by Amanda GallagherA team of surgeons hovered over a body, meticulously separating blood vessels and tying bile ducts. They removed a large portion of a liver, wheeled it into the next room, and gave it to Raymond Barnes. The transplant would end over a decade of health problems.
Meanwhile, doctors in the first operating room tended to the donor. But this patient wasnít headed to the morgue - she was still very much alive.
In an incredible, but increasingly popular, procedure, Kristin Barnes donated 64 percent of her liver to her father. But unlike traditional organ donation, Barnes was healthy and expected to survive.
She is one of hundreds of people who have participated in living-related organ donation - a process thatís shortening the endless organ waiting list and saving scores of lives.
Kristin Barnes grew up in an ordinary household. She was the middle of three daughters and had a great relationship with her dad. "I was sort of the honorary boy," Barnes said. "I was always the one who went fishing with him. I helped him fix things around the house."
But she never thought sheíd save his life. Her father, Raymond Barnes, developed liver disease almost 40 years ago. "I acquired it through the use of a chemical, but no one is sure which one," Raymond said. "I did nuclear weapons maintenance in the army. We used a lot of cleaning solvents from different chemicals. Quite a few of us had this problem."
From 1965 to 1989, Barnes led a fairly normal life. "I knew I had a bad liver so I didnít smoke or drink," he said. But he wasnít really sick either. There were a few unusual incidents - Kristin couldnít use nail polish remover in the house because the smell of the acetone made Raymond sick. But it wasnít until 1989 when he really started to feel bad.
For the next 10 years he battled the complications of liver disease. Last May, doctors put him in intensive care.
"We had a big family meeting. We all got together to decide what to do," Kristin said. "The living donation was my idea. I had researched it and read about it on the Internet. There was no question in my mind that I was going to do it."
Living-related liver transplantation is a fairly new practice. The Health Science Center began its program in 2000 and is one of only 20 institutions in the United States performing the procedure.
"There are significant advantages and disadvantages to a living-related donation," said Glenn Halff, M.D., professor and interim chair of surgery and director of the Health Science Center/University Health System transplantation program. "The waiting list for organs continues to grow relative to the number of cadaver organs available. Many patients die while waiting on the list and most have a poor quality of life. Now we have the advantage of performing a transplant before a patient becomes so desperately ill that the chances of success are low and quality of life is diminished."
Currently about 17,000 people are waiting for a new liver in the United States. Only 4,000 livers become available each year.
Raymond Barnesí name went on the list in 1999. But when Kristin saw her fatherís health take a turn for the worse, she knew it was time to help.
"I didnít want her to do it," Raymond said. "I didnít want her to risk her life."
The procedure does carry a 1 percent to 2 percent risk of death for the donor. Both patients risk infection and there was no guarantee that Raymondís body would accept the donated liver.
Still, the odds of success were overwhelming. The liver has the unique ability to regenerate itself. Doctors predicted Kristinís liver would grow back to its normal size within three months after the procedure and she would resume an active, healthy life. Raymondís new liver also would function normally.
"I really had to twist his arm," Kristin said. "He knew I had to pass a lot of medical tests to see if I was a viable donor. I told him, ĎIf I pass the tests, itís meant to be.í"
Discarding her lifelong fear of needles and the sight of blood, Kristin approached Dr. Halff about the program. "We donít usually pursue this unless the patient approaches us because we donít want to pressure people," Dr. Halff said. "Once the donor expresses interest, he or she must complete a very thorough screening process. We have to compare the blood type and make sure the liver is functioning normally. We also want to make sure the patient is properly motivated."
To do that, Dr. Halff refers patients to a "donor advocate" - a liver specialist who is not on the surgical team. "He performed a lot of tests, an EKG, a stress test, a psychological evaluation," Kristin said. "And he told me if I wanted to change my mind he would come up with a medical excuse." But she had made her decision.
On the night of Aug. 28, Kristin and her father found themselves in University Hospital, with only a few hours before their lives, and their livers, would permanently converge.
"I was kind of scared. I couldnít sleep the night before the surgery. Iíd wake up and wonder if my father was sleeping down the hall," Kristin said.
But by 7:30 the next morning, she was ready. In a five-hour procedure, doctors carefully removed the right lobe of Kristinís liver - about 64 percent of it. Once they were sure Kristin would pull through, a second team removed Raymondís diseased liver, and replaced it with Kristinís right lobe.
Both Raymond and Kristin spent the next seven days in the hospital. "I felt like a little old lady. I was walking slowly and hunched over. It was hard to bend," Kristin said. "I was sore, but Iím really glad I did it. Itís something anyone can get through."
Both the Barneses said fatigue was the most difficult part of the recovery. Raymond also had to go back for a second procedure to cure an infected bile duct. "It was one of the complications they warned me about," he said. "Actually, the president of the Health Science Center, Francisco Cigarroa, M.D., did the surgery. He was great. It was on a Sunday afternoon. And he even came back to check on me about three or four times."
Now - more than three months after their ordeal, the Barneses are doing just fine - which is exactly what Dr. Halff expected. "So far, weíve had a 100 percent success rate," he said.
Dr. Halff predicts about 10 percent to 20 percent of all liver donations eventually will be living-related. More insurance companies are funding the procedure, including TRICARE, which covered the Barnesesí surgery. "We estimate it is less expensive than allowing a patient to become ill and spend more time in the hospital," Dr. Halff said, "and we are still developing treatments for ordinary disease so people donít end up with a cirrhotic liver."
Until that happens, Dr. Halff will continue to perform this truly amazing procedure - one he said he never dreamed possible when he was in medical school. But it seems anything is possible when modern science meets the modern minds and healing hands of Health Science Center physicians.
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