ONE LIVER, DOUBLE BLESSING : Woman, Infant Given Transplants Using Same Liver

ORANGE — Ingrid Anderson needed a new liver, fast. But when a donor liver became available, Anderson’s doctor had an unexpected request: Would she give part of the organ to a baby who also needed a transplant?

“When I heard it was a baby, that was all I had to hear,” said Anderson, who agreed immediately to the split-liver procedure.

“I have three children. If I can survive on three-quarters of a liver and help a baby who needs a liver, there’s no question.”

On Monday, Anderson, 33, was checking out of UCI Medical Center in Orange, 10 days after receiving the larger portion of a liver from a 19-year-old trauma victim in San Bernardino. The baby recipient, 7-month-old Eduardo Lemus of North Hollywood, is recovering well at UCLA Medical Center, said his mother, Cynthia Ramos.

While this was not the first time UCI and UCLA doctors have done the procedure, the split-liver transplant is still a relatively new development that helps alleviate the critical shortage of donor organs, said Dr. David K. Imagawa, chief of UCI’s transplantation division.

“It’s two for one, if you will,” he said.

The concept of splitting a liver from a cadaver developed after doctors began transplanting parts of livers from living relatives into children, which is still a new area, Imagawa said. Doctors found that both donors and recipients recovered well.

Because liver tissue is the same throughout the organ, a donor liver can be split for transplant into one small adult and one baby, who needs a small organ anyway, he said. Liver tissue regenerates, he said. Anderson’s liver should be normal size in a few months, while the baby’s liver will grow with him, he said.

The risks are minimal, Imagawa said. The chief concern is “the plumbing,” he said--cutting the blood vessels into and out of the organs so that both pieces can be connected to the vessels in the recipients. But the donor liver must be perfect, or it compromises the success of both recipients, he said.

The liver received by Anderson and Eduardo was the 40th split and transplanted as part of a three-hospital program composed of UCI, UCLA and Cedars-Sinai. Anderson was the 10th UCI patient to receive a split liver; about 25 adults at UCLA and five at Cedars-Sinai have received the others. All 40 babies receiving the partial livers have been at UCLA.

Split-liver transplants require three teams of doctors, Imagawa said: one for the donor, and one for each of the two recipients.

Anderson was the first recipient at UCI to receive one in an emergency.

Anderson, 33, of Santa Ana suffered from acute acetaminophen poisoning, the result of inadvertently taking too much aspirin-free pain reliever in too short a time. She had been taking the medication, she said, because of chronic shoulder pain.

“It kind of goes with motherhood,” she said from her hospital bed. “I didn’t take time to take care of myself. It was easier to take some pills than to do what I needed to do--have it checked out.”

Her husband, Jim, could not wake her on the morning of Feb. 9. Paramedics rushed her to Coastal Communities Hospital in Santa Ana, and two days later she was transferred to UCI Medical Center.

Imagawa said that 90% of acute acetaminophen poisoning cases are treated without a transplant. But Anderson was not responding to treatment. After a week, he placed her on the transplant list. Most people waiting for a liver suffer from chronic disease and wait for months, but emergency cases go to the top of the list, he said. Without a transplant, Anderson had no more than three or four days to live, he said.

Within 48 hours, the transplant team learned of the liver in San Bernardino. Then Imagawa received a call from UCLA. Could Anderson’s transplant be delayed several hours, long enough for UCLA to send someone to San Bernardino to bring back part of the organ for a baby? Imagawa said yes, then asked Anderson if she would agree.

“There was no doubt,” Anderson said. “I feel blessed. I was able to get a new liver and able to help a young baby too.”

Ramos, baby Eduardo’s mother, said the procedure was the second liver transplant for her son, who had biliary atresia, a congenital malformation of the bile ducts. The first liver came from another baby, but the surgery was not successful because Eduardo developed a clotted vein afterward. The second transplant has taken well, she said.

On Wednesday, a beaming Anderson said she felt “on top of the world” as she hugged her children, praised her “dream team” doctors and told all who would listen about the dangers of taking over-the-counter medicine without following the label directions.

But almost everyone does it, Imagawa said. “We have a bad headache, and we figure that if the label says take two, we can take three,” he said. But acetaminophen is toxic to liver cells, he said, and must be taken within carefully determined limits. Any consumption of alcoholic beverages while taking the drug can cause further damage.

In Anderson’s case, he said, though she had not been drinking, there appeared to have been some built-up toxicity from repeated, frequent usage of acetaminophen, culminating with a high dosage--15 tablets within 24 hours.

“I learned the hard way,” Anderson said, her eyes filling with tears as she recalled that at one point, doctors told her husband to prepare the children--Peter, 9, Joseph, 7, and Kristina, 3--for the possibility “that mommy won’t be coming home.”

Surrounded by cards and hand-drawn get-well wishes from her children’s classmates, she vowed Monday that she will take better care of herself.

She has a busy schedule of volunteering in her children’s classrooms, helping out at the family’s two freight businesses and taking care of three small children. But now she has a different perspective, she said.

“It’s not the quantity of things I do, it’s the quality. I can always get the other things done tomorrow,” she said. “But if I don’t take care of myself, I won’t be there to take care of my kids.”

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Transplant Process

The liver is the body’s largest internal organ and performs several critical functions. A malfunctioning or diseased liver can cause severe illness, even death. A new transplantation procedure allows doctors to save two lives with one liver. Three teams of doctors are required for such a procedure:

1. Teams 1 and 2 remove old livers from patients, usually one adult and one infant

2. Team 3 removes donor liver and divides the organ for transplantation

3. Patients receive partial transplants of donor liver; doctors sew into place

Note: Follow-up includes two to three weeks of hospitalization, up to six months for recovery

About the Liver

The cone-shaped red-brown organ functions as the body’s chemical factory and regulates chemicals in blood. Some fast facts:

* Weighs 2.5 to 3.3 pounds

* Produces important proteins for blood plasma, including albumin and cholesterol

* Regulates blood level of amino acids

* Clears the blood of drugs and poisonous substances

* Up to three-fourth of the liver cells can be destroyed or surgically removed before the organ ceases to function

* Partial liver transplants will grow and regenerate

Source: UCI Medical Center and Stedman’s Medical Dictionary; Researched by MARCIDA DODSON and APRIL JACKSON / Los Angeles Times