• Choose a category
• All
• Classic-Fiction

By Root 961 0

hepatitis B infection. This was why the internist hadn’t felt an enlarged liver when he examined Omar. Still, it wasn’t clear why his blood tests didn’t improve. “I felt good and was working full-time,” Omar told us. “But my laboratory tests kept getting worse and worse.” An extensive evaluation was undertaken to investigate why Omar’s liver function was deteriorating. He was tested for parasites common in the Middle East that can affect the liver, queried about toxic solvents in his lab that might damage that organ, and screened for inherited disorders like Wilson’s disease that might cause cirrhosis in adult life. But no cause other than hepatitis B was found. His doctors kept waiting and hoping that things would improve. But they didn’t.

“We need to start thinking about liver transplantation,” the liver specialist at the medical center told Omar and Ayesha. “It’s not definite that you’ll need a transplant, but your liver is slowly deteriorating, and the treatment for the virus doesn’t seem to be stopping that.”

Omar and Ayesha were shocked to hear this. “Neither of us ever imagined a transplant,” Omar said. “But the specialist told us that we’d have six to twelve months before the decision about transplant needed to be made. It wasn’t a decision we had to make immediately. And that gave us a sense of relief.”

Modern technology can support, at least temporarily, organs like the lungs with a ventilator, the heart with a bypass apparatus, and the kidneys with dialysis. The liver cannot be supported by a machine, but this vital organ can be transplanted. Dr. Joseph Murray of the Brigham and Women’s Hospital in Boston pioneered organ transplantation. In 1954, he proved the long-term feasibility of the operation by beginning with identical twins. One healthy twin was able to donate his kidney to his ailing brother without concern about rejection, since they were genetically identical. This success spurred further research on how to overcome genetic barriers to transplanting the kidney, with refinements in selecting the organ not only from living donors but from cadavers.

Since Murray’s achievement, which led to a Nobel Prize, the field of organ transplantation has expanded to include not only the kidney, but also the liver, heart, lungs, pancreas, and intestine. Each advance was enabled by progress in surgical technique and the development of new drugs that temper the recipient’s immune system and reduce the chance that his or her body will reject the donated organ. Despite its considerable risks, transplantation can restore a very sick patient to a healthy life.

Although there has been much progress, transplantation is still fraught with uncertainty. Because donor organs are in such short supply, patients must be seriously ill to even be eligible for a liver transplant. Then a suitable liver must be obtained immediately after a donor’s death, and the organ must be functioning and compatible with the recipient. The surgery itself is complex and demanding. The drugs that prevent rejection of the transplanted liver can have serious side effects, including putting the patient at risk for fatal infections or damaging the kidneys and lungs.

By the time a patient is poised to receive a new liver, he may not be capable of making choices for himself because his failing liver has caused confusion or even coma. Then it falls to family members or other surrogates to make decisions for him, as the doctors assess whether the intensive, uncertain, and extraordinarily expensive procedure of liver transplantation would be futile or lifesaving.

A month later, when Omar went in for a follow-up appointment with the liver specialist, his blood tests were much worse. He was planning two trips, one to the West Coast in December and one to Japan in January to attend scientific meetings. But the specialist insisted he cancel the trips. “We need to keep you close by. Your MELD score has reached the level where our transplant surgeon should evaluate you now.”

MELD, short for “model for end-stage liver disease,” is a calculation based