Reply to 'Episode "Wilson" discussion'

[eucleia]

Reply to the Episode "Wilson" discussion at house_wilson, which ran way over the LJ reply character-limit. Possible spoilers ahead.

1) Will Wilson's friend live through the episode? Will he die even with Wilson's donation surgery? If he dies, what do you think Wilson will do?

One of the questions I have been asking myself these past few days.

Scientifically, even with immunosuppressive medication, there is a chance of graft rejection which may be caused a myriad of different factors (even if Wilson is type O, the universal donor), and can also happen at any time (perhaps immediately or years down the line). There are three main ones, but I don't think it would be sensible to go diving into them when we aren't even sure such a thing would happen. Also, the liver is a very special and curious organ. (^^) Liver transplantation is unique in that the risk of chronic rejection decreases over time, although recipients need to take immunosuppressive medication for the rest of their lives.

I have decided it is not possible to tell the conclusion to part 1 with the current information, so I'm going to simply wait until I watch the episode and be pleasantly (or not so pleasantly) surprised. Doesn't mean we can't hypothesize like good little scientists while we're waiting though. :D

2) According to the description of the global promo, is the transplant really that risky or is House worrying too much because it's Wilson? Will we get some sick!Wilson?

[Please note:
- I am making several hypotheses here.
- Also, I am no doctor, but I did do Biology to Advanced Level and my father passed away due to liver cancer, so there has been a fair amount of reading done on the subject.
- Another thing. If it's NOT liver transplant, the whole of parts 2 and 3 of this reply are VOID. xD]

Since Wilson's friend looks jaundiced in the promo, and kidney failure can be supplanted by dialysis, I hypothesize it is liver donation. Living donor liver transplantation (LDLT) is considered to be even more technically demanding than cadaveric donor liver transplantation. LDLT over here in the UK is practically nonexistent, though doctors are campaigning for a change.

Mortality rate, whilst lowish considering modern day amenities (~0.5-1%), is still significantly higher than that of say, kidney donation (~0.03%). That being said, those were global averages, and considering by country gives an estimation of LDLT mortality being reported at 0% (Japan), 0.3% (USA) and <1% (Europe), with risks likely to improve further as surgeons gain more experience in this procedure. Postoperative donor complications in Japan were reported to be 12% in one study. Lancet. 2003 Aug 30;362(9385):674-5. Very occasionally, a second operation is needed.

While the heart drives the body and the brain is the conductor for the whole orchestra that is the human body, the liver is basically the powerhouse for the entire system. Most of the body's major chemical reactions take place in the liver, and the surplus heat generated by such reactions are used to heat your body via both radiative (rest your hand over your abdomen; you'll find the skin there intrinsically hotter than that over anywhere else on the surface of your body) and circulatory means.

Several MAJOR arteries run through and around the liver - most notably the almighty hepatic portal vein (which provides ~75% of the liver's blood supply), and the hepatic arteries. Nick one of those accidentally and there's going to be problems.

3) Are there renewed hopes of seeing House "nurse Wilson back to health" with these spoilers? Will House have to help Wilson once again? Do we dare hope for some hugging or hand holding?

The liver is the only internal human organ capable of natural regeneration of lost tissue; as little as 25% of a liver can regenerate into a whole liver (which, might I add in a personal opinion, is PRETTY FUCKING EPIC 8DD). A human liver is known to grow back in no less than 8 years. However recent studies seem to suggest regeneration may occur faster than originally thought:

"Expressed as a percentage of the original volume, the mean liver volume 6 months after hepatectomy was 90.70% ± 12.47% in this series. For right graft donors, mean liver volume after 6 months was 89.68% ± 12.37% of the original liver volume, whereas that for left graft donors was 91.99% ± 12.6%. Only 26 of the 109 (23.85%) donors were able to achieve full regeneration 6 months post-donation." Liver Regeneration and Splenic Enlargement in Donors after Living-Donor Liver Transplantation (You can download the full pdf on the page if you are interested.)

More recently, adult-to-adult liver transplantation has been done using the donor's right hepatic lobe which amounts to 60% of the liver. Due to the ability of the liver to regenerate, both the donor and recipient end up with normal liver function if all goes well. This procedure is more controversial as it entails performing a much larger operation on the donor, and indeed there have been at least 2 donor deaths out of the first several hundred cases. A recent publication has addressed the problem of donor mortality, and at least 14 cases have been found. (Howard J. Worman. The Liver Disorders Sourcebook, McGraw-Hill, 1999) The risk of postoperative complications (and death) is far greater in right sided hepatectomy than left sided operations.

In conclusion, hopefully this recovery time will provide ample opportunity to show some affection/feelings. ;) I know I'm game to see some!

4) Will there be repercussions to this episode that will continue on in episode 11 (which apparently will have lots of House/Wilson)?

Probably. Both mental and physical, I can only assume (the latter of which I addressed above).

5) Happy that there will be a bit of Huddy storyline on this episode Y / N?

N = No, not "happy". But only because in my highly biased opinion, I think that "Huddy" storyline has no place in such an episode. And also because I sullenly predict that there will be little House/Wilson in the "Cuddy-centric" episode.

6) Will this be one of the best episodes of the season or of THE WHOLE WORLD Y / Y? =D

Gosh, I certainly hope so. :D :D :D

Comments

[idonmatrix.livejournal.com]

I love analysis but this has to be one of the best I've seen particularly because you provide a great deal of information on liver transplants and the stats for right or left liver donors. I was also surprised to read that livers are regenerative. That's amazing.

In which of the promos did you notice evidence that Tucker was jaundiced?

Sadly, I think Tucker is going to die because I desperately want him to live. Because you know it's all about me :))) If Tucker lived, I could imagine lots of jealous!House scenes and besides I love, love, love Josh Malina. But I loved Amber and look what happened to her. Maybe we'll get ghost!Tucker telling Wilson to give House a chance and let House love him. But yes, I think Tucker will die.

Also, I think there will be complications for Wilson as the donor. I imagine Wilson will want to do the 60% liver transplant to give his friend the best chance of surviving. I also think House is going to be enraged at the friend because of his fear of losing Wilson. I also think he will be mad at Wilson - AT FIRST - for being willing to risk his life - knowing that he is the only person Houseloves and has. Yep I said it. There's no way in hell I believe House is in love with or loves Cuddy - NO WAY. Doesn't make sense or follow from the story they've been telling since the PILOT EPISODE.

In terms of House/Wilson touching, I'm thinking there will be some touching at the end of Wilson. But I think most of the touching will be in episode 11, the one that airs January 10 or 11. I think the touching in 10 will be about House's fear of losing Wilson. When Tucker dies, I think Wilson will withdraw emotionally which will devastate House. In episode 11, I think it will be about two people who love each other and demonstrate this love through physical intimacy. I'm almost certain we'll see House climb into Wilson's bed and probably hold him and YES kiss him probably starting on his forehead and with Wilson's encouragement eventually on the lips. I think it will be more about love, comfort, and intimacy rather than lust and sex. I think it is possible to be physically intimate sans the lust. We could also see House bathing Wilson or feeding him. But bottom line, what prompts House to get physical with Wilson is his attempt to draw Wilson out of his shell - to bring him back from the emotionally dead so to speak.

I hate Cuddy, Huddy, Luddy and the baby momma drama. But I understand why they are doing it. The TPTB are basically doing HOUSE/WILSON under cover of Huddy. I think episode 14 is a Cuddy centric episode. I don't oplan to watch UNTIL I hear on this LJ that there is a fantastic Wilson or House/Wilson scene I shouldn't miss. Last week, Ausiello reported that Cuddy who is still bedding Lucas will do the bump&grind with an additional person. My assuption is that it's House unless of course Cuddy goes all 13 on us. I hated the Huddy kiss. It grossed me out - BIG TIME!!. The Huddy dance - didn't see it - Tivo's past it. Well I've been doing that pretty much anytime she's onscreen - except with Wilson. I can't TiVo past anything with Wilson in it. Just can't.

Back to House/Wilson. I think their physical intimacy which probably take place mostly in ep 11 will be romantic and gentle and sweet and magical and just lovely. The HEAT, HOTNESS, SEXY, AWESOMENESS WILL COME FROM THAT POWERFUL CHEMISTRY BETWEEN THE TWO ACTORS. I swear I could watch HL and RSL sitting in a room doing nothing. They are just that awesome together.

[daymarket.livejournal.com]

The patient looks yellowy in the US promo. :)

[daymarket.livejournal.com]

Thanks so much for the medical info! I'm wondering, though: how close genetically does a donor have to be in order to successfully donate a liver (or any other organ, really)? I know next to nothing about organ donation; what I do know can be summarized as thus:

1) O's universal donor, AB's universal acceptor.

2) Bone marrow donation is really, really complicated.

And that's about it. I'm assuming that in order to donate an organ, more than blood types need to match, but is it as complicated as bone marrow? Thanks for any reply!

[taiga13.livejournal.com]

I did know that livers grow back, and I agree it is pretty fucking epic, but didn't know that livers heat the body.
I remember reading this story once where a baby and a young boy received liver donations from the same adult cadaver, they cut it in two and gave one half to each child. Now they're liver twins. It's done here (Canada), and living kidney transplants too. Actually there was a campaign to encourage people to donate these organs. I don't know. My liver would grow back, but I'm not a nice enough person to give a kidney to a stranger.
I'm wondering if we'll see a scene with House confronting Tucker about this surgery. Maybe not, if the whole thing is from Wilson's POV.
I have no idea if Tucker will die or not. It's possible that this surgery, even if successful, will just extend his life by a few years because he has cancer or something else.
Maybe this epic event is what prompts Wilson to move out of Amber's apartment.

[midgar-skyline.livejournal.com]

Mmm... The human body is quite an amazing piece of work.

The first (American) promo was when first noticed jaundice, I believe. In the scene right after Wilson says, and I quote, "You've only got about 24 hours left." Tucker looks incredibly yellow, so I assumed jaundice and thus liver failure.

My personal opinion is that House probably thinks he loves Cuddy, or that he "wants" to love her, because that is what he thinks he should do/be feeling. I hover back to season 5's finale, Both Sides Now, where House's own mind in the form of Amber chastises him with the words, "So this is the story you made up about yourself. It's a good one," before his mind conjures Kutner with the rather final words of, "Too bad it isn't true."

I'm also drawing on last week's Ignorance is Bliss. The POTW storyline where he was deliberately dumbing himself down since it was the only way from his point of view that he could sustain happiness, and because he wanted to want his wife. Frankly, on a very personal note, I was horrified that House approved of the patient continuing to destroy his intellect. It may be lonely at the top, but House has had Wilson beside him for near two decades. Seems like he's still taking Wilson for granted, but I have high hopes this will finally change after 6x10, if Wilson's very life is at risk.

I hope for all the House/Wilson touching possible. :D
I find it interesting that whilst I cringe in revulsion/embarrasment by proxy and bemoan in "not again"-ness at any House/Cuddy touching, and have thus come to fear it, I have negligible to no such fears of House/Wilson touching. While I admit I may be biased towards the "slash" so to speak, my feelings are that any touching on the part of House/Wilson would not be born out of lust, and may thus be why I am not adversed to anything physical hapening between them.

Reply continued below due to LJ-character limit.

[midgar-skyline.livejournal.com]

Please be aware that I am not judging you, or anyone else that may read this for that matter (I am also well aware this next statement of mine may seem contradictory to that, but it is meant to illustrate a different point rather than contempt), but I have a massive disdain for people who cannot control their own behaviour with their mind. I think that's why I scoff at people who can't control either their (depending on what mood I'm and and what the circumstances are surrounding the feelings) lust/love - my brain wants to believe that one can overcome hormone-based lust based on willpower. It is also why I scoff (not intentionally - I am trying to rectify this horrid behaviour) at those who gravitate towards one another on pure lust and no apparent logic, the latter of which I have become convinced does not exist at all with House/Cuddy (I refuse to even mention the contraction "Huddy" - sounds awful).

I see why the writers gave Cuddy the storyline of wanting a child of her own, but being unable to conceive because of her age, as it is a real and serious and growing problem for many women around the world whom originally passed on the opportunity of family to further careers (something which I actually admired Cuddy for during the first couple of seasons). Wanting a child of her own does not make her any less of a "strong" woman. However, I am personally convinced that we are have long since past that, and are now somehow into the idea that the traditional nuclear family is the only way for Cuddy to be happy, and the only way for House to be happy/fufilled while we're at it. Having a father in the family does not make a family functional, but Cuddy no longer seems satisfied with just a child; she wants the man she fancies (I refer to the UK term here, where "fancy" means "to have a crush on") as well, nevermind incompatible personalities and objectifying comments (which I am convinced she unconscously likes), and my respect for her has dwindled (along with her clothing) since mid-season 3 or so.

As for Tivo, I assume that is the American version of Sky+? We used to have Sky (not Sky+, the latter which allows you to record your favourite programmes), but they started to jack the price up by a good amount each year, and considering we had hundreds of channels which we did not watch, we ended up cancelling the package. Anyways, I have to watch House on the internet until the DVDs come out, so there's unfortunately no fast-forwarding. Even if there was, however, my morbid curiosity would eventually win out, and it would likely be a case of "Huddy" curiosity kill the Phoenix cat.

And I completely agree that the characters of House and Wilson have remarkable chemistry. <3 They should so get together, fly off to Canada and marry already.

[midgar-skyline.livejournal.com]

Hmm... I am not sure about the genetics about organ donation, if there are any, as I am not a doctor, but I assume that the genetics may not come into play all that much as organs are often donated by complete strangers. How close they have to be in blood type though, depends upon the blood type of the recipient.

Blood type is determined by the type of antigen found on the surface of one's red blood cells (the ones with the oxygen-carrying haemoglobin and no nucleus). Detection, and compatability, is based upon the antibodies formed on the present antigens. Take a look at the diagram below.



If we say a person has blood type A, it means the surface of their red blood cells have type A antigens on them. Thus, they will have antibodies against the other type of antigen, B, which would be unfamiliar and foreign to their body. So if you dumped a load of blood with red blood cells containing the B antigen (whether it be B or AB) into this blood type A person, then you are going to have a very big problem - their B antibodies are going to end up sounding the invasion siren and are going to end up attacking/impairing the transfused red blood cells which have B antigens on them. It leads to a whole Pandora's Box full of problems which I am not sure about, but are pretty lethal if left untreated.

The same goes in reverse for a person with blood type B receiving A type blood.

A person, however, with AB type blood and hence both A and B antigens on the surface of their red blood cells, will have neither A nor B antibodies in their system, and thus will be able to receive any blood type. It's why they call people with blood type AB "universal recipients" (House was AB if I recall correctly, unless Wilson was joking).

O is a different case. People with blood type O have no antigens on the surface of their red blood cells (they thus have both A and B type antibodies). Since their blood cells have no antigens, then a recipient with any blood type whatsoever is not going to have their antibodies thinking there's an intruder in the body, and will thus be able to receive said blood, hence why they're called "universal donors". Conversely though, it means that people with blood type O will only be able to receive blood type O, as being in possesion of both A and B antibodies means that if you dump any other blood type into the system, it's going to detect foreign bodies.

So I THINK organ donation falls under the same catagories when it comes to blood type (there's weight and other stuff as well but I don't know about that).
- A person with blood type A can receive A, AO, or O.
- A person with blood type B can receive A, BO, or O.
- A person with blood type AB can receive A, AO, B, BO or O.
- A person with blood type O can receive O.

I THINK I have it right. *facepalm* There's also whether someone is Rhesus +ve or -ve or not, which gives rise to the positive and negative variations of each blood group *headdesk* but that's a whole different story.

Bone marrow so far as I can tell has to do with antigens on the surface of blood cells as well, but they are lookin for additional antigens or markers. Certain proteins I think. Wait, yes it is. You can read here (http://www.cancerhelp.org.uk/about-cancer/cancer-questions/how-is-blood-matched-for-bone-marrow-transplant) if interested.

[idonmatrix.livejournal.com]

Great reply :) here's the part of your post I am responding to:
I hope for all the House/Wilson touching possible. :D
I find it interesting that whilst I cringe in revulsion/embarrasment by proxy and bemoan in "not again"-ness at any House/Cuddy touching, and have thus come to fear it, I have negligible to no such fears of House/Wilson touching. While I admit I may be biased towards the "slash" so to speak, my feelings are that any touching on the part of House/Wilson would not be born out of lust, and may thus be why I am not adversed to anything physical hapening between them.

I think the touching will be borne of love, affection, knowledge of what each needs emotionally and physically, and comfort. I too find the Huddy touching cringeworthy and just plain gross. Technically, the actors, directors are doing a good job but the Huddy physical scenes seem to lack something. I think it has to so with chemistry between the two actors - really it's just not there. Everyone knows that HL and RSL are very close friends and they enjoy working together. I think someone posted some candid shots of Epic Fail and there;s one where HL is chewing on a carrot and smiling at RSL. Of RSL looks like he's somewhere else. Now back to the characters.

I don't see House moving on Wilson in a sexual way. I really think it will be about drawing Wilson out, providing some physical comfort, and House showing Wilson how he really feels about him. It may be sexy, romatic and HOT, but I don't think sex will be the motive behind any H/W touching. I definitely think we'll see them in bed TOGETHER. We start out with them sharing a hotel room, Then House drugs and depants Wilson. Later, recall that Wilson accused House of not asking him what he wants or respecting his wishes. I think in any physical scene, we're going to see House doing both. Maybe Wilson ask House to sleep with him or House ask Wilson if he can join him. Whichever way it happens, it wil be about love and respect and comfort - NOT SEX AND LUST (which rarely if ever translate well onscreen)

[idonmatrix.livejournal.com]

I too was wondering if there'd be a confrontation between House and Tucker.

And I want to know why House would be worried about Wilson dying as a result of the donating a portion of his liver.

If Wilson is the one on death's bed as result of saving Tucker, will Tucker even offer to stick around to help Wilson?

[midgar-skyline.livejournal.com]

Typo:
"- A person with blood type B can receive B, BO, or O.
- A person with blood type AB can receive AB, A, AO, B, BO or O."

I copy-pasted from the sentence above it, and forgot to change one the letters. Whoops.

[daymarket.livejournal.com]

Holy crap, biology class! XD Thanks for the reply (and so sorry for this late comment! I haven't checked my mail for a while). Eeeek, the bone marrow stuff I did not know. Then again, my bio knowledge is about nil, so that's not surprising.

[midgar-skyline.livejournal.com]

Meep! Sorry! XD I tried to make the explanation as comprehensible as possible, as in, I tried to not use science-speak and just typed colloquially. And I didn't know about the bone marrow stuff either - someone had just mentioned offhand before that it was different surface proteins and I went, "Oh...", but secretly 'MEH. *files away for later reference in cobwebbed area of brain*' XD.

Ahh~ The wonders of Google.

[midgar-skyline.livejournal.com]

"Maybe this epic event is what prompts Wilson to move out of Amber's apartment."

Looks like you totally hit the nail on the head! XD *nerdy high-five*