Family steps up in live donor transplant

One man's powerful act of kindness and an extraordinary medical team bring a family through a harrowing crisis

Author Sapna Pathak (above, left) with her dad, Lalit, who received a live donor liver transplant, and her mom, Dharmista. Her mom's brother Satish Trivedi donated more than half of his liver. (Cheryl Senter for The Boston Globe)

The words rattled around in my head, reverberating like the sound waves from a hard-hit Chinese gong: "Your father is going to need a liver transplant. It's our only option at this point."

Sitting inside an exam room at Lahey Clinic, I pondered the irony of how two succinct sentences from a doctor stood as the culmination of more than a year's worth of questions, relentless diagnostic tests, and trip after trip to the hospital.

How could my father, Lalit Pathak, a lively, seemingly healthy 56-year-old man, turn into someone who was now to be a number on a list, waiting for a liver transplant?

It's a question perhaps I will never get the answer to. I can, however, look back at the experience with new perspective: a post-operative appreciation for the work and generosity of others.

I learned lessons of kindness in the way our family was treated by the liver transplant team at Lahey, where the operation was done. I learned of courage when I, my younger brother, Sukesh, and my three uncles, all living in Florida, stepped up to be tested as potential live donors for the transplant.

And I learned of genuine selflessness when my mother's younger brother Satish Trivedi put his life on hold and agreed - without hesitation - to donate half his liver to my father when we learned he was the perfect match.

To this day, my family and I do not know why my father became ill with acute hepatitis last summer. Lahey's pathology reports simply cite the cause as "autoimmune hepatitis."

My father never had more than the occasional social drink with friends or been exposed to any type of blood transfusion or infected needles in his life. He was an engineer for Cardinal Healthcare, working with doctors and nurses in Cardinal's hospitals throughout New England, including Lahey. His job was to help take care of Lahey patients, not someday be one.

In April 2007, my mother, Dharmista, noticed him losing weight and exhibiting jaundice behind the eyes. Dr. Prasanna Gulur, practicing at Southern New Hampshire Medical Center in Nashua, took over my father's case and directed us to Lahey.

"I'm sending you to the best liver team in the world. They will be the ones to help you through this," he told us.

He was right.

Though it took several months, a number of liver biopsies, hundreds of vials of blood drawn, and too many anxious minutes spent at Lahey, a course of action was finally clear: a liver transplant.

"About two or three times a year, I will see someone with a case of subfulminant hepatitis," said Dr. Frederic Gordon, the hospital's liver transplantation director. "It's when a normal liver is there, and something else comes in and you can see it's clearly not going to do well. That is what Lalit had, but we didn't know the time frame. So you get to a point where enough is enough. When things come in and damage the liver and it's not getting better after a few months, then enough is enough."

Gordon made his diagnosis. We made our decision: a "live" donor liver transplant, which, though more complicated to perform, offers the recipient a higher chance of survival.

"It is something that's becoming more heard of and more families are coming in here educated about it," Dr. James Pomposelli, director of kidney transplantation at Lahey, said of live transplants. "Ten years ago, it wasn't being done very often in the US, and now it's coming more into the limelight and people are learning that the kidneys aren't the only organ that can be transplanted with a living donor."

Kidneys, the most commonly transplanted human organ in this country, can be transplanted from a living donor due to the body's ability to survive with just one of its two kidneys.

The liver is the second-most commonly transplanted organ. The largest internal organ in the body, it is also the only internal organ that can regenerate itself, as can the skin.

It is split into two sections, or lobes. The liver's right lobe generally comprises 60 percent of its volume and is the part that is removed in a live transplant, which takes six to eight hours, and given to the recipient.

From the day a transplant candidate is accepted at Lahey, the hospital assigns a team of specialists for both the donor and recipient, assuring proper care for both.

Gordon remained my father's hepatologist and Pomposelli his lead surgeon. Nurse coordinator Marti Hoar and social worker Eric Richman came on board, as did a nutritionist, psychologist, and medical doctor.

Donor nurse coordinator Denise Moran soon became the smiling face we looked forward to seeing in the hallway before appointments, while Dr. Elizabeth Pomfret, director of live donor liver transplantation and lead donor surgeon, delivered information to us with confidence and reassurance.

Pomfret and Pomposelli, now a husband-and-wife team, had first trained in Germany more than 10 years ago with Christoph Broelsch, a German surgeon who introduced live liver donor transplants to the United States through a series of published studies conducted at the University of Chicago.

"We performed our first live liver donor transplant here on Dec. 10, 1997," said Pomposelli. "We actually did back-to-back ones, because we did Lahey's second one on the 11th."

On June 30 this year, my father and uncle went through Lahey's 170th live donor liver transplant.

The hospital still maintains connections with Germany, where it employs a company with expert mathematicians who convert black-and-white CAT-scan images - taken of all recipients and donors - into three-dimensional color images that illustrate a patient's liver volume and biliary and vascular anatomy.

The technology makes the Lahey team's job much easier, its leader says.

"There's no guesswork, it makes things very safe," said Pomposelli. "It's about 95 percent accurate, so when I go in, I know exactly where to cut and what things are going to look like."

The process for my father and uncle, from the transplant evaluation to the day of the surgery, took about three months.

Once my brother and I were ruled out as donors - I for not having the same blood type as my father and my brother for having a high clotting factor - it took another month for my uncle to be thoroughly evaluated as the chosen one.

The operation consists of two surgeries occurring both simultaneously and sequentially. Pomfret's team begins on the donor first, while Pomposelli's team opens the recipient about an hour later. Once Pomfret has successfully removed the right lobe, Pomposelli is near removing the recipient's damaged liver.

With communication flowing continuously between both operating rooms, the donor segment is then brought to Pomposelli for the transplantation while Pomfret begins to close on the donor.

Exhausting. Nerve-racking. Hopeful.

Finding the right words to describe the day of surgery escapes me. It was a long and emotional day, spent sitting in a family waiting room with bated breath.

The transplant was successful, with no complications. In seven days, my uncle returned to our home in Merrimack, N.H., staying with us for about a month before returning to Florida.

My father was home in eight days, feeling better than he had in more than a year. We learned that a recipient's rate of regeneration is faster than a donor's and the transplanted segment is generally fully regrown within three weeks.

My father received 68 percent of my uncle's total liver volume, and in two weeks it had grown to the size of a normal, healthy liver. My uncle's liver regrew to about 85 percent after four weeks and should be fully regenerated in 12.

A donor typically is completely recovered after three months and, aside from an L-shaped scar on the abdomen, will have nothing to show for having gone through such an extensive procedure. The recipient is expected to begin recovering almost immediately.

Two days after the transplant, my father was joking at the nurses' station - at 4 a.m. More than six weeks later, the day is fresh in my mind.

I know now the power of family. It is my 44-year-old uncle heroically stepping up to help save my father. It is doctors Gordon, Gulur, Pomfret, and Pomposelli, and the other staff at Lahey, doing their jobs with genuine care and kindness.

We could not be more grateful. To the Pathaks, they are no longer doctors, nurses, and medical professionals anymore.

They are family.

Sapna Pathak can be reached at sportsgalsp@gmail.com.