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Lives forever linked

Niece saves uncles life with live liver donation

By Kirk Rogers

Three days before Thanksgiving in 2020, Mark Constance arrived at the Saginaw VA for his annual checkup. The appointment had been scheduled in advance and was routine. His blood pressure was checked, his temperature taken, his weight measured, and his blood drawn. He left the VA happy to have the appointment behind him.

In retrospect there had been signs. He tired easily and sat for too long. Each morning there were swollen ankles, but they would soon disappear, and he paid them little attention. Then came the black Friday phone call. Blood tests indicated his liver was not functioning properly.

Within a few short days Mark had gone from feeling like a relatively healthy man to knowing he was a dangerously unhealthy one. “I was told that the outside of my liver was tightening up like a fishnet and slowly choking off the blood flow.”

The liver lies heavily beneath the lungs, stretching out across the abdomen like an underinflated football. It is the largest organ in the human body and performs hundreds of critical functions. It is not some easily discarded body part like the lowly tonsil, gallbladder, or spleen. When any of those organs are removed, in large part it is the heroic liver that saves the day. However, when the liver fails no other organ can step into the breach. Only another liver can answer the call.

Mark was advised to apply for the opportunity to receive a new liver.

At first Mark kept most of his ordeal quite private, sharing the physical and emotional twists and turns with only his wife Tracy, family, a few close friends, and business associates. Mark’s niece, Courtney Tapiawala, was among the few.

They were close. He traveled to her home in Manistee from Roscommon often and they made it a point to see each other, as Courtney says, “because 75 is a road that only runs south.” He would sometimes drive the three hours for only a coffee and a donut. He had officiated her wedding, had photographed his great nephew’s sporting games and supported Courtney in her role as coach.

“To all the memories and events in between, my Uncle Mark has been a staple in my life and helped shape who I am as an adult.”

In casual conversation, Courtney asked Mark if a live organ donor was possible. Mark had not considered it but said he would check with his doctors.

Over the intervening weeks and months, Mark maintained the restrictions placed upon him in an attempt to mitigate his deterioration. Still, he tired more rapidly and his ability to focus waned. Reluctantly he reduced his work responsibilities as others, most notably Tracy, stepped into the void. He penned a heartfelt personal essay for the November 2021 edition of The UpNorthVoice that explained to a largely unaware readership why he had stepped back.

mark leaving hospital
Mark Constance walks out the door of UPMC in Pittsburgh after receiving a new liver, courtesy of his niece, Courtney.

Through it all Mark waited for the phone call that might save his life. While that phone did not ring, on the live donor side of the equation, the side that Mark had not considered, things were moving.

On her own, Courtney did some initial investigation and knew that the chances of Mark quickly receiving a cadaver organ, though far from impossible, were also far from guaranteed. She learned that a liver can be reduced to half its normal size through surgery and then, over the next few months, regenerate in mass and function to levels that rivaled its state before surgery.

Shortly thereafter, Courtney filled out a donor form on-line with the UPMC-Montefiore Hospital and made a phone call. Then began a series of online interviews that screened for potential issues. It was only then, after much of the leg work had taken place, that she told Mark she had every intention of being his liver donor.

He was taken aback. Overwhelmed by her love and generosity, he was now filled with anxiety for his niece’s health and how such a serious surgery might affect her. He was not willing to say “yes” immediately but, as it turns out, to Courtney “there was never even a question as to whether I’d provide the donation.”

In March of 2022, Courtney made the journey to Pittsburgh and had 28 vials of blood drawn, numerous tests, and interviews with a social worker, the chief and assistant chief of staff, and a donor advocate. Each interview ended with the same question, “are you certain that you want to go through with this?”

Initial surgeries for October were delayed when Mark developed a serious complication, but ultimately, they were rescheduled for December 19; one to remove half of a liver, and one to transplant the half that had been removed. The delay gave Mark more time to worry that something might happen to Courtney. Courtney was unfazed.

Live donor liver transplant surgery does more than pair a donor with a recipient. It takes two surgery teams that time their procedures so that the newly removed organ can be placed quickly inside its new abdominal home. Surgeons then reconnect the adjoining blood vessels and bile ducts.

Mark’s surgery lasted nine hours and Courtney’s six. At the crucial intersection of the two procedures, approximately 55 percent of Courtney’s liver became 100 percent of Mark’s, with the organ having been transported from one operating room to an adjacent room in a stainless-steel bowl. Mark inquired prior to the procedure “if you accidentally drop the liver on the floor does the three second rule apply?”

Mark was sedated for several days after surgery. His first vague post-op memory was “seeing Courtney wave to me as she was wheeled out of the ICU. I couldn’t have asked for a better Christmas present.”

On January 11th, 2023, two plus years after the original diagnosis, Mark was still in a hospital bed recovering. He had hoped to be released that day, but a painful battle with gout had him immobile and medicated.

Courtney is back home in Manistee, but fatigue is a constant companion. She will return to Pittsburgh in March to be fully monitored for her recovery and then hopes to return to work on April 6.

Mark too has plans. He plans to worry less, spend more time talking with people, and to allow others to carry most of the load that has for years interrupted his desire to write, write, and write some more.

Mark and Courtney are literally closer than they’ve ever been. When Mark is finally up and about, his plans include more trips to Manistee.

“Without her this story and life aren’t possible.”

Liver Transplant Facts

  • According to the Health Resources and Services Administration, every ten minutes another person is added to the organ recipient database. And, while there are over 169 million people registered to donate organs, only three in a thousand do.
  • A major factor in matching a donor with a recipient is the condition of the recipient. With all other factors being equal, it is the neediest of the two potential recipients that will receive the donated organ. However, it is not at all rare for a patient to stay on the waiting list so long that he is no longer a candidate.
  • Currently there are over 17,000 people awaiting a liver transplant.
  • Each day that list of names is shortened by about twenty-nine; twenty-four who receive a transplant, and five more, not because of a lifesaving surgery, but because no surgery ever occurred. Sometimes the numbers just don’t add up.
  • Adult live donors for liver transplants represent less than five percent of surgeries.
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