Liver Life Cafe

Depression (a fresh approach)

So what’s new?

Back in 2018, University of Cambridge Professor Edward Bullmore published his book, “The Inflamed Mind”. A radical new approach into the understanding of depression. This concept may sound a little deep for some people, but please try and bear with me. What Prof Edward has discovered is a link between depression and our body’s immune system. This then can have serious consequences for those people who may have endured some form of physical injury, who then go on to suffer from depression. This is the first breakthrough in the understanding of depression within the past 40-50 years. Professor Bullmore is also Vice-President of Experimental Medicine at GlaxoSmithKline in London, so it is hoped that in the coming years a different range of medication will become available in the treatment of depression. To try and understand this concept further, Professor Bullmore has put together a rather nice, easy to follow video which some may find interesting (this video is best viewed in full-screen mode). What   Professor Bullmore has identified is a connection between the body’s immune system and the cause of depression in some patients. I think it’s safe to assume that although the body is fully unconscious, the immune system is still very much awake. The very first cut of the surgeon’s scalpel can cause the immune system to release loads of cytokines, which in turn travel up to the brain, and affect the change in mood. Even post-transplant, the body’s immune system is turned right down to prevent organ rejection.   This   in   its   self   could   very   well   cause   the   immune system   to   respond   in   producing   more   cytokines, which in turn bring about a feeling of melancholia and depression. I have written to Professor Bullmore about this possible scenario, which at the time I am still awaiting a reply.

So What about the Liver Transplant then?

Most people will realise that having a Liver Transplant is a very big ordeal. The person’s liver may well be so badly damaged that a liver transplant is the only real viable course of treatment. Because the liver is responsible for carrying out over 500 different functions, any one of these may well be having an impact upon other parts of the patient’s body. This then becomes a very stressful time for the patient as their life is hanging in the balance. Before a patient can be considered for a transplant, there is a strict criterion that has to be followed. The decision as to whether a patient should be added to the waiting list is made by a review panel. These are normally made up of around five different healthcare professionals. It is understandable therefore that a person with a history of alcohol abuse, will undergo a greater amount of further scrutiny, as assurances have to be made that this organ will be respected and not abused. So, a person not knowing if they are going to be accepted on to the transplant waiting list is of enormous cause for concern and worry. This then has an impact not only for the patient but also for their partner or relatives. It must also be remembered that there are other cultures within our community and these often have a much stronger bond with others. Even when a person is accepted onto the waiting list, the stress and concerns don’t let up. The waiting game can go on for years, and it is a sad fact that some patients will die before a suitable organ becomes available. It should also be remembered that adults aren’t the only ones that may require a liver transplant. This can also be a very traumatic time for children too. So, your over-night bag has been packed for months and your waiting for that phone call to tell you that they now have a liver with your name on it. The clock is ticking as you race to get to the transplant centre before the liver starts to deteriorate and becomes unviable. So, while you are all excited and on route to the hospital, the liver is being tested. It’s only when you get to the hospital, that you are informed that the liver isn’t suitable. This can happen time and time again. The mood change from excitement to disappointment can happen almost instantly, and for some, the drive home can be a silent, empty one. But then the day finally arrives and it’s all systems go. So, I’ll be alright once I’ve had my transplant - Right? The next thing you realise is that it’s all over, the porter is wheeling you on a trolley from the ICU up to the liver transplant ward. You begin to take in where you are and then WHAM, the enormity and the reality of your situation hit’s you. You’ve   now   been   reborn.   You’d   think   a   person   would   be   elated   and   full   of   happiness   and   joy.   However,   for   some,   there   is   a   deep   feeling   of   sadness.
They   start   to   think   about   their   poor   donor.   Who   was   this   person   who   has   now   saved   their   life?   This   unselfish   gift   from   a   total   stranger   becomes   an
overwhelming   pressure.     This   can   be   made   even   worse,   as   in   my   case.   I   realised   that   I   didn’t   deserve   this   gift,   I   felt   I   wasn’t   worthy.   I   suffered   from
horrendous guilt.
There   is   a   transplant   technique   that   can   be   used   on   young   children   who   require   a   liver   transplant.   Here   they   can   perform   what   is   known   as   a   split   liver
donation.   This   is   where   one   liver   can   be   split   in   two,   and   save   the   lives   of   two   small   children.   I   became   very   aware   of   this   and   felt   so   sad,   I   blamed
myself and cried in my hospital bed for two days. It took me over ten months to come to terms with this.
Once   a   person   walks   out   of   those   hospital   ward   doors   they   are   very   much   on   their   own.   Oh,   they   may   well   have   a   family   member   there   to   help   them
when   they   get   home,   but   they   can   only   really   help   the   physical   person,   The   emotion   wreck   that   hides   behind   a   mask   inside   is   another   issue.   Nearly
three   years   on,   I   have   only   recently   learnt   of   the   existence   of   these   little-known   mental   conditions.   It   would   appear   that   a   post-transplant   person   can
suffer from a form of PTSD and that there is now an internationally recognised medical condition called, “Survivors Guilt”.
(Click on picture for more
information)
Sadly,   there   remains   little   or   no   support   available   to   address   these   conditions   in   the   whole   of   the   West   Midlands   -   until   now.   This   is   just   one   of   the
issues the, “Liver Life Cafe” hopes to address.
By the time Dr Erin Walker turned 20 she was on her third liver transplant
In January 1986, aged of just 4-years old, and with primary sclerosing cholangitis, Erin had her first liver transplant. She now lives here in the UK. Erin knows only too well the emotional and mental strain that having liver disease and a transplant can bring. Here she talks about the impact that her physical health has had on her mental health. At the time of this recording, Erin was still on her second transplant. Erin’s story can be found on the British Medical Journal article: https://www.bmj.com/content/364/bmj.l1004 Further information can be found at UCL Partners: https://uclpartners.com/blog-post/three- livers-transplants-gave-life-back/