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California and the West

Woman, Infant Given Transplants Using Same Liver

March 03, 1998|MARCIDA DODSON | TIMES STAFF WRITER

ORANGE — Ingrid Anderson needed a new liver, fast. But when a donor liver became available, Anderson's doctor had an unexpected request:

Would she give part of the organ to a baby who also needed a transplant?

"When I heard it was a baby, that was all I had to hear," said Anderson, who agreed immediately to the split liver procedure.

"I have three children. If I can survive on three-quarters of a liver and help a baby who needs a liver, there's no question."

On Monday, Anderson, 33, was checking out of UC Irvine Medical Center in Orange, 10 days after receiving the larger portion of a liver from a 19-year-old trauma victim in San Bernardino. The baby recipient, 7-month-old Eduardo Lemus of North Hollywood, is recovering well at UCLA Medical Center, said his mother, Cynthia Ramos.

Although this was not the first time UC Irvine and UCLA doctors had done the procedure, the split liver transplant is still a relatively new development that helps alleviate the critical shortage of donor organs, said Dr. David K. Imagawa, chief of UC Irvine's transplantation division.

"It's two for one, if you will," he said.

The concept of splitting a liver from a cadaver developed after doctors began transplanting parts of livers from living relatives into children several years ago, Imagawa said. Doctors found that both donors and recipients recovered well.

Because liver tissue is the same throughout the organ, a cadaver liver can be split for transplant into one small adult and one baby, he said.

Liver tissue regenerates, he said. Anderson's liver should be normal size in a few months, and the baby's liver will grow to normal size with him, he said.

The risks are minimal, Imagawa said. The chief concern is "the plumbing," he said, cutting the blood vessels into and out of the organs so that both pieces can be connected to the vessels in the recipients. But the donor liver must be perfect, or it compromises the success of both recipients, he said.

The liver received by Anderson and Eduardo was the 40th split and was transplanted as part of a three-hospital program composed of UC Irvine, UCLA and Cedars-Sinai Medical Center. Anderson was the 10th UC Irvine patient to receive a split liver; about 25 adults at UCLA and five at Cedars-Sinai have received the others. All 40 babies receiving the partial livers have been at UCLA.

Split liver transplants require three teams of doctors, Imagawa said: one for the donor and one for each of the two recipients.

Anderson was the first recipient at UC Irvine to receive one in an emergency.

Anderson, of Santa Ana, suffered from acute acetaminophen poisoning, the result of inadvertently taking too much aspirin-free pain reliever in too short a time period. She had been taking the medication, she said, because of chronic shoulder pain.

"It kind of goes with motherhood," she said from her hospital bed. "I didn't take time to take care of myself. It was easier to take some pills than to do what I needed to do, have it checked out."

Her husband, Jim, could not wake her up on the morning of Feb. 9. Paramedics rushed her to Coastal Communities Hospital in Santa Ana, and two days later she was transferred to UC Irvine Medical Center.

Imagawa said that 90% of acute acetaminophen poisoning cases are treated without a transplant. But Anderson was not responding to treatment and after a week, he placed her on the transplant list.

Most people waiting for a liver suffer from chronic disease and wait for months, but emergency cases go to the top of the list, he said. Without a transplant, Anderson had no more than three or four days to live, he said.

Within 48 hours, the transplant team learned of the liver in San Bernardino. Then Imagawa received a call from UCLA. Could Anderson's transplant be delayed several hours, long enough for UCLA to send someone to San Bernardino to bring back part of the liver for a baby? Imagawa said yes, then asked Anderson if she would agree.

"There was no doubt," Anderson said. "I feel blessed. I was able to get a new liver and able to help a young baby too."

Ramos, baby Eduardo's mother, said this was the second liver transplant for her son, who had biliary atresia, a congenital malformation of the bile ducts. The first liver came from another baby, but Eduardo had a clotted vein with that one, she said. The second transplant has taken well, she said.

On Wednesday, a beaming Anderson said she felt "on top of the world," as she hugged her children, praised her "dream team" doctors and told all who would listen about the dangers of taking over-the-counter medicine without following the label directions.

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