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While his younger brother Tynan was recovering Monday from a liver transplant, Max Krakoff made a request.
"When you came out of the hospital, you owe me ice cream," he said. "I'll take the cookie dough in a waffle cone if you like it."
That's what Max asked in exchange for giving his brother Tynan about half of his liver to replace the one that had derailed last year.
Max, 32, from Akron, was the first to offer such a gift as part of the new living donor liver transplant program at the Wexner Medical Center's State University. from Ohio.
On September 10, Dr. Sylvester Black, using a very powerful jet of water, had split Max's liver in two. The slightly larger piece was immediately taken to another operating room and placed in his 30-year-old brother on the East Side.
Both pieces are expected to regenerate into normal size livers within six to eight weeks.
The new program is part of a "robust expansion" of Ohio liver transplant offerings, said Dr. W. Kenneth Washburn, director of the Wexner Comprehensive Transplant Center. In recent years, the number of livers transplanted at the center has increased from about 30 to over 100 per year.
Along with the offer of living donors, plans are underway to increase the number of deceased donor livers available using technology that allows surgeons to assess organs that would have been eliminated as too risky, a said Washburn.
Previously, the center expanded its criteria for donors, including reducing restrictions on livers likely to have been exposed to hepatitis C, but currently showed no signs of the disease.
"All of these elements fit into a puzzle that allows us to really expand our profile, which we can offer to our patients," he said. "The ultimate goal is to stop them from dying and bring them back to an active lifestyle."
Across the country, more than 14,000 people, including 517 in Ohio, are on the waiting list for liver transplants.
Living donors account for about 4% – 6,643 – of the 161,111 liver transplants in the United States from 1989 to August 31 of this year, according to the Organ Supply and Transplant Network.
In Ohio, 198 live donor liver transplants were recorded between 1997 and August 31, 2018, representing approximately 3% of the total 6,335 liver transplants. The Cleveland Clinic Foundation is the best performing, with 135 since 1999.
Black, a transplant surgeon at Ohio State, said 92 to 93 percent of live donor transplant recipients survive at least a year, slightly more than the rate of all liver transplants.
He indicated that living donors allowed surgeons to intervene earlier in liver disease, when a transplanted patient was more able to tolerate surgery and plan surgery, thus avoiding the need for surgery. frenetic nature of transplants quickly after the donor's death.
Yet only about one in four candidates can be a donor. To be eligible, they must have a blood group compatible with that of the recipient, be generally healthy and go through a battery of questionnaires and medical tests to make sure they are able to support the donation.
In addition, according to Dr. Black, since liver anatomy can vary considerably, surgeons must ensure that the "connections" used to secure the liver to the relevant blood vessels will be aligned.
Max Krakoff's donor liver scans were superimposed to create a computerized 3D image, which Black used to perform a virtual surgery before entering the operating room.
On the day of the transplant, Black, Washburn and other surgeons performed the two overlapping procedures over approximately seven hours.
Tynan was diagnosed in January with primary sclerosing cholangitis, a progressive disease with a blurred cause that attacks the bile ducts and causes infections, hospitalizations and, possibly, scarring of the liver.
He was placed on the transplant list in April, but was not a high priority because of his average score on a measure of mortality risk in people with end-stage liver disease.
As such, Max said that the offer of part of his liver was a "no brainer" that he thought for about 10 minutes before deciding to start the process. Evaluation.
He followed a post-operative roller coaster that caused intermittent anxiety and intense pain, especially at night. But he is optimistic about the recovery and then the long distance race with the goal of an ultra-marathon in Colorado next summer.
Tynan, who also beat Hodgkin's lymphoma with blood cancer in 2008, said he thought he could face the world. Once cured, he plans to return to work as a social justice activist with a new urgency for health issues after receiving his transplant through Medicaid public funds.
The brothers, who grew up in Akron and Southern California, have always been close, sharing a lot in life: friends, baseball, video games, struggles and happy memories.
And now, a liver.
"I have three sisters, but that's my only brother," Tynan said. "There's just something special about him that saved my life and lived with me."
@JoAnneViviano
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