TIME: Almanac 1993/TIME Almanac 1993.iso/time/121189/12118900.067

Text File | 1992-09-23 | 3.5 KB | 70 lines

                                                                                HEALTH, Page 96

A Mother's Gift of Life


Her baby gets the first U.S. liver transplant from a living
donor


    Like some 150 other young children in the U.S.,
21-month-old Alyssa Smith was waiting for a new liver, her one
chance to avoid death at an early age. Her prospects did not
look bright, since the supply of livers taken from cadavers and
suitable for transplant is critically slim. But last week a team
of surgeons at the University of Chicago Medical Center gave the
little girl from Schertz, Texas, her chance to live. And what
seemed truly miraculous about the operation was the source of
Alyssa's new liver: her mother.

    In a 14-hour procedure, the surgeons removed the fist-size
left lobe from 29-year-old Teresa Smith's liver and transplanted
most of it into her daughter. The revolutionary technique --
transplanting a liver from a living donor -- had been performed
in Brazil, Australia and Japan, but this was the first time it
was tried in the U.S. Doctors have had a great deal of success
in kidney, pancreas and bone-marrow transplants from living
donors, and hope is rising that the liver will join that list.
Says Dr. Christoph Broelsch, who led the Chicago transplant
team: "This surgery potentially opens up a whole new pool of
donor organs for infants. It's the first step in answering the
problem of juvenile organ shortage."

    So far, both mother and daughter are doing well. Because
the liver has the power to regenerate itself by forming new
tissue, Teresa's liver should grow back to its normal size.
Similarly, baby Alyssa's new liver should grow as she does.

    The operation was not without serious complications. While
the surgeons were removing part of Teresa's liver, they tore her
spleen and decided they had to remove it. The loss of the spleen
means she will be slightly more susceptible to infections, and
may have to take antibiotics for the rest of her life. To gain
access to the liver, the doctors also had to remove Teresa's
gall bladder. As for the baby, she had to undergo a second
operation to stop bleeding from her new liver. The doctors hope
Teresa can be released from the hospital this week and that her
daughter will be home for Christmas.

    The dangers inherent in such complex transplants pose
ethical dilemmas for the medical community. University of
Chicago ethicists and physicians spent a year discussing whether
doctors have the right to ask healthy parents to donate portions
of their vital organs, even if it means saving the life of their
child. Critics argue that there is no way parents can refuse
such a request when under the pressure of having a dying child.
For that reason, university officials required a two-week delay
between the time Teresa and her husband John signed the consent
forms and the date of the transplant, so that the family could
reconsider the decision. "It was purely voluntary," says Dr.
Peter Whitington, a pediatric hepatologist on the transplant
team. "I think this mother, even if she had greater
complications, would believe she did the right thing. I believe
this father, even if he lost his wife, would believe he did the
right thing."

    Some families may not want to have two members undergo
major surgery at once. But for the Smiths, the risk was well
worth the possible returns. Says Teresa: "Once you've given
someone a big piece of your heart, it's easy to throw in a
little bit of liver."