Leuven hospital has a excellent abdominal transplant department headed by Dr. Jacques Pirenne, or as the Belgian call the proficient surgeon Professor Pirenne. At Birmingham's Queen Elizabeth he went by the title of 'Mister', following British tradition where the first surgeons were barbers.
We started off with some rountine checkups and a counsultation. Two patients were recovering from a liver transplant. One had had cancer of the bile duct. Liver cancer is very hard to detect as it has virtually no symptoms. Tumours are found using echographs. 25% of those with small tumours are eligible for surgery. Large cancers don't qualify for transplant as cancerous cells are dispersed and the cancer returns. The second patient had liver cirrhosis due to non alcoholic causes and the third due to excess alcohol consumption. Only people who have stopped drinking for at least six months are offered treament which I found just and fair. A large porportion of liver replacements were due to heavy alcohol consumption and as another doctor pointed out there wasn't enough public awareness about the adverse effects of too much beer, Belgium's pride.
The last person, a lady who was suffering form polycystic liver disease, was eligible for a liver transplant. She complained of poor diet and short of breathness which made it hard to take care of her two children. Dr. Pirenne had the job of explaining to her about the pros and cons of surgery. I learnt that it was imperative that every patient made an informed decision when at a crossroad in their medical treatment. Individuals sometimes often regarded the transplant as miracle with no strings attached and by doing so they completely disregarded the potential risks.
The wait after being placed on the waiting list, could greatly damage morale and lead to a lot of other problems such a depression. Candidates are placed on the waiting list in order of priority. Priority is largely determined by the MELD (Model for End-Stage Liver Disease) scale which assesses the function of the liver. However in some cases such as the lady's PLD, the score didn't reflect the urgency of the situation and so extra points were given to her. A sad fact is that an alcohol abuser may be higher up on a waiting list than a child whose illness is due to no fault of its own. I found surprising that when re-transplants were needed for example due to organ rejection, the patient was once again placed on the top of the waiting list. The organ can be rejected at any point after surgery. However the likelihood decreases as time passes. If the body rejects the liver in the first two weeks, a replacement is vital.
Transplant recipients take anti-immunosuppressants for the rest of their lives. The list of medication needed to be taken was extensive, and would therefore amount to quite a total, an expense that not everyone would be fit to bear. Thankfully both the British and Belgian healthcare systems are able to cover this cost and greatly assist their citizens. Americans have to rely on private insurance. These compulsory medications are another factor to consider when thinking about surgery. They are to blame for the development of chronic kidney disease in most transplant patients. After surgery, a tooth problem or small wound could cause problems due to the suppressed immune system. On the other hand, these drugs are tiny miracles that have "revolutionised" transplantation allowing a 90% success rate of surgeries on people who would have otherwise died on the waiting list.
No treatment is risk free. And in liver transplant death is always an unfortunate possibility. People may rush into surgery claiming their current quality of life is unbearable. But personal suffering is subjective and its the doctor's job to look at each case objectively in order to devise an appropriate waiting list. A person may be taking on unnecessary risks. Its very challenging to balance a persons interests and wishes with an professional, knowledgable outlook. Dr. Pirenne had to put to rest an elderly gentlemen's fear of dying. He had luckily received a donor's liver but wasn't able to relax with the thought still weighing on his mind.
I also had the opportunity of sitting on a staff meeting, which hit home once again how integral teamwork was to healthcare. At the meeting were surgeons, nurses, a pathologist, junior doctors, medical students and a medical hopeful (me!). There was also an administrator who was responsible for tracking down donors and making the organs matched the patient in criteria such as age. The members also discussed involvement in medical survey. Dr. Pirenne had to make a tough decision as although he personally thought the study and its accompanying work had merit, the hospital personnel just wouldn't be able to cope with the additional workload and responsibility. The team had dealt with 5 liver transplants in the last week, each procedure lasts 6-8 hours. Furthermore the study was very specific and possibly just 2 or 3 patients fitting the bill. It wasn't worth it.
I spoke to a Dr. Pirenne about medicine as a subject, we discussed about the breadth and diverse opportunities within the disciple. He told me about how his studies took him abroad. He did his medical degree in Liege, Belgium, did his specialisation in abdominal surgery in Minneapolis, USA and took his first job as a senior consultant in Birmingham, England. I asked the doctor studying to specialise in surgery why he chose to do so, he reply it was a field where the results of work your work were tangible, the effects can be clearly seen. Lastly, I chatted to the last year medical student how he found the workload at medical school. He confided that he found the level of study quite a struggle in the first year but went on to say that he was able to achieve a good balance between his education and social life and so really enjoyed university.
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