By Jeff Kelley

As an Air Force commander and “human performance specialist,” Adam McLean uses his Ph.D. in performance psychology to coach others — soldiers, airmen, businesspeople — to succeed in high-stress situations.

And this year, he’d need a dose of his own medicine. It was late summer 2020, and Adam and Melissa McLean had started preparing for his end-of-life care.

Diagnosed with cirrhosis more than a year earlier, Adam’s liver scarring had progressed to late-stage liver failure. Doctors in Orlando told him there was nothing they could do. So Adam, a 52-year-old Air Force veteran, had gone home to — as the doctor put it — “enjoy your family.”

Back home, the McLeans worked with a nurse to make Adam’s last few weeks comfortable. Frustrated with the devastating forecast, the nurse inquired as to whether they’d talked to a doctor at the Veterans Health Administration. The McLeans hadn’t considered it.

“I called the VA, and by the grace of God, saw a doctor there, and two days later we were admitted to the ICU,” Melissa recalled. Physicians at the VA determined Adam was indeed a candidate for a liver transplant. On September 12, they were transferred from Orlando to the Central Virginia VA Health Care System (CVHCS) in Richmond.

Nine days later, in an overnight surgery at VCU Medical Center, Adam was given a “second chance on life” with a liver transplant.

Long-standing partnership for veteran care

That second chance was made possible by an anonymous donor and a VCU Health care team that included Dr. Marlon Levy, chair of the Division of Transplant Surgery and director of VCU Health’s Hume-Lee Transplant Center. He is one of the many VCU faculty, medical students, and fellows who regularly visit the CVHCS to treat veterans at the 399-bed South Richmond facility. VCU has a long-standing academic and medical partnership with the health system. 

CVHCS is one of only six VA centers in the nation for liver transplant patients. And that’s why Adam and Melissa, who were married in late August when they believed his time had come, found themselves “honeymooning” in Richmond this fall.

A blurry summer amid a blur of a year

Lt. Col. Adam McLean, a 1991 U.S. Air Force Academy graduate, spent 10 years piloting KC-135 air refueling aircraft. He’s worked on various bases over the years and is in the process of retiring from the Air Force Reserve.

Despite his spring 2019 cirrhosis diagnosis, Adam felt fine for several months — but things took a turn this summer. “My physical appearance was changing, my cognitive ability was changing, and my attitude and demeanor was changing,” Adam recalled. Melissa recalls his personality as “salty.”

After visiting doctors in Orlando, they found he was in advanced liver failure. Adam’s Model for End-Stage Liver Disease (MELD) score — which ranges from 6 to 40 and measures severity of liver disease based on lab tests — was so high those physicians believed he would not be a transplant candidate.

By the time the McLeans arrived in Richmond by mid-September, Adam was extremely ill. “He was at death’s door when he came to us,” Dr. Levy said. Liver failure quickly leads to additional conditions, and Adam had gastrointestinal bleeding and temporary brain damage (encephalopathy). He required dialysis for kidney failure and breathing support with a ventilator. 

The VA healthcare system and UNOS (United Network for Organ Sharing) prioritizes transplant candidates based on the progression of their illness. “He was at or near the top of our list based on him being literally days away from dying,” Dr. Levy said.

A turn for the better at Richmond’s VA

Adam was stabilized five miles northeast of McGuire VA at VCU Medical Center. Once stable, he was put under the care of doctors at the Hume-Lee Transplant Center, home to one of the busiest transplant programs in the nation. Last year alone, the center performed 87 liver transplants, a calendar year record for VCU Health. Even amid the COVID-19 pandemic, the center has safely continued transplants. In September, it celebrated its 100^th liver transplant of 2020.

With Adam bedridden at VCU Health, Melissa met with Dr. Levy, the surgeon who would help lead the diverse clinical team to greenlight his transplant. Candidates must meet a series of guidelines based on lab tests, X-rays and interviews with members of the liver transplant team.

“I was petrified. I thought it was over for us. I was sitting in the office and Dr. Levy came in and sat down and looked me in the eye and said, ‘I think he’s a great candidate,’” Melissa said. “He had an upbeat tone in his voice. I just melted on the spot.”

The transplant selection committee approved Adam’s transplant, which took place the evening of September 21 and into the 22nd.

“The team at VCU Health and McGuire have been amazing. Everyone from support staff to administrators to the nurses and doctors and surgeons and interns — they have all had a smile on their faces and remained upbeat. They made it as easy and enjoyable as they could,” Melissa said. “This has truly been a gift — for him, for us, for our seven children.” (The McLeans have a blended family of seven kids.)

“To be given that chance and new lease on life is absolutely humbling,” Adam added. “The people who are organ donors, and then the professionals who can make the transplant happen, are truly doing amazing work and are genuinely selfless.”

Continued care under VA system

Adam’s prognosis is excellent, Dr. Levy said. Today — Veterans Day — at less than two months from surgery, “he’s not through the tunnel, but he’s well on his way,” Dr. Levy stated. On the day of Adam’s transplant, his one-year survival rate was 90 percent; today, it’s closer to 95 percent. 

A year after transplant, the survival rate for the next five years is 90 percent. After two years, the probability of five more is 95 percent. Based on publicly available data ,VCU Health’s estimated probability of surviving at one year and three years is at or above national averages.

When he’s cleared to leave Richmond, Adam will return to Orlando under the integrated VA health care system. His team in Richmond will coordinate his care with the Florida team. He will be followed by hepatology and liver specialists who will have his records from Hume-Lee and will remain in contact with the team here as needed.

“As physicians and health care providers, many of us feel a particular commitment to veterans because of their service to the country and the tremendous risks and sacrifices they and their family have taken,” Dr. Levy said. “All of us who practice medicine feel veterans deserve nothing less than the most advanced, sophisticated care that America has to offer.”

And perhaps Adam, as a hard-nosed commander, had another ace up his sleeve beyond his world-class care team: A doctorate in dealing with overwhelming odds.

Throughout his transplant journey, “I have used every strategy and technique as far I know to regulate breathing, regulate thought process, regulate emotional responses, to recognize what your body is telling you, to accept things for what they are, and bring it all back to a neutral or sustainable state,” Adam said.

So did his own methods work? “It’s gotten me this far,” he said with a laugh.

For more information on our transplant services, please visit the VCU Health Hume-Lee Transplant Center.