Living Donor Screening – Day 2
So, as I mentioned in Saturday’s post, Jim didn’t go with me for my second day long liver screening marathon at Columbia. Emily was sick with a bad cold so he stayed home with her and my friend Kathy was my care partner for the day.
We got to the hospital where I checked in fifteen minutes early for my first appointment which was with Dr. Ben Samstein, the liver surgeon. He was incredibly intense and pretty amazing. He reiterated a lot of what I had already been told about the procedure including the various complication risks and could not state enough that safety was his top priority for the donor. There have been no living donor deaths at Columbia – ever. This of course made me worry about why he felt he had to say that out loud. I mean, are living donor deaths that common? Don’t Google it – I went down that road and now regret it.
Dr. Samstein looked at Ana’s CT scan and confirmed that he felt a partial transplant would work for her even though her case is very complex due to the involvement of the portal vein. So this was my key takeaway from this meeting – Dr. Samstein felt that a partial liver transplant would be successful because Ana’s portal vein can be reconstructed. If he did not feel this was possible, he would not approve a living donor transplant (a full liver from a cadaver donor would then be Ana’s only option).
Dr. Samstein also reviewed my preliminary blood test results and so far everything looks good. All my tests are normal – even my cholesterol which is a shock considering all the crap I’ve been eating. My clotting factors are normal, I’m not anemic and my blood type has been confirmed as A+ which is a match for Ana’s. They’re still waiting on some additional blood test results having to do with various clotting factors in my blood which they will get next week.
Next, I met with Dr. Eva Sotil – my hepatologist. She was very good at steering the conversation away from Ana and back to me, no matter how much I tried to ask questions about Ana. She explained the anatomy of the portal vein for me because I was not clear on how Ana’s portal vein could be rebuilt. So, essentially, the portal vein looks like a tree that splits into two separate trunks – there is one long trunk and it splits off into two channels, one of which enters the liver from the right lobe, and one from the left. Whatever lobe of my liver that Ana ends up with will have some healthy portal vein within it (from me).
The main trunk of Ana’s portal vein is clogged with tumor and will have to be removed, although Dr. Samstein (as well as other surgeons) felt there may be enough healthy vein to use for the transplant (this begs the question: Is the tumor more likely to come back with a partial transplant because we’re leaving some of her vein in there?”). The tumor extends into both branches of portal vein that enter her liver, although it is way more extensive on the left lobe of her liver. Any additional vein needed will be taken from Ana’s neck and possibly my leg. This is the vein that will be attached to the main trunk of the portal vein and possibly within the transplanted section of liver. Ana won’t need as much vein as someone with a whole liver (I think) because she won’t have two full lobes. The partial transplant is more complex because of all this splicing and dicing of veins, and the need to surgically reconstruct the vein makes it more prone to thrombosis (blockage) due to subsequent scarring. Still, it’s a viable option for Ana.
I am totally going to ask Dr. Kato review this post to see if I’m explaining this right. Here is an illustration of the portal vein system within the liver.
So the portal vein delivers 75% of the blood supply to the liver (this blood is nutrient-rich blood from the intestines). The remaining blood is supplied by the hepatic artery which comes from the heart. According to Ana’s scans, the hepatic artery is clear of tumor.
At this point I learned that one of the things that my prevent me from being cleared as a donor is the anatomy of my liver. Sometimes livers don’t divide into two neat lobes (60% right/40% left) – but the right lobe ends up being disproportionately large. If this is the case, the liver can’t be successfully resected for transplant because the smaller lobe would be too small for the recipient (or the donor). The MRI is the major determining factor in figuring this out and also mapping the vasculature of my liver (it should uncover any anomalies that would preclude me from being a donor).
My key takeaways from the meeting with Dr. Sotil are that I will be extremely fatigued after the surgery for at least a month due to the time it takes for my liver to regenerate, her crash course in liver anatomy and also her explanation of how the liver will regenerate in both my body and in Ana’s. Basically, whatever lobe we end up with will enlarge to about 85% of the size of a normal liver, but it won’t be like I will regrow the lobe I lose. I’ll have an extra large right lobe and Ana will have an extra large left lobe (or vice versa). Kind of like a friendship necklace when it’s split in half (Ana was horrified with this analogy).
After Dr. Sotil, Kathy and I went to a different building (which was connected to the main Presbyterian building by a glass walkway) and I met with and was examined by an independent physician who was a general practitioner. I guess this was just to assess my general health and well being. He advised me to get a mammogram and pap smear (both tests are overdue) but did not feel that there would be any problem with these tests as my overall health is good.
I then got my EKG and chest x-ray. These tests took all of 2 minutes each.
My final test was the MRI. We were about 90 minutes early to this test (it was in the same building as the EKG and chest x-ray), so Kathy and I endured this long wait in a FREEZING cold waiting room until I eventually went in at 4 p.m. I got an I.V. so they could give me contrast and was actually sliding into the coffin-esque interior of the MRI machine at about 4:45. By then I was starving, so that distracted me from the weirdness of the test. It took all my willpower not to scream, “Major Tom to Earth!” at one point when the machine went silent for 5 minutes.
Now it’s just a waiting game to see if I’m approved. The final decision will be made at a conference next Tuesday, but I’m hoping to get some sort of preliminary yes or no sooner than that. I will, of course, post the results here as soon as I know them.