Liver Transplantation: A Bond Regenerated Between

Brothers

Jessica McGuire

Professor Cohen

Anatomy and Physiology

16 February 2011

Johnson & Wales University

Donating Life

• James McGuire’s Insurance Application required the routine battery of blood tests

• There were problems with James’ liver numbers

• The application was declined and was immediately directed to go see a Doctor.

• Perfectly Healthy Before

• By October James’ health had declined at a rapid rate and was admitted to the hospital

• His Doctor concluded that he in fact had Primary Schlerosing Cholangitis

Primary Schlerosing Cholangitis

• Primary Schlerosing Cholangitis (PSC) is a rare liver disease that typically affects Men in their 30-40s

• Doctors still don’t know what cause it.

• Average time between diagnosis and transplant: 9-10 years

Four Years

• In four years James had gone from feeling perfectly normal to having his name added to the cadaver waiting list.

• In four years he had become very tired and fatigued

• In four years his skin turned ‘yellow’ or “jaundiced” because his liver couldn’t get the bile out of his system.

• Organs used for transplant typically come from cadavers

• More than 96,000 people nationwide are waiting for an organ

• More than 1,400 are in Arizona

• Every 12 minutes a name is added to the national transplant waiting list

• An average of 18 people die each day waiting for an organ.(UNOS)

A Second Option

• The liver is one of the few organs that can be transplanted from a living donor

• The liver is made up of two parts, a right lobe and a left lobe

• The right lobe is removed from the donor and transplanted into the recipient

• The donor’s remaining left lobe regenerates itself in about 6 weeks

Testing Process• As a family it was decided that a living donor would give James the best

chance of survival, and a normal life.

• Blood type, Cross match, Antibody screen, Urine Tests, X-Rays, Arteriogram, Psychiatric and Psychological Exams ( Wives are tested as well)(Mayo Clinic).

• Final Blood Test and Cross Match (done within 48 hours of the surgery) • A friend volunteered and was eliminated due to vessel anatomy

• Kelly (Sister) was eliminated due to lack of support system, and liver composition

• Pernell was tested March, 2006 and was found to be a suitable match

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McGuire siblings April, 16th 2007 (night before transplant)

The McGuire Brothers Pre-Surgery.

“Just do it”

•April 17, 2007 Transplant day

•Pernell went into surgery first, it took the Doctors five hours to remove the right lobe of the liver.

• The liver is dissected at the falciform ligament

•The surgery takes about 10-12 hours

•The liver should be pink and fleshy, James’ liver was completely green from the bile and rock hard due to the scarring.

•Due to the severity of James’ liver damage his entire liver was removed and replaced with part of Pernell’s

Diseased PSC Liver Healthy Liver

Right Lobe

Left

Lobe

Right Lobe

Left Lobe

Complications

• Although Pernell had undergone the battery of testing, once he was open on the table it was discovered he had an extra bile ducts.

• One week post surgery, he thought that he was feeling so bad due to the intensity of the operation, but bile was leaking into his abdomen

• Dr. Mulligan’s first complication in 55 living donor transplant’s

• Common complication in recipient, but not the donor

• Stents were inserted and replaced four different times for drainage and his condition stabilized

Post – Transplant

• James’ long term prognosis is good

• The success rate for a single organ transplant is 80%(UNOS)

• The biggest obstacle is organ rejection, which James with continue to take medication to prevent

• As long as he stays healthy this should not affect his typical lifespan.

James McGuire Pernell McGuire

Five Years Post-Transplant

• Pernell is currently the managing partner of McGuire Gardner PLLC. A law firm in Arizona

• James is currently an Attorney for the firm helping to manage the Tempe, AZ office.

• Both are wakeboarding enthusiasts, and can typically be found on a boat with their families