Rare Procedure Offers Transplant Hope

Bruce suffered from primary sclerosing cholangitis (PSC), the disease that killed Walter Payton, a Hall of Fame football player for the Chicago Bears.

PSC causes the bile ducts in the liver to become inflamed and makes it more difficult for the liver to function properly. The disease is a slow, degenerative illness that eventually requires a transplant.

The Wengers, from Mechanicsville, Va., decided to take advantage of a new procedure called a living donor transplant, in which a large portion of a healthy donor liver is transplanted into the sick individual.

Nikki Lawson, transplant coordinator at Georgetown University Hospital in Washington, D.C., said this procedure is possible because of the liver's ability to regenerate itself.

Both the donor and recipient will have fully functional livers in six to eight weeks, she said.

Bruce fully recovered from the surgery after a minor infection, though he will still have to take medication for the rest of his life to keep his body from rejecting the liver.

Lawson said one reason this procedure works so well for diseases like PSC is that it can be done before the recipient becomes extremely ill. "It takes so long for (people with PSC) to get sick, the rest of the body is still healthy enough for (the transplant) to work."

Lawson stressed that there are risks involved, for both donor and recipient.

"For the donor, (the surgeon) is going to manipulate major arteries and blood vessels," she said. "The person could bleed to death."

Lawson said this is unlikely, but other risks for the donor include reactions to anesthesia and infections, which are normal risks for surgery. She added that the procedure is very painful. "There's a tremendous amount of pain involved."

She also said the recipient has risks to worry about, especially because they will have to receive drugs to prevent the immune system from attacking the foreign liver. "We're dumbing down their immune system," Lawson said. "There's 10 times more of a chance for infection."

But she said she thinks the procedure is promising and that it is a good option.

"If we get more information about living donation, we will have less people dying while waiting on the list," Lawson said. "There's such an organ shortage, and to die a liver death is one of the most gruesome."

But despite the risks, Kristina Wenger had no doubts about her decision.

"He was dying," she said. "It was my chance to finally do something."

Kristina said they could not wait any longer for a transplant and that the living donor procedure was their only choice. "We had waited and waited and nothing," she said.

Kristina added that she and her husband were the first nonrelated living donor and recipient in the nation, although the procedure had been done three times before.

The procedure has become more common but is still very rare. Georgetown has only performed six living donor liver transplants so far.

Terry Gassert, a resident of Germantown, Md., is a patient at Georgetown. Like Bruce Wenger, Terry suffers from PSC and, like the Wengers, his wife, Karen, is a match for a living donor transplant.

But Terry said he is not sure he wants to go through with the living donor transplant. His alternatives include waiting for a full liver transplant from an organ donor -- which will mean months of waiting as his condition only worsens.

Terry said the potential for failure is a risk he might not want to take because the procedure is done earlier than regular transplants. "If the liver is rejected or something goes wrong in surgery, you're further down the line," he said.

Terry also added that the risk of something going wrong for the donor is another important consideration. "If something were to happen, there are still kids at home that would possibly be without two parents," he said.

But Karen said she is willing to take that risk. "No surgery is without chances," she said.

"We've been back and forth on (the decision)," Terry said, only to be cut off by Karen.

"He has been back and forth on it," she said.

Despite the ups and downs, both the Gasserts and the Wengers expressed hope for the future of this procedure.

But the newness of the procedure creates obstacles such as lack of widespread awareness about the procedure and concern over its safety.

"It's still a new procedure," Terry said. "Maybe in a few years they might have it down."

Kristina echoed Terry, expressing optimism for the procedure.

"There is such a shortage of organs and people wait for so long, they see their family getting sicker and sicker," she said. "This gives them an opportunity to do something to help while (those requiring a transplant) are still healthy."

The State & National Editor can be reached at stntdesk@unc.edu.