To the unschooled eye, a healthy human liver is neither particularly ugly nor appealing. Brownish-red inside the body, it pales to a pinkish-purple once a surgeon cuts off the blood flow and removes it. You might mistake the liver for a lady's evening bag if it didn't glisten like something from the butcher's case.
No other organ is so taken for granted. Small children understand that the heart goes thump, that the brain adds two plus two, that the lungs capture each breath, that other organs process food. The liver, meanwhile, cleanses the blood of poisons, makes protein and bile and does scores of other tasks, not all of which scientists fully understand. Human genius has created kidney dialysis machines and artificial hearts, but it has yet to mimic the life-force character of the only internal organ that can regenerate.
"The liver is an amazing organ," says one specialist. "I don't want to comment on other organs, but the heart"--a dismissive shrug, a sly grin--"the heart is a piece of muscle. It is a piece of muscle that pumps blood to the liver so that the liver can function."
The body's unsung hero only gets noticed when it starts to fail.
Now, however, it is faltering en masse, in tens of thousands of cases every year. Liver doctors, or hepatologists (hepato being Greek for liver), say these figures represent just the edge of a gathering epidemic of chronic liver disease. They blame the crisis on hepatitis C, a blood-borne virus so stealthy that researchers labeled it non-A/non-B hepatitis before finally isolating and christening it 10 years ago. Now the leading cause of liver failure, it affects more than 170 million people worldwide, including about 4 million Americans, many of them unaware for decades of the peril.
Treatments sometimes neutralize the disease before it inflicts too much damage. But many people will just get sicker and sicker until they wind up on the transplant list kept by the nonprofit United Network for Organ Sharing (UNOS). In early June, it contained 13,095 names, more than triple the number waiting for hearts.
This is where the havoc wrought by hepatitis C collides with another crisis: a critical shortage of donor organs. Almost 4,500 liver transplants were performed last year, yet 1,319 patients died waiting--double the death toll of four years earlier. Demand for organs, particularly livers, far outpaces the modest gains in donations. Over time, hope rests with biotech research aimed at cloning organs and at genetically altering animal organs to implant in humans. Even then, experts caution, it will be much easier to replicate the kidney, essentially a filter, or the heart, a glorified pump, than the multifaceted liver. Meanwhile, America's triage system for transplantation will be on trial. The disparity between the need and the supply will worsen before it improves, compounding the pressure not only on patients but on doctors.
All of which hints at why, on a spring day in subterranean Operating Room 1 of UCLA Medical Center, Dr. Ronald Busuttil is thrilled to see a liver that is so purplish and plump and glowing with the promise of life. "Oh, that's great. That's just beautiful," he says of the blob on a table in the corner of the room. It is, actually, only the right half of a liver. But to Busuttil, one of the world's best transplant surgeons, the only thing finer than a healthy donor liver is one expertly cut in two, to save two lives.
A few hours earlier, this organ rested unscathed beneath the abdominal wall of an Orange County man who died tragically young. (Transplant protocol prohibits doctors from releasing a donor's identity or cause of death.) With his grieving parents' consent, transplant teams from hospitals throughout Southern California converged at the hospital. After one team removed the kidneys and before another took the heart, Busuttil's colleague, Dr. Hasan Yersiz, divided the liver inside the body, then placed the halves on ice in picnic coolers for the drive to Westwood. If it had been rush-hour, Yersiz would have gotten a helicopter ride.
Inside OR 1, the "Pulp Fiction" soundtrack plays low, Dick Dale's surf guitar washing over 73-year-old Julie Stein. She lies anesthetized on the table, abdomen agape with an incision the shape of an upside-down Y. ("We give them the Mercedes emblem," says Busuttil, a car buff.) Down the hall in OR 17, a 62-year-old man is being prepped to receive the left half of the liver.
Busuttil examines Stein's half, touching it with gloved fingers. "I like the color, the way it feels and everything," he says. Focusing through loupes that magnify his vision 2 1/2 times, he gently tugs at the organ's plumbing with forceps. "Oh, it's a beautiful artery," he tells Yersiz. "But I do think you should put the external link on it. Now where's the right hepatic vein? Let's put a vein patch on this."