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organ. You waste people's lives. Good quality leads to better performance and lower costs for the business." To achieve quality, every detail must be accounted for. "You must have an efficient, organized program that takes every discipline into consideration," Dr. Wu says. "Transplants do not succeed by surgery alone, but through a combination of medicine, surgery, psychology and other fields." Prior to transplant, patients are screened to ensure they are good candi- dates, while conditions such as hepatitis or hepatocellular carcinoma are treated before surgery to ensure a higher chance of surgical success. After transplant, patients are closely monitored to ensure they do not experience recurrence of the cirrhosis, liver tumors or other factors that neces- sitated their transplant. "If we detect these conditions early, we can treat them," Dr. Diflo says. "We are in the process of developing a system to monitor patients with regular medi- cal, psychological and social follow-up to ensure their surgeries continue to be successful." Dr. Wu personally reviews all current and past transplant patients weekly with a hepatologist and nurse coordinator. Nurse coordinators function as managers and patient advocates for the transplant program, which is key to keeping up with all the patient details. "Patients are closest to our nurse coordinators emotionally," Dr. Diflo says. "These nurses meet with patients before they're listed for transplant, help them with their medical evaluations for candidacy, follow them before and after surgery, assist with their medications and social service needs, and make sure they keep their appointments. Their position is key to both the short- and long-term success of our patients." All Hands on Deck In the operating room, the centerpiece of Westchester Medical Center's liver transplant program is a procedure known as cavaplasty. Dr. Wu, who developed the procedure in 1994, was involved in the liver transplant advances that made the technique possible. "In 1987, I joined Dr. Thomas Starzl, who performed the first successful liver transplant surgery, at the University of Pittsburgh," Dr. Wu says. "We were work- ing on how to shorten transplant times and reduce the need for blood transfusions. Dr. Starzl developed a procedure known as the piggyback technique, which is still in use today." The piggyback technique was designed to limit hypotension and the bleeding common during traditional liver transplan- tation. By maintaining the retrohepatic vena cava, the procedure overcame some of these shortcomings. However, the piggyback technique can lead to complications, Dr. Wu says, because there is potential for outflow blockage if the hepatic vein is too small. COV ER FE AT UR E Dr. Veillette inspects the donor liver for suitability for transplant. Surgeons remove the diseased liver. GREGORY ROBERT VEILLETTE, MD LIKE YOUMIN WU, MD, and Thomas Diflo, MD, Dr. Veillette, transplant and hepatobiliary surgeon at Westchester Medical Center and Assistant Professor of Surgery at New York Medical College, is a multi-organ transplant surgeon who brings a host of strengths to the team. After obtaining his medical degree from the University of Connecticut School of Medicine, Dr. Veillette was a resident at Massachusetts General Hospital and subsequently completed a fellowship in transplant surgery at the University of California, San Francisco. "I am a well-trained general surgeon, having spent seven years as a resident at Massachusetts General Hospital," Dr. Veillette says. "After completing my surgical training, I pursued a multi-organ transplant fellowship at the University of California, San Francisco, where I became interested in liver transplantation, especially live donor transplant. I enjoy learning and teaching, and I look forward to continuing my professional development under the mentorship of Dr. Wu." 8 | Mid Hudson MD NEWS ■ M D N E W S . CO M