With one liver, two lives are saved
Liver transplant patient Pamela Lawson, of Salina, talks with doctors Timothy M. Schmitt, far left, and Sean C. Kumer, September 25, 2012, at the University of Kansas Hospital. Lawson was one of the two recipients of a split-liver transplant. (Keith Myers/Kansas City Star/MCT) Purchase photo reprints »
Pamela Lawson had been on the list for a liver transplant since July, waiting for doctors at the University of Kansas Hospital to call.
At 1 a.m. Sept. 22, the phone rang. The hospital had a liver, but there was a catch: It was too large to fit into Lawson’s 5-foot-4-inch, 129-pound body.
So her doctors had decided they would try an operation they said was a first for the Kansas City region. They would cut the liver in two, putting one lobe in Lawson and the other in another small woman needing a healthy liver.
“It’s hard to turn down a perfect organ when you can modify it,” said Timothy Schmitt, one of the two doctors who performed the dual surgery. “Transplant surgery is sometimes like MacGyver surgery; you make it work.”
At any given time, 16,000 to 17,000 people across the country are waiting for a liver, and only about 6,000 are donated each year. The University of Kansas has 140 people waiting for liver transplants.
“Nationally, 10 to 12 percent of people needing a transplant die waiting for a liver,” said Sean Kumer, the other doctor who with Schmitt performed the surgeries.
The procedures took six hours — fast for even one liver transplant. Usually, Schmitt said, a single liver transplant can take up to eight hours.
But these doctors have a lot of experience. Just before the Lawson surgery, they completed six liver transplants in five days.
Patient two in the Lawson transplant didn’t want to be identified. She only wanted it known that she’s 60 years old, from Kansas, and doing well.
Lawson had hoped but hadn’t really expected to get a liver. She quickly agreed one lobe would work for her.
“I couldn’t turn it down. I may never get another chance,” Lawson said Tuesday from her hospital bed. “I’ve had my suitcase packed for months.”
She confessed, though, that she’d said more than once to her husband, Roger, that a 64-year-old great-grandmother didn’t stand much of a chance of getting the donor call with so many people, some of them children, waiting for transplants. “I feel very, very lucky.”
Splitting a liver when an adult organ becomes available and a child needs one is not uncommon. Transplant centers across the country have been doing that procedure for years, said Joel Newman, a spokesman for the United Network for Organ Sharing, a national allocation system that manages the donor-recipient connection. Many centers also do split-liver transplants from one adult to two adults fairly regularly. Last year, more than 200 split-liver transplants were done across the country.
“It is a means, even if it is not increasing the donor supply, of reducing the wait for a transplant,” Newman said. “Multiple transplants can be done, so it’s a way of getting the most possible transplants out of the existing donor supply.”
Newman said it is not uncommon for a person to wait as long as two years for a transplant. The sickest patients go to the top of the list.
During the two-hour drive to the hospital that morning from her home in Salina, Kan., Lawson got nervous.
“Let’s just turn around and go home,” she told her husband.
“We were both just sick with nerves,” Roger Lawson said. “I told her, ‘No way. You got me up at 1 a.m. We are going.’”
His wife had been sick with liver cancer since December 2011. The cancer was a result of Hepatitis C, which Lawson had lived with for decades. She thinks she contracted the viral disease from a blood transfusion after a car wreck when she was 18. It attacked her system in early 2000. By the time she got on the transplant list, “my liver was shot,” Lawson said. “There wasn’t much of it left.”
When her name and the name of the second transplant recipient popped up on the list, Kumer and Schmitt knew right away the liver they had was much too large to fit whole in either woman.
“We had gotten a high-quality liver,” Kumer said. “That lends well to being split.”
The donor was a young man “probably weighing twice as much as either of the women and maybe about a foot taller,” Schmitt said.
Scalpel in hand, Schmitt cut the triangle-shaped liver in two. He was careful to be sure each woman would get enough of the organ — a person needs a liver 1.8 percent of their body weight — and that each lobe had good vessels for blood flow in and out, as well as bile drainage.
Schmitt said the risks associated with split-liver surgery are for the most part the same as any other liver transplant surgery.
“Both patients should do just fine as long as they take care of their organ - taking their medicines and doing their labs. The organ will take care of them.”
Live transplants next
Last year, the University of Kansas Hospital did 91 liver transplants and more than 100 kidney transplants. It also transplants pancreases.
“The next thing for us is a living donor transplant,” in which surgeons remove the small lobe of someone’s liver to give to a child, Schmitt said.
Lawson, an avid country western dancer with 10 grandchildren and four great-grandchildren, is looking forward to getting back to the dance club where she and Roger are members. The last time she went, about two years ago, she was in so much pain she could only sit and watch.
For now, Lawson said she’s excited to get home and play with her new puppy. And, she said, “I’ve got lots of grandchildren who want their grandma.”