20 die every day waiting.

On the next Health Matters you'll learn just how many live you can save not only after you're gone, but today.

He definitely is living his best life.

and it was because of that kidney.

And the wife that took her vows of "in sickness and in health" to a whole new level.

- [Narrator] Health matters is made possible with the support of Providence Inland Northwest Washington.

- [Lady] Oh, life, how we admire you, all your twists, and turns and wild rides you take us on, you are the reason we'll always provide world class healthcare, Providence.

We see the life in you.

(upbeat music) - Good evening and welcome to Health Matters.

- Good evening and welcome to "Health Matters."

I'm Teresa Lukens.

April is national donate life month, a time to raise awareness about organ, eye and tissue donation and to honor those that have saved lives.

Joining us tonight is Dr. James Mudd.

Dr. Mudd is a cardiologist specializing in heart failure and heart transplantation at the Providence Spokane Heart Institute and the Center for Advanced Heart Disease and Transplantation.

He's board certified in cardiovascular disease with sub-specialty certification in advanced heart failure and transplant cardiology.

Caleb Buck is a senior hospital development program manager at LifeCenter Northwest.

LifeCenter Northwest is committed to working together to save and heal lives through the gift of organ and tissue donation.

And Dr. Christopher Sturbaum is an ophthalmologist at Empire Eye Physicians.

He is a cornea and refractive specialist with over 27 years of experience in medicine.

Thank you all for being here tonight.

An important topic to talk about especially this month and Caleb, I wanna start with you and talk about the work that LifeCenter Northwest does.

- Yeah.

So LifeCenter Northwest we're one of the 57 federally designated organ procurement organizations across the country.

So we work with the hospitals in our donation service area, covering all of Washington, Northern Idaho, Montana and Alaska to partner with our hospitals to do organ donation and tissue donation in those regions.

- A little bit about how that works within that community.

- Yeah, so we partner with our hospitals to identify patients that are meeting potential donation criteria.

So if those patients do meet that criteria, we work with that hospital to kind of navigate that conversation.

And if you are registered, we wanna do everything we can to honor your wishes to become a donor.

And so we work very closely with those families and those patients as they go on to give that gift of donation.

- And Dr. Mudd, from your perspective, the importance of organ donation.

- I think it's critical.

We have lots of diseases and solid organ problems in this country and people just don't have an opportunity when me and are no longer working.

And so for certain candidates, we think that having a transplant is the next best thing for them that can improve their quality of life and quantity of life.

And organ donation is that amazing gift that gives them that opportunity to spend more time and more years with loved ones.

And so it's a great gift to have, and we're really proud to have those services in our region.

- The first heart transplant was done in Spokane now some 30 years ago.

I can actually remember when that took place.

And now it's fairly common would you say?

- Well, I would say it's, there's a demand mismatch.

So a lot of people need potential organ donation but not everybody's a candidate for it and not everybody survives long enough to receive that gift.

But it's certainly in the Pacific Northwest, we are proud to have a program here in Spokane, Washington in a growing area of the inland Northwest that's been here, as you said for 30 years to provide those services not only for heart transplant but kidney transplant partnering with other institutions for liver and pancreas transplant and certainly corneal transplant and other opportunities for people in our region.

- I was surprised Dr. Sturbaum when I was doing my research to learn that corneal transplants have become one of the more common transplants done.

Can you talk about what's involved with a corneal transplant?

- Yes, it's the most common transplant done today, partly because it's easy to procure the tissue.

There's a team that goes into the hospital and procures the tissue as soon as they're notified.

And obviously the sooner they can get there, the more healthy the tissue is, but it can be many hours after the patient has passed on.

So we're fortunate that we can accept a lot of tissues.

So about 40,000 tissue corneal transplants are done per year.

So once the tissue is harvested then it's taken to the eye bank, processed, tested and then further processed for other different kinds of corneal transplants that can be done today.

- And what types of conditions patients are we talking about?

- The most common kind is Fuchs corneal dystrophy, where the little pump cells wear out.

And originally we did a full thickness transplant but the last 20 years we've evolved with advantages of LASIK surgery and the technology there has allowed us to do interlining transplants where we replace the pump cells.

And so the recovery is much quicker for those patients.

- And the conditions are, or I guess the typical age of someone is what I'm looking for here, of someone who would have a corneal transplant.

- Well, you can do transplants on babies that have corneal dystrophies that are cloudy.

Most patients are in their 50s, 60s, 70s.

If you have an infectious etiology, you could be in your 30s or 40s or trauma.

Keratoconus occurs one in 2000 which causes corneal ectasia where the cornea bulges out.

I've done transplants on patients as young as 20.

So the range is quite vast.

Most patients are in their 50s or 60s though.

- And Caleb, I think a lot of people are curious about the process of being a donor.

You and I talked prior to the show about the fact that so many of us go to the DMV and we have that information put on our driver's license.

- Yeah.

- Is that binding?

Does that stand up?

- Yes, it is.

So if you go to the DMV and you agree to be an organ donor at the time, or generally you're agreeing to be an organ, tissue and cornea donor when you just check the box at the DMV.

So if you wanted to make a specific request to that gift, you can go online to registerme.org and you can choose to be an organ only donor, a tissue only, or cornea only donor, but that is a legally binding gift.

So we do have access to that national registry.

So regardless of if you have a heart on your license or not, that's a good external visual rule for if you are a donor or not, but the actual registry is what we have access to.

So regardless of that heart, we'll be able to see if you are a registered donor or not.

But it is legally binding at that time.

- So if a family were to say come in into a situation where they're losing a loved one, or they've lost a loved one, they can't really fight that?

- They can overturn that decision, no.

And you know, we do work very closely with the families in these situations to kinda help understand why they're saying, you know, no in that situation.

And generally what we're finding is a lot of times families are saying no to the death of their loved one rather than saying no to donation.

Until they have a very clear understanding of what donation is the, you know, the great prognosis of their loved one, generally we see families do come around to understanding to being supportive of their loved one's decision to give that gift.

- Dr. Mudd, when it comes to the patients and going back 30 years, what do we know from those first heart transplants to the procedures that are done now?

Have we learned a lot along the way, are there different techniques and changes that have taken place or is it pretty basic process?

- It's a very similar to where it was 30 years ago.

As a cardiologist but not a surgeon, my surgical colleagues will say that the techniques itself are very similar.

There's been some nuances over time.

The things that have revolutionized transplant medicine is the immunosuppression.

So I always talk to patients when you receive a solid organ transplant, if you're a candidate we trade diseases.

We take away the disease of a sick kidney or a sick heart and we give you the new chronic disease of immunosuppression.

But because of the modern advances in immunosuppressive therapy, we now have people that are living more than only a couple of months to a couple of years, now decades.

You know, the advent of cyclosporine in the late 80s, really revolutionized transplant medicine for solid organs to where we see it now where we have heart transplant recipients with an average annual or an average survival up to 12 to 14 years.

And we have some patients in our program over 30 years after heart transplant, which is really quite rare.

- So what takes place or around before the transplant, and that's your area of expertise?

The whole heart failure, heart disease leading up to someone being a candidate for a heart transplant.

- Yeah, and as we discussed earlier there's, obviously transplant is a sort of at the end of the game.

And we wanna do everything we can to keep people's organs intact, to use modern medicine, to help save those organs, to help them recover if possible.

But for some people despite everybody's best efforts, the patient, the family and the provider teams, their organs will continue to fail.

They will continue to outpace the advances of modern medicine.

And when it comes to that, we will sit down and look at these individuals and say, could they be a candidate for a heart transplant?

Particularly, could they be a candidate for a heart pump?

Unfortunately, not everybody is.

There's some high bars that people have to get through to be able to be a candidate.

I always say it's the company that it keeps.

So for people that have had other chronic comorbid conditions for years, sometimes that makes the rest of their body not a good candidate for major surgery, not a good candidate for years on the lifetime of immunosuppression.

So we try to do everything we can to touch these people early in their journey of heart failure specifically to get them on the best medical therapy that we can so that if there are a opportunities for transplantation, we can start that dialogue and really are kind of doing an evaluation year after year to see if that's a possibility for them.

- And Dr. Sturbaum, could the same be said for a corneal transplant, that there's a lot of consideration before you actually make a transplant?

- Well, fortunately for eye surgery, we can operate on very sick patients with multiple comorbidities.

So, almost everybody's a candidate for a corneal transplant.

- And talk about the matching process.

- Well, that's another nice thing about corneal transplants.

We don't have to match.

- [Teresa] Really?

interesting.

- So- - So there doesn't have to be an exact blood type or anything like that?

- No.

So there's they actually did a study years ago that matching made it worse so there's no need to match.

And we don't have to worry about immunosuppression either because we just use topical steroid drops for one to two years and that usually takes care of the reject.

And most patients can go off of the drops, but 20% in 10 years do fail or reject, but it's not hard to do another transplant.

So patients can have multiple corneal transplants.

- And do they last a lifetime then beyond or beyond the transplant?

- Some can, yes.

I have a patient right now that a transplant 50 years ago, I had to replace one, the other one's still doing okay.

I just saw a patient I did her DSEK surgery, partial corneal transplant in 2003, and it's still doing great so.

- Oh my goodness.

That is really fascinating.

Caleb, can all organs be you donated or which ones are donated?

- Yeah, that's an interesting question.

So when we talk about all organs, so we're really looking at our solid organs in our thoracic and our abdominal region.

So we have heart and lungs, kidney, pancreas, intestines, and liver is generally what we're looking at for solid organ donation.

When we talk about tissue, there's a laundry list that we can look at there.

So, you know, skin is considered the largest organ in the body, right?

But we do consider it a tissue for this gift.

Then we have tendons, ligaments, veins, nerves, corneas are of course part of that, tissue recovery.

I think I said bones.

Yeah, so there's a lot that you can recover off of a donor, yeah.

- For the most part, we're talking about adults right now, but what about children and parents making that decision if they lose a child?

- Yeah, so the opportunity is there really for anybody.

You know, there's not, the criteria that we look at, you know, we don't look at that criteria until we actually go in and are evaluating the patient but we don't make any assumptions based on age, medical, history, race, you know, income, anything along those lines, that would never rule you out for being a potential donor.

So we'll do the evaluation regardless of that background, age, medical, history.

And if they are a suitable donor and we'll have that conversation to potentially move forward with donation.

- Okay.

We're talking a lot about donations that are made after someone is deceased but they're also living donors as well.

And there's a lot to consider before someone decides to be a living organ donor, after all, you are giving up a part of yourself and there's major surgery and recovery to consider as well.

It's a decision that for many can take some time and should, or maybe just seconds.

So about seven years ago, I was put on the kidney transplant list and my function was deteriorating to a point where they put me on the list.

TOM ARNZEN WAS BORN WITH A CONDITION THAT CAUSES HIS BODY TO GROW CYSTS IN THE KIDNEYS.

THINGS TOOK A TURN WHEN THE CYSTS BEGAN TO RUPTURE.

Fortunately, someone stepped up and donate a kidney and I did not need dialysis and did not need to have them removed before transplant.

THE DONOR WAS AS CLOSE AS THE NEXT ROOM.

We always thought we were pretty good match, but it turns out it was proven.

IT TURNED OUT THAT MARGIE -HIS WIFE OF 27 YEARS- WAS THE BEST MATCH FOR A KIDNEY DONATION.

SHE SAYS IT WAS NOT A SURPRISE TO HER.

AND OF COURSE, NO DOUBT THAT SHE WOULD GO THROUGH WITH IT.

BUT TOM WASN'T AS SURE.

It's a tremendous ask from somebody and you just don't want to do that.

I didn't want to do that even though I knew what it would mean.

MARGIE WAS ADAMANT, AND SHE WENT THROUGH A BATTERY OF TESTS.

For me I was like, please, please don't find anything that's going to stop me from doing this.

SHE RECEIVED A CLEAN BILL OF HEALTH, AND THE DONATION WAS ON...

BOTH SURGERIES WERE A SUCCESS.

By the time I was released, I was released two days after surgery.

Margie was released three days after surgery.

My lab work had nearly normalized from stage four kidney disease to a normal functioning kidney.

AND FROM THERE, IT DIDN'T TAKE LONG TO RETURN TO THE LIFE THEY ENJOYED BEFORE TOM'S KIDNEYS STARTED TO FAIL.

But six months after that, we did our first four night backpack.

Yeah.

With the kids.

I wanted Tom to live his best life.

I knew he was going to live a life, but I wanted him to live his best life.

And he definitely is living his best life.

SHE HAS SOLID ADVICE FOR ANYONE WHO'S CONSIDERING BEING AN ORGAN DONOR.

I just would say don't hesitate.

For more information on how you can become a kidney donor visit the National Kidney foundation's website at kidney.org or contact Providence Sacred Heart Medical Center.

And Caleb we should point out that LifeCenter Northwest does not work with living donors.

So there's that whole piece where people basically need to seek out the information.

- Yes.

Yeah, there's a lot of resources out there around living donation but as an organization we're the organ procurement organization so we specifically work with deceased donation.

- There's also a lot of misconceptions around organ donation.

Let's clear up a few of them.

The fact that people will say, well, if I donate organs or my loved one does, I can't have an open casket.

- Yeah, so that's actually not true.

So we do a full body reconstruction on every donor regardless of those funeral arrangements.

So if your loved one wanted to go, or if you were gonna have an open casket viewing, we would just work very close with the family on, you know, what is that your loved one gonna be wearing so that we can make sure there's no visible scarring or anything along those lines.

And even if a patient's going directly to cremation, we still do a full body reconstruction just out of respect for that donor.

And our goal as an organization is if a family saw their loved one before and after the recovery took place, that they would have no idea that a recovery ever really occurred.

- Okay.

And Dr. Mudd, there's a lot of fear involved especially for patients as well.

I can imagine that there could be some excitement as well in finding out that you're receiving a heart, but talk about some of those emotions that come into play.

- Yeah, I think the emotional aspect of chronic disease is in certainly those facing solid organ transplantation is a big deal and something we take very, very seriously.

The social and mental fitness, if you will, of the individual and their families around that individual for this very long journey is gonna be really important.

And so we are constantly working with our mental health team, our psychologists and our psychiatrist, not only for the people that are contemplating organ transplant but for those that are waiting on the list, those that may have been on the list for months to years or sitting in the hospital because they can't wait at home.

Are we addressing those mental health issues?

And even thereafter, there are people that will have survivors guilt after transplantation.

There are things that can happen.

And so it's very important that we understand what mental health challenges they may bring to the table and that we support them through the listing and the transplant process and forever they're after.

- Dr. Sturbaum, do you run into that with your patients where there can be kind of an emotional piece involved?

- Well, usually it's one of excitement.

The gift of sight is so rewarding.

They're so appreciative they usually write letters.

Of course they go anonymous, but they're very happy and very grateful for the gift that they perceived.

- [Teresa] What's their recovery like?

- For some of the transplants they can recover in three to six months, other take six to 12 months, and then other things can be done to help improve the sight further.

- And there's so many different procedures now.

It's pretty exciting field to be in I imagine.

- Yes, corneal transplantation surgery's come a long way.

It's been around for over a 100 years.

We've done full thickness transplants where we remove the entire cornea, we can remove 90% of the cornea, or we can just replace the inner lining part of the cornea.

So the advances are really quite amazing.

They're trying to work on cloning cells or genetically getting stem cells and growing those in the lab and then putting those inside patient's eyes, but that's down the road.

- Oh my goodness.

So advanced.

Where does that process start?

What is the process with you start, with their eye doctor and they're told that this would be something that would be recommended?

- Yes.

The patients are often referred to me because their cornea is swollen or cloudy or scarred from a trauma or infection.

Herpes simplex I is the most common infectious etiology in the United States.

And then I'll look at the patient, assess the situation to see if they're severe enough for a corneal tr transplant.

And if their vision is bad enough that it looks like a corneal transplant would be worthwhile then we scheduled the patient.

And fortunately with the corneal transplants with cornea tissue, we can just call up the eye bank and order up the tissue.

In days past they had to get on a list 30, 40 years ago but with the evolution of the eye banks that are out, we can order up a tissue and usually don't have any trouble getting transplanted tissue.

- And you work with the eye bank?

Is that part of what LifeCenter Northwest does?

- No, so Sightlife is actually- - Okay.

- The organization that does those recoveries and then they work with their eye bank to then send off to surgeons.

But I work very closely with Sightlife and doing educations and working with the hospitals, but we don't do cornea recoveries through LifeCenter.

- Caleb, let's clear up another misconception.

One being that a doctor will not do everything possible to save a patient.

We've heard this one before.

- Sure.

- [Teresa] Because they're an organ donor.

- Yeah, so that is very much a myth.

So, you know, the physician team, the healthcare team is gonna do everything possible to treat you, to save your life, everything possible.

Really when we come into play is when every, you know, possible treatment has been exhausted and there's really nothing left to do and your loved one is going to pass.

That's really when we get looped into that conversation, to be able to provide that as an opportunity for donation, and if they are registered, then we wanna do everything we can to honor the wishes of that patient to be a donor.

- Dr. Mudd, does the size of a person correlate with the size of the organ?

- So for heart transplantation that's something we take into consideration.

And so your wait time, waiting for an organ is dictated by your size and your blood type.

Sometimes people that are shorter may have a less wait time and people that or larger looking for a taller donor may have a longer wait time.

So we not only match for blood type, we don't have the luxury of the cornea.

We have to wait on the list, sometimes for months, sometimes for years, to find not only the right blood type, but the right size.

So sometimes shorter men or women may be transplanted much quicker than somebody who's been on the list for months and there's nothing we can really do about that.

But we have those conversations with patients about what the projected wait times could be once they get on the list if they're a candidate.

- And Caleb, I wanna talk a little bit about the pandemic as well.

Did that affect what you do at LifeCenter Northwest in procuring donation?

- Yeah.

Yeah, absolutely.

So early on, you know, there were so many question marks when the pandemic first hit and so we weren't really sure how it was going to impact us.

And I think on the transplant side of things, there were a lot of question marks as well around, you know, accepting certain organs and, you know, patients that are testing positive for COVID and XYZ.

So for a long time if a patient was testing positive for COVID, they were an automatic rule out but that's no longer the case.

So we are evaluating on patients that are either previously diagnosed with COVID or are still testing positive for COVID.

We are still doing a full evaluation to see if they are a potential donor.

So we've pretty much been able to move past that now from the pandemic state.

- And you were able to continue your work with patients, just had to modify a little bit as far as working within the hospital system?

- Yeah.

I mean, it was definitely challenging because of how shut down everything was, right?

And we aren't part of the hospital system so we're coming in as kind of a partner with the hospitals.

And so that was absolutely challenging.

You know, we have staff all over the state, you know, traveling to all four of our states in our donation service area and so that was absolutely challenging trying to navigate that.

We did see donations slow down a bit during the beginning of the pandemic, but it, I would say that we worked very well with our transplant teams to turn that around pretty quickly and get back to our standard of recovery and transplant.

- Would you say Dr. Mudd, you had to pivot a little bit as well?

- Oh, we did.

And we had lots of patients that had already received transplant on immunosuppression that were very concerned about the pandemic.

And certainly we've had, unfortunately, some people that did not survive COVID on chronic immunosuppression.

But I think as Caleb said, we've learned a lot in the solid organ transplant world and we're moving a little bit beyond, and we're understanding more about COVID positivity and duration of infection and active infection versus positivity.

And so we're looking and casting a wide net because we have a lot of patients that are still needy.

We have tens of thousands of people on the wait list currently.

We have about 3,500 people on the wait list for heart transplant.

We only transplant about 3,400 people a year although that's going up a little bit each and every year and so there's still a great need.

And so we have to be mindful and let the science guide us to find the best suitable donors for the recipient.

- Did you have to put things on hold a little bit, I mean, when it comes to your practice?

- We certainly shut down all our elective cases and patient exams and then patients that needed to be seen, fortunately, we kept our doors open.

We would only see maybe 10 to 20 patients a week but the patients that needed to be seen, we were able to keep seeing those patients.

- [Teresa] Still playing catch a little bit?

- I think we're pretty much caught up.

- Yeah, yeah.

Very good, very good.

Well, we're getting toward the end of the program and I know you're all very passionate about what you do.

So I'd like some final thoughts on an organ donation and transplantation and you know, how you feel or your last pitch if you will, to our viewing audience.

And Caleb, I'll start with you.

- Yeah.

Well, I just wanna thank you very much for having us on here and being able to speak about donation and, you know, really as an organization, we just wanna be stewards of the gift and honor the wishes of these patients who choose to be a donor.

And that's really our goal as an organization is to honor your wishes and provide this as an opportunity to families.

So what I would just pretty much like to say is that if you would like to be a donor, make sure you're registered.

Shout it from the rooftops, tell your loved ones and if you don't want to be a donor, you know, unregister yourself, have that conversation with your loved one because more times than not, what we run into is these situations where we ask families, you know, when a patient's not registered, you know, what would you like to do?

And they say, I don't know, we didn't talk about it.

So, you know, of course it's a challenging conversation.

No one really likes to talk about death but it is a very important thing to have that conversation about so.

- Very good Dr. Mudd?

- I would echo that.

You know, organ donation is absolutely important.

But just as important is if you have chronic diseases get to your provider, get early treatment, get preventative treatment so hopefully you don't have to be considered for organ donation.

But for those of us that are even young and healthy, like myself, be an organ donor, give that gift of life.

We think it's very important.

- Listen, thank you for having us on.

If patients do have resistance to being an organ donor, they really could consider being simply a cornea donor.

So real, very common thing to do, it's easy to do, and it really doesn't change much for the patient's post donor.

So, a cornea donation is an easy one to do for people.

- Yeah, and changing lives too.

- [Dr. Sturbaum] Yes, the gift to sight is a great thing to give.

- Thank you all for being here tonight.

And that will do it for this addition of "Health Matters."

You'll find some helpful information on tonight's topic on the "Health Matters" page at ksps.org.

Be sure to join us on May 19th.

We'll be in the Second Harvest Kitchen for some healthy recipes and tips on making the most of your food budget.

Until next time I'm Teresa Lukens.

Stay safe and goodnight.

- [Narrator] Health Matters is made possible with the support of Providence Inland Northwest Washington.

- [Lady] Oh, life, we hear you beating out the rhythm of our days.

We know you live fully.

It's why we pioneer new treatments, because when it comes to matters of the heart, you deserve world class healthcare.

Providence, we see the life in you.

(upbeat music) (upbeat music)