COVID-19, Vaccines and Organ Donation

Hello, and welcome to the Gifted Life Podcast, where we have conversations about organ tissue and eye donation and transplantation. You can always find us guys at thegiftedlife.org. I'm Maurice Diehl, I'm Joey Bujiro, and Nyla Schwab. Coming up on the Gifted Life today.

COVID and donation. We have an expert wing in on what a cucumber can mix. And I'm going to be talking about feeling uncertain and really what can you do about it. All that and more, episode 171, here we go.

We are excited to have an in-studio guest and what a timely guest to have, Dr. Jonathan Hanh, how are you? I'm great, thanks for the invitation. We appreciate you coming in.

He serves as a medical director of the Transplant Infectious Diseases Program over at Washington Medical Center. And we kind of know him, honcho. Yes we do. Actually, I lean on Dr.

Han quite a bit, especially over the last year. Especially now, yes. And all this craziness. He is Lópa's medical director as well, associate medical director.

And of course with his specialty being infectious disease, that's one of the things that we have to look at quite a bit from an organ donor standpoint of whether a patient would be a good candidate for donation. So, as I said, he's been one of my, he's on my speed dial, pretty much at all times. And so I guess, the reason he's on my speed dial lately, I'll go ahead and kick it off with this because it's not just a lopa thing. I get questions from family, from friends, from all over in the community, you know, that the people that know what I do, and they ask me this basic question.

If a patient gets COVID, can that person become a donor? And my answer is always very complex. So with that, I guess I'll go ahead and kick it to you, Doc. What do you say?

Well, you know, I'm always going to say a lot more stuff than you asked and then finally get to your question. And we do the same. But I think it's important to, we have to start with some type of context. And so when we're talking about a shared finite sort of resource in the country of organ donors, and we're talking about people who are on a wait list and we're talking about the gift of life that these that donors are giving and we're talking about people who are very, very sick on that wait list waiting for an organ, we really can't just say, Oh, this sounds like a bad idea.

Let's go. Let's let's not use this donor. And so we have to really think about all of that context in each donor that we evaluate. And so my specialty from an infectious diseases standpoint, we think and do a lot of work around infections in donors.

And there are a lot of infections that donors can have. And they're a most of the time, we have pretty good science that tells us that they're safe to use and we can treat our recipients in the post transplant setting if we need to. So certain donors with bacterial pneumonia is even bacterial meningitis. If we have available drug options, we can treat the donor for a little bit and then treat the recipients once they actually get the organ.

So we've also made a, I'd say that the transplant community has made significant strides in using other types of infected or donors with infections, specifically hepatitis C. And I know we've talked at length on this podcast about donors with hepatitis C used for recipients who do not have hepatitis C and then we're able to cure patients in the post transplant setting. So a great option to increase the amount and type of donors that we're using. And then you, as you always, you know, I'm going to always talk about the hope act or the HIV organ policy equity act.

And this is allows for people living with HIV to donate their organs and, you know, give that gift of life and save other people's lives through donation. And so we use HIV positive donors for people who are living with HIV that may have kidney or liver disease. And so we're, you know, a lot of places in the country are transplanting under those protocols. And so this is kind of how I got involved with LOPA to begin with was evaluating and optimizing donors who have certain types of infections.

So when COVID came as, as Joce alluded to, we had a lot of conversations together and with other experts in the country and there is a lot of unknowns and there still are a good amount of unknowns. But to answer your question, at this point, if you had COVID, can you still be an organ donor? Absolutely. Absolutely.

You can be an organ donor. In most scenarios, we probably would not transplant organs from a donor who has COVID in the, in a severe case of COVID at that time. So if unfortunately you're in a hospital and not going to make it from COVID in super, super sick, we, we probably would not use donors in that scenario. But any other scenario, we really want to have a nuanced approach to how we're evaluating the, the, these donors and, you know, how severe their infection is how long have they had infection?

Does it look like other organs are involved with their COVID presentation? So, and I'd say this all the time with all infections and everything, I know you all say the same thing, you know, don't rule yourself out. Let an expert like the team at LOPA, your physicians, people taking care of you, you know, you just sign up to be an organ donor and then we can kind of decide because though there are, I think situations where we wouldn't use certain types of infected donors with certain types of infections, it's important to know that these are really tough and nuanced conversations that we have. And so you never want to rule yourself out.

And I appreciate you coming in. It's hard. Like where do you find us good information? There's so much information out there, but some of them are not from reliable sites, some of them are just a kind of white coat.

We don't know where he works, right? So we appreciate yourself making yourself available to answer these questions. I deal with most of the recipients and they talk about this booster shot that came out. Do we need that?

How, how is this vaccine impacting them? So can you kind of tell us kind of where we are now? Yeah. So, um, with, after someone is immunosuppressed and people after solid organ transplant, receive life-saving immunosuppressive medications, kind of take away parts of your immune system, if you want to think of it that way.

So for essentially for life, you are somewhat immunosuppressed. So with other vaccines, vaccination is extremely important part of post transplant living, post transplant life, saying, say, if getting all recommended vaccines that your transplant providers want you to have, including your family to protect you to cocoon you. But even with things like influenza vaccine, we have seen that the immune response with patients who are on immunosuppression is less, meaning you may not be as protected after you get a vaccine than someone else with a more quote, unquote normal immune system. So immunosuppressed patients may not be as protected from vaccines.

Doesn't mean you don't get them. They're absolute very, very, very safe and effective at preventing severe disease, but the immune response could be less. So in certain groups of patients or certain studies have shown in certain immunocompromised immunosuppressed populations that the two doses of the COVID vaccine, um, didn't have as high antibody responses in those immunocompromised patients as it did in, you know, competent or people with, again, this more normal immune system. So, and the initial trials for all these vaccines didn't include people who were living with immunosuppression.

And so the rates of an anteroid responses are excellent. And those trials, again, very, very safe, very, very safe for transplant patients. We want everyone to get them, but the immune response might be less. So you might be less protected than someone else.

So this, uh, there were, there's been the big kind of the more landmark study in this space was in the New England Journal from investigators in Canada. And they showed that giving a third dose compared to just two doses significantly increased the antibody response in patients after transplant. So the, um, the FDA and then the CDC came out with recommendations that if you're immunosuppressed, a third dose of vaccine is recommended for you. And the list of these are on the, if you qualify for this, the list of these are on the CDC website, but, um, I'll go through them.

So immunocompromised as being described as receiving active cancer treatment for tumors or cancers of the blood, organ transplant, stem cell transplant within the last two years, and you're continuing to take medications that use the pressure immune system, uh, moderate or severe primary immunodeficiencies, such as the George syndrome or with Scott Aldrich syndrome, and then advanced or untreated HIV infection and also active treatment with high dose steroids or other types of drugs that suppress your immune system. And tons and tons of people are on drugs that suppress their immune system. So that goes for people with Crohn's disease, you know, different IBD multiple sclerosis. And there's lots of different patients that are on immunomodulatory types of medications.

And if you consider yourself high risk or you're concerned about your medications you're taking, always ask your doctor if you qualify for that third dose. Um, because again, we recommend it. This is a, uh, well, the CDC recommendation. So, um, and that's, this is kind of the group of types of patients that I'm able to take care of at auction to help formulate some of these recommendations for our own patients and be a resource for, uh, our providers who take care of those folks.

And so the third dose is different, separate from the booster. So the third, so the third dose, yeah, great question. So the third dose is for people who may not have had a high enough antibody response for the first two doses. The booster that is being discussed a lot in the news right now, um, is for people who probably, there are immune systems probably responded well to the first two shots, but because the antibody response goes down over time, we've seen that in multiple studies that you may need a boost to get that antibody response back to where it was after the first two.

That is the clever name. And so there is that difference that the, the distinction that we try to make. Um, but there's, there's no difference necessarily in those different vaccine boosters are being studied, uh, different mRNA vaccines that cover new variants of concern are definitely being studied. But right now if you go, you get the, you know, where pharmacy, your doctor's office, you'll get it.

Uh, uh, and immunocompromised, you'll get the same vaccine. It's just an additional dose. You just hear all these terms coming out. It's like, how does it apply to me or our friends?

And we talk about it. Um, and I'm out in the community, I used to be a lot more out in the community, pre COVID, um, but then we, you know, not children as well. So, um, those, uh, young kids and our pediatric recipients, I worry about them. So where are we on that?

Because we heard, you know, this new vaccine for those who were little. Yeah, we're, we're very excited about this. Um, for kids 12 and older, absolutely recommended and approved for those kids to get, um, get vaccinated for the five to 11, five to 12 range. Uh, we just see some positive data that's coming out in the news, uh, that this is both, uh, very safe and looks like it creates a good antibody response.

So effective in these, in younger kids, we're going to need to wait a little bit more to see what the official recommendations are from governing bodies about that younger group. But right now 12, 12 and older, no question under that very promising data to, I think, I think we will have, um, safe and effective vaccines for those groups. But right now there's not an official recommendation or, uh, availability yet for those, those younger kids. I like that you make yourself accessible.

Um, where would you suggest people go for information? Like there's just so much information. Yeah. You know, it's hard.

It's hard. No, it's a, it's a great question. Because there's just so much stuff out there. And I know most people don't have the CDC's webpage as their home page on their computer or the, you know, just say, what did the CDC say today?

You know, I totally get that. But when you do have specific questions, it really, the CDC, it's very user friendly. It's up to date. It's, um, it gives, it actually doesn't just say the information.

It gives you links to the citation, so the actual science on which they're basing these, their decisions. So I do recommend that you check in the CDC. You can always ask your doctor, but it's, um, I think the CCE is, is really the most kind of straightforward up to date place you can go. And it's, it's user friendly and there's specific questions that you have.

It's not, you're right. So you're saying, well, when can my kid, you can literally type that in to Google and find the CDC's page for winter children going to be vaccinated. It'll tell you we expect data in the next few weeks on this, um, right now 12 and up. Definitely get vaccinated.

So I know that's a, it's hard to say where to find information, but. Trust it. That's, that's trusted information. Right.

Right. Right. Um, that's, that's honestly where we would go. And I know you hear a lot of, uh, debate about different branches of government and science and politics and it gets, it's all very messy, but the most hospitals, I was put it this way, most hospitals and, um, most scientists who are kind of, uh, doing work in public health to kind of get some of these recommendations done.

The recommendations they are using are typically in line with the CDC's recommendations. So, um, you know, the scientists definitely debate on certain answers and certain ways that questions and that's what you want. Like you want the scientific community to try to figure out the best and right answer. Um, but the most up to date, uh, recommendations and guidance are going to be from the CDC's website.

So doc, I have a question just, just to go back, just a minute, uh, you know, you talked about the, the children that are getting vaccinated, you know, the fact that you can get vaccinated at 12 now. Uh, I get a lot of questions from, uh, from, again, from the community, from friends about the fact that, well, if the, if my child, uh, in general, if children aren't being, um, having to be, uh, you know, put into hospitals, aren't getting that sick. Uh, if, if they're most of the time, they're carriers, then why should I go through the quote unquote in a mayor quoting the risk, the risk with the vaccine that they, of course, you know, shout back at me. Uh, why should I do that?

Why should I put my child through that? Why should I run the risk of that if the risk of, you know, getting, uh, uh, COVID and, and being fine with it, you know, it's, it's, it's not that severe. Yeah. It's a, it's a, it's a common question for sure.

Um, but you know, with Delta, we really are seeing a lot more children, unfortunately affected by this strain of virus being hospitalized. And in the region, we've seen a lot of that too. And I know you've, uh, unfortunately seen that too in the role that, uh, you serve here. And so I think one, it, it does affect kids.

It may not affect kids as much as sex adults, but it definitely does. Number two, we really want to, and I think since we're talking about immunocompromised patients and the trans, after a solid work and transplant, we really want everybody that can be vaccinated to be vaccinated so that we can prevent transmission to, I mean, you know, people who have less of immune response to vaccine. And so we're protecting some of the people who, again, are immunocompromised or older patients. Um, and I think, or even younger babies, right?

That still can't get vaccinated. So, um, for instance, if I, my household has a, um, six year old and then a newborn and the six year old can be vaccinated and newborn can't, well, by me vaccinating my six year old, I'm protecting my newborn. And so this is the sort of cocooning effect that we want to see after transplant for sure, but in general, to try to end this pandemic and prevent people from pre people from having severe disease. We want everybody who will be eligible to be vaccinated to be vaccinated.

So it's not just for the individual risk, but it's also that community family close contact risk that you would want everybody who can to be vaccinated. And then I'd say this a lot, the third reason to get vaccinated, obviously want to protect yourself, but really do it for yourself because as you're seeing, you can't go anywhere or get anything done or travel abroad or do anything, any of the things that you need to do to kind of be part of society if you're not vaccinated. So if you can't do it to prevent disease and yourself or prevent disease and others, then do it for yourself so that purely selfish reasons, so you can actually go do stuff. And I think that's going to be applicable to children at some point too, with educating them.

And so I think it's a good question that you have, but there's a lot of things that we need to think about, about reasons to vaccinate anyone's who's eligible, that will include children and hopefully under kids under 12 soon. Do you love the question? The flu disappeared. So what's up?

Do you like that theory? Yeah, well, with all of our, the fancy word for this is respiratory hygiene, but with masking, with social distancing, with everyone really thoughtful and aggressive about hand hygiene and us designing spaces that are considered respiratory hygiene with the barriers in different places as we have here. We saw a significant decrease in the amount of community acquired respiratory viruses that we normally see. So influenza, RSV, metanumavirus, these are kind of common cold viruses.

We stopped seeing a lot of those. And a lot of this was kids were not in school. That's part of it, but we were also doing this again, these respiratory hygiene aspects of how to curb a pandemic that also affected these other rest of our viruses. So what I think we still have though, COVID and influenza are very, very different.

We still know that when you vaccinate people against influenza, it prevents severe disease and hospitalization and death from influenza may not be perfect at preventing the flu, but it's the vaccine still prevents you from having severe disease. So as everything opens back up, as we try to keep our kids safely in school, right? We want that's a big thing for us for everyone is we want everyone to not forget about their flu vaccines. It's very, very important.

And it obviously includes people living with immunocopromising conditions. That includes their family members, the cocooning aspect of this. I know I keep repeating that, but it's so important that people are eligible. I think again, I think you can get it.

People protect your family members who are, you know, suppressed by that cocooning mechanism and getting all age appropriate vaccines that you're recommended to have. So I do, you know, I think a lot of us do kind of worry that what's going with everything open back up. What are we going to see from with flu combined with COVID? We had a very odd RSV season.

It came at a time and it doesn't come. So how are we going to what are we going to see with again, all these other respiratory viruses like RSV on top of COVID, not to say that we need to all be panicked and fearful of this, but we need to be thoughtful. And what can we do to try to prevent this? All of these things from coming together.

It's to get any vaccine that you're eligible for, COVID, if you're eligible. And flu vaccine, which we give to little kids all the time. So my kids, whenever they're eligible for the flu vaccine is actually out and available right now. So they have appointments coming up to get that and when they're eligible to get COVID vaccine, like I told you before, good luck getting in front of me.

He told me that today. It makes me nervous. I had to get in line too. But I did hear you speak of questions that are out that were in my head too, but I had a teen and you did a talk and I was struggling with it because you hear all these things.

That's why I asked you where you go for information and to help understand for someone like me. So I have a teenager and I talked about fertility issues and I have another friend who's nursing. And so there is, you know, you're kind of scared as we learn about this virus. So, but you help me make a decision with my team, which is, you know, to vaccinate, right?

That's the smart thing to do. So what is the thinking around that? For those who didn't hear that discussion that you had, I thought it was great. So I'm not exactly sure which points you're asking that I've discussed a lot of different scenarios.

I'll specifically talk about fertility because I think it's interesting. There is no association with infertility in these vaccines in the large, very large clinical trials. The people who were pregnant had no issues with miscarriages and we're getting pregnant. People in those trials got pregnant as well.

But really one of the better studies to date on this is it came out fairly recently, a few thousand women looking at women who were vaccinated within 20 weeks. So within 20 weeks of becoming pregnant, there was no difference in miscarriage rates or anything like that. So, you know, we're getting more and more data that it's it is safe and doesn't have any effect on fertility. But so that's kind of my answer for that.

It's like we have no evidence that this affects fertility. Well, I mean, you just want to be there. Yeah, no. So you just hear these scare tactics, especially on social media, things are coming from everywhere.

And then it was okay to make a decision for me, but to make a decision for my growing girl and her future. That was a lot. And so while I was struggling with that, I was praying on it, looking for information and then you pop up and that's the specific one. I was like, I just needed to hear you say that and talk about it.

And though I think it's important what you're saying about your children and making decisions for them. You know, personally, I want my kids to look back at this time and say, my parents did what they needed to do for me to help me keep me safe during a global pandemic. And I think that if your kids can look back and say, you made the right decision to vaccinate them, I mean, I think that's, that's what I want my kids to be able to look back and say, right? That we took care of them during pandemic.

And all them to talk about, you know, be around to tell their kids about it, right? So we want to do that. And we're taking all of those steps and being cautious. I know this is going to be a continuing conversation as you learn more.

We'll come back and obviously there's more questions that will come up. But just to make yourself available, someone with your knowledge, and this is what you do, right? So you can hear a news anchor talking about it, which I used to be. So not an expert on infectious disease and any means, but so much trying to pay attention and trying to learn and asking questions.

Yeah. No, I think, like you said before, it's important to listen to true experts on this, because, you know, we're all as experts, we're all trying to understand and digest new information that comes out and the science that comes out and critically appraise those types of articles to understand how this, these things then need to be implemented. And so I think you see the CDC trying to do the best they can with the science that's coming out so quickly and trying to turn that around into a recommendation that can help us out here. Yeah.

It's all changing very fast as my point. So I think it's hard for even professionals. It's hard sometimes for people to keep up on everything that comes out around this virus. And I like with you too, you just make it personally, you have a family, like you go home to them, you have children, and you're doing these things as well.

Yeah. I'm just preaching it. Yeah. No, I think, I don't know.

I always, I'm from Louisiana. I'm from here. I was born and raised in this state. And so I think, you know, we have a certain way that we treat each other in the state.

We have a certain culture that I think is not always about formalities, right? And we care about family and people care about faith. And so I think you have to really address those specific issues because that's what people really want to hear and care about and makes more sense to them. And so I think I think it's important how we message a lot of this stuff to your point.

You know, I really appreciate sitting here listening to this because before we started, I thought, I'm not going to understand any of it, but you have you broken it down really easy for me to understand. So yeah, so I work with families after donation. And so we have families that I've talked to that have really gone back and been very nervous and uncertain when they suggested a donation. Was there any chance of that?

You know, they're luck one, not helping someone, but actually harming someone. And so hearing you say, leaving that to the experts and that you'll actually, you know, a lot of thought goes into that whether you say yes or no to donation. So not just only ruling don't rule yourself out, but don't rule your family member out. It is really good to hear.

No, I think that's important. There's just so many, which is one of the reasons why this podcast was started right because there's so many misconceptions and misunderstandings about organization in general. And you know, the infection part, sure, donors do sometimes transmit infection to recipients, but that is so extremely rare. It is extremely rare when you compare that to the issues that recipients have with donor infections, infection of donors, you compare that to the people on the wait list to don the wait list.

It's not even close to comparable, not even close. That's great. So it's context that's important. When we're thinking about donors in general, so I'll keep that in mind when I'm talking to families because they really care about saying yes and helping others.

And I've been hearing so often from a wide variety of people, so many different opinions that come from so many different areas. Some, some from, you know, concerns with media and media just wants ratings. So they're pushing this agenda, some from, you know, from a political standpoint, pushing this agenda. And I've always said, I've been very fortunate to have an expert like you, Doc, that's at my fingertips that we can have conversations and that has completely raw and apolitical information.

You've got an apolitical point of view. And I was hoping that, you know, you can tell us a little bit about what you're seeing in hospitals with your own eyes, you know, as far as comparing patients that have been vaccinated versus not vaccinated, how sick or much sicker or percentages of people that are in there in critical care situations with each. So if you can talk to us a little bit about that, a little bit more about what you're seeing and some of the treatments that are being effective. Yeah, it's a good question.

I have, I definitely have no political dog in this fight at all. And I'll tell you this virus is not political. And the people who are in ICU, that's also not a political thing. But unfortunately, the people who are in our ICU, it's not even talking about they didn't have a third dose.

It's actually they didn't have a first dose. So the people we're not seeing people in our hospitals and our ICU is that got vaccinated still it remains that our patients who are admitted with severe disease for the most part are unvaccinated. And we know that this vaccine doesn't 100% prevent infection, but we know it's absolutely fantastic and excellent preventing severe disease and hospitalizations. So unfortunately, we still see patients who are unvaccinated in our ICUs.

And I think we also see surgeries that aren't considered elective, excuse me, that aren't considered urgent and are elective that are pushed back. And so we may be delaying diagnoses and treatments for other people that are where they don't feel like they're not directly affected by COVID, but they actually are indirectly affected because the utilization of health care is so high by unvaccinated patients who develop COVID that other people in the health care system do suffer from this. And so I think it's important to think again, coming back to the context, it's really not just about one person getting COVID. And I think a lot of us have trouble seeing that, but this is how we beat this pandemic, we really all have to come together regardless of political backgrounds and follow the science in this way and get vaccinated so we can try to minimize the severe illness and death that we're seeing from this.

And you know, you talk about getting vaccinated, more and more people that get vaccinated, obviously, that affects potentially those who can become donors. And I'm saying that with air quotes here because I've gotten the question. So a couple questions on it. So if you do or one of those that are getting vaccinated, can you still become a donor?

Is that going to interfere in any way, especially with the mRNA? And second, do you see as effective as this has been against this virus, it seems to be one of the more effective vaccinations that we've seen in our past, at least in the last 30, 40 years since probably polio, I guess. Do you see possibly a change in the future on even say the flu vaccine changing to an mRNA or something like that? Yeah, mRNA technology has been around for quite a while, at least 15 years.

So but this is as you're kind of alluding to one of the first times it's been used in a vaccine. But I think you absolutely can anticipate that other vaccines, given how well this science and vaccine, at least vaccines have performed in preventing severe illness, you can better believe that you will see other disease states and vaccines developed with mRNA technology, absolutely. So Doc, I've been asking many times, you know, recently, of course, people have questions, they still have concerns about the vaccine. I might have changed my DNA, might have changed this or that.

So and actually questions about monoclonal antibodies, since that's also something that's being used, and it's obviously something that's very new. So if someone either got the vaccine or received the monoclonal antibodies because they were positive for COVID and as a treatment option, they've got any of these minimize your opportunity to become a donor, should that, you know, should that time arise? So first of all, we know these vaccines do not change people's DNA. If anyone who took some basic biology courses could probably go back to this textbooks to better understand that this mRNA technology does not change your DNA.

But they do not exclude you or prevent you from becoming a donor. So in fact, it might even increase your likelihood of becoming a optimal organ donor because if we're preventing the severe complications of COVID, which sometimes can injure your liver or kidneys, then we might again be optimizing you as a potential organ donor. And monoclonal antibodies, also not a contraindication to donating. These are pretty, been really used very successfully in preventing patients from being hospitalized with COVID.

So when patients, in the outpatient setting are testing positive, we will give these monoclonal antibodies to prevent progression of lung disease due to COVID. And it again, keeps people out of the hospital. So pretty great and helpful drug to be able to use. Unfortunately, we don't have a lot of tools in the outpatient setting to prevent progression of COVID.

So our science tells us that things like Ivermectin don't work at preventing progression of disease, really monoclonal antibodies for this. And the outpatient setting can prevent you from being hospitalized. Is there a reason y'all don't use it for inpatient and people who are in the critical care setting? So in patients who have severe COVID pneumonia with oxygen requirements, if you look back at some of the early monoclonal studies, those patients actually didn't do as well when they received monoclonal antibodies.

So we're really trying to get to patients before they develop a significant oxygen requirement or severe disease to try to prevent that from happening. So it's more of a preventing progression. And once you're hospitalized in a way that the ships kind of sail, we have a whole another kind of package of medications and therapies that we will use for patients who have oxygen requirements that have severe COVID-19 pneumonia. All right, Dr.

Han, thank you very much for the visit. We appreciate your patience in letting us ask you all of these questions from our listeners. And I'm sure this conversation on COVID will continue and we'll expect you back. Yes, sir.

Oh, yeah. I'm happy to come back. All right. We appreciate the visit.

Thank you. At this point in the get to life, we are taking a moment from mental health. And as Nyla Schwab is here, she is Lopa's family services support coordinator. So welcome.

She's also a mental health professional. So Ms. Nyla, what are we talking about today? Oh, we're going to be talking about feeling uncertain.

There's a lot of uncertainty going on in our world today with politics. Speaking to me. Yes. Yes.

Yes. It's like I'm looking at you, Ori. But yeah, we've got so much going on. And I think people can feel overwhelmed.

They can feel anxious. It can cause depression. So I even looked it up in the dictionary. So a definition of uncertainty is the quality or state of being uncertain.

So if you want to send in for that, there's doubt, mistrust and suspicion. So these, I think, are really big words in our, you know, in our language today with everything going on. And so it's like a topic we talked about today, like you're hitting the head. Yeah.

Do I get the COVID shot or not get the COVID shot? Who do I listen to? Who are my resources? So, you know, I'm just, you know, one thing that we give to our families after donation occurs is a card that talks about self care.

And so the reason I wanted to bring this up is when you're trying to make a decision, you've really got to look at what you can control and what you can't control. And once you kind of look at that, you've got to take a, take a step back, take a pause. And this card that we mail out is called self care and it's got a picture of a stool on it. And it's really looking to keep some balance in our life.

So how do you do that? Ask yourself, like, am I balanced? One leg of the stool is called support. And the second leg of the school is called daily living activities.

And the third leg is physical health and the fourth leg is productive and creative life. And so we'll never always be balanced, but just trying to search for that. So support, what does support mean? That means reaching out, finding your resources.

There's four different types of support. If you really want to break it down, keep it easy. I mean, you've got your emotional support, the person who's going to hold your hand, who's going to be your cheerleader, who's going to encourage you. And probably always say, yes, like Lori, I want to come to you if I'm having a bad day and you're going to be the person to say, Oh, you can do this, Nyla.

You know, I trust your going people are popping in my head. Here we go. We got this. Yeah, exactly.

Now look, I got a clinical question. You know, I'm going to find a different type of support. I'm going to find my informational support. And that's going to be Joey.

Right. So I'm not coming to you, Lori, about, you know, my, I'm okay with that. I'm going to go with you. Yeah, let's go together.

And then there's the steam support. And that's just looking for again, somebody that's going to kind of build you up. Um, and then the tangible support. That's the person that I'm stuck at home.

They might bring me some soup. Um, they might make me feel better. That's you, Nyla. You know, I do.

I do. Like what kind of support do I need? And it's really looking at that. Because if you go to the same people for the same information, are you really going to get what you're looking for?

That's the point. Yeah. So I would go to Dr. Hand if I had a question about COVID or the CDC resource, your daily living activity.

So if you're not getting stuff done and you're laying in bed and you're just, it's a heavy load and you don't want to get up. Um, are you getting your stuff done? Are you paying your bills? Are you feeding your dog?

Are you making up your bed or taking a shower? Those things matter. And when you aren't doing those things, that can get heavy. Um, the third leg is the physical health.

And so that incorporates a lot. Like are you getting outside to get some vitamin D? Um, are you talking with your doctor? Are you asking your doctor questions?

Are you seeing your doctor about your health? Um, are you drinking a lot of water? If you're not drinking all your water and you're dehydrated, you might not feel well. So there's all these things that go into keeping a balance and the fourth when you're in a, in a crisis or a difficult time, are you're having a challenging, um, you know, week?

You want to look at the things that drop off or joy and things that bring us, um, laughter, uh, creativity and you might even be stuck. Like where do I go? What do I do? I don't even remember what I like.

Well, what did you like two weeks ago? What did you like before you lost a loved one? What did you like when you were a kid? Did you like fishing?

When's the last time you went fishing? So I would say to anybody kind of keeping a check on are you balanced as you make a decision? What can you control? What can't you control?

And then going to the right people to kind of help you sort through all of this, but most importantly being kind to yourself and really being patient because, you know, one week you might really struggle with the uncertainty in your life, but maybe you'll be that support system for someone else when they're having uncertainty in their life. That's great. Especially talking about COVID. I was thinking about pandemic and all of those things as you were stuck home with babies and trying to learn, um, all of their lessons.

Yeah. And different grades and so we had to reach out to other moms for support and, um, you know, if you're feeling depressed and you don't reach out, that's a dark place. It is a good tip. Yeah.

And it's a good tip. Yeah. And I said you can be in a dark place sometimes. So I hope if anybody ever feels like they're in a dark place, there is the National Suicide Prevention Lifeline and that number is one 800 273 8255.

And so you don't have to have suicidal thoughts. That can just be a lot of the calls they take are emotional support. I mean, they are there to talk to you about, um, I don't know your physical illness, your loneliness, getting over abuse, depression, um, relationships, anything. So just make sure you reach out to someone, someone in your support system or you can always call that lifeline and our family services department is always open.

So you can call LOPA to reach out to us and we'll try to help you find the right resources. Reach out. Yes. Reach out.

Yes. All right. Maybe have a topic you want us to cover here on the gifted life email us info at the gifted life dot org. In every episode of the gifted life, we honor a hero.

Today, we honor hero Miles Swallow. And we learn about miles from his mother. My son, Miles passed away when he was three years old. He was such a good kid.

And as his mother, I would have taken his place if I could have. I miss him so much, but he will always be my hero. I donated Miles's corneas to help someone see. I wish I knew who received my son's corneas just to chat with them.

However, I thank God for helping the recipients see. And now we pause and say thank you to Miles for the gift of life. And that'll do it for episode 171 of the gifted life. Learn so much.

Yes, we did. So much thanks to Dr. Jonathan Hand for coming in. He's got such a wealth of knowledge and to be able to explain things on the levels that he does is so educational.

It's so great. We've had him for our staff and of course bringing him into the podcast. I thought it was wonderful. Yeah.

I walked away with so much love that. We want to thank you guys for listening and remember you can register any time as an organ I and tissue donor at register me.org the best place to find us. Tell your friends that gifted life dot org. Listen there and find links to listen on Apple podcast, Google podcast, Spotify, iHeartRadio, or wherever you listen to podcast.

If you listen on Apple podcast, please leave us a five star rating. It really helps others find our podcast and on social media, guys, Facebook, where they get to life podcast. You can also follow us on Twitter and Instagram at gifted life pod. Thanks for tuning in.

Tell your friends and we hope that you go out and do something you would normally do to help us make life happen. But one big team until next time. This is a production of LOPA, the Louisiana organ procurement agency. The gifted life is hosted by Lori Steele, Joey Boudreau, and Sarah Blakemore, our executive producer is Kirsten Heis, producer is Shalom Caraway.

Intern is Rebecca Rannam and we are recorded, engineered and mixed in our Covington, Louisiana studio by Troy Perez.