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On Dec. 4, Juan Candelaria celebrated his 49th birthday with a seven-mile hike in Yosemite National Park. But a few months ago, this hike—or even the chance to celebrate Christmas with his family—might not have happened without a cutting-edge liver transplant from a living donor.
“This is a brand new day for me,” San Juan Bautista resident Candelaria said. “I’m still going through it with some training wheels and rediscovering who I am. It’s all about building back my strength and seeing how I identify with the world.”
In a small yet important way, Candelaria has Facebook to thank. His friend of 28 years, Ryan Gray, saw a post about his condition and had himself screened as a possible donor.
“There wasn’t much hesitation on my part,” Gray said. “I thought, ‘Here’s a friend I care about. He needs something. I’m going to figure out if I can help.’”
Thus began a year-long process to ensure the two were compatible.
According to UCSF Liver Donor Transplant Coordinator Finesse Wong-Louie, time is a serious factor when a patient is identified as needing a new liver.
Candelaria had been diagnosed with liver disease, which had led to liver failure. He was then diagnosed with liver cancer and had to be treated for that before any surgery. And with cancer and a high MELD (model for end-stage liver disease) score, the clock was ticking.
“We discussed treatment,” Candelaria said. “I was informed that, essentially, there’s no cure for liver cancer unless you remove the cancer, which would require removing the whole liver. They said the safest bet for me was to get it out of my body as soon as possible.”
While UCSF performed over 5,000 successful transplants this year, its wait-list currently totals over 400 patients. Around 300 who entered that list over the year did not make it to surgery in time.
Wong-Louie said that when UCSF receives an organ donation it goes to the person who needs it most.
“So people have to be very sick to have a chance for a transplant,” she said, “and they might end up dying before an organ is available.”
And, she said, the sicker a patient gets before the transplant, the less stable they are after surgery and the longer recovery takes.
Friends and family
Three of Candelaria’s direct family members agreed to undergo an evaluation to determine whether it was safe for them to donate. The tests included basic lab work, a chest X-ray, an electrocardiogram, an echocardiogram, a cardiac stress test, an abdominal ultrasound and an MRI.
“I was honored they would make such a sacrifice for me,” Candelaria said, “and just as much pain as I would be going through. But slowly, after the testing and retesting, all my donors started falling off the list.”
Gray was the only one left who qualified. After meeting with a social worker and a psychologist, Gray, Candelaria, their advocates, the surgeon and the transplant committee then met to approve the operation.
There was still a delay while Gray had to clear his system of unhealthy habits. Donors who drink, smoke, or take certain drugs have to discontinue them to reduce the chance of complications. For Gray, that took three months.
“It didn’t scare me away,” he said, “but it was very, very frustrating. I was ready to give all that up, so that was not a big deal. But I was told my friend has six months to a year to live, and now they are delaying this whole process because of my behaviors?”
To complicate things further, Gray lives in Oregon, making it difficult for him to advocate for himself or participate beyond coming to this area for testing and counseling. But, he said, his path was predetermined once he was confirmed as a match.
“It’s like everything was frozen,” he said, “and then everything started to move, so all the pieces could align. At this point, I was so invested in it that I just wanted the process to be over.”
Candelaria said it was a great comfort to have his old friend by his side during his crisis.
“He made me feel we’re in it together,” he said. “I had someone who understood my fears and insecurities. We’re right there, together, in lockstep. It made the whole process leading up to the transplant much much easier for me.”
An ordeal
Wong-Louie said the donor’s five-to-six-hour transplant operation usually begins at around 7 a.m. The recipient’s surgery, when he is given half of the donor’s liver, begins about halfway through and lasts eight to 12 hours.
“They wake you up and say, ‘Let’s go,’” Gray said. “They just start the process: you are on a gurney being wheeled around, there are all these people talking to you, and then you wake up, and it is over. Part of me wants to know in more detail what they did but I am not ready for that.”
The surgeries were done side-by-side in the same room, as 60% of Gray’s liver was removed following a final visual inspection. Candelaria’s liver was completely removed, and all traces of cancer were cleaned out. After the new liver was installed, he was in the operating room for another two hours as it struggled to start functioning.
“It scared me to hear about it,” he said. “They said, ‘It’s that window when we hope it kicks in, and yours did at the right time.’ They started packing me back up once they got confirmation it was alive.”
Donors take five to seven days to recover; recipients take 10 to 14 days. The liver’s regeneration begins an hour after surgery. For both patients, their livers will grow to normal size within two months, though Candelaria will be on anti-rejection medication for the rest of his life.
Candelaria said that one question weighing on his mind is whether he could have been a donor himself if the circumstances were reversed.
“You start asking, ‘What are the motivators?,’” he said. “I can’t believe I put somebody through this. But it really changes people’s lives. Not just the person whose life you saved but everyone around them: all the people who love them and rely on them. I am still trying to process that emotion.”
As for Gray, it was a simple choice.
“For me,” he said, “rather than get wrapped up in all the emotions and implications of fear, I just thought, ‘Screw that—let’s just do it. And it’s a privilege to even be part of this process.”
For more information about the living donor program, contact:
Finesse Wong-Louie
Living Liver Donor Transplant Coordinator
Liver Transplant Service at UCSF Medical Center
(415) 518-7163
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