By Jeff Kelley

During the month of April, VCU Health News will be publishing a series of stories to mark National Donate Life Month, a national effort to spread awareness about the importance of organ, eye and tissue donations.

When he got word an old friend needed a liver, Henry Chambers III didn’t hesitate taking action. I called VCU, and I was pretty much in the front of the line at that point,” he said.

With his age, then 58 years old, and blood type a match, Chambers became the top candidate to donate a liver to his friend, Robert Redman, whom he’d met decades prior while both worked at NASA Langley Research Center in Hampton, Virginia.
There was never a reason to not continue with the living donor process,” Chambers said.

In doing so, the Hampton man became one of more than 800 living donors under the care of Vinay Kumaran, M.D., during his career. The 800 mark is one that Kumaran, VCU Health Hume-Lee Transplant Center’s living liver surgical director, crossed late last year after joining the health system in 2019 to restart the living liver donor program.

Virginia is one of 25 states with medical centers that perform living donor liver transplants, according to the Organ Procurement & Transplantation Network. Of the nation’s 603 living liver donations in 2022 — a figure that has doubled since 2014 — 31 were done in Virginia. VCU Health performed 21 of them.

When a person requires a liver transplant, they join a list of 11,000 others who are prioritized by those who need one the most. With 9,000 liver transplants in the U.S. each year, liver demand outweighs supply, and some won’t survive the wait. But the list can be bypassed entirely if a living donor, like Chambers, is found.

The idea of doing living donor transplants is to eliminate the waitlist mortality,” Kumaran said.

Pioneering robotic assisted surgeries make VCU Hume-Lee Transplant Center an uncommon place to receive care.

Joel Wedd, M.D., Hume-Lee’s medical director of liver transplant, says Chambers coming forward was a huge turning point for Redman. Despite being very ill from liver disease, he did not have a high enough Model for End-Stage Liver Disease (MELD) score — which ranks patients nationwide largely by those who need a liver the most — to put him in a spot where he’d get an organ anytime soon.

“A longer wait can leave open the opportunity for developments that could derail the transplant process,” Wedd said.

And since living-donor transplants are elective, the surgical team and patients could plan ahead of time — compared to a deceased donation, where transplants must occur within hours and every minute counts.

“Mr. Redman’s team-based, pre-transplant care was excellent and supported him through his risky pre-transplant course, setting him up for his lifesaving living donor liver transplant,” Wedd said.

Testing, testing, testing

Chambers’ journey to living donation began in early 2022, and included what he described as “a thorough checkup” beyond anything he’d ever had before. The transplant center also builds 3D models of the donor liver from CT and MRI scans to prepare for the surgery. Donors also undergo intensive psychological evaluation.

“The last thing anybody wants is a living donor who has gotten in over their head,” Chambers said. “They give you plenty of avenues to get out of going through with the donation.”
But even with other donors in the wings —  and a mom who, understandably, was concerned —  Chambers felt confident to proceed and had the blessing of his wife and daughter.

 

 

During their hospital stay, long-time friends Robert Redman (left) and Henry Chambers III (right) had a special visit from VCU Dogs on Call. (Contributed Photo)

Benefits and future of living donation at VCU

Unlike using a deceased donor, where the recipient suddenly learns of the organ’s availability and must be transplanted within a few hours, living donation is scheduled, giving donor and recipient time to prepare.

Though Chambers was a blood match, VCU Health is one of few centers to use donors with incompatible blood types to the recipient. Donors in such cases are given Rituximab, a drug to filter antibodies from the organ before it is transplanted, to lessen the chance of rejection.

Hume-Lee has also started offering living donor transplants for patients with liver metastases from colon cancer. This disease is considered a contra-indication to liver transplant, meaning using a deceased donor isn’t a practical option.

Safe, complicated surgery

Chambers’ surgery was August 1. He donated 57% of his liver, which grows back to normal size over a few weeks.

Though low risk, Kumaran says a living donor liver transplant is a much more complex operation than deceased donor transplant. Blood vessels must be reconstructed on the living donor’s organ prior to transplanting the recipient, whereas a deceased organ comes with longer vessels and other properties that make the surgery more straightforward.

“It takes a lot of experience to know how to do a living transplant safely,” Kumaran said.

He joined VCU Health after practicing in India, and notes Asian and European countries are further ahead in protocols surrounding living donor liver transplants, which are more common than using deceased donors. It’s that level of knowledge Kumaran brought to Richmond and allowed VCU Health to quickly ramp back up its program after a five-year hiatus.

Dr. Kumaran is likely the most experienced living donor liver surgeon practicing in the U.S., and bringing him here was critical to reviving our living donor liver transplant program,” said David Bruno, M.D., Hume-Lee’s interim chair.

Kumaran was hired in 2019 by then-head of transplant surgery, Marlon Levy, M.D., interim CEO of VCU Health.

“Experience is the best predictor of good patient outcomes,” Bruno said. “That’s what Vinay brings us. VCU and our patients are lucky to have him.”

 

 

Vinay Kumaran, M.D., (center) performed a living liver transplant surgery on Robert Redman (right). Long-time friend and former coworker, Henry Chambers III (left), provided the selfless gift of a living liver donation to Redman. (Contributed Photo)

Considerations and looking forward

For the average living donor, the hospital stay post-surgery is five to seven days. Chambers stayed for 10 days after developing a minor intestinal obstruction. His surgical scar – “like a shark bite” – starts just below his sternum, to the belly, then hooks to the right. While substantial and something Chambers is treating, body image post-surgery is a consideration for prospective donors, Kumaran notes.

With a physically and mentally demanding job, Chambers returned to work as a licensed massage therapist in January after five months away. The first three months included no heavy lifting, made clear “plenty of times” by transplant coordinators, Chambers says.
A man brimming with positivity and goodwill, Chambers remarks that he has come away from the surgery with a better perspective on life and on illness.

There’s more to recovery than the physical healing of the body,” he said. “I had to take time to find more spiritual, deeper, healing.”

“I'm more,” he says of his life now. “I've given myself this opportunity for regrowth and relearning aspects of myself that you won't get unless you put yourself through something [as intensive as organ donation].”

Redman, in an interview with NASA, called Chambers his “Hercules.” It’s a reference to the Greek myth in which the strongman saves the titan Prometheus, who was strapped to a rock by Zeus and sentenced to have his liver eaten by an eagle for eternity.
“[There are] no words to describe this man,” Redman said. “Just a selfless, wonderful human being.”

“Donors are amazing people,” Kumaran said. “It restores my faith in humanity that people will agree to undergo a major operation like this to save someone’s life. All the donors I’ve known have been enthusiastic and gone in with little doubt about the process. It’s amazing how well they recover and how good they feel about having done something to help someone’s life in a profound way.”

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