Liver donor James Steffanic (left) visits with his uncle, Joseph Steffanic, the recipient, five days after the living-donor liver transplant surgery.
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Joseph Steffanic just celebrated his 60th birthday Oct. 15, thanks to his nephew, James Steffanic, who gave him an unusual early birthday present.

In late August, James gave his uncle a part of his left liver through an advanced type of liver transplant surgery performed at the University Transplant Center, a partnership of The University of Texas Health Science Center at San Antonio and University Health System.

Patients can die waiting for traditional transplant
Before the surgery, Joseph might have died on the transplant waiting list. The Bastrop man was diagnosed with Primary Sclerosing Cholangitis, an advanced form of liver disease situated in the bile ducts. Because there is a long waiting list to receive a liver from a cadaveric donor — a newly deceased person who has consented to become an organ donor or whose family has consented on their loved one’s behalf — having a living person come forward to donate part of his liver may have made the difference between life and death for Joseph.

The transplant team is extremely selective when matching donors and recipients to ensure the donor is not put at unacceptable risk. For this reason, this is the first living-donor liver transplant performed at the University Transplant Center in two years.

Living donors can provide viable alternative for waiting transplant patients
“This is a highly complex decision that only a liver transplant center with experience doing living-donor liver transplant procedures is suited to make. We feel that consideration of a living donor is something that should be offered to all potential liver recipients due to the incidence of dying on the waiting list,” said Glenn A. Halff, M.D., a surgeon and director of University Transplant Center, and interim dean of the Health Science Center’s School of Medicine. He established the liver transplant program — among the best in the country — in the early 1990s.

(From left) Kenneth Washburn, M.D., professor of surgery and director of Liver Transplantation at University Transplant Center; James Steffanic, living donor; Joseph Steffanic, the liver recipient; and Vincent Speeg, M.D., Ph.D., professor of medicine and medical director of Adult Liver Transplantation, meet several weeks after the transplant.

Historically, not enough cadaveric livers are available for transplant compared to the number of people on the waiting list, and patients in urgent need of a transplant receive priority over patients who have milder or moderate symptoms. However, those in the middle group with moderate symptoms, such as Joseph, continue to be at risk of dying while waiting.

“A lobe from a living donor may be the best opportunity at a new life for some patients on the liver transplant waiting list,” said Dr. Halff, one of the surgeons who operated on the case. “This donor had a large left lobe, so it worked out well for both the recipient and the donor. The donor and recipient also are about the same size, which was a favorable factor.”

In Joseph’s case, approximately 35 percent of James’ liver was transplanted, giving the donor 65 percent for his immediate needs. Fortunately, the liver regenerates quickly. After six months, it will have regenerated to 80 percent of its size in both men, Dr. Halff said.

Risks relatively low for living donors
For a healthy living donor, the risk of dying is less than 1 percent, said Kenneth Washburn, M.D., surgeon and director of Liver Transplantation at University Transplant Center, as well as a professor of surgery and the Valero Distinguished Chair in Transplantation at the Health Science Center. Many routine surgeries, such as hernia repairs, carry similar risks. Donors do not need to be blood relatives of recipients to participate in a living-donor liver transplant.

“Living donation is an important option to evaluate for many patients, and those in the middle segment of the waiting list have good results with these transplants,” Dr. Washburn said. “It is clear that the donor’s safety must be considered paramount. We want patients to be referred here and then we can make the decision.”

Meanwhile, Joseph is healing and getting stronger every day. “What my nephew did is a beautiful thing. I’m very proud of him for stepping up to help save my life," he said. "The surgeons are wonderful, too. I feel like everything is going to be OK."

For more information about living-donor organ transplantation, please visit the University Transplant Center Web site, www.UniversityTransplantCenter.com.