Profound Conversations

Building Trust & Serving the Vulnerable: Organ Procurement & Transplantation in a COVID-19 World

June 21, 2020 Today's host is Linda Howard and the panelists are Dr. Marwan Abouljoud, Kelly Ranum, Dr. Tyler Amell, Andrea Johnson, and Barry Massa. Season 1 Episode 12
Profound Conversations
Building Trust & Serving the Vulnerable: Organ Procurement & Transplantation in a COVID-19 World
Chapters
Profound Conversations
Building Trust & Serving the Vulnerable: Organ Procurement & Transplantation in a COVID-19 World
Jun 21, 2020 Season 1 Episode 12
Today's host is Linda Howard and the panelists are Dr. Marwan Abouljoud, Kelly Ranum, Dr. Tyler Amell, Andrea Johnson, and Barry Massa.

We are in the midst of events that highlight health disparities and inequities. Preliminary data has shown that African Americans are dying from COVID-19 at higher rates than whites, even though they make up a smaller percentage of the population. The pandemic is bringing to light health inequities that have existed for many years. Protest around the world are also calling attention to other inequities. These health disparities, as well as, existing and historical inequities are the foundation for distrust of American institutes, including those connected with healthcare systems. How do we build trust and the competencies to serve all?


Today's host is Linda Howard and the panelists are Dr. Marwan Abouljoud, Kelly Ranum, Dr. Tyler Amell, Andrea Johnson, and Barry Massa.


The Profound Conversations Podcast is produced by Erika Christie https://www.ErikaChristie.com


The Profound Conversations Series can be found at

https://www.profoundconvos.com/series








Show Notes Transcript

We are in the midst of events that highlight health disparities and inequities. Preliminary data has shown that African Americans are dying from COVID-19 at higher rates than whites, even though they make up a smaller percentage of the population. The pandemic is bringing to light health inequities that have existed for many years. Protest around the world are also calling attention to other inequities. These health disparities, as well as, existing and historical inequities are the foundation for distrust of American institutes, including those connected with healthcare systems. How do we build trust and the competencies to serve all?


Today's host is Linda Howard and the panelists are Dr. Marwan Abouljoud, Kelly Ranum, Dr. Tyler Amell, Andrea Johnson, and Barry Massa.


The Profound Conversations Podcast is produced by Erika Christie https://www.ErikaChristie.com


The Profound Conversations Series can be found at

https://www.profoundconvos.com/series








Trina Laube :

Well welcome everyone. My name is Trina Laube, and I'm the VP of strategic initiatives with the National wellness Institute. And we are really pleased to be partnering with the Muslim life planning Institute on this conversation today, and excited to hear what everyone has to say and have some great dialogue today. So thank you all for joining us. I just want to go over a couple of housekeeping things before we get started. First of all, we really encourage you to ask your questions. That's what we're here for to have a quick question and answer a conversation. And your questions matter too. So there is a q&a section where you can type those in at any time. And we'll have a q&a with the audience throughout this as well. Also, the National wellness Institute will be offering continuing education for its certified wellness practitioners, as well as if you need a General Certificate of condition Education credit. So if you attend this full discussion and need that credit, you can complete the evaluation and request your credits on that. And that evaluation form will, I believe will be sent by email tomorrow. So it's about 24 hours after this that you'll get that and you can fill up that link. So, without further ado, I do want to again, thank all of our panelists for being here. And our host today who is Linda Howard. Linda is president of the National wellness Institute Board of Directors, and she's also Chief Compliance and impact officer for the Muslim life planning Institute. She CEO of Alturnative which is a healthcare compliance consultancy that helps build people forward organizations and establish compliance ethics and quality standards for the health, fitness and wellness industries. Linda is a founding member of the National wellness Institute multitec excuse me, the National wellness Institute multicultural competency committee and as a lead subject matter expert for NW is high level wellness through multicultural competency professional certificate program. And that program just to let you all know, is being developed in partnership with hr.com. And we will be launching that with our pilot on July 6. It's an online program that is really focused at individuals who are working in wellness, HR and benefits and wish to develop their multicultural competencies. So, definitely look at National wellness.org check that program out. I'll also put in a little plug for our national wellness conference. Like many conferences, we will be going virtual this year. That'll be July 21, and 22nd. And you can find out more about that on national wellness.org. So, a couple other little announcements if you've got your pen out and you're marking your calendar for all these exciting July events. The Muslim life planning Institute will also be has also been asked to participate in the 2020 Muslim mental health conference, which will be convenient in July. It's a wonderful opportunity for the MLP to create pathways to lifelong learning and healthy communities at the national level. And lastly, MLP is happy to announce that it's been chosen to present at this year's association of organ procurement organizations 2020 annual meeting July 25. So a busy July for this group. The topic there will be multicultural competency and family dynamics engaging the Muslim community. And the intended outcomes for that are that participants will understand why multicultural competency is essential and how it improves community engagement outcomes, enhances donor family support services and helps increase overall donation rates, gaining understanding of Islamic beliefs and the diversity of the Islamic community. So we hope that you'll check all all or some of those out as well as you as you look to build on these topics. So Linda, I also want to congratulate MLP i, this is the 12th and final episode for Season One of Profound Conversations. So quite an achievement that you've all had this year and I understand season two will be kicking off this summer. So without further ado, I'm going to let you go ahead with this 12th and final episode of season one.

Linda Howard :

All right. Thank you so much, Trina. And thank all of our Profound Conversations lists for for joining us we have, we have a really diverse and interesting lineup today for Profound Conversations. We have people that are working in some different fields. We have one of our board members, Dr. Tyler Amell, who is an epidemiologist, and so he is going to give us some foundational information around COVID-19 kind of where we are where the trends are going and I'll be asking him to just be have this space, just keep an ear open and see, you know where there's opportunities to think about how what's being planned will be impacted by the by COVID-19. We also we also have Dr. Marwan Abouljoud, and he is a transplant surgeon from Henry Ford. And so we're going to be able to have a conversation with him about some of the things that he does on the transplant side. And we have Kelly Ranum, Kelly Ranum is with is with an organ procurement organization in Louisiana. And Kelly, are you still head of the board for AOPA?

Kelly Ranum :

I am for four more days.

Linda Howard :

Four more days All right. So um, for those of you who don't know AOPO is the Association of organ procurement organizations. And we have two of her colleagues that will be joining us a little bit later from the center and from the Cincinnati organ procurement organization. And when they come on, we will do an introduction and kind of let you know who they are right now, and I'm going I will ask that, that when you're listening to this for some of you, because I know some of those that have joined this is really specific area for certainly for the National wellness Institute's audience. And so for some of you that are joining when you're listening to this conversation, I'm sure there will be a lot that you will you will learn just from for your personal lives and as you think about things like organ donation into life, maybe family members who family members who may be in a situation of being on a donor list or have considered being an organ donor. So listen from a personal space. But also if this is not a specific field that you're working in, to also look at some of the things how this might apply some of the discussions that we have today, how it might apply to the work that you're doing. And we always encourage the cross conversation between industry. So listen and seeing how are you in this story? How are you in the stories that that you're hearing, whether it's at a personal level, or whether it's the work that you do, and for those of you that are joining us from the transplant community from the Oregon procurement space, I'm also hoping that you're listening to this conversation and being able to gain something from from COVID-19 and environment and you will hear throughout because it's, it's what I live in breathe as well is the multicultural competency. So you will hear some things where you can start to think about where are where your blind spots. With respect to multicultural competency, are you reaching the audience's that you need to reach? Are you serving people in a multicultural, competent fashion? So I'll ask for you to listen, to be present in this conversation, and to listen from what you can get out of this conversation. And understand that even if you don't think this is related to what you do, it is going to be related somehow in terms of the stories in the lessons. So I will start with I'm going to start with our, with our board member, Dr. Tyler and asked him to to just give us a brief introduction around who he is and what he does and then we'll get a little bit more into the COVID-19. I know a lot of you probably want to know what's happening. Are we looking for a second wave What's going on? And then we'll move through some of the other panelists and ask for just kind of do a quick round robin about Who you are in what you do and why you do it. So Dr. Tyler.

Dr. Tyler Amell :

Thank you, Linda. And good afternoon, everyone. And thank you so much for the invitation to be here today. It's great to participate in such a diverse multicultural event with with varying areas of interest. I personally don't get to interact very much with folks who have an interest in transplant. So I'm quite looking forward to that portion of today's discussion. So I'm an occupational epidemiologist by training. So I practice in a very specific branch of medicine is very much focused on understanding who's getting hurt or sick, why they're getting hurt or sick, and what we can do to stop others from becoming hurt or sick. So it's very much a evidence informed sort of approach whereby we try and figure out what's happening and then recommend the best strategies to reduce risk. So that's something that epidemiologists tend to focus in on. Now because I'm an occupational epidemiologist, I tend to focus just on the workplace. Which is very much focused on, you know, helping employers understand the risk helping employees understand the risk to their health, as resulting from from their work environment, and so on and so forth. Now, in terms of a pandemic, you know, the lines are a little bit blurred, you know, we're using the same ideology and the same science in the same understanding to look at things through a slightly different lens than we ordinarily would being from an epidemiological background. Now, the downside of being somebody like me is nobody really listens to us, unless there is a pandemic going on. So right now, we're quite popular. You know, once we're through this, and believe me, we will get through this is just going to take us a while to get there, you know, maybe we'll go back to lurking in the corners of the of the offices out there and not quite interact as much as we usually do. In terms of my role, so I'm the chief medical officer and chief relationship officer at a corporate well being company that provides technology to help support hospital systems. Organizations that procure and distribute these types of solutions. I also am a faculty member at Pacific Coast University for Workplace Health Sciences. So this is a an organization or university that's totally focused on on Workplace Health Sciences. So understanding risks of people, you know, introducing work disability, you know, how do we factor in diversity, you know, how do we integrate people with disabilities back into the workplace and so on and so forth. And I also sit on a few other boards, of course, one of them is National wellness Institute and I sit also on another board of directors, which is the work wellness and disability Prevention Institute, recently renamed the work wellness Institute, which is not quite a sister organization to end Wi Fi but definitely an organization that has a similar approach but not the same mandate whatsoever so I can I can sit on both boards comfortably.

Linda Howard :

And I also add that he is from Canada and is based in Canada and does a lot of work. Internationally, so. So we also have the benefit of getting some of the information about what's happening around the globe. So I'm hoping that you'll be able to share some of that information as well.

Dr. Tyler Amell :

Yes, absolutely. Linda.

Linda Howard :

Thank you. And, Kelly.

Unknown Speaker :

I am Kelly Ranum. I'm the CEO of the Louisiana organ procurement agency and have been the AOPO president for the last almost 12 months. And I sit on the board of directors as well as the Alliance board of directors. So come to this field. 24 years now. I started as a coordinator that actually approached families did donor management had responsibilities for helping organs get from the donor to the recipients been doing that for quite some time and then the role of CEO the last 19 years. I love what I do ICU nurse by training And really happy to be part of this panel. So thank you.

Linda Howard :

So Kelly because there's individuals on the phone that's probably hearing about the organ donation world, maybe for the first time. I know very little about it. So you threw out a couple of acronyms. AOPO. An alliance. So if you can maybe tell those who don't know what those organizations are.

Unknown Speaker :

So there are 58 organ procurement organizations throughout the country. And we are represented by the Association of organ procurement organizations. AOPO, represent us in the respects of advocacy in the hill, also doing education having our annual meetings. And you know, this is the United network of organ sharing, which is the entity that holds the list. They are the contract entity For the government, and they have the list of all the recipients. And so that's where our donor information goes in. And information for the recipient gets matched up and then that list prints up. And that's how we know who to call if you will for for that organ. And they do a lot of other activities outside of that. But the main functionality, thing for your audience is to know that that's how we're symbionts and donors get matched up. The Alliance is another association that helps to promote education of the transplant center, side and the organ donation side. So I'm all in the same field, if you will, but different aspects.

Linda Howard :

So um Andrea Johnson just joined us. Kelly, warm them up for you. Yes, they all are up to speed on what a AOPO is, and Alliance and organ procurement organizations. And as I mentioned before, Andrea joined and I see Barry has, has also joined. Andrea, and is it Andrea or Andrea?

Andrea Johnson :

It's Andrea. But I also go by Andi. That's what everyone calls right.

Linda Howard :

So I like Andi. So Andi and Barry are organ procurement organizations in Cincinnati, Ohio. What we are doing since you just joined we're doing a quick round robin to just say who you are, what you do, and kind of why you do it. So, Andi.

Andrea Johnson :

well, thank you for having us. As Linda said, I'm Andi Johnson. I am Community Relations Director at Life Center organ donor network. Located in Cincinnati, Ohio. I've been with the organization it'll be 15 years in September. My department is really responsible for all of the communications with respect to organized tissue donation, which includes outreach, education, marketing, advertising, community outreach, engagement, really everything that we can do to connect as many people to the why. So the why that you know, organ, tissue organ and tissue donation is so important and really sharing stories of people who've been impacted. So, we are trying to work to encourage more people to join the the registries. Life Center is unique in that we touched three different states within our service area. So we have eight counties that we serve in southwest Ohio, six in Northern Kentucky and then two in southeast Indiana. So we work with all of the hospitals, about 44 hospitals in that area to facilitate donation.

Linda Howard :

All right, Barry.

Barry Massa :

I'm Barry Massa. I'm the executive director for Life Center organ donor network. I've been with the organization 16 years, I started as the chief financial officer. And then four years after that became the executive director. During that time we've, we were part of the University of Cincinnati Department of Surgery and we broke out as an independent organ procurement organization. They changed our board pretty much completely changed the entire organization. I got started because during before coming to life Center, a friend Mine had a daughter who needed a heart and lung transplant pretty much at birth. Within the first nine or 10 months of her life, she received her heart and lung transplant in Philadelphia and came back to Cincinnati before tragically, catching pneumonia and passing away a couple years later, but kind of went through that journey with my friend. And then I saw a CFO job available at Life Center and I didn't know the place existed. So I called my friend up and said, You know, I'm all about the mission of donation. But I had no idea that Life Center or these kind of organizations existed and you know, what can you tell me about it? He told me, that's what you bury or what they need, you should apply for it. And here I am.

Linda Howard :

We have Dr. Abouljoud who is also with us and We are asking for you, Dr. Abouljoud you to give us a little bit of information about yourself. And what you do. Now I know one of the things is that I do know that you are also the president for the American Science Society of transplant surgeons. That I get that right. So we've kind of coming full circle here. We've talked to those who are outside and now just tell us a little bit about what you do from the transplant side.

Dr. Marwan Abouljoud :

Thank you, Linda and Karim for the invitation. I thought this big smile on Kelly's face when I said she was exiting a role. I can see a vacation coming. Well deserved vacation. Your reputation has followed you everywhere you went. Thank you for your work. Yeah, I'm a transplant surgeon, abdominal transplant surgeon and my area of interest is liver transplantation and living donor liver transplants. And I've been attended for now for 26 years and in the business of transplant for 28 years. And I've got involved with a variety of things I, I started off as the head of the liver program and then became Division Chief. And then we started one of the earlier service line integrated transplant Institute's about 16 years ago. And so I direct the Transplant Institute with a great team of people, but been actually for the most part, the same physician for the most part and many of the administrative partners since then, which is terrific stability for the program. We are part of Henry Ford health system, which is a big system and a medical practice and the Ford Medical Group. It's a delightful partnership. It's a very value based And in principle based kind of organization, we all say that this is a kind place to work at. And that's why generally you come in for a job and you stay for the carrier. I was involved also with organ recovery. This is part of what transplant surgeons do. So the organ procurement organizations and and transplant hospitals are joined at the hip. We have what I call codependency of existence, two sides of the same coin. And so I was involved quite a bit with gift of life Michigan. And earlier in my times at Ford, I was president as well. And I was on the board and then we moved on doing different things and then I chaired the Board of Governors for our practice, and I was Chief Medical Officer for a period of time. So I turned back and devoted most of my time not to transplant again. And then I got involved with the American side of transplant surgeons, interests in physician well being and wellness, business practice. practices and design, leadership development, and training and credentialing of transplant centers, training programs and fellows and board activities. As servos on American Board of surgery, I was serving on units. And when I finished my term, it was a celebration. This was a lot of meetings at the time between the board and the MPC, which is one of the committees that manage quality and oversight, and so on and so forth. Transport is an amazing thing. It's about life, passing it from one person to the other. And you're bound to love it, otherwise you don't stay in it. And it's a privilege to be in that place.

Linda Howard :

All right, thank you. So I'm going to ask you all that are in the organ procurement and transplant space to be thinking about, you know, how your work has changed. And this new reality that we find ourselves in And that's dealing with COVID-19. And, and while you're thinking about that, I'll ask Dr. Tyler Amell to, to talk a little bit about kind of where we are right now, as far as our epidemiologists in this profound conversation to tell us a little bit about where we are right now with COVID-19. And what what you've been seeing in terms of some of the trends and where what we can expect.

Dr. Tyler Amell :

Great. Thank you, Linda. Yeah, happy to provide some insight. You know, where we're at right now, particularly in the US is, you know, we're sitting at about, you know, two and a quarter million cases, about 120,000 fatalities so far. But there's a big asterisks beside those numbers. You know, they're very much under representative of the true impact of COVID-19. Not just because of lack of Testing capabilities and confirming diagnoses, but under reporting at the front end. And also, there is a notion and this has been demonstrated clearly in the research evidence that there are people who are completely asymptomatic, that are actually positive for COVID. So what that actually means is that they've been exposed to this virus covid2 virus that has infected them, they can infect other people, although usually at a lower rate, and for less amount of time than somebody who is pre symptomatic. Only with the asymptomatic people, they don't really know that they've been infected, or they have such a mild symptoms that they could be attributing them to seasonal allergies now, whereas when this started, you know, you could have thought that this was a cold or something along those lines. So the true number is, in fact quite larger than the official numbers that we have access to. So that's something that always has to be considered whenever we look at the impact on the economy, the impact on the country, the impact on the states and How we actually get through this out the other side. Now, as I mentioned at the start, you know, this is an ongoing pandemic, you know, we're nowhere close to being over with regards to this, this process, you know, we're at the point now where we've got a much better handle on testing capabilities. So that's diagnostic testing. And we also have some capabilities to, to do what I like to refer to as rearview mirror testing, which is antibody testing. So that basically confirms that you've actually had COVID-19, and you've gotten through the other side. And so the odds of you getting it again, are pretty close to zero. And so that that's quite a good number to have. And it's a good credential to have because it means that you know, no, next time you encounter the virus, you know, you're probably not going to have any symptoms whatsoever, which is, you know, quite quite good from a variety of different perspectives and because we have, you know, two and a quarter million people that are in that category, that's good for the for that group. Now when it comes to the actual legality of the virus, You know, if we do rock calculations in what's called a case fatality rate in comparison to something called an infection fatality rate, which is something we don't really know, we just have to infer it simply because we don't know how many people have been infected because of those asymptomatic people and because of inability to test it in many instances. So we know that about 85% of the people who who come into contact with the virus are able to get through it, you know, with relatively mild symptoms or complications. Of course, if you don't have any symptoms, you don't know you have it, you don't see care, you don't seek treatment, you don't end up in hospital. So that's a smaller portion. Now that 15% on the top side, or the much more severe cases. So those are the ones that we really need to worry about. And those are the ones that we have to look at, from a from a few different perspectives. The majority of those, let's say the next 10 plus percent you know, will require, you know, they may require hospitalization, the top two or 3% may require dental Later supports and so on and so forth. And then, of course, the very tip of the iceberg of the people who succumb to, to the virus, and to, to to associated diseases such as pneumonia. Now, of course, that's the minority of the people who are infected with COVID-19 disease or the virus. And so, you know, that's the worst case scenario for individuals. And of course, that's the linkage with our discussion here today around normal procurement, organ procurement and so on and so forth in a broader conversation. Now, just because, you know, we have some data and, you know, the, we've had some some rather significant impacts on the economy and various other aspects of society. You know, there's this, this mentality that, you know, the worst is behind us, and, you know, we're done with the first wave and, you know, bring on the second wave sort of thing. And that is most definitely not the sands you know, we're still in in the midst of the first wave. In most areas, there has been a decrease in in cases. And this is Due to a couple different factors, you know, some of the more significant things that we that we did as a society was we started shutting things down and started reducing the likelihood of people bumping into one another. So introducing barriers, introducing physical distancing measures, you know, looking at six feet between you and the other person, covering your cough campaigns covering your sneeze, if you're symptomatic, those sort of things, which are things that we normally do as part of our normal influenza, or common cold sort of control practices anyways, there's things that you can do to reduce the likelihood. Now one of the things that we probably should have started doing much earlier on was getting a lot more people wearing masks. Now, or, you know, we didn't think that the asymptomatic transmission was going to be the degree that it is in this particular case. So when you put all these things together, we actually have a pretty good way of controlling your own risk and your own likely disease. But we definitely need more people to be practicing this. You know right now I think we have 19 states in the US I've seen an uptick in their new cases. So that's what's called their incident, the number of new cases that are coming forward. So which is not a good position to be in because we know the weather's getting better. You know, there has been protests, you know, large masses of people. There's all these sort of factors that they're coalescing together to create an environment whereby people are letting down their guard and we are seeing more people become infected from that perspective. So obviously, that is something to keep an eye on, as we go through this, this this, this near term here. Now with regards to Linda's question about a second wave, you know, a lot of people like to jump to what happened 200 years ago in Spanish influenza. Now fortunately, we don't have a lot of the same things occurring as we did 100 years ago. You know, when we look back to how the virus was transmitted in the Spanish influenza outbreak in 1918, you know, it was a perfect cocktail. You had a large numbers of people in Co located you know, living together army bases, things are ramping up World War One was raging. And then you actually had a lot of these people spread all over the world, primarily in Europe, which had a tremendous impact over there. Fortunately, we don't have that happening right now. So you know, we've got travel restrictions in place, we've got adoption of various different control measures. So the severity of the second wave could be mitigated as long as we keep moving down this pathway of trying to reduce the likelihood of you coming into contact with a close contact with somebody else, you know, protests can definitely go on always a great idea. Just support that, but you know, do it in a socially distinct manner wherever possible, and of course, wear the mask. Now, the final point that I would like to make is this, to touch on the the vaccination process and the vaccine discussion because this invariably comes up in every webinar that I've been involved with for the past couple of months. We get asked these questions a lot. Now, fortunately, as of last count, which is for web manara did a couple days ago, there's about 135 different vaccine programs underway. Typically speaking, it takes about a 12 to 18 months. And keep in mind that this clock started back in January, whenever we first started paying much more attention to this, of course, we're a little bit slower off the off the start then within then we should have been with regards to the, to the approach, but that's probably part of a different conversation altogether. Now, that being said, you know, it looks like we're going to be in a position to to to move beyond clinical trials into what's called, you know, there's several different phases to clinical trials. Phase One, phase two, phase three, several different vaccines are moving out of phase two and into phase three, and they will be ongoing test throughout the summer. Then the next next step is to scale up production in a rather significant way. And so we're probably in a position where, depending on which virus or evac which vaccine we're looking at and the manufacturing pieces, we will have vaccines for The most vulnerable members of our population towards the end of the year to the tune of about half a billion doses. So which is quite good, quite good news for us for sure. But that doesn't necessarily mean that things are going to be over. It's going to take, you know, another year beyond that to get to a level of what's called herd immunity, whereby you're able to vaccinate very, very large number of people globally so that we can resume some level of normalcy.

Linda Howard :

And let me let me ask, Dr. Marwan because I see him nodding his head as you're talking and I want to give you an opportunity to get in and just how have you been seeing this impact on the hospitals?

Dr. Marwan Abouljoud :

Yeah, this was very unique, and obviously it differs from one area to the other. Detroit and Michigan was one of the epicenters of the Covid pandemic early on. We were the second or third, you know, state with the highest prevalence of Covid and then we went down to six or seven, with a lot of the precautions that the state was putting together, so I did in early phase, our main hospital, we think sometimes over 1000 patients coming through the door with symptoms between flu, actual flu and kovat. And some quite sick. And within a very short time 80% of our hospital was in isolation. And what that meant is somewhat over tested that if you remember, we didn't have capacity for testing at the time and our lab that a very good job immediately procuring resources, and got multiple testing available and within a couple of weeks, they were testing nearly 300 specimens a day and then that had 1000 with an additional two weeks. So so the everything in the hospital besides emergency surgeries, and medical admissions basically stopped because Because the resources were not going to be available. And then the other thing is that if you admitted a patient within you covert without really having all the resources to insulate people and create the safe pathway, and quarantine, you'd be infecting them. So so we stopped doing transplants at the time and many other elective things until we get our arms around it and at that time, the mortality rate was extremely high. Until we figured out that giving steroids early on the moment they manifest pommery symptoms, reduced mortality significantly of those who started manifesting the pulmonary symptoms and the paper just came out, showing that the submitter zone actually indeed significantly reduced mortality. But this is something we figured out in the second week about exposure for transplant. When you have an operating hospital that has 54 or 50, some operating rooms they went down to for emergencies only. So you can imagine, transplant for us we do 300 plus solid organ transplants a year. We have to stop. So for living donors is for the first week up. And then for deceased donors, we recipients with prettified. We said if somebody's that sick, they suddenly the transplant for those two weeks when we could not even offer it here. We didn't ask for them to refer elsewhere where they were still doing transplants safely. And we were able to transplant those individuals. So fortunately, we didn't have anybody die. Because we could not respond during that window. And when we started resuming tasks fine. We had to number one, make sure that the hospital has what you call safe practices, you know, go this way, not that way. Only four people in this elevator, two people in this elevator. Everybody gets checked on the way in with temperature and symptoms gets a green sticky on that ID badge. You can only enter from two doors and exit from these two Doors, nobody comes in it was basically quarantine hospital. And you could see that the infection rate that went up even among staff, and nurses and frontline health care providers started coming down very quickly. And that's when we started going back to do transplants, but only the sickest first living donor, we just assumed that about three weeks ago, and we had to install new protocols for that. So we check the symptoms and the donors and the recipients. We check them two times to make sure that COVID serology isn't negative. And they have to be so many hours apart beginning at two weeks, and then within 24 to 48 hours of the exam of the operation. And also we insist that those who get tested have to quarantine themselves between the test in and coming in, because they can get exposures. And fortunately that that protocol has worked. This is a protocol for all surgeries electively. And then transplant unit has always been a cohesive unit. So we protected there. All the staff who work there, whether physicians, nurses, medical assistants, we're not allowed to serve in COVID units or COVID hybrid units. And then we implemented a testing protocol also for the staff said they have had suspected exposure and so on and so forth. So knock on wood, you know, we haven't had patients get second, our tests on unit from COVID. We did have early and COVID staff exposures, you know, whether it is physicians, we've had nurses, we have nurse mid level providers. That was scary. That was very scary. In some got admitted in the hospital recovered, but surprisingly, most of these were exposures from outside the hospital. One was raised to be inside the hospital when somebody coming in and it was not wearing masks and was coughing, right unless everybody immediately jumped in and isolated but by then, several people got exposed. In so that definitely changed our life. I mean, we walk around now, you know, we don't shake hands. We you know one time I had my facemask down because I had a bottle of water. I think people thought that was radioactive. You can see how everybody just is like, oh, I'll get my mask back on. And soy we function definitely the the hospital looks like a weekend, every day because where is everybody? You know, we staggered folks, they all come at the same time they come, they go from different hallways, and are these stickers around controlling traffic. So there is a bit of socialization there with that comes along with that.

Linda Howard :

Now, when did you start doing transplant surgeries again?

Dr. Marwan Abouljoud :

For after COVID You mean you have to call it Yeah, we started six weeks after the first COVID case attended for hospital. So we were on hold practically for six weeks.

Linda Howard :

Now I know in the early days because we've had some conversations of the organ procurement side. And I know that things that pretty much come to a screeching halt. For you guys in terms of, you know, just doing the donor work. Can you talk a little bit? And I'll maybe I'll go to Barry and ask Barry to maybe just talk a little bit about how this really how COVID impacted the industry initially and whether or not you're seeing any changes now?

Barry Massa :

Well, it's interesting because, like, was what was said before impacted opioids differently across the nation. And if you look at where organ donation was, before this happened, we were on pace much higher than last year. We were on a record pace for a number of organ donors and organs transplanted and then when about mid March, when everything got I would say completely changed around in terms of everybody's expectation and of COVID and state start shutting down hospitals and elective surgeries and staying at home orders and so forth. At least at Life Center. in Cincinnati, Ohio, we saw a decline in donations and for a 10 week period, we had two organ donors, which is very, very, very low for us. A lot of it was ruled out for Coronavirus. We actually had people that were you know, for, there's reportedly a high false positive rate so we wouldn't have a false we would have a negative test from one hospital after being trained at the person started in a rural hospital then got trains transported to one of our main hospitals in the city, the one hospital his report would show negative and the other ones test would show positive. So we didn't without knowing who's was what we had, we would have to walk away from the case. So for us, donation fell pretty rapidly. Starting toward the end of May, it's start picking back up again. Now, I would say, in the Great Lakes region, which includes the state of Michigan, Ohio, Indiana, Illinois, and Wisconsin, there really wasn't that big of a dip in donation. Or there were in some of the IPOs but in the majority of the IPOs, that did not occur. Ohio has four IPOs, two of us had a decline in donation and two did not so again, just impacts different IPOs differently in different regions differently.

Linda Howard :

Kelly, how about you what was happening in New Orleans?

Kelly Ranum :

So two weeks after Mardi girl I think it all exploded in Louisiana and we became one of the hot beds. We didn't have the volume of population that New York or New Jersey or Michigan half but in comparison to the number of cases we are getting in deaths. We will right up there. I think we're we have stayed in the top five, actually, for us, the transplant center, our main Transplant Center, they became the main COVID hospitals. So transplants in our state pretty much came to an abrupt halt as well. dialysis machines were in use for COVID patients, ventilators and use for COVID patients didn't have the at least initially didn't have this isolation units. Of course that came along a little bit later. We were still able to do demos. We have a donor Care Center where we actually bring our donors over and we can do that actual ICU management and are here. And I would say that that was our saving grace. Because we were able to free up hospital resources. We were able to give them back their ventilators, their nursing staff. We were able to minimize our staff exposure to COVID because they were in a contained area with limited staff. I think it does vary across the state, as Barry said, are across the country, New York, New Jersey. They've seen tremendous decreases somewhere in the neighborhood of my my peer in New Jersey said 60% less cases that they're doing a donation. For us we were in 30 to 38% decrease, which is pretty much what they found across the country. Same thing on the west coast. Washington was one of the first big ones hit so they saw that decrease. I think our big challenge was nobody wanted to come in to get the world Because we were a hotspot. So we had to find alternatives to be able to recover those organs and send them out, which is not something that happens in our field. Marwan that everybody likes to come get their own organs don't really want it to happen any other way. But we were really pushed into having a surgeon that we had locally both abdominal and thoracic, so heart and lung. And we were able to actually video out those surgeries so they can watch it the entire time and we were able to then send organs out for transplant. Without that ability, I think we would have seen a tremendous, higher decrease in what we do and I think part of our problem is actually being able to be face to face with donor families. That's one of our things that we do like to care for our families. We like to be there. In the south. You like to hold hands and hug and said this no hands shaking, no hugging is really difficult thing for most of us, but not having visitors in the hospital not being able to see their loved ones not understanding that they left the house having a little trouble breathing, and now all of a sudden they're dead, with no transitions. So, for us, we saw a tremendous decrease in our number of authorizations. From donor families, we went from a 75% to into the 55%. And that's huge. Everyone, donor counts. And so that was really our biggest struggle was how do we connect with these families when we can't physically connect with them, they can't physically connect with a loved one. It's getting better now that they're opening up for visitors a little bit more. But I think to me, that's one of the bigger problems that we've had in our field. Much like Barry said, there are some opiates that still see record numbers in March and April. That was not the case for us, but we were still doing donors and still sending organs out for transplant.

Linda Howard :

Now, tell us a little bit in any of you can kind of jump in. What was what's the impact? So we were hearing that it definitely had an impact in terms of on the donor rate. But what does that mean when the donor rate goes down? Because, I mean, a lot of us that's, you know, to do work in the in the organ procurement community, we understand the numbers. How many people on the waiting list how many people die waiting on the waiting list shortages? You know, those type of things, you know, are discussed in the industry. But can you just for those for some of us that don't know, just talk a little bit about what is the impact of having those donor rates go down and not being able to perform transplants?

Dr. Marwan Abouljoud :

Maybe I can mention something here, Linda, that's a good question. transplant centers when they are offering a transplant option for a patient with liver failure or kidney failure or heart failure, what they're doing is that pre empting, that kidney transplant, even being on dialysis for a period of time, it's a significant higher mortality than not being in kidney failure. And so it's almost like having cancer. So so we're dealing with mortality. So when you're offering transplant, you're pre empting mortality. And depending on how sick you are, that is kind of a race to who he gets to first, do I get to your first with an organ before you die? Or does fatality and the severity of your disease get your first and you either die or get so sick that we get you off the list? So you notice that Kelly mentioned keeps track of the people who come off the list or die on the list. And then so that's a number that gives us a sense of the fact that say for living I used to live it as an example if it's 100 people on the list every year, somewhere around 10 to 15%, will die waiting and then another 10 to 15%, maybe another 10%, let's say come off the list for a reason. And most of the time it has to do with they got too sick for transplant. So maybe somewhere between 22 and 25%. Get off that list because and that's with all things being equal, the best of circumstances with all delivers available, almost 105 to one and four will die or get removed off the list. So now when we say this is the equation, and now has happened at the peak of COVID, our organ donation in the country went down to what the kellian body to 40% of from nationally now some areas were worse off than others. It's kind of a wave kind of carried across the country in wave, some peaked some draft, but basically the organ donation we're down to 40% from speak Now, between not getting offered an organ, and then the lag of catching up with those who didn't make it to get an organ, and an organ that is not used as an organ gone, you don't make it up there is no make a provision. I cannot turn on my head and say, let me schedule this donor liver because I lost one last week I'll make it up. It there's no makeup provision or catch up provision. So what's going to happen is and we all anticipate that that the mortality and drop off from the waiting list and then coming weeks and months is gonna play out. And I'm leg to that. So I don't think it's materializing with clarity yet. Another thing how we report that mortality COVID related COVID delay, not COVID delay. It's not going to be as obvious, but we are going to see that I don't know if Kelly and by the way, think about that.

Kelly Ranum :

I mean, I agree and I think that some of the things that we see on the donor side also is A lack of going in and getting health care because they were afraid to go into the hospital or were encouraged not to go into the hospital. And so, you know, we saw an increase in strokes, which is something we see normally. But over the last couple of months, we saw more of that stroke population, the older population. And so I do agree that I think that the long term effects of this COVID are really going to probably not play out in real numbers for us for some time to come maybe a year or two. For we really know what that is. And I can say initially, hearts and lungs were not being recovered and particular Long's because there was such a fear of of what was going on with COVID and transmitting and just staying away. So there's a loss of that Oregon in particular for a month, a month and a half before anybody would really start picking up and transplanting. So I think you know, it Time will tell exactly what those numbers are right. I think there's no doubt that the impact is far greater than that. That number that we see on the on the screen when you put COVID in your Google search bar.

Dr. Marwan Abouljoud :

You know, Kelly, you mentioned that collateral damage, which is people delaying coming in for disease. What we have seen and many other people are seeing is that some living donors even though now, we're open, they're not want to come and we had many people who were can have living donor transplants not all we just did one this past Monday do not want to come because they're afraid of getting covered. And we've had a heart transplant with it. Three weeks ago now, three weeks ago, she delayed because of COVID. Yet we would open and she came through the emergency room and heart failure ejection fraction of 5% got put on the pumps and machines and became status one and they went I've got a hug from you know for us from which is fine from Kansas City, and, and so, so there's collateral damage related to behaviors and choices people make. And then the other thing that we are struggling with is the safe discharge. Let's say I'm in Detroit, and we're in Detroit, we had a peak there. And obviously there is socio economic challenges with crowding in families and support systems. So now me transplant somebody. And I say, so we're going to go and again, I'm going to go on, I say, who lives home? Oh, my wife, my grandson, my two children, their nephews and in a house that's 1200 square feet. And how are they not going to get exposed? So that that is a challenge, and we're having to figure that out of how we isolate people when they go back home. Because in Detroit, it was clear that the socio economic circumstances and the makeup of the Community and Social crowding and a variety of other factors played heavy into this heavy pandemic that we got, specifically in Detroit in the Wayne County area.

Linda Howard :

So that that, that brings to mind questions around kind of these disparities, these health disparities, and, and also, you know, particularly vulnerable populations. And I know, Tyler with the work that you do in terms of both the epidemiology as well as just the work you do in the works in the workplace. Can you talk a little bit about what what we've seen in terms of some of the disparities, how COVID might have impacted certain communities more and also, just any kind of conversation around addressing these vulnerable populations where we do know that one of those vulnerable populations are donor patients

Dr. Tyler Amell :

It's an excellent question and and absolutely, the research corroborates you know, everything that you just mentioned. And not just from My us lens, but internationally as well, the National Health Systems of the NHS in the UK actually looked at that question directly. And, you know, obviously, this is, you know, it's a unique approach given the fact that you've got almost 70 million people all in one health system for lack of a better term. So you've got access to information that is quite invaluable. And they did actually look at you know, various different breakdowns and stratifying data, which is a fancy way to slice and dice information accordingly, you know, certain segments of the population were vastly over representative. So, you know, the African American community would be the core of their coordination there, but also the deprivation. So, the poorest people, you know, had a higher mortality rate and a higher hazard ratio associated with that, using rather advanced statistical models. So these people use greater than 99% chance of these people having a much, much poorer outcome with regards to their their SARS exposure and their their experience with COVID-19 We also saw this in predominantly male populations as well. So the older you are, if you're male and poor and deprived, you know, those three factors alone drive up your risk of mortality, you know, you know, five or six times right there, so it's rather significant. And then when we look at it through the organ procurement lens, you know, becomes a little bit more significant simply because we're dealing with people who have what are called comorbidities. Right. And so we're trying to deal with people who are addressing their own individual health concerns, which are compounded when when you layer on a COVID-19 experience or pneumonia or something along those lines, when we look at the data that the CDC uses to, to, to inform strategy. We know that hypertension, obesity, metabolic syndrome, type two diabetes, you know, lung disease, asthma, a few other ones, you know, they're definitely bubbling to the top of the list. Of course, we know that when we look at certain segments of the population who are who are more susceptible to these, we find that the data corroborate that. Yes, in fact, you know, there are people who are being over represented here, and they really shouldn't be. It should be across the board because, you know, we're all people at the end of the day, but the research definitely Does, does underscore that need and can substantiate, you know, differing approaches in different areas for those reasons.

Linda Howard :

When I listen to to both of just the last two comments, Dr. Marwan and you talking about kind of that, basically that race against the clock, talk when when people are in need of an organ, and listening to Dr. Tyler, where we're talking about that, because of these, these disparities in health, you got certain populations is more likely to get sick from COVID and more likely to die, which to me, that speeds up that against the clock. So if it puts a certain population in a particularly vulnerable place, one, you have a slowdown in organs being available, and you have an acceleration of an illness that can then either end in death or make you so sick that you're no longer eligible for transplant.

Dr. Marwan Abouljoud :

I think that gets even more complicated with a couple of things because during the course of the year, also people were not going through preventative care. So these people who are wait listed are sick people, sick meaning physically sick, they need maintenance to be readied for the transplant. So when during Kovac when everybody sat down and not everybody was ready to go virtual or even have face to face encounters of specific nature, people got sicker. So we would think people with organ failures, who basically got in the hospital are numerous around knowing that That they probably could have avoided that had they accepted to come or were able to come. That's another thing, too they get that and when we talk disparities in Detroit here, we look at it through a lens that illustrates the strata of disparities from way, way, way at the very bottom, which is access to preventative care, access to support systems, access to medicines, access to insurance. And we've established long time ago that an African American minority in Detroit, just just by taking getting that label, you are more likely to be turned down for transplant. And, and because sometimes you may not be able to get support systems in meaning somebody to drive you back and forth. You may have an insurance that underinsured or you don't have co pays for medicines and and your minute understood what you're getting into and you say no. When you said say yes, because you just can't comprehend. And you try to take it down several notches and we have a community here called the transplant living community. Their job is to really connect patients to patients as ambassadors to explain things about quality of life and how to be compliant and what it all means. And so so the disparity is so rooted, we all know that right? We had so rooted that harassment only highlights it, when we looked at the number of COVID patients in Michigan and you can pull the maps and CDC and all that the the case fatality rate is higher among African Americans. And the prevalence rate is higher among African American above the representation the general population based on your statistics. In Michigan, we may have 13 and a half 14% African Americans, well, almost 40% got COVID and among ghosts, we'll get covered. It was worse off for the African American and then you say, well, maybe because they Had this and they had that? Well, yeah, but that's also disparities too, because that started off from lack of preventative care. And it may not be my place to say that, but I've read and I've read epidemiology studies that also say, just being discriminated against or being looked at definitely increases all stressors in your life that includes high potential risk of diabetes, and all that and unemployment future of uncertainty in your life that makes you every American with hypertension and diabetes. And I said when I'll become a potential diabetic, if I have no social ladder an opportunity to to get educated and my kids have a secure future. So I think that COVID blew it all in the open. It just put it all out there.

Linda Howard :

It's it certainly did. Andi, I know you take yourself off mute. Because I want you to get in here because I know you are working more with the community side. And so what Have you been seeing just in terms of at a community level? How is this How is COVID kind of change your work in and what you've been doing and how you try to relate to families?

Andrea Johnson :

Well, it's changed our ability to do outreach dramatically. You know, this is, you know, April is really kind of our spring springboard into to, you know, warm weather, lots of outdoor events and being dumped, you know, April's national Donate Life month, it's kind of our, you know, coming out party for the year where we start to really do a lot more. And all of that was essentially shut down because of COVID. Our community events are just critical for our outreach and education, particularly with the African American community. There. Quite a few events held in Greater Cincinnati during this time, that Try to offer different services to those that may be in the minority community or impact or lower socio economic status offering free health services and other things of that nature. And those events attract thousands of people, you know, in need of, you know, the preventative care that they they can't afford to get with a doctor because they can't afford a copay and those types of things. So we're able to connect with that population in that way. And that was essentially we just couldn't do it anymore because of COVID. So I think that's, you know, for us, it's important to have that dialogue with people about donation. What it means we like to always have recipients indoor donor families with us at these events to share their personal stories about how donation impacted them. So again, we weren't able to do that. We are partnering with some other organizations, one in particular, it's called closing the Center for closing the health gap that specifically works to address health disparities in our community. They're holding what they call COVID town hall meetings and have been doing so since COVID occurred. And we'll be participating as a panelist to talk about donation in the midst of COVID particularly as it pertains to African Americans and kidney transplants. So we're, you know, it's been tough. It's been really tough to navigate. But it's I think, I think just the what Dr. Mark Marwan said, it's kind of blown this thing all the way open because it's really kind of exposed. That any quality that is exists across all levels and showing that it is systematic. And so, you know, we have a lot of work to do with respect to making sure people have adequate health care and access to services.

Linda Howard :

So if any of you may be able to answer this, particularly on the from the lpos, is there a resource, a place a site, that any of the listeners who say, Okay, I want to know more about organ donation, I want to, you know, have the information I need to decide if I want to be an organ donor? Or is there some things that, you know, initiatives that people can join, to help improve the donation rate during this crisis. And if you don't have anything right off the top, if you want to send it to us, we can make sure that it goes out in the follow up email to participants, so I'll just ask that you do that just in case you're someone who is is listening and say, Okay, I want to, I want to understand more and perhaps I even want to be a donor. So I do know that we have a no, we have a few. I know we have a few questions that's lined up. And I want to make sure that our participants get a get an opportunity to be able to ask questions. But one of the things that I'm Trina mentioned when we first got started, that the national wellness Institute is just launched its multicultural competency and wellness certificate program, and is also one of the things that Muslim like planning Institute focuses on and we're going to be talking about that with with at the APL conference next week. So just kind of the one question that I have, for any of you in the any of you in the group is to really, is there anything in particular that you're Seeing as a gap or anything that you are proactively doing to ensure that as, as an organization that you're able to reach a cross section of the population, or is there some things that you say, Hey, listen, this is an area that we need help in and this is an area that we need supportive.

Barry Massa :

Linda, to go back to your earlier question for people that want to know more about donation, I would encourage them to go to donate life, America's website that will give you a idea for donation across the United States and you would be able to register on the national registry. For your state registry, you should go to your Donate Life and put in your state name like Donate Life, Ohio, and you could register within your state registry as well. That would be the best thing for your listeners to do and that is the best way to register is do that online. But as far as filling up gaps, we always are looking for ways to fill gaps. And we look out to those who are whether it's the African American community or the Muslim community or different leaders in those areas for their guidance on how best to hit that outreach within the respective communities.

Andrea Johnson :

And if I could just add on to that, I think during during all of this what has been really important what has been, what I've realized is that because this happened, it also means we can't we have to continue to let our communities know that we're here. And so I know that Life Center has had to be innovative and how do we do that outreach and so we're doing outreach with different faith organizations. Some some of the mosques in the area as well as true Churches and a God's putting together bags like what's the word that I'm looking for with like hand sanitizer and so been information about donation because now there's this this move to get back into places of worship because everyone's been doing it virtually. So we want to make sure that folks realize that we're still here. We want to continue to do outreach and education. We're also beginning an initiative with some of our local hair salons and barbershops located in our urban communities, again, to do more outreach and education. So I think it's just important that we, we continue to have a presence although it looks a little different right now. We still have to be doing the outreach, doing the grassroots and just being more innovative and how we're doing it.

Linda Howard :

Also to when we think about multicultural competency, one of the things that we do talk to cultural competence and then the lens. Because a lot of times when people think about multicultural, they think around race and ethnicity. And so when we're talking about dealing with vulnerable populations, it's also looking at kind of widening that lens because it does extend beyond race and ethnicity. You mentioned some of the faith base. It's also understanding how to address people taking in consideration your religion as a part of their culture. It's things like age, it's it's other, looking at health disparities, the social economic factors that put people in certain categories that might make them more vulnerable. So I will just also say to you all that are a part of our profound conversation list as well as those who are listening in that when you think about developing those competencies that we think about a broad range of groups that make up culture and sometimes put those groups into more vulnerable positions as we look to provide services and do outreach to those groups. And you know, we'll talk more about that at Apple next week in our session. And also the national wellness Institute does have, you know, different things that we do as well to kind of highlight being able to start expanding your view as you look at providing services to cross section of the population. And on that note, I am going to ask Trina from the National wellness Institute to see what kind of questions we have because I do know we have some questions lined up

Trina Laube :

Thanks, Linda. And so we talked about this a little bit but it can you Discuss how we might best address the complexity with health disparity and mid COVID-19 is the challenge of creating understanding and trust regarding health care and more specifically trans plant surgery. So where does that trust piece come in?

Dr. Marwan Abouljoud :

Yeah, this is a very good question, I think to begin with, we all know that historically, there are some various subgroups in society based on either race or background, religion or self may have an element of trust or distrust in the healthcare enterprise, right. We've known that in organ donation in sometimes in transportation. And it boils down to for us and we implement that is education, and leveling and understanding the cultural background and the issues and understandings the person comes with and approaching them in a way that is informative, educational and non judgmental. And, you know, time To understand the perspectives that people bring to the table now in our community here, which is Southeast Michigan, in multiculturalism is part of the DNA. You know, my staff here at Ford, nearly half of us are international, and also multi ethnic, and the community is the same way. So it's very, it's much easier for us to connect in to reach out either through the church or the mosque or the group or the society or the club or the family and be able to level with that. Now, that said during the COVID era, it is very common that people are afraid not to come to Detroit or to computer hospital. And now we I am getting letters from New York, from Chicago, people telling everyone would open come in, you know, and they not coming in. I mean, our referrals continue to be low. Patient do not want to come in and doctors are telling some patient not to go to Detroit. And yet we know safely, that we can get people through the door knowing what we know, with isolation measures and other practices, education, education, education.

Kelly Ranum :

There was a question about where to find information about donation. Um, I think Barry's previous recognition of that Donate Life website will get you some basic information. But if you just realize that there really isn't an age cutoff, it's always better to say yes to being a donor and then on the back end, we can evaluate with surgeons and professionals, whether that disease process would allow you to be a donor or not be a donor. If you don't register, then we don't even have that opportunity, nor do you or your family so don't make any judgments just say yes.

Dr. Marwan Abouljoud :

Kelly, I was told a story that one of the first livers I did when I was training was from an 18 year old donor and delivered didn't work because of the donor factors, and then it called primary non functional. Basically, the person would die within a day or two. Well, we saved that person by transplanting with a liver from an 81 year old lady. And it worked like a charm.

Kelly Ranum :

It's a resilient little organ.

Dr. Marwan Abouljoud :

I tell you those grandparents always come to the rescue.

Kelly Ranum :

And a little earlier, you were saying I think that some of the issues that I've found with COVID is that losing that face to face and then in our populations that don't have the financial resources are not always internet available and computer savvy or computer up and running. And so we've relied a lot on any kind of virtual social media presence and education. I think the struggle for me in particular moving forward is, how do we tackle that because not every community that we serve is up on the internet with all of the tools that they need to access what they need. And so I think that's that struggle, right? Of how do you get out to that community? And how do you educate in churches, you know, having the churches shut down, that was such a huge blow for all of us. We worked with church nurses and and their individual groups and that that was all taken away. And so that connection to the community was gone. And, in particular, that was, at least for us in Louisiana. That's a vital part of how we get into the African American community. It's church based education, church based learning. It's that that faith that our have our staff have and it opens the door for families to feel safe and to talk and then to express that Yeah, I'm on I'm on the kidney list and I get dialysis and you start learning that, hey, it's a lot closer to home than I thought. So I think that's the challenge coming forward for Andy. And most, how do we continue to get out there in the community? How do we can not just talk about donation, but also include health education as part of that, because if my staff can keep one person off the waitlist, that's a win for me. And that's a win for the community. And so I think we have an obligation to kind of mix that donation and transplantation what how can you prevent even getting on that list.

Andrea Johnson :

Absolutely. I think to this has been, this has opened up the opportunity and with respect to faith, faith based organizations as we've used this time to connect with the leaders of the faith based organizations just because we've been able to just we've been able to get time with them because things are coming. kind of slow down. And we found that I think when you're able to continue to build relationships like that with with trusted leaders within the community, particularly with the faith based organizations, it then lends itself to kind of cascading down to the rest of the congregation. And so we've tried to use this opportunity to foster and build more relationships there in the hopes that we can then, you know, as we continue to transition back into a sense of normalcy, we'll have more support from the leadership as well, which I think will translate will be important as we're working with different congregations and doing education and outreach.

Barry Massa :

And then just add one more thing to that topic. If you really want to build trust within the healthcare system. You have to end the healthcare disparity between all the different groups, whatever they may be. So if you want to build that trust, you have to tackle that.

Unknown Speaker :

And I can say Barry and nine other leadership within Life Center. We've had some some really the beginnings of some honest and tough conversations just with everything that's unfolded over the last several weeks. And this he's right, you know, but it's it's not just the flip of a switch. There's there's so much that has to be done and rebuilt, but recognizing that I think is the first step.

Dr. Marwan Abouljoud :

Yeah. You know, me as a transplant surgeon who has seen and I am not born here, so I lived in different countries. So I've seen fossilized systems, hybrid systems and the American system and I think that capitalism has a lot of good things about it. But I think health care and education and safety and fossil you know, how shall I say progress and ascending within communities should be public. Right. And and I think that we seem to see it in different iterations. And I think at some point, we're going to bite it and say, education for all healthcare for all in stop segregating, I mean, we will segregating rates. I mean, people have to admit that we'll do that. But it literally is an affordability or based on whatever that is. And then all of a sudden, we're surprised why those schools are not funded. Public Schools are not funded. Well, yeah. Well, that's what you create this tax base for that. And then you immediately start hitting a glass ceiling when you can break through that. And then between all these other problems, and yeah, I think needs to snap out of it and just change.

Dr. Tyler Amell :

Yeah, excellent point. Doctor. I would you you know that this is an area that when Linda and I were discussing my participation here, because I'm kind of the anomaly, right, everybody has a common thread and then you have you thrown in an epidemiologist.

Dr. Marwan Abouljoud :

You're the wise anomoly.

Dr. Tyler Amell :

But in all seriousness, you know, when Linda and I were discussing, you know, we were looking at things through the lens of COVID-19, exposing, you know, vast discrimination amongst healthcare practices, you know, all these different things coming into into fruition into the limelight, you know, these things aren't new, you know, you know, I have the the ability and the the, it's very unfortunate, you know, I get to speak all over the world on health and health practices and things like that. When we look at the US, the US is very much on its own. You know, there's only two areas when we look at healthcare globally that the US leads it and that is number one in cost of health care per capita. It's, you know, in the neighborhood of four or five times the next most costly country. And the other leading area that the US leads in is not another one to be proud of, and that is, you know, preventable chronic disease. In every other instance, you know, if we're looking at outcomes treatability cost, you know, infant mortality, life expectancy, you know, the US is barely in the top 25 countries globally. So, you know, the, to your point earlier about being exposed to all these different health systems, you know, there's a lot of people out there who think that, you know, this approach is doing just fine. And you know, most of us who have an opinion, that's justified by evidence, you know, have evidence to the contrary, that that's not necessarily the case. And this is just an example of this being, you know, looked at through through through a microscope and being thrust into the foresight that this is not par for the course it doesn't actually need to be this way. There's many other instances that have been proven time and time again, to be different approaches that do provide health care on a broader scale, and reducing the discrepancies reducing the the other elements that we've been talking about today that lead to these elements of marginalization and poverty and all these sorts of thing. So I agree 100% and, you know, fortunately, there are other countries that you can look to for some solutions. Now they're not all going to work 100% of the time, but at least having dialogue such as this is a great way to move that forward.

Trina Laube :

Great. Thank you, Dr. Tyler, and everyone. For those of you who may still have some questions or looking for more information, and there have been some resources provided and hope you'll reach out to both of the groups here, the National wellness Institute, and the MLPI. Just one quick reminder, if you need continuing education, credit for chairs or for your CW PS to complete that evaluation form that'll come in tomorrow's follow up email. And then I do want to give a little time to Karim here.

Karim Ali :

Yeah, I'm actually going to just conclude with some special thanks and acknowledgement was a fascinating conversation. I appreciate everyone's contribution. And so on behalf of the Muslim life planning Institute, I want to thank and give some special thanks to the me hospital system. Dr. Abouljoud and his staff have been very supportive over this past year. And as well joining us today on this on this webinar ever site ibank are in Ann Arbor Michigan. like to also thank john Hopkins Bayview Medical Center in Baltimore. john hopkins, Bloomberg School of Public Health by to the fake Michigan State University School of psychiatry. All of our guests within our in our conversation list over the last 12 episodes. Erika Christie, who is our podcast, producer and engineer, like Special thanks to our executive producers, the most like planning Institute, senior senior executive by century our media expressionists, Aaliyahnetwork with diversify holdings, who does much of the production, production planning for of the work that we do like to send a big shout out and thank you to the audience. wellness Institute for their seamless collaboration. And this work today on in the previous work that we've done one of the episodes, I like to send a thank you to the alternative consulting services, of which Linda Howard is the president, consultant services. And I'd also like to thank viewers like yourself who made up the broadcast possible. With your continued support, both through your viewership and through generous donations, I welcome you to visit our website of profound combos calm, listen to our podcasts, subscribe, and hit the donate button because it's with your assistance in your help. That keeps our program alive. And just a congratulations to our team on the finishing a completion of our first season of 12 episodes. Look forward to To Season Two coming in the summer, so tune in. That's it. That's that's all I have. And I really enjoyed the conversation today.

Trina Laube :

Thank you, Karim.

Linda Howard :

I would just like to say thank you again, everybody. This was truly a profound conversation and it and it looked like Dr. Marwan wanted to say something.

Dr. Marwan Abouljoud :

Well, I just wanted to thank the guests and the the CO panelists, everybody get an amazing perspective. I think we're all on the same page. And we'd love to see our country learned a big lesson. We've had a lot of tough lessons come in succession, and you're not ready for the cold, and then dead it is. And so I hope that we emerge stronger and more insightful and wiser as a country and as a nation. And I think that these are the kind of dialogues that you have a new support that allow people to just open up and engage.

Linda Howard :

I think that's, I think that's a strong, closing remark. Thank you.