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Liver transplantation a bond regenerated between brothers l.jpg

Liver Transplantation: A Bond Regenerated Between Brothers

Jessica McGuire

Professor Cohen

Anatomy and Physiology

16 February 2011

Johnson & Wales University


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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 he was immediately directed to go see a Doctor.


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  • Perfectly Healthy Before

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

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


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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 causes it.

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


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Four Years

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

  • Over four years he had become very tired and fatigued

  • During that time his skin turned ‘yellow’ or “jaundiced” because his liver couldn’t get the bile out of his system.


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


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  • Organs used for transplant typically come from cadavers

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

  • 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)


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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


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Testing Process

  • The family decided that a living donor would give James the best chance of survival, and a normal life.

  • The following criteria must be met: 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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The McGuire Brothers Pre-Surgery.


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“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


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Right Lobe

Right Lobe

Left

Lobe

Left Lobe

Diseased PSC Liver

Healthy Liver


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Complications

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

  • One week post surgery, he thought that he was feeling sick 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


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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 will continue to take medication to prevent

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


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James McGuire

Pernell McGuire


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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


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