By Alan Prendergast
By Michael Roberts
By Michael Roberts
By Amber Taufen
By Patricia Calhoun
By William Breathes
By Michael Roberts
By Melanie Asmar
In the pioneering days of liver transplants, surgeons used to clamp off the vein at either end of the liver and remove the portion that was inside the liver along with the organ. Then, like connecting garden hoses, they would attach the vena cava ends from the donor liver to the recipient's counterparts. The problem with that was that the heart was cut off from more than half of its blood supply, and its response was to increase the rate at which it beat, while blood pressure dropped. The longer the vena cava was cut off from the blood in the lower half of the body, the greater the danger of a heart attack or stroke.
Although surrounded by the liver, the vena cava is not actually an integrated part of the organ. It's like an interstate highway that passes through a city: There are a few "on ramps" -- small veins that drain from the liver into it -- but otherwise, one doesn't have much to do with the other. Kam was going to attempt to separate the vena cava from the liver while leaving the vein intact, a relatively new procedure he'd helped develop.
The team worked with few words, but a radio in the operating room was tuned to KBCO. The chief surgeon began freeing the vena cava just as Jimi Hendrix launched into "All Along the Watchtower." There must be some kind of way out of here/Said the joker to the thief...
Goldberg's head bobbed to the beat as Kam began working from the bottom of the liver up. As he lifted the organ away from the large vein, he and Goldberg found the "on ramps," which he cut and passed a suture through that his assistant promptly tied off. If all went well, Kam wouldn't have to clamp the vena cava and cut off the blood supply to the heart, except for a brief time when he would have to tie the ends from the donor's vena cava into Chris's system. There are many here among us/Who feel that life is but a joke...
After about a half-hour, the vena cava was freed from Chris's liver. Paul Simon's "Graceland" was playing when Kam, his scrubs smeared with traces of blood and the band of his surgical cap dark with sweat, asked nurse Adams to make sure there was enough ice on the donor liver. I may be obliged to defend/Every love, every ending/Or maybe there's no obligation now..., sang Simon as Adams hopped down from his perch, walked over to the plastic basin and looked under the blue towel. He added more ice and returned to his post. Maybe I've reason to believe/We all will be received/In Graceland...
Thos Evans entered the operating room but hung in the back where he could not see his friend's face or much of what the surgeons were doing. He'd have preferred not to be there -- this was just too personal -- but he knew that Chris's family was in the waiting room, anxious for any news. Kam assured him that everything was fine, and he risked a peek.
"Would you look at those abdominal muscles?" Evans said with admiration.
Kam deadpanned, "This is a liver, not a muscle."
"Thank you, Doctor Kam, for pointing that out to me," Evans said with a laugh as he turned to walk back out the door.
"Sure, you're welcome," Kam replied. The surgeon glanced up at Goldberg. His mouth was hidden by a surgical mask, but his eyes were smiling.
For several hours, the surgical team of Kam, Goldberg and Adams worked as one organism with six hands. Goldberg, who had assisted with ten liver transplants, anticipated Kam's next moves with only the occasional correction or guidance. Adams was even more automatic.
While the surgeons operated, Henthorn came around from his end of the table to check the plastic canisters that collected the blood suctioned off from the abdominal cavity. "He's doing great," he said.
At 10:02, Kam announced that the liver was out. He handed it to a nurse, who placed it in another plastic basin. In the meantime, the new liver had been flushed with a saline solution to remove as much of the dead boy's blood and the preservative as possible -- just that much less foreign material for Chris's immune system to react with.
The boy's liver was smaller than the organ removed from Chris. Devoid of blood, it was tan in color as the surgeon slipped it into its new home. With hardly a pause, Kam began to reverse the steps he'd been taking for the past two and a half hours by attaching the vena cava ends from the donor liver to Chris's vena cava, which he now clamped.
With the donor liver off the ice and still lacking a blood supply and Chris's heart under stress, it was important at this point to work as quickly as possible. "You can have the vena cava back in four minutes," Kam told Henthorn. At 10:25, he released the clamps on the vein, and the anesthesiologist immediately reported that Chris's blood pressure was climbing back to normal while his heart rate slowed. "The heart's happy to see all that blood," Henthorn said.