Over that summer, Lamb was in and out of the hospital. Cirrhosis scarring can cause blood in the portal system to back up and leak into the intestinal tract; a patient can actually bleed to death in this manner. In order to avoid such a fate, Lamb had to undergo a TIPS procedure, in which a shunt is inserted between the veins on one side of the liver and the other, in effect creating a bypass. Although the blood no longer passes through the organ's filtration system, it can't back up, either. Lamb's first TIPS eventually scarred over, and he required a second procedure.
Then last fall, just after Halloween, he got a call from Tracy Steinberg, one of University's two transplant coordinators. They had a liver donated by another hepatitis C carrier that might work, she said. Livers of hepatitis C carriers aren't necessarily damaged if the virus hasn't been active, but they can be transplanted only in other hepatitis C patients.
(It's also been debated whether livers from donors not infected with hepatitis C should be given to people with the virus. While it normally would take twenty years or so for an active virus to destroy a healthy liver, there's a catch: To keep the body from rejecting the foreign organ, transplant patients take drugs that suppress the production of white blood cells that would otherwise resist the advances of the virus.)
Lamb shot up to the top of the list. He rushed to the hospital, where he was whisked to a room that already had his nameplate on the door. He showered, and the nurses prepared him for surgery. Then he got the bad news: The donor liver was no good, and the operation was off.
He returned home to his mother's apartment in a Colorado Springs retirement community populated by former military personnel. They live on streets called Patriot Way and Veteran Heights--an irony that isn't lost on Lamb. He survived Vietnam 27 years ago, but it may kill him yet.
Tracy Steinberg can barely sit still in her chair. In a few minutes, she gets to do the best part of her job.
"I get to call someone and say, `Hey, you get to live,'" she says.
Although Steinberg is also a coordinator for University's kidney and pancreas transplants, it is the life-and-death drama of liver transplants that really pulls her into patients' lives.
She's part of a team that includes hepatologists, surgeons, a psychiatrist and a social worker. This is the team that meets to determine who goes on the list for transplants. That's a tough part of the job; saying "Sorry, but no" means someone will die. But there aren't enough livers to keep up with the demand, and the organs must go to the people with the best chance of survival. About forty people are on University's list at any given time; odds are that anywhere from ten to twenty will die before a liver becomes available.
The liver-transplant program, a combined project with Children's Hospital, will perform between fifty and sixty operations this year; only one liver transplant in the state has been done outside University. The hospital could add more staff and do more operations, but while the need is there, the livers aren't.
By the time the transplant candidates reach Steinberg and the rest of the team, the assessment has already been made that they qualify financially for the $155,000, eight-hour procedure. Now they must go through two days of physical and psychological tests. They are screened for alcohol and drug use--no sense giving a liver to someone who'll just destroy it. The team also assesses whether the candidate is likely to survive a wait that could easily stretch to a year.
Since Igal Kam began transplanting livers in 1988, the University/Children's teams have done almost 300 operations. The program has one of the best long-term survival records in the country--which has loosened the purse strings of insurance companies, some of which only recently began covering liver transplants.
The University team monitors patients monthly after their release from the hospital. So far, all hepatitis C transplant patients have shown some signs of the virus attacking their new organs, but only one has needed treatment with interferon.
Steinberg keeps her transplant list with her day and night. Patients are given pagers; their chance at a second life can arrive at any moment.
Next to Claire Reilly's tiny office at University, nine-month-old Todd squirms to get out of his mother's arms.
Cathy is exhausted. Todd would tax the endurance of a young mother, but he was a surprise baby when Cathy was past forty. Still, it's not watching an infant that gets her so tired she just wants to sit in a chair and cry. It's the virus and the interferon she takes as part of Reilly's study.