When liver failure becomes a reality

When Donald Henderson was told he would need a liver transplant due to a bout of hepatitis he had suffered in 1980, his life was changed forever.

It all started in June 2003, when he was away on business in Natal, when this previously healthy 57-year-old man suddenly fell very ill.

“I became disorientated and restless one night and by morning my eyes had turned yellow,” he said.

Fighting for his life
Life irreversibly altered after that, and for the next few weeks he spent a lot of his time in hospital fighting for his life.

“When I got back, I spent 10 days in hospital, then another five a few weeks later after a more serious bout of disorientation. Then I was diagnosed with encephalitis.”

When the real reason for his illness became apparent, life became even more complicated for him as he had to move overseas to the United Kingdom to seek a liver transplant. The waiting list in South Africa was, at that stage, just too long for him to be able to wait, according to his doctors.

“I was told my liver was in serious trouble and was the cause of my recent illnesses. Three weeks later I was told that I had to go overseas and seek the transplant, otherwise I would be dead in six to nine months,” he said.

Once in London, Henderson registered at the Kings College Hospital liver unit; the real trouble was only just beginning.

Back to casualty
“A month after getting there, I passed a large quantity of blood and was rushed to hospital. In casualty, I brought up another large quantity of blood and was rushed into theatre where they closed a large number of varices in my oesophagus. It took the doctors hours to sort it out and it was 50-50 that I survived that, according to the doctor,” said Henderson.

“From then I was put on a regime of pills, up to 20 a day, but it wasn’t until September 2004 that I was put on the waiting list for a liver.”

Henderson was put on the list after four days of tests with the proviso that they would have to operate on his heart as he had a ‘murmur,’ which the doctors feared might have a fatal effect on the transplant.

A suitable liver
After almost three years of waiting and endless medication, on February 25, 2006, Henderson received the long-awaited call that they had found a suitable liver. He was operated on that evening.

“My operation was complicated, as I had to have an aortic valve replacement before the transplant. This was done in the same theatre and overall, the procedure took 14 hours.”

After the operation was done, the side-effects of the post-op medication were terrifying for Henderson, who claimed that he became “abusive, foul-mouthed and convinced that the staff were either trying to kill me or were selling my medication. My memories for three weeks must be similar to that of someone on permanent hallucinogenic drugs.”

He was in hospital for eight weeks. However, four weeks into recovery, his heart beat had to be corrected, he became diabetic and his kidneys collapsed. He also had fluid on the lungs.

Once that was in order, he had to learn to walk again, after spending so much time on his back.

Back to surgery again
Four months later Henderson suffered another set-back when he was rushed back into hospital with excruciating stomach pains. Scar tissue had in effect twisted and blocked his bowel. He had another minor operation to sort this out and has not looked back since.

More than one year down the line, he has a new lease on life and said, “I am in awe of the remarkable things that super surgeons can do and of how much the body can take and survive. Without this operation I would not be here today.”

Liver transplants have been in the news a great deal lately since Health Minister Manto Tshabalala Msimang had her liver transplant done on 14 March this year.

A few liver facts
But what is it all about? Who is at risk and what causes a liver to become so damaged that it needs to be replaced? We dispel some myths and answer your questions:

  • The liver is the largest organ in the body and is essential for keeping the body functioning optimally.
  • It removes/neutralises poisons from the blood, produces immune agents to control infection, removes germs/bacteria from the blood and makes proteins to regulate blood-clotting while also producing bile to absorb fats and fat-soluble vitamins.
  • You cannot live without a functioning liver.

Cirrhosis of the liver
In South Africa, chronic alcoholism is the most common cause, although there are other conditions which can cause it too, such as:

  • Chronic hepatitis B, C and D: Hepatitis B is the most common cirrhosis cause worldwide and, like hepatitis C, causes inflammation of the liver which can lead to cirrhosis. Hepatitis D also affects the liver, but mostly in those who already have hepatitis B.
  • Autoimmune hepatitis: occurs when one’s own immune system attacks the liver.
  • Inherited diseases: Diseases such as Wilson’s disease and hemochromatosis can affect the way the liver works.
  • Alcoholic liver disease: Develops after more than a decade of heavy drinking and varies between individuals, leading to cirrhosis by injuring the liver.
  • Non-alcoholic steatohepatitis (NASH): Associated with diabetes.
  • Blocked bile ducts: This can lead to damage of the liver tissue. Often caused by primary billary cirrhosis in which the ducts become inflamed, blocked and scarred.
  • Drugs, toxins and infections: Severe reactions to prescription drugs, prolonged exposure to environmental toxins, or parasitic infection schistosomiasis, and repeated heart failure with liver congestion.

Can it be prevented?
Due to the many different types of liver problems, most cannot be prevented. Although following a healthy, balanced diet and avoiding alcohol are essential.

How is it treated?

  • Cirrhosis of the liver is irreversible, although often treatment of the underlying liver disease may slow down, or sometimes stop, its progression.
  • It depends on the type of cirrhosis.
  • Treatment also needs to include remedies for the complications which arise as part of the cirrhosis.

When is a transplant the only option?
When the symptoms cannot be controlled, or the liver is too damaged from scarring to function effectively.

How long is the current list in SA?
According to the Organ Donor Foundation (ODF), there is no way of estimating how long a person can be on a waiting list for an organ as there are a number of issues to consider such as their specific condition (they could be stabilised and react well to the medication/ treatment they are on) and you could also have someone come onto the list whose condition is life-threatening.

Facts on liver transplants

  • There are three major factors which determine the success of a liver transplant: donor age, how urgently the recipient needs the liver and the length of time a liver is cooled between procurement and transplant.
  • According to the ODF, the first liver transplant in South Africa was carried out it in 1987, but the official transplant programme started in 1989.
  • The ODF estimates that up until December 2006, 185 people in South Africa have had liver transplants.
  • 80 – 90% of people who have liver transplants survive.

(Amy Henderson, Health24, August 2007)

Read more:
Liver dialysis on horizon
Why a liver transplant?

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