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I'm Not Sure That It's Right To View This As Excluding A Particular Group. When The Institution Of Marriage Developed Historically, People Didn't Get Around And Say, 'let's Have This Institution, But Let's Keep Out Homosexuals.' The Institution Developed To Serve Purposes That, By Their Nature, Didn't Include Homosexual Couples.

-John Roberts

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I'm Not Sure That

John Roberts

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I'm Not Sure That It's Right To View This As Excluding A Particular Group. When The Institution Of Marriage Developed Historically, People Didn't Get Around And Say, 'let's Have This Institution, But Let's Keep Out Homosexuals.' The Institution Developed To Serve Purposes That, By Their Nature, Didn't Include Homosexual Couples.

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I Find That When I Tell Lawyer Jokes To A Mixed Audience, The Lawyers Don't Think They're Funny And The Non-lawyers Don't Think They're Jokes.

We Are Always In Awe Of What The Donors Have Done In Terms Of Providing Of Themselves To The Recipients. It Really Is A Heroic Act Because People Take On Themselves Not Only A Risk Of Death But Also Pain-and-suffering In Order For Their Loved One To Get The Benefit Of The Liver Transplant.

When We Think About Living Donor Transplant, What We're Banking On Is The Ability Of The Liver To Regenerate Itself. Now, It's Not The Same Sort Of Regeneration We Think About With The Starfish Where We Cut Off The Arm And It Grows A New Arm. With The Liver, What Happens Is The Remaining Liver Gets Bigger, And Your Body Knows The Size Of The Liver That It Needs, And When It Recognizes That There Is Not Enough Liver, It Sends Nutrients And Signals To The Liver And Says "get Bigger."

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When A Liver Becomes Cirrhotic, Those Are The Common Complications. We See That The Patients Have Bleeding From Their Stomach And Intestines. They Have Abdomens That Become Full Of Fluid. Their Ankles Swell With The Same Type Of Fluid, And They Also Can Become Confused And Not Themselves. Those Are Kind Of The Main Things That We See When People Get End-stage Liver Disease And Have Cirrhosis.

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I'm Not Sure That It's Right To View This As Excluding A Particular Group. When The Institution Of Marriage Developed Historically, People Didn't Get Around And Say, 'let's Have This Institution, But Let's Keep Out Homosexuals.' The Institution Developed To Serve Purposes That, By Their Nature, Didn't Include Homosexual Couples.

There Is A Risk Of Death Associated With Donating A Piece Of Liver. It's About One In 500 For The Risk Of Death. The Risk Of Death Of Donating A Kidney Is About One In 3000, So This Is A Riskier Operation Than Donating A Kidney. The Stakes Are Usually Higher For The Recipient Of The Transplant Because Unlike Kidney Failure, Where You Have A Dialysis Machine, In Liver Failure We Don't Have That Kind Of Machine That Allows A Patient To Survive Until They Can Get A Cadaver Organ.

End-stage Liver Disease Refers To A Liver That's Failing, And A Very High Percentage Of Those Livers Are What We Call Cirrhotic, Or The Patient's Liver Has Become Cirrhotic, And What Cirrhosis Is, Is The Scarring Of The Liver Tissue.

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There Are Many Different Causes Of The Scarring. Viruses Are Common. Hepatitis B, Hepatitis C, What We Call Autoimmune Diseases Where The Body Attacks The Liver Itself Such As Primary Biliary Cirrhosis Is An Autoimmune Disease; Sclerosing Cholangitis Is An Autoimmune Disease; And So Those Diseases Where The Liver Is Being Destroyed By Either The Virus Or An Autoimmune Disease, It Can Only Scar, And Why It Doesn't Regenerate Has To Do With The Fact That There Is This Ongoing Scar Tissue That Blocks That Regeneration.

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Pretty Much Everybody Knows There Are Not Enough Organs For All Of Those Patients Who Need To Get Transplants, And What Happens Is, Is That Organs Are Actually Directed In Liver Transplantation To Those Patients Who Are The Sickest. So The Patients Who Have The Greatest Chance Of Dying In The Next Three Months Or So Are The Ones Who Get The Priority For The Liver Transplant.

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If We Had Enough Cadaver Organs To Go Around We Wouldn't Do Living Donor Liver Transplants Because One Is We Don't Want To Put A Donor At Risk, But The Second Is That It's A More Difficult Surgery For The Recipient Because You're Getting A Piece Of A Liver Rather Than A Whole Liver. It Takes You Longer To Recover, And It Has More Complications Related To Where We Sew Together The Blood Vessels And The Bile Ducts.

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