Critical Care Scenarios Episode 68: Liver transplant with Meera Gupta
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Dec 6, 2023 Dr. Meera Gupta, a transplant surgeon, discusses liver transplants, covering eligibility criteria, peri-operative care, and post-op complications. The podcast explores the importance of liver transplants, detailed patient evaluations, criteria challenges, organ allocation, surgery complexities, and ethical considerations in critical care scenarios.
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Use MELD To Guide Allocation
- Do use MELD (labs-based) scoring to prioritize allocation and monitor it every 2–4 weeks for listed patients.
- Track rising MELD closely because allocation is based on current sickness, not time on list.
Geography Shapes Organ Offers
- Allocation uses proximity circles (500 nautical miles) so donor location shapes which centers get offers.
- Policy widened circles to improve equity across geographic areas and organ utilization.
Screen Donor Quality Before Acceptance
- Review donor factors before accepting: BMI, cause of death, serologies, labs, imaging, and signs of liver recovery.
- Request biopsy or use perfusion pump for fatty or marginal livers to reduce risk of primary non-function.