As an anatomic pathologist, Emma Furth, MD, professor of Pathology and Laboratory Medicine in the Perelman School of Medicine at the University of Pennsylvania, spends most of her day involved in “behind the scenes” work, such as examining specimens under a microscope. But, thanks to her new patient education initiative, she’s now getting face time with patients as well.
“How Did This Happen?”
While most people know what the heart and lungs do in the body, the liver seems to be more of a mystery. In fact, the liver is an amazing organ. It not only plays a major role in metabolism — for example, converting glucose to glycogen to balance energy metabolism — but also breaks down fats, maintains a proper level of blood glucose (blood sugar levels), filters harmful substances from the blood stream, stores vitamins and minerals, and produces most of the cholesterol in your body.
But when a patient needs a liver transplant, they’re often in the dark as to how they got to that point. In fact, one of the more common questions Stephanie Veasey, MSN, CRNP, and Samantha Halpern, MSN, CRNP, nurse practitioners in post-liver transplant, often get from post-transplant patients is “Just how bad was my liver?”
And that’s how the initiative got started. Collaborating with Veasey and Halpern, Furth began creating customized presentations and using them in one-on-one sessions with post-liver transplant patients to help them better understand both the liver’s function and their own liver’s disease process. “By providing insight and knowledge about what is a very complex and overwhelming situation, we hope to empower them and provide a certain amount of peace,” Furth said.
The PowerPoint presentation includes photos — of the patient’s diseased liver and a healthy one. “The picture of the old liver is impactful,” Furth said. “You can tell a patient that their liver is cirrhotic (a late state of scarring due to disease) but until they see it, it’s just medical jargon.” Following the presentation, Furth sends the PowerPoint to the patient.
Patients who need a liver transplant arrive at that point for different reasons, she said. Alcoholism and obesity can severely damage a liver but so can other disorders. The presentation was especially appreciated by a patient who had a liver transplant last fall due to fatty liver disease. “I never felt sick. I’m not a drinker and there’s no family history,” he said. “But seeing my liver and the actual scarring was amazing. It gave me closure of why and peace of mind.”
“Helping them understand what role they had — or sometimes didn’t have — empowers them,” Furth said. “If a patient thinks ‘I brought this on by myself’ but didn’t, they need to know that.”
Furth stressed that these conversations are not to point fingers. “I try to be supportive but nonjudgmental,” she said. Especially in cases of alcoholism, slides of liver specimens don’t lie. “I tell them that under the microscope I can see evidence that they’ve been using alcohol for a certain period of time. It’s just the fact. The objective is to have them understand how they got to where they did and not go back.”
Furth provides the sessions when patients are in for a post-transplant visit, about one a week, either in person or by telehealth. Post-session surveys show “they’re feeling more positive and have a greater understanding of their liver disease,” Halpern said. Before meeting with Furth, “most patients report their understanding level as one out of five. Afterwards it’s typically five.” Veasey and Halpern have also started researching if there’s any correlation between patients who meet with Furth and greater compliance and fewer episodes of rejection.
Furth finds the sessions meaningful for herself and hopes they are helpful for patients. “I encourage them to take their medications and follow the transplant team’s recommendations. I tell them with their new liver, they now have a gift… a new chance of life.”
The Transplant Wait List Continues to Grow
While Furth can help post-transplant patients better understand their need for receiving a new liver, she cannot increase the number of organ donors available for the 12,000+ on the liver transplant wait list. “The need has been here but the supply of donor livers is one of the most limiting factors to having more transplantations,” she said. “The number of patients dying on the waiting list continues to grow.”
In addition to the general shortage of available donor livers, UNOS (United Network for Organ Sharing), which the federal government tasks with ensuring fair organ allocations throughout the country, made a recent policy change that expanded the local geography to which organs are sent. This has reduced the number of livers that might normally stay in our area,” said Denny DuPont, manager of Transplant Outreach and Communication at Penn Medicine.
“As a result, patients have to be much sicker to get a transplant,” she continued. “The need for living donors is more important than it ever has been.”
The Miracle Worker
What many people may not know is that the liver is a transplant superstar: it is the only solid organ that can regenerate. Indeed, within weeks of a living donor liver transplant (LDLT), the liver in both donor and recipient will grow to match each body’s needs!
LDLT benefits the recipient in many ways. The surgery can be scheduled sooner, before patients get to the end-stage disease level and are much sicker, which leads to fewer post-transplant complications. And the liver, which currently must come from someone a patient knows (relative or friend), is generally of better quality than from a deceased donor, i.e. from someone the patient knows is healthy. As a result, the donated liver usually lasts longer.
Over the past year (July 2020 through June 2021), the Penn Liver Transplant Program — the largest in the region — performed 135 liver transplants. However, only 10 were through LDLT. With all its benefits, DuPont hopes to increase awareness of living donor transplants and get more people screened to become living liver donors. The lives of thousands are on the line.