Stanford Medicine Newsletter Updates For the Local Community

 

A sister’s life-saving gift

"I wanted to help her," said Christine Webb (right), who donated part of her liver to her sister, Judith Lattin.

   

Judith Lattin’s life had become a very dark landscape. What she thought was a simple case of stress-induced intestinal trouble in her 20s had been the beginning of the end of her liver. At 48, she was stunned to learn that an autoimmune disease had scarred the organ beyond recovery.

For the next nine years, Lattin fought the consequences of liver failure, enduring procedures to control a bleeding esophagus, an enlarged spleen and major vein blockages. Her life became an unpleasant regimen of medications, with uncomfortable side effects, that could not always control her condition.

For Lattin and others like her, the odds are not good. Only 6,000 cadaver livers become available each year for transplants, while 16,000 to 18,000 people remain on the list. One in seven dies before receiving a new liver. There is no equivalent of kidney dialysis or cardiac ventricular-assist devices for the liver.

Nearly eight years into her wait, Lattin’s doctors told her that the complications of her disease made a transplant problematic and they thought she wouldn’t survive the procedure. But they gave her an option: Stanford Hospital & Clinics, one of the few centers in the United States where doctors perform liver transplants from living donors. Its highly experienced team of liver transplant surgeons performs three to five living donor transplants a year.

The liver is the one organ in the body that responds to loss by expanding to its original volume. That restorative quality allows someone to donate as much as 60 percent of a liver without repercussions.

Stanford was willing to do what many others would or could not: use a piece of liver from Lattin’s sister, Christine Webb. Nine years younger and in good health, she was an ideal candidate for the procedure. (Donated livers do not have to be a perfect tissue match—only blood type must match.)

But Lattin wasn’t so sure it was a good idea. “She has three children and a husband, and I just felt it was too dangerous,” she said.

But Webb, told carefully and frankly about all the possible complications, was not dissuaded.

“My sister didn’t want me to be in harm’s way, but I didn’t want her to have to wait. I wanted to help her,” Webb said. One night on the phone, she told her sister, “You need to stop trying to talk me out of this. This is my reason for being alive, to give you this piece of me.” After that, Lattin said, “I just accepted that this was something that she had to do.”

Webb was put through a tough evaluation and assigned her own medical advocate to represent her interests. “It’s a challenging, difficult surgery,” said transplant division Chief Carlos Esquivel, MD, PhD. “The risk of life-threatening hemorrhage is ever present, but we do this because there aren’t enough organs to go around.”

Three senior surgeons were in the operating room that day in December: Esquivel; Waldo Concepcion, MD; and C. Andrew Bonham, MD. The team used instrumentation and tools to reduce blood loss and carefully calculated just how much liver to take. Every step of the procedure was designed to protect both donor and recipient.

“We’re kind of obsessive-compulsive when it comes to managing these patients to reduce the risk of complications,” Bonham said.

Lattin left the hospital several days after the transplant and now carefully follows rules for her medication, diet and exercise. “I have energy to do things,” she said. “I just have so much more of a joy for life.”

It took three months for her sister to experience a full recovery. “There’s not a feeling in the world that is better than when doctors come to you and say, ‘You saved two people,’” Webb said. “I saved my sister, but I also saved the person who will now get the cadaver liver she doesn’t need. It really brings it home when you think about it that way.”

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