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A flawed liver he can live with


It has a few miles on it, and a major defect, but Russell Ward happily took it.

No, not a clunky used car. A damaged liver.

As part of an unusual double transplant, Ward received the liver from another patient, who in turn got a healthy organ from a brain-dead donor. The procedure, which took place May 19 at the University of Maryland Medical Center, was the first of its kind in the state. It was announced at a news conference yesterday at the medical center.

Ward, who is 74, had non-alcoholic cirrhosis, in which the liver becomes scarred and can no longer remove toxins from the blood. He was willing to take the damaged liver because it probably would not cause him problems for several decades.

"I won't have to worry about it for 30 or 40 years," said Ward, who lives in Salisbury and attended yesterday's news conference. "I'll just get some good times in before then."

Ward's new liver came from 64-year-old Donald Guyton, who suffers from a rare genetic liver disease, familial amyloidosis. The illness, which causes a range of problems including paralysis and fatal heart damage, takes decades to appear, and Guyton began experiencing symptoms only in the past 15 years.

Guyton, who lives in Middletown in Frederick County, received a perfectly healthy liver from a donor.

Both operations were done back-to-back over 18 hours. Dr. Benjamin Philosophe, head of the UM medical center's transplant division, directed a team of about 20 medical professionals. The undertaking was technically challenging, he said, in part because Guyton's diseased liver required extra care during removal.

In general, liver transplants are difficult. The organ is closely connected to the heart; when the liver is removed, it can rapidly trigger cardiac problems.

Patients recovering

Nevertheless, the two operations went off without a hitch, and both patients are recovering normally. To reduce the chances that their bodies will reject the new organs, the men will take drugs to suppress their immune systems for the rest of their lives.

Since 2000, there have been 51 double liver transplants in the United States, according to the United Network for Organ Sharing (UNOS), which oversees transplants in this country. Currently, 17,381 people are on the waiting list for a liver. Last year, 6,169 received a liver, and 1,784 died while waiting.

The road to the procedure began in January, when Guyton was diagnosed with amyloidosis. The University of Maryland transplant center quickly determined that he was a good candidate.

Unlike many liver transplant candidates, Guyton was not in immediate danger of dying. But his condition was deteriorating rapidly, and in the preceding months he had lost the ability to walk. University of Maryland transplant surgeon Dr. Luis Campos, who performed the surgery with Philosophe, said Guyton would likely have died within two years.

In February, Philosophe and Campos applied to UNOS for a waiver that would allow Guyton to receive a liver quickly. UNOS granted their request. At that point, Philosophe and Campos began looking for someone who would be a good recipient for the diseased liver.

Their ideal candidate was someone who was old enough that the amyloidosis would not matter. They also wanted a person who was unlikely to receive another organ, but who was also having serious liver-related problems. Because Guyton was a living donor, the doctors could choose to give his liver to anyone. With a dead donor, transplant recipients are largely determined by UNOS rules.

"In a sense, I played God here," said Campos.

Ward was actually the second person who was offered the liver. The first choice turned it down. "He thought we were selling him rotten eggs," said Campos.

Ward and his wife, on the other hand, eagerly accepted. At the time, he was suffering from serious cognitive problems related to his liver's inability to rid his body of ammonia.

"He was just completely confused," said his wife, Dee Ward. Sometimes he would even forget her name, she said.

Ward, a retired property manager, was willing to take Guyton's diseased liver because he had little chance of receiving a healthy liver, in part because of his advanced age.

Previous experience

In the early hours of May 19, the doctors received word that a brain-dead donor was available. Ward and Guyton rushed to Baltimore, and within hours the procedure began. The operation was demanding, but both Campos and Philosophe had prior experience; each had done the procedure twice before while working elsewhere.

Doctors hope that Guyton, an electrical contractor, will regain some of his mobility.

Ward's progress has been much more rapid. Since the operation, he has become lucid again. "It's like a light turned on," said his wife. "Now he's coming back, the same old Russell."

Once he recovers, she hopes they will be able to go fishing and camping, activities they loved before he got sick.

Guyton and Ward had never met before the news conference. When they met, both men shed a few tears. Guyton said it was humbling that he could help save someone else's life.

"It's amazing," he said, "that my liver was good enough to be used again."

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