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Surfing the MASH Tsunami continues its 2023 wrap-up conversations with Global Liver Institute Founder and CEO Donna Cryer, along with co-hosts Louise Campbell and Roger Green. The conversation focuses on Donna's personal health challenges in late 2023, what her absence revealed about the strength and depth of the GLI team, and what she foresees as major challenges for 2024. 

The conversation starts with Donna discussing a major medical event in her life during the last few months in 2024, one during which, in her words, "I almost died." She speaks briefly but clearly about the nature of the event itself, as well as how and why she is rebounding to full strength. Donna goes on to describe how well the GLI team performed in her absence and the various forms of feedback she received confirming this. In response to a question from Louise, she notes that building a strong team has always been her priority at GLI and cites several past examples where the team has led while she assumed other roles and challenges. 

From here, Donna notes a major change in 2023: the evolution from being a liver community to what she describes as "a community that cares about the liver," a multi-specialty, multi-stakeholder group focused on the wider implications of liver disease and patient and public health. As examples of this broader community, she cites the common guidelines from AACE and AASLD, conversations with payers and a willingness from other liver disease groups to share capabilities with the SLD community. She goes on to note that none of this change happens quickly, but that in the 10 years since GLI was formed, the scale of change has been consequential.

The discussion turns toward the process of nomenclature change. Donna notes her concern throughout the process that some important implementation steps were not being considered on as timely or thorough a basis as she would have hoped. Specifically, she cites the issue of ICD codes and the need to involve primary care providers and organizations into the key processes. Louise Campbell agrees, noting the challenges around bringing wider use of VCTE into the UK system even after NICE has accepted the need to do so. 

Donna notes that this is the reason that GLI is calling its annual event Global Fatty Liver Day, not to be "recalcitrant, but because, as a global organization, we recognize" that not all parts of the world have adopted this nomenclature. She anticipates using what she calls "bridging documents" so that people using different nomenclatues can explain the same processes. 

From here, the conversation transitions to cover the growing momentum and energy in the patient and advocate communities, as evidenced by general energy and Roger's experience (along with Mike Betel) of getting pushed out of overflow rooms for patient sessions at AASLD (listen to E50.2 for more details). Finally, the conversation returns to the value of the MetALD classification, some issues around Donna's recent health scare, and a promising view of the future.