gland in the body, weighing in at about 4 pounds. Diseases of the liver may result in diminished ability to emulsify fats. Your liver normally makes 250 to 1,000 ml (over a quart!) of bile DAILY. Most (about 80%) of your bile salts are reabsorbed by the intestinal tract and returned to and recycled by the liver. This is how your body, with about 3.6 grams of total bile salts in it, can secrete 4 to 8 g of bile salts per single fatty meal. Gross, huh?

Fatty liver is much more common than you would expect. 25% of people have this condition, according to the Merck Manual, 14th ed. Fatty liver is the most common response of the liver to injury. It typifies the alcoholic's liver upon admission to the hospital. The Merck Manual indicates "no specific treatment" (p. 830) and says it likely indicates other problems, such as alcohol, drugs or malnutrition (oh, my!) Treatment certainly includes cessation of alcohol intake. Therapeutic juice fasting gives the liver an opportunity to use all those extra built-up fats.

10. Use safe sex, Tex
If you are not in a monogamous relationship, you are at increased risk for hepatitis.

11. Wash your hands, Stan
Good grief, is that so hard to do? After a bowel movement, that paper you use to clean up with is thinner than a politician's election promise. Do you really think the tissue keeps you hands squeaky clean? To put it another way, do you think it keeps someone else's hands clean enough for you? No? Then wash your hands with soap and hot water! I read once that over half of all physicians don't wash their mitts after using the toilet. I hope this is not true. My supposition is that it is, however. When heads of state, billionaires, or doctors use the john, they are about as likely as you to do what you do. Think about that in your spare time today. And wash.

12. Prevent that stone, Joan
Now here's an obvious argument for vegetarian diet, as only animal foods contain cholesterol, and cholesterol forms gallstones. Some people manufacture excessive cholesterol, and this can be controlled through intelligent use of therapeutic vegetable juice fasting and large doses of vitamin C, both of which significantly reduce cholesterol production.

13. Spare the bile, Kyle
About 33 ml of bile is stored in the average gallbladder. Many animals (rats, for instance) do not even have one. In addition to bile salts for emulsification, bile contains the pigment bilirubin, neutral fat, phospholipid, assorted mineral salts... and high concentrations of cholesterol.

The gallbladder is more than a storage receptacle. Bile is concentrated in the gallbladder. Also, water is removed, and resulting concentrated cholesterol level may be too much to remain in solution and cholesterol gallstones may precipitate out. In addition to hurting, gallstones obstruct the bile duct and thereby interfere with fat digestion. One indicator: light-colored stools. Why? Bilirubin, the bile pigment, darkens them to brown-green. Otherwise, stools would be manila to grayish-white in color. Ugh. Low-fat meals probably help prevent future gallbladder problems.

14. Eat lecithin, Tim
Phospholipids in bile help emulsify cholesterol. Lecithin therapy is therefore almost certainly worth trying for threatened gallstones. Three to five tablespoons daily is more likely to be effective than a few capsules. Even a large 1,200 mg capsule contains only about 1/8 tablespoon lecithin because of size limits and added carrier oils. Lecithin is harmless and without side effects. Bulk granules run between $8 and $15 per pound. Lecithin is non-prescription, and available at any health food store.

15. Be sure to read, Steed
References and Sources Cited:
Gerson, Max A Cancer Therapy: Results of 50 Cases, Totality Books, Del Mar, CA

Ray, O. and Ksir, C. Drugs, Society and Human Behavior, Mosby, 1990, chapter 9

Vander, Sherman and Luciano Human Physiology

Werbach, M. (1988) Nutritional Influences on Illness. New Canaan, CT: Keats Publishing.

Williams, Sue R. (1993) Nutrition and Diet Therapy, seventh edition. St. Louis: Mosby.

What is in a name???????? EVERYTHING

For those of you who do not know me or Ricki... She is one who believes in naming EVERYTHING, from her Venus-fly trap (Chomper) to -- yooooooou guessed it! ME, her Liver -- Larry. Since I will hopefully be vacating the property soon, we must find another - more suitable name for Ricki's new liver. So please, think hard, be creative and think of a name I can be proud of! Post it in the comments and we will be voting after November 9th!