How to Do a Liver Transplant (24 page)

I continued on for what seemed like an hour but was probably only twenty seconds. I pulled back for a moment as I thought I felt a whimper escape the baby's lips. I couldn't quite believe it and kept going with the mouth-to-mouth for another few breaths. A nurse had arrived by that point and touched my arm.

‘She's started to breathe,' she said kindly, ‘you can stop now.'

Her touch was enough to break my intense concentration and I paused for a moment to evaluate the situation. I was pretty pumped up, feeling like a mother lion protecting her cub. I quickly realised, though, that things might be OK as the little girl's deathly pallor turned rapidly to a healthy pink. I cradled this beautiful girl in my arms and watched the life flow back into her face. She started to bellow and that was the best sound I have ever heard. Some of the bystanders watching were clearly overwhelmed and, feeling helpless, rushed in to comfort and quiet her.

‘Please, just let her cry,' I said. ‘When someone is crying it means they are breathing.' I carefully handed her back to her stunned mother, who rocked her back and forth and kissed her head, not quite allowing herself to believe what she had just seen. A minute too late the ambulance arrived and whisked mother and daughter off to hospital to be checked out. All I had time to do was ask the girl's name
and wish them well. It was a little bit like a dream and I too found it hard to comprehend what had just happened.

When it was over, I started to shake as the adrenaline took effect. I began to walk away, not sure what else to do, my legs feeling a little wobbly. The dazed staff thanked me and took down my name and number. I walked outside the store and collapsed in a chair at the closest coffee shop I could find. It really hit me then and took me about half an hour before I was composed enough to even contemplate driving home. A kindly bystander who had witnessed what had happened bought me a cup of coffee. As I sat there, I realised that I didn't get my bra. Could I really go back to the store and buy it after everything that had happened? I decided there was no reason not to, so I went back in. There were still a few staff members milling around and reliving the events. They had retrieved the bras I had tossed aside and they were sitting on the counter.

‘We thought you might be back,' one said, smiling. ‘They are all yours, on the house.'

As soon as I got home, I was surprised to find TV and radio stations calling to get the story. Less than an hour after the whole thing happened, I was doing a live radio interview. Friends were calling all evening and asking whether it was true that I resuscitated a child at the shops wearing only a bra! The next morning, in the middle of my operating list, ABC radio called and asked me to go live on air with presenter Madonna King and tell the story. The
only thing I knew about the mum and daughter at that stage was the little girl's first name. She had been taken to hospital so quickly, I didn't even know if she was OK. Madonna King put out a call for the girl's mum to ring in if she was listening. She was, and I finally got to ask if her daughter was all right. We all ended up sobbing on the radio together as Madonna King recounted the events. The lovely mother said that I would never know how grateful she was. But of course I knew. I was a mum, so I could imagine exactly how thankful she felt.

A few days later I got to meet all the family, including the poor helpless dad who had been on the other end of that frantic phone call. What beautiful people they were, and I am privileged to have been involved in their lives in such a way. I am so glad I could get their little girl back for them. My husband and I had been trying for another baby for three years at that time with no success. The very next month our dreams came true and I fell pregnant with our much longed-for son. I do wonder if it was fate rewarding me for keeping that gorgeous soul alive. I'd like to think so.

Transplanting babies

I
t was a very unusual thing, to have my fingers inside the abdomen of a tiny baby. At a mere 3.1 kilograms, he was one of the smallest people to have received a liver transplant in Australia and I was there that day, assisting Professor Jonathan Fawcett, the head of the paediatric transplant program. When I walked into the operating theatre to start the case that morning, the first thing that hit me was the heat. Liver transplant theatres for babies must be 30 degrees so that our precious charges don't lose too much body heat when their tummies are laid open. The more they cool down, the more blood they lose. We swelter like it's a
summer's day, made worse by the layers of gowns we wear. But it is not about us, is it?

The second thing that struck me was the person on the operating table, or the little there was of them. Almost hidden by the vast amounts of anaesthetic equipment and tubes was a scrap of a thing. Once we covered him up with our surgical drapes there was an area the size of the palm of my hand to operate on. I had to continually remind myself that this baby's head was where an adult patient's chest usually is and to not squash him with my resting elbow. The anaesthetists were on to our habits of absent-minded squishing when we are caught up in the heat of the case, and circumvented the problem by suspending a wide metal frame over the baby's head.

It seemed very wrong to make a cut in that innocent child, but we did because if he didn't get a new liver, he would be dead within days. He was born with liver failure, through no one's fault, just a cruel quirk of nature. We worked for hours to remove his tiny liver and when it finally came out, it was so small that it was a little perplexing that it had taken us so long. We were
very
careful about our blood loss. An adult can bleed a litre and not really miss it. For a baby this small, though, a litre was several blood volumes and every drop counted. He had blood vessels so minuscule that I could barely see them even with my magnifying glasses, and they had to be joined together by a plastic surgeon with the aid of a powerful microscope. So
meticulous was this work, those six minuscule stitches to join the artery together took an hour and a half.

Getting the right donor liver for these tiny babies is another challenge. Thankfully, there are almost never donors this small. To get the right-sized piece, we must cut a segment from an adult liver. For these really tiny babies, however, even the smallest piece of liver is usually too big for their little tummies. Once his brand-new piece of liver had blood running through it, it doubled in size and in this tiny bub it protruded from his abdomen, reminding me of a triangular sail of the Sydney Opera House. There was no hope of closing the wound over the bulging liver at the end of the operation, and any attempt to do so would have squashed the liver, pushing it up into the baby's chest so hard that he would have been unable to breathe by himself. The solution was simple, albeit a little confronting. At the end of the transplant, we left his abdomen gaping open, protecting the new liver with a simple piece of plastic sheeting sewn around the edges of the wound. We slathered the plastic with a thick coating of antiseptic cream, rather like icing a cake, and the little boy was carefully delivered to the Intensive Care Unit in an induced coma.

Over the next week or so an amazing metamorphosis took place. The liver began to shrink until it fitted. We took the baby back to the operating theatre every second day, slowly pulling his abdomen together over the rapidly
shrinking liver. After a couple of weeks, everything was back where it should be. The little boy was woken up and his parents got to hold a baby who was not yellow.

Interestingly, apart from these super-small babies, the operation to give a child a new liver is not as different from doing an adult transplant as you might think. Clearly children are much smaller, but fortunately for us, their abdomens are disproportionately large. The liver is one of the biggest organs a baby has and its bulk gives them their cute ‘pot belly'. So despite the blood vessels and bile ducts being a whole lot smaller, there is usually a reasonable amount of room to work in. The other difference in paediatric transplants is that they are definitely more emotional for me to do. Most of these kids have been sick their whole lives and have endured many painful experiences. When I see their little bodies lying there helpless on the operating table with IV lines in every limb and monitors covering almost every part of their body, I just want to give them a hug instead of potentially causing them more pain. These kids have fear in their eyes as the anaesthetic mask is clamped over their faces and they drift off to sleep. How could they possibly understand why all of this is happening to them? Most of the kids I transplant are the same age as my own children and it is hard to not imagine myself in their parents' place, pacing the corridors while they wait to hear if things have worked out. I feel a heavy burden of responsibility to return their baby to them in better shape than before.

What is really extraordinary about these plucky little kids is their endless resilience; they seem to take the whole transplant ordeal in their stride. The hospital has usually become a very familiar place to them because most are so sick that they have seldom had the chance to go home. A few are born in the hospital and have never known any other home. Because they are cared for by dozens of different people in the course of their young lives, they are usually friendly, outgoing kids who keep us laughing with their antics. I used to think that a small child would find it difficult to cope with having myriad tubes and wires attached to them for any period of time. You would think that they would pull them out. This is usually not the case, though, and these children seem to accept this as their reality as they sit and play with tubes up their noses and IV lines in their necks, stuffing potato chips into their mouth despite them.

The Queensland Paediatric Transplant Service has hundreds of liver transplant kids who have grown successfully into adulthood. Most of them go on to live exceptionally normal lives, only needing to take one or two tablets a day to stave off rejection. Many visit us only once a year, mainly to say hello and to remind us why our job is so great. These former transplant babies now have jobs, kids of their own and, best of all, quality of life. One of them, transplanted as a young child, now in his late teens, even has the ambition to go to medical school so
he
can become
a liver transplant surgeon too. These are the triumphs that could never have been made possible if it wasn't for the work of Professor Strong and many other pioneers of liver transplantation.

While transplanting the tiny babies is amazing, there is no paediatric transplant I will remember more vividly than the nine-year-old boy born with a very rare genetic problem. His disease causes a pigment called bilirubin to build up in the blood. Bilirubin is the brown substance that is normally disposed of by the bowel and it is what gives the faeces its colour. This genetic disease alters the way the body processes bilirubin, causing it to build up in the bloodstream. Shortly after a victim is born with this illness, the bilirubin levels become dangerously high and the baby's eyes will turn an alien shade of yellow. If left untreated, they will rapidly become brain damaged. If it is diagnosed early enough, the brain damage can be put on hold for a while with an unusual treatment. Kids with this disease must lie under hot blue lights for more than ten hours a day. The light converts the harmful bilirubin into a molecule that can be safely passed in the urine. Of course, this treatment severely restricts their lifestyle and in the long term becomes less and less effective and the jaundice will return.

This little boy we were treating had been living his life under the lights for nine long years. To get enough exposure to the blue light, he needed to be semi-naked most of the time. He was sick of being called ‘devil eyes' by his classmates and all he wished for was to go to sleep at night in the dark and feel a pair of pyjamas on his skin.

He was healthy in every other way and it was a terrible existence for everyone in his life. His family could never go anywhere because they could never be far away from the lights that were keeping him alive. His devoted parents had to work hard to make sure this active boy, who wanted nothing more than to be outside with his friends, spent the right number of hours per day under those lights. The little boy was becoming more and more jaundiced as the light treatment began to fail. His disease could be completely cured with a liver transplant, so when his quality of life became intolerable, the boy's family made the difficult decision to move to Brisbane and wait for a liver to become available.

He waited a long time for the ‘right' liver to come along and when it finally did, I removed his faulty liver and replaced it with the new one. Everything seemed to go really well and I felt confident as we wheeled him back to the Intensive Care Unit around midnight. Just as I got home and drifted into an exhausted sleep, I received a call from the doctor in Intensive Care. They told me that the little boy was not doing well, his liver tests were highly abnormal and his blood was showing no signs of clotting. His blood
pressure was dangerously low and they were concerned that if we didn't take some drastic action he would soon be dead. I was pulling on my clothes and getting back in the car even before I got off the phone.