November 8, 1996

Teams await call for rare double organ transplant

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A dual organ transplant will help patient Jean McCarthy achieve her goal of getting back to a normal life.

Teams await call for rare double organ transplant

Doctors at Vanderbilt University Medical Center are preparing to do their first abdominal double organ transplant.

Both organs, a kidney and a liver, will come from the same donor. The surgery will require two specialized transplant teams.

"This is the first abdominal double-organ transplant we have done here at Vanderbilt," said Dr. C. Wright Pinson, surgical director of the Vanderbilt Transplant Center and professor of Surgery. "This two-organ transplant will involve two different operations, two different organ systems and two different transplant teams of doctors.

"This is not a common procedure. Although there are several kidney-liver transplants done every year in this country, it is by no means routine."

The recipient of the planned double-organ transplant will be 37-year-old Jean McCarthy of Boston, who first developed problems with her kidneys when she was seven years old. A strep infection left untreated slowly destroyed her renal function, she says.

When she was 15, McCarthy started on kidney dialysis. After three treatments, she received a kidney from her father. Unfortunately, two-and-a-half years later the donated kidney was rejected by McCarthy's body and she went back on dialysis.

"It was as perfect a match as could be expected," McCarthy said. "The kidney had tried to reject twice before, but steroid medication saved it. But the third rejection could not be stopped."

McCarthy decided not to try another transplant and continued with dialysis.

She graduated from high school in 1977 and graduated from college with a two-year medical secretarial degree. She worked full-time on a nearby army base, still fitting in the three-times-a-week dialysis, which she maintained through high school, college and into the working world. She was busy and she enjoyed life.

"I worked a lot of overtime as well as my full-time job. I had a pretty regular life, busy with friends and work."

The routine continued until June 1994 when she started feeling sick after dialysis.

After several tests, it was determined she had liver disease caused by Hepatitis C, probably contracted from blood transfusions many years earlier. Soon after that, an infection flared up.

"I got really sick. I had a temperature of 107 degrees and was delirious and in a lot of pain. I was hospitalized immediately and was there for almost two months, although I don't remember much about that stay. I was too sick."

That was the end of McCarthy's working life. She was too weak to return to her old job.

It was then that doctors told her she would need a liver transplant. After a search of several hospitals, she decided to come to VUMC. She arrived in September 1995, in a wheelchair, too weak to walk. She was told it would be only a few months wait for the transplant.

But the wait has stretched into more than a year.

"Part of the reason we have had to wait so long is Jean is so small," Pinson said. "She only weighs 90 pounds. We also are looking for both the kidney and the liver and we want a perfect donor for her since it is a double-organ transplant."

While the two organs could come from different donors, Pinson says it would be advantageous to receive them from the same individual.

"The liver and kidney grafts would then have the same immunogenicity and the same set of antigens. The liver tends to be protective of any other graft, including the kidney, so that would make it that much better for Jean."

Pinson says both the kidney and liver transplant teams have spent a lot of time determining how to approach this extensive procedure, expected to take up to 16 hours.

"We plan to bring a dialysis machine into the operating room and we will have the nephrologist available to manage dialysis right in the operating room, if we need it," Pinson said.

"We are going to do the liver transplant first and, if everything is going well, we are going to continue immediately with the next operation, the kidney transplant. If we need to, we can take Jean to the Intensive Care Unit for a few hours and let her stabilize from the liver operation and then take her back to do the kidney operation."

The liver transplant surgical team will include Pinson, Dr. John Kelly Wright Jr., assistant professor of Surgery, and Dr. William C. Chapman, assistant professor of Surgery.

The kidney transplant surgical team includes Drs. Robert E. Richie, professor of Surgery, David H. Van Buren, assistant professor of Surgery, and William A. Nylander Jr., associate professor of Surgery.

The nephrologists involved are Drs. Raymond M. Hakim, professor of Medicine, J. Harold Helderman, professor of Medicine, and H. Keith Johnson, associate professor of Medicine.

The hepatologists are Drs. Raymond F. Burk, professor of Medicine, and Ellen B. Hunter, assistant professor of Medicine.

While waiting for the transplant call, McCarthy keeps busy with dialysis three days a week and exercise therapy at the Dayani Center, along with keeping in touch with her family back home in Boston. She also is keeping a journal with plans to write a book about her experience.

Her physical condition has improved somewhat since her arrival here. She now walks on her own and her dream, she says, is to be healthy again and get back to a normal life.

After the transplant, McCarthy will need to stay in Nashville for another month or two. Then she will return to Boston to be with her family.

She wants to thank in advance the family that will donate a liver and kidney to her.

"I would just thank them for thinking of me at a time that is very painful for them. I would tell them that I would do my best to keep my organs functioning and how much it means to me to be able to go on living and be with my family. I would tell them how much I want to live."

McCarthy is very pleased with her care at VUMC.

"The doctors and other staff members are willing to assist me in trying anything I think will be helpful for me. They are open minded and treat me like a whole person, not just a bunch of diseased organs."

McCarthy is the only person on VUMC's waiting list for the double organ transplant right now, but a second patient may be added soon, Pinson says.

Pinson says McCarthy's chances of a good outcome are about 90 percent. In her favor, he says, are her young age and her improved general physical condition.

Pinson expects the transplant to take place any day. McCarthy says she is ready, but still a little nervous.

"Every time my pager goes off, I am a nervous wreck. I need to get to the hospital within a few hours, but first I need to make sure everything in my room is in order. And I have to call my family, so they can come down and be with me.

"I just know that when I get the call, it's going to be a success. I really feel good about it and I am glad I came to Tennessee and Vanderbilt for this."