Week 2: Nina

This week, I started off by seeing a liver transplant with Dr. Samstein. I saw the liver pre-transplant while it was being preserved under normothermic machine perfusion using the TransMedics Organ Care system. Dr. Samstein showed me all the different features of the machine, such as the oxygen pressurization system and efflux routing ports, that are designed to provide constant circulation to the organ. I learned that the transplant was coming from quite a few states away, so it was flown in the previous day and immediately put on the pumping system. The organ then sits overnight until the patient is prepped for surgery the next morning. Some of the advantages of this system are the ability to provide oxygen-rich red blood cells to the organ, prevent thermal injury, and decrease ischemia. Static cold storage can only preserve organs for around 4-6 hours, however organs pumped using normothermic machine perfusion can preserve for nearly double or triple this time. Yet, I learned perhaps one of the most overlooked advantages is the time for medical professionals to rest and prepare for the surgery. This increased preservation times enables donor organs to travel further distances and also allows surgeons to more thoroughly examine an organ before accepting or rejecting it. However, I was told that this time window is so crucial in allowing the surgical team to prepare and perform well-rested. I learned that transplants at night run the risks of understaffing and can put strain on physicians who are operating well into the night. Normothemric machine perfusion is a way to decrease errors and overall risks to the patient, as it give more time for the surgical team to plan.

I also got to see the OrganOx organ preservation system, which works off the same concept of normothermic machine perfusion to preserve organs. I learned that one of the main differences for this machine is the cost and sometimes even organ viability. Both OrganOx and TransMedics systems offer ways to pump organs, but their use varies patient to patient. When I saw the OrganOx machine it was not in use, but I was able to examine all the features and interface design. Dr. Samstein noted that a large difference between these systems is the way the organ is oriented while it is being perfused. The TransMedics system situates the organ about a foot or two higher than the OrganOx system, which can be easier to monitor the organ, as it is closer to eye level. I learned that sometimes the liver can injure itself while sitting these perfusion system simply due to its own weight. I though was very fascinating because this phenomena does not occur in physiological states due to the liver being cushioned by other organs in our bodies.

I also shadowed Dr. Samstein's clinic this past Thursday. This involved seeing a variety of cases ranging from genetic conditions, cancer, organ donor screening, and liver transplant consultations. We also rounded through the surgical ward to follow up with patients post-op. I met residents, fellows, med students, nurses, PAs, dietitians, and pharmacists who all work together to help patients heal. I was surprised that the there were so many professionals from a variety of fields who all went to round together. Next week, I will see a robotic liver resection surgery and continue going into clinic with Dr. Samstein.