Living Donor Transplant Emblemmatic of Loving Family

When Gloria Ramos received the call in August 2000 that UCSF Medical Center had a liver for the transplant she badly needed, the Ramos family drove to the hospital with great anticipation and excitement. But further testing of the available organ revealed it wasn't a good match for Gloria and her daughters and husband expressed their disappointment.

"This only means that I'm at the top of the list," Gloria recalls assuring her family. "I'll get called again!"

Gloria contracted Hepatitis C through a blood transfusion in 1982 but the deadly virus lived undetected in her body until the summer of 1997 when she went to the doctor to find out why her stomach appeared so bloated. By that time, the disease had already considerably damaged her liver. Three months of treatment failed to improve Gloria's advanced cirrhosis, so her gastroenterologist at Kaiser Permanente, Dr. Joanna Ready, referred her to the UCSF Medical Center Liver Transplant program. Replacing Gloria's nearly dysfunctional liver with a new one was her best hope.

In her Internet research to learn more about cirrhosis and liver transplantation, Leticia, Gloria's younger daughter, read about a relatively new kind of transplant that uses a portion of a liver from a living donor. The human liver has the amazing ability to grow a missing portion. When part of the liver is surgically removed from a healthy person, that person's remaining liver will, within a few months, grow back to normal size and function.

The donated portion of liver, with the help of immune suppressant medications to avoid rejection of the "foreign" liver, will grow to full size and function in the transplant recipient. The UCSF Medical Center team has extensive experience with living-donor surgeries, including 60 adult-to-child and more than 50 adult-to-adult liver transplants.

"I remember when the girls brought it up with Dr. Roberts," says Gloria. John Roberts, M.D., Chief of UCSF Medical Center's Liver Transplant Program, agreed that living-donor was a possibility if there was a willing family member with the right blood type. Both daughters were tested. Veronica, it turned out, has the same blood type as her mother. She went on to pass all the other medical tests with flying colors, including discussions to ensure that she understood the risks.

"It's really important that the donor understand that if something goes wrong, it's not their fault," Veronica explains. "The doctors go through so much to make sure that rejection of the liver doesn't occur, but if it does, the donor needs to realize that what they did is give a gift. They should never feel responsible if the recipient's body doesn't accept the organ."

All four members of the Ramos family - Gloria, Ruben, Veronica and Leticia - were there for every step of the process leading up to the transplant.

"It was a family event for every appointment," Veronica remembers. "Everybody took off work. Everybody went together. We weren't messing around!"

On Oct. 11, 2000, the day scheduled for the transplant, Ruben sat with Leticia in the waiting room at UCSF Medical Center while Roberts and Nancy Ascher, M.D., Chair of the Department of Surgery, worked in adjacent operating rooms, one performing the harvest procedure on Veronica and the other transplanting the portion of Veronica's liver into Gloria.

The surgeries were fairly long, but went smoothly. Both donor and recipient healed very well and were home in less than two weeks. Gloria remembers how quickly after the transplant she felt better: "Oh my gosh, it was amazing how alert and how different things were for me almost as soon as I woke up after the surgery."

But the road to recovery was not without a bump or two. Veronica and the doctors discovered after the surgery that she is allergic to many pain medications, including morphine. She had to deal with the significant pain of a large incision without the benefit of strong pain-relieving drugs. For Gloria, the bump came after about two weeks at home when she developed an infection. Transplant patients who are taking large doses of immune-suppressant medications are extremely vulnerable to complications from infections. She returned to UCSF Medical Center, where she was closely monitored until the infection cleared up.

Both Gloria and Veronica attribute the success of their transplant to the superb skill of the UCSF team.

"We had the top, the very best doctors and nurses!" says Gloria. "You get to know them all so well because you see them many times before the surgery and then they come around several times every day while you're in the hospital. Even now, they keep track of my blood work that gets sent from Kaiser to UCSF every month, and I see them when I go to UCSF Medical Center every few months for a check-up."

Within two months of the surgery, Veronica returned to teaching, filling in as a mid-year replacement for a kindergarten class. By the next school year, she had finished her master's degree in administration of education and accepted a job as a program coordinator for the Manteca School District. Veronica also serves as principal for the district's Saturday school, a special program for students who are failing.

Gloria went back to her job as a first-grade teacher the April following her transplant, finished out that year and taught one more full year before retiring at age 62. Well, sort of retired - she still substitute teaches and tutors.

Veronica, Leticia and Gloria now put in many volunteer hours to share their transplant experiences with others. Gloria works with a support group to help people waiting for transplants know what to expect and to keep their spirits up. Veronica and Leticia volunteer for the California Transplant Donor Network, speaking at high schools and working the group's booth at events.

"I'm always ready to talk to people about it," says Veronica. "Answering their questions, getting them to sign their donor cards, that type of thing. Organ donation has become kind of my hobby now!"