Transplant Surgeons At The Nebraska Medical Center Use Revolutionary Technique In Performing Living Liver Transplants

Doctors say the procedure greatly increases safety, especially for the donor


For nearly two decades, Russ Hart knew his liver was failing. Doctors told him it was only a matter of time before the degenerative liver disease he had would precipitate the need for a transplant. “Fortunately, I made it much beyond the ten years they were predicting,” said the Manhattan, Kan. native. “I made it 18 years before I needed a transplant. And for most of those 18 years, I was very healthy.”


But the good health Hart enjoyed quickly came to an end. “I started to get quite jaundiced and yellow,” said Hart. “I was very tired and obviously was going downhill. I could hardly stand up at times. I just didn’t have the strength to do that.”


Hart got on the waiting list for a transplant. His wife, meanwhile, started spreading the word about the possibility of a living donor. “I wasn’t really interested in doing that because I didn’t want to put somebody else in harm’s way,” said Hart. “But the sicker I got, I realized that might be an opportunity for me to live.”    


Hart says a lot of people didn’t realize the liver is one of the few organs that has the unique ability to regenerate, so they didn’t know living donation was even an option. “The biggest question we always got was, ‘Can they do that? I didn’t know they could do that.’ So I explained at The Nebraska Medical Center they had a unique procedure where they took a quarter of the donor’s liver which made it much safer for the donors.”


Hart said it was this new procedure that prompted him to accept a donation from a member of his church that would eventually save his life. “There has always been something inside of me that’s pushed me to do something self-sacrificing in a big way,” said eventual donor Josh Nelson. “I trusted Russ that this was one of the best places in the world to get a transplant.”


There was another realization that prompted Hart to accept Nelson’s offer. “I realized if I accepted this gift from Josh, the liver I would’ve possibly gotten (from a cadaver) could go to someone else,” said Hart. “Another life would be saved in addition to mine, so really we got two great benefits out of the one gift Josh gave.”


“The need for living donation has arisen because of a shortage of cadaveric organs,” said Nebraska Medical Center liver transplant surgeon Jean Botha, MD. “About ten percent of our liver transplant patients will die every year because of a shortage of organs.”


Dr. Botha says this is where living donation attempts to fill the gap. “Historically speaking we’ve tended to take the larger portion of a donor’s liver, or their right side, for a living liver transplant. That takes between 60 to 65 percent of the donor’s liver mass to be able to provide enough functioning liver mass for the recipient.” But Dr. Botha says that method always placed much of the risk on the donor. “While that risk is low, it is still real.”


It was that risk, Dr. Botha said, that prompted transplant surgeons here to change their approach and change the way the operation was done. “We can now take a smaller piece from the donor,” said Dr. Botha. “That makes the operation safer for them, while still providing the recipient with the opportunity to get transplanted and to survive. So we are now taking the left lobe from the donor to be able to make it work in the recipient.”


“To be a leader in this field is very exciting,” said transplant surgeon Wendy Grant, MD. “If we can lead the way in donor safety, we think that’s a benefit to our patients and to the transplant community.”


When the time came for the transplant, Hart said he wasn’t fearful at all. “I knew I was in the best hands I could be in,” said Hart. “When I woke up, my wife immediately said my eyes were whiter. And that was the first time I knew things were going to work out.”


“I feel better than I have in years,” said Hart. “I wake up every morning and can see my wife and kids. I’m more thankful than I’ve ever been. I think about things in a different way.”

“The biggest thing I received,” said Nelson, “was the satisfaction of knowing that I did something to save someone’s life. If you didn’t take the chance, nothing happens. Nothing changes. But you’re taking that chance that you can change everything.”


“You’re basically dead, then you get a new life almost overnight,” said Hart. “It just takes your breath away.”


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