Daughter gives back gift of life

It's one thing for a daughter to give her mother 'a piece of her heart' as a sentimental gesture.

But Pam Stewart's 'gift' of more than half of her liver, in a relatively rare operation, has probably saved her mother's life.

During daylong, simultaneous operations on Jan. 24, doctors at UPMC Presbyterian hospital, Oakland, removed 60 percent of Stewart's liver and transplanted it into her mother, Margaret 'Jan' Henderson, who was dying of cirrhosis.

'Right up until the last minute the doctors say, 'Are you sure you want to do this?'' Stewart, 37, of Bolivar said Wednesday as she and Henderson sat in a 10th-floor room at the hospital.

'You always have that option of backing out,' Stewart said. 'But I can't imagine anyone not doing it. I know my sister or my brother would have done it, too.'

Though there have been only three such transplants at UPMC, said Dr. Andrew Bonham, one of three surgeons who operated on Henderson, the procedure went 'without a hitch.'

Stewart is expected to return home today and should regain full liver function within four weeks, Bonham said. Henderson could return home this weekend and could be back on the golf course by the end of the summer.

Henderson's outlook has been an important factor in her recovery, Stewart said. 'Mom is a wonderful patient,' she said. 'All along, we have marveled at her sense of humor. She's always pleasant with the doctors and nurses.'

Nevertheless, Henderson doesn't expect recovery to be easy. 'Today, I hurt bad,' she said. 'But every day, I feel like I've gone a few yards.'

If all goes well, she will eventually feel as if she had never been sick, Bonham said.

'She's still at risk of rejection,' he said. 'The only time there would be no risk would be if (the donor and recipient) were identical twins. But in liver transplantation, (rejection) is not as big a problem' as other organs.

The liver, which produces digestive fluids, controls blood sugar levels and breaks down hazardous substances, is one of the few human organs capable of regenerating. It is divided into two lobes of different sizes.

For more than a decade, doctors have been able to remove the smaller, left lobe of an adult liver and transplant it into a child.

The larger, right lobe is required to sustain an adult's body, however, and doctors have been reluctant to remove so much of a donor's liver.

'You're taking a perfectly healthy person and putting them at the risk of a surgical procedure,' Bonham said. 'There have been four or five deaths (of donors) around the world.'

Lengthy backlogs of patients awaiting livers from cadavers have helped doctors overcome their reluctance, he said. It frequently takes 18 months to two years for such a donor to be found, Bonham said, and up to 20 percent of patients awaiting liver transplants die.

In Henderson's case, a lengthy wait would have been a death sentence, he said.

'She had advanced liver disease,' Bonham said. 'The cavity around her lungs was filling up with fluid. You have to have that fluid drained off once a week or you can't breathe.' Most patients at that stage die within a year, he said.

Doctors don't know why Henderson developed cirrhosis, though they believe it might be hereditary. An avid amateur golfer who also operated Jan's Bakery in New Florence until her diagnosis seven years ago, she had grown increasingly weak in the past year, Stewart said.

'The donor list is a year long, and the only way to move up any closer is to be in the intensive care unit or in a coma,' said Vickie Boring of New Florence, Henderson's other daughter. 'You see what people look like when they're waiting and waiting, and we didn't want her to get to that point.'

The illness meant many long drives from Westmoreland County to the hospital for Henderson's husband, Norm, and their three grown children. Boring said the family gladly shared the duties.

'Pam and I have pretty much said it's not my mom's illness, it's our illness,' she said. 'This is just what we do.'

When doctors suggested a live donor transplant, Stewart, Boring and their brother, Scott Henderson, were tested and found to be perfect genetic matches. Stewart volunteered.

'Pam joked that she'd rather be the donor because at least she'd be done running around for a while,' said her husband, Bert Stewart, brother of Tribune-Review Editor Tom Stewart.

Their daughter, Alexandria, 10, expressed few reservations, Pam and Bert Stewart said. 'She said it's fine, as long as you and grandma get better,' Pam Stewart said.

On the morning of the operations, Pam Stewart was taken into surgery first. There, a team of three surgeons under the guidance of Dr. John Fung, chief of transplantation at UPMC, examined her liver and decided that it could be divided, Bonham said.

'The donor operation takes around eight hours,' he said, 'longer than a normal liver resection, if, for example, you were removing a tumor. You're doing a very tedious dissection. Just splitting the liver takes four or five hours.'

Then, while surgeons began the delicate task of dividing bile ducts, blood vessels and other structures, Jan Henderson was taken into an adjacent operating room and prepared for the transplant.

Henderson's operation took about 10 hours, or several hours longer than a normal liver transplant, Bonham said.

'That was a very long day' for the family, Pam Stewart said. 'I thought I had the easiest part.'

Despite the difficulty involved, Bonham expects the procedure to become increasingly common within five to 10 years. Only 69 such transplants were done in the United States between 1997 and 1999, according to published reports, but several hundred were done last year.

'The technology and the techniques actually are such now that doing a right or left lobectomy carries a very small risk,' Bonham said. 'A lot of people feel it's justified to take that risk to benefit the recipient.'

Henderson once objected to organ donation on moral grounds, her daughters said. That objection has melted away.

'I feel like I have been blessed,' Henderson said.