A Mother's Gift of Life

By Barbara Dolan/Chicago

Like some 150 other young children in the U.S., 21-month-old Alyssa Smith was waiting for a new liver, her one chance to avoid death at an early age. Her prospects did not look bright, since the supply of livers taken from cadavers and suitable for transplant is critically slim. But last week a team of surgeons at the University of Chicago Medical Center gave the little girl from Schertz, Texas, her chance to live. And what seemed truly miraculous about the operation was the source of Alyssa's new liver: her mother.

In a 14-hour procedure, the surgeons removed the fist-size left lobe from 29-year-old Teresa Smith's liver and transplanted most of it into her daughter. The revolutionary technique -- transplanting a liver from a living donor -- had been performed in Brazil, Australia and Japan, but this was the first time it was tried in the U.S. Doctors have had a great deal of success in kidney, pancreas and bone-marrow transplants from living donors, and hope is rising that the liver will join that list. Says Dr. Christoph Broelsch, who led the Chicago transplant team: "This surgery potentially opens up a whole new pool of donor organs for infants. It's the first step in answering the problem of juvenile organ shortage."

So far, both mother and daughter are doing well. Because the liver has the power to regenerate itself by forming new tissue, Teresa's liver should grow back to its normal size. Similarly, baby Alyssa's new liver should grow as she does.

The operation was not without serious complications. While the surgeons were removing part of Teresa's liver, they tore her spleen and decided they had to remove it. The loss of the spleen means she will be slightly more susceptible to infections, and may have to take antibiotics for the rest of her life. To gain access to the liver, the doctors also had to remove Teresa's gall bladder. As for the baby, she had to undergo a second operation to stop bleeding from her new liver. The doctors hope Teresa can be released from the hospital this week and that her daughter will be home for Christmas.

The dangers inherent in such complex transplants pose ethical dilemmas for the medical community. University of Chicago ethicists and physicians spent a year discussing whether doctors have the right to ask healthy parents to donate portions of their vital organs, even if it means saving the life of their child. Critics argue that there is no way parents can refuse such a request when under the pressure of having a dying child. For that reason, university officials required a two-week delay between the time Teresa and her husband John signed the consent forms and the date of the transplant, so that the family could reconsider the decision. "It was purely voluntary," says Dr. Peter Whitington, a pediatric hepatologist on the transplant team. "I think this mother, even if she had greater complications, would believe she did the right thing. I believe this father, even if he lost his wife, would believe he did the right thing."

Some families may not want to have two members undergo major surgery at once. But for the Smiths, the risk was well worth the possible returns. Says Teresa: "Once you've given someone a big piece of your heart, it's easy to throw in a little bit of liver."

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CREDIT: TIME Diagram by Cynthia Davis

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