When doctors diagnosed 30-year-old Candace Ward with liver cancer in February 1999, the college student and her family fell into a state of shock. Surgery ensued, and all was well.
Nine months later, though, the state of shock struck deeper when she heard the cancer had returned. Surgery came and went again, but the cancer still thrived.
University physicians then offered her a choice: Take a risky procedure now or wait a year for a safer option that might never come.
Ward’s decision resulted in Minnesota’s first adult-to-adult liver transplant on March 28 at Fairview-University Medical Center.
The fairly new technique — only 200 such transplants have been performed nationwide — involved taking a portion of a living donor’s liver to replace a recipient’s cancerous one.
Presented with the living-donor possibility, six of Ward’s family members arrived at the University to volunteer. Ward’s sister, Lori McEvoy, provided the best match for a transplant.
“This was her only hope,” McEvoy said.
However, because Ward’s condition remained stable, she was at the bottom of an organ waiting list that ranked critically ill patients as a top priority.
By the time she would reach the top of the list, doctors told the family that Ward’s cancer could spread too far for a transplant to cure.
The decision then became a simple one, McEvoy said.
University surgeon Abhi Humar and other physicians spent nine hours extracting 60 percent of McEvoy’s liver and another 11 hours transplanting it into her sister.
A healthy human body only needs 40 percent of a liver to survive, so doctors take the spare 60 percent to perform the operation.
The excess 20 percent for the recipient is needed because some liver tissue is lost in the transfer.
Liver transplants are not new. The world’s first came in 1967, but it took more than 20 years before living donors could be used instead of cadavers. Even then, the living-donor process only worked with children.
Children require only 25 percent of the liver, so the surgery poses much less of a risk, Humar said.
In some ways, the new technique is better, although little data exists on the long-term results of the adult-to-adult living-donor transplants. So far, survival rates for cadaver transplants range between 85 and 90 percent, while living-donor rates hover at 80 to 85 percent.
The most significant advantage is the reduction in waiting time.
If Ward had elected to wait for a cadaver liver, a year might have passed before a liver could be available.
According to the United Network for Organ Sharing, more than 14,000 people fill the nation’s waiting list.
Humar said while the procedure could eventually make a dent in the waiting times of needy patients, the number of cadaver organs used needs to increase.
“We need to increase the awareness of the public toward transplants, so that when family members pass away, their willingness to donate their organs is higher,” he said.
While waiting-time reduction is beneficial to recipients, the adult-to-adult procedure provides doctors with another patient to care for and more possibilities for complications in people who would not otherwise require surgery.
Doctors also prefer to provide recipients with a whole cadaver liver instead of a 60-percent liver transplanted with the procedure.
“We wish we didn’t have to use this option,” Humar said. “We wish that there were enough organs for everyone, but because there aren’t, I think it’s a viable option for (certain patients).”