Hello and welcome to the gifted life podcast where we have conversations about organ tissue and I don't nation I'm Lori Steel I'm Joey Boudreau. I'm Sally Junterrey and today on the get-to-life. We're talking about myths why someone may not say yes Guys, yeah, are you one of those people that say I can't donate because blank. We'll be talking to an expert shortly We'll be able to let us know what's fact and what's fiction and we're going to talk about how some people are very hesitant to seek help When going through the grief journey and we're gonna walk you through it I like it all that more right here on the gifted life and our ask of you guys to please spread the word We try to make it as easy as possible easy to find read us subscribe to it You can find us on Apple podcast Google play or whatever your favorite podcast app maybe and all those cool people on social media Sally Yes, there you go on Facebook find us at the gifted life podcast Twitter and Instagram or at gifted life pod at gifted life pod, right?
I'm sorry our goal is to spur those healthy conversations about organ tissue and I donation your part of our team Obviously, we have lots to get to right guys. Hey, and it's so good to see you all this morning That's right. You like us now. I do like you too, right?
We thank you for listening guys episode 95 hang on to your hats All right, we have a guest here joining us on the gifted life doctor Jonathan hand sounds familiar Yes, and we know dr. Hanson sees co-chair on Lopez medical advisory board. Yeah, and of course He's been very instrumental dr. Han and I have become very close over the last few years and he likes us and he still likes us Well, let's ask him when well, yeah, you know, of course We've got a lot of questions oftentimes with potential disease transmissions We want to make sure that everyone who's receiving an organ transplant has the safest organs available and whatever we can do to Maximize the safety of course is what we try to do so we're on the phone quite often So welcome dr.
Han to the podcast and can you tell us a little bit about yourself? Yes again for having me? I do say before I start think this podcast is played a really important role in Transplant education for patients and that's with donors in advance as well as other people on the US that are involved in different aspects of the Transplant process a lot of people are probably thankful for this podcast I know I know nice so first off I do have the day I am from Louisiana from like Charles and I ended up going to LSU for undergrad and LSU from Ed school here in New Orleans And then I was in New York and did internal medicine residency and especially this fellowship there at Mount Sinai Hospital And during my time the infectious diseases fellowship I focus specifically on caring for the infectious complications Transplant recipients and other immunocompromised patients so they get people who don't have normal immune systems They end up dealing with different bacterial fungal parasitic infections that people with normal immune systems Don't commonly deal with because of there is a growing group of immunocompromised people in the US in the world That's a growing need is for a provider or a specialist to take care of those So that they go through and also dealing with how can their immune system is a little bit down and that's kind of what we're here for So I focused on that specifically and then after I finished that training I moved to New Orleans about three years ago to work at Ochner where I was able to start transplant infectious diseases program So I've started a group of people focusing on the quality and safety revolving around infectious issues in transplant recipient Given that we work very closely with agencies like LOPA We know it's very important to understand the infectious issues and donors because they would then in turn may affect infectious issues in recipient I think I reached out to LOPA when I first moved down here and since I was at a really great working relationship as Joey alluded to But my goal has been to work with you guys to optimize donors that may have infectious issues It's interesting because I think as we may get into these are donors that historically we may not have been able to use or felt safe using in the past Right so for the public out there we mentioned it in previous podcast But on the recipient they are also immunocompromised because they have to take anti-rejection medication for the rest of their lives So they don't quite have the same immune system So it's very important on the front end to make sure that the organs are completely safe What we then have to do in turn to make sure if they aren't at the time How do we get them to be safe and of course, you know as dr. Han alluded to when he first got on at Ochner You know one of the first phone calls he made was to us we met and ever since then we've been having a very close relationship So our growing relationship that we've had has been mutually beneficial because we've been able to Optimize the number of donors and optimize the number of organs for transplant some of which go to dr.
Hands the recipients and others go to other recipients across the country So it's been a huge benefit in a great relationship that we've had together Yeah, and I'm glad that you're on I'm glad that we have this medium to talk about I'm out in the community So some folks are just scared to talk about death some folks are scared to talk about disease and don't even mention Transplantation, but I saw a presentation with you and you made it so easy for me to understand So we're glad that you hear we want to talk about some of these like hepatitis that comes up a lot What if I have hepatitis what I receive an organ from someone who had hepatitis? How does that work? So can you give us a general overview? Yeah, sure So I say this now I could say it again later because I do think it's worth repeating It's really important to educate our organ transplant candidates that their biggest risk overall is of not getting a transplant And that infection risk is very low and that really has to be compared to or within context of the risk of spending more time on a wait List so I think that's an important before we start talking about through infections and donors I think it's really first important to talk about the risk of staying on the wait list and even if staying on dialysis waiting for any transplant any type of wait list you have an increased mortality when you're on that wait list So any type of risk that you're thinking about you're thinking about it important to put that risk in context of what if you don't get a transplant and dr.
Hand to be clear when you said increase mortality rate on what does that mean? Yeah, that's a very good question So anytime someone is on a waiting list for a transplant that means that they have in stage or the organ is not functioning liver disease Heart disease long disease or kidney disease and so the longer someone's in with that organ not being functional or at its end stage So the longer they're on the wait list the more likely they are you have complications and therefore in a dying from that underlying end organ disease So if you're question specifically about so we'll focus on hepatitis C I think that's probably the biggest issue there's hepatitis A which is more of an acute If I don't have a type of type of B which is a chronic hepatitis We do use organs from patients with hepatitis B But more recently hepatitis C has been a bigger question that sounds like in the community and definitely in the candidates are sitting at the Ants and centers in the country So hepatitis C can be transmitted to blood blood products and so a big change five years We are in a new era now of hepatitis C treatment So and this has been a really quick change over the past few years So we've gone from a hepatitis C being a really difficult disease to treat a very toxic medication Historically is any patients didn't do well without therapy now We have many new hepatitis C cures So these aren't just the long-term suppressive therapies These are actual cures and patients can take a combination of these drugs They're referred to in the medical field as DAA's or direct acting antiviral And so they just can take these bill medications typically ranges from about eight to 24 weeks with very high care rate Typically over 90% and in these drugs are very very well tolerated so in the past this type of cure was kind of unimaginable So you bring that back to the other side So after recipient receives a hepatitis C positive organ Then that recipient can then be actually cured with these new effective and very well tolerated medications And so I think it's important we talk about hepatitis C positive They either want to clarify what that means because there are two types of donors that will sometimes be lumped into that Hepatitis C positive category So there are those patients who have been exposed in the past and show evidence of exposure without actual detectable level of virus in their blood So these are people who were previously cured or their body may be cleared the virus itself and in these types of patients The transmissibility is extremely low. We can compare those patients who've been exposed and cleared to those who actually have detectable virus in their blood or have active hepatitis C and these patients have nearly a hundred percent chance of transmitting to hepatitis C to the recipient We end up testing all these recipients routinely after they get an organ from a hepatitis C positive donor And we monitor them closely to see if there is any transmission of virus if there is then we will treat the organ recipient with these new drugs And so many programs in the United States are safely utilizing to get the light from these donors who have had Hepatitis C or Hepatitis C or Hepatitis C or Hepatitis C and the past and cleared it Which is obviously it's a change from in the past where you know We had transplanted a Hepatitis C positive organ into a Hepatitis C positive recipient because we didn't have that antiviral the DAs that he talked about We've had a podcast couple podcasts in the past where we did touch on HIV donation a little bit and now as you know doc We've here at Lopa in Louisiana become involved with the whole back Which brings me to the similar infection in HIV another viral infection where we've talked in the past about the whole back HIV organ Policy equity act that has been enacted a few years ago that has now made it legal again Which it wasn't for years but legal now again to be able to transplant HIV positive donor organs into HIV positive recipients at this time I know he mentioned the Hepatitis C that there's a cure for Hepatitis C of course for HIV We don't have that exact cure but we do have the medicines to keep it kind of at bay Can you talk a little bit about the whole back and a little bit about how the impact that now being able to donate HIV positive to HIV positive Is that on our community? Sure in context HIV positive patients do have similar life bands compared to HIV-unintracted patients now over the past 34 years There's been a lot of scientific progress made in this area.
We have now a lot of well tolerated suppressing medications They're not curative as you mentioned, but that ends up meaning that we have a lot more patients with HIV who are living longer And those patients need life-saving organ transplants as well Similarly HIV positive patients may now also be donors So as you alluded to 2013 President Obama signed the hope back the HIV organ policy equity act and this act authorized clinical research And revised rules about organ donation and transplantation between HIV positive individuals So now many centers across the country like Asher as well as agencies like LOPA are participating in these protocols for HIV positive Organ donation so this has been led in most part by Dr. Duran and Dr. Sejev out of Johns Hopkins And we're really learning more about HIV positive to HIV positive Transportation as more and more centers do become involved in more and more procurement agencies like LOPA are more involved with this process Recently actually Dr. Rans group published that once the confirmatory tests were done on these donors So these are donors initially screened to be HIV positive and once that Affirmatory testing was done actually around half of them were not truly positive to they were confirmed to be ultimately negative and Used and given to HIV positive patients So this is a really great move for patients HIV positive patients can now be organ donors and gives HIV positive recipients more access to these types of organ Dr.
Hand I do have a question for you about the opioid problems that we're having today It's one of the questions we get is how can someone who overdoses how can they still be a candidate for donation? First you know I think these drugs are there's probably certain amount of these drugs still in the donor system But this is going to decrease over time while they're hospitalized and this doesn't always affect the actual functionality of the organ You have to also understand that transplant teams are doing their best to ensure that organs from the donors are adequately functioning So they're doing a whole host of tests to ensure that they're appropriate organ functionally to be used by a recipient Overall it does seem to have a little to do with how the recipients of these organs actually do They seem to do just as well as recipients who did not receive the definition that you bring this up It was a group from I think it was Cedars sign on California that it just presented their work an international conference the International Society of Heart and Long Transplant In a meeting in Nice and I saw poster there where they actually looked at was there a difference in recipient outcomes in heart transplants from donors that Over those sources that didn't and they didn't really find any significant differences in our other recipients did or in the function of the actual Orgum right Sally So of course, you know I didn't touch on it earlier and I probably should have you know among those tests that we do to make sure that every organ is safe for Transplant or test for hepatitis C We do an antibody and anogen test and then hepatitis B and then HIV and all of these viral infections that can potentially be transmitted But we also do what's called nucleic acid testing we call that for short and what those tests do as they can narrow down the time frames of Which you know a donor potential don't have been infected down to seven days and you talked about the opioids and people may ingest opioids They may snarter inhale opioids and those really don't increase their risk of obtaining HIV or any of those viruses that we're talking about It's really only the ones that are injecting the opioid and then overdose from an in injected opioid overdose So that's where they're considered a phs increase risk for the infectious disease. So Dr Han what do you guys do in these situations with phs increase risk? 2013 public health service guideline was created and these were a set of risk factors that were assisted with HIV Hepatitis B hepatitis C There's a list of about 12 related to donors that help us better risk stratify or at least attempt to help better risk stratify certain Though at most institutions when a candidate is going through the transplant evaluation process They discuss what their transplant providers these specific types of donors and whether or not they're willing to receive an organ from one of these specific types of donors I think it is important to highlight You know you mentioned that low potess all these patients for HIV, Hep C and using the clic acid testing We don't miss a ton and we can miss within that window period or quips period as Joey was alluding to earlier But I think it's important to think about risk in context as I mentioned earlier because again the biggest risk is a patient not getting an organ Transplant and so the risk of overall transmission risk of these viruses is about 0.1% or about 1 in 1000 So the risk of getting infected with HIV or Hep C from an increased risk organ donor is about 0.4 out of a hundred people So when we compare that to the risk of dying during your lifetime from a traffic accident that's 0.9 out of a hundred people So that's more than double there You can compare this the risk of dying in the next year if you're waiting on a kidney transplant That's 9 out of 100 people versus that 0.4 out of 100 people for PHS increased risk And then really with really frightening as the risk of dying in the next three months from a liver disease if your metal is between 20 and 29 That's about 20 out of 100 people So it's really important to keep all these numbers in context And I think it's also very interesting to know that your risk of getting hepatitis E actually staying on hemodalysis Which is the documented risk for Hep C is the same as getting infected by an increased risk donor And so we really try to work with educating patients and providers Physicians involved in this coordinators that we really want to make sure that the risk is all in context the risk of staying on the wait list is real And a lot of times I don't know if we do as good a job as we can of really putting this all in in context and helping people to see the big picture I am encouraged that all this has been figured out in order to make life happen more like thank goodness You know you went into that line of work and others do the same I'm in our presentations around the community We get odd questions sometimes I have to text Joey and say hey I got this clinical question can you help me out?
But my overall saying is you never know what's gonna happen tomorrow Maybe we can't recover that today for this reason or another but you never know what's gonna happen tomorrow That kind of sounds like you guys are pushing the envelope working together to figure out how to do more with what we have So that's encouraging it sure is especially having someone like dr. Han to lean on so that we can be more diligent and Transplant more organs and save more lives a lot of our colleagues a lot of my colleagues friends of mine and in other state Do the same you know they lean on their infectious disease physicians It pushes the envelope further than we did in years past and certainly that is one of if not the most Important and biggest aspect of saving the amount of lives that we're saving now versus 10 and 20 years ago Well doc you certainly touched upon a lot of important topics that we often get from the community and of course at the Rekleur and directly even come to some of the conditions like myself that I usually have to lean on you to help answer and you know We talked a lot about the risk and understanding the risk that by not getting a transplant You know and how much that outweighs the minuscule risk that we're talking about for potential infectious diseases and in compounding or adding upon that We're seeing cures these really bad viruses that we've had in the past like hepatitis C We get oftentimes that man. I really can't donate or I shouldn't donate not get it often because I have this or that and it really Lens upon itself and not rule yourself out and the more medical breakthroughs that take place the less likely any disease processes really impact the donation and Transplantation process. Yeah, that's exactly no one rules themselves out.
Just as you mentioned Let's think five years ago. We did not have many good hepatitis C cures and now we do a thing back six years ago We were not taking HIV positive organs and now we are I think it's really important like you said all of the different medical progress That is currently going on the field of transportation We really are able to utilize many different types of donors that patients and even some physicians and other providers may not feel like we are able to use It's important everybody that can should be signing up to be a donor Thank you so much, Doc for all the information You were great and of course if you're out there if you're a patient waiting on an organ and you've got any more concerns or questions about disease transmission Please talk to your transplant coordinators or your transplant professionals They will talk to dr. Han and other infectious disease Physicians for you and make sure you understand the risk also you can always send us a question and that email address is info at the giftedlife.org Right, it's all about learning. I learned a lot today.
I'd like to thank our guest dr. Jonathan hand a transplant infectious disease specialist at oshner Thanks a lot, Doc. Thank you. Thank you guys for having me here on the gifted life.
It's all about learning new things Spurring those healthy conversations and we always get a little bit from Sally, right? Sally what you got for us today? I'll tell you what Joey we have something kind of interesting here I had a co-worker that said you know I have a family that really could use some grief counseling But he said no no no no no I don't want to go through all that because Situation just make it worse and besides my wife and I don't talk about it. We don't discuss it with the kids I'm thinking first of all, I'm not sure how your situation could be anymore in dire straits first of all You've lost someone you love very much But now you're not even communicating with your family about what these thoughts and feelings are for you You know my suggestion to the co-worker was just talk to him very gently and emphasize the importance of communicating How you're thinking about things you don't have to go into all the emotional background because well as we know men don't usually like to go there So you know maybe just spend a little bit of time just letting them know how important it is just to take a few minutes out of the day And maybe just discuss it a little bit more with your family It's also important that people know they can take a break from grieving I know that some folks think that if they're not maybe they're not thinking of their loved one the way that they should but just a Few minutes out of the day where someone is just you're just kind to yourself And you remember some of those really good moments that you had and to be grateful for that time that you had with your loved one Wrapping all this up is to say that sometimes reaching out to others that care about you But they're not going to share all your information that you want to talk about with them could be very very helpful To get you through some of the very stressful and difficult times of the grieving process It's healing once you start you find that person and you have those conversations I like it encouragement inspiration right Joe.
Are you gonna tell us about your feelings? That's a big no here on the gift of life. All right work on guys Honoring a hero here on the gifted life today's hero Cooper Gibson and we hear from Cooper's family I had my son Cooper on May the 14th 2018 He passed away at 16 days old on May 30th that morning He passed away I got a call letting me know that my son had a match for someone that needs a heart bow and I immediately suggest to donating it The idea that my son saved someone or even someone else's child when he was only 16 days old I feel like that's amazing and now we pause and say thank you to Cooper for the gift of life And our question and answer segment today my physician told me that I can't be a donor because of my illness Should I take myself off the donor registry? Well as dr.
Han so eloquently put it earlier, you know that no The quick answer and then of course the elaborated part is that look we've got medical breakthroughs every day Oh, yeah happening in donation and transplant organs that we couldn't transplant five whatever years ago We're transplanting today saving more lives So don't ever take yourself off because that breakthrough for that particular disease might just happen tomorrow Yeah, he's not rule yourself out you've said that many time here on the podcast great question guys Thanks, and we do want to hear from you So if you would please give us a call at five zero four six four eight three four seven seven We may even play your message on the podcast or email us at info at the gifted life org And I'll do it for this episode of the gifted life learned a lot We want to thank dr. Jonathan Han for coming on and sharing all the knowledge that he's got with us and with our audience about Disease transmission and the impact that it has an organ donation and transplantation and certainly more importantly understand the risks that are there But keep them in a certain context. I like the way he put it You've got to always understand what the risk is of a certain disease processing that impact versus not getting a transplant itself That's really important And we want to thank him for coming on and talking about that as well as being such a good partner with lopa and helping us to save more lives Because certainly over the last three years with his help We've been able to pursue certain organ transplants that we wouldn't have before without his knowledge and with all this information We just want to remind everybody please do not rule yourself out Alright, let's make life happen we can do it together Maybe inspire you to go out and say yes to donation if you hadn't already register me Dot-orgas where you go and then we want to ask you to go out and do something that you wouldn't normally do to help us make life happen Thanks for listening This is a production of a Louisiana organ procurement agency or Lopa The gift of life is hosted by Lori Steele Joey Buudrow and Sally Dendry our executive producer is Kirsten Hines producer is Shalom Caraway and we are recorded engineered and mixed in our Covington Louisiana studio by Troy Perez