In the moments leading up to his liver biopsy, as Bobby Click put on a hospital gown and sat in a room at the University of Colorado Hospital, his nerves fluttered. The procedure was the next major step in determining if he was eligible to become a living liver donor.
Click started the process of becoming a non-directed donor (also called an altruistic or anonymous donor) in the spring after he learned from his wife, Kristie Click, a staff member in the University of Colorado Anschutz Department of Medicine, that a person could donate a slice of their liver to a stranger. Driven by a desire to help one of the thousands of people in need of a liver transplant, Click began working with the Living Donor Liver Transplantation Program at the University of Colorado Hospital, led by transplant hepatologist Whitney Jackson, MD.
“I don’t think most people know how serious of a need there is, because I didn’t know until this year,” says Click, whose goal is to donate part of his liver to a child. “I hope people will hear my experience and see how this process has come a long way so we can increase the number of people interested in becoming living donors.”
The transplant program has a thorough vetting process to assess people’s physical and mental health before approving them to be a living donor, because a liver donation is a major abdominal surgery. After going through the initial tests, the transplant team determined Click would need a liver biopsy.
“Generally, we perform a liver biopsy in selected patients before donation when there could be a low but possible risk of liver disease,” says Jackson, an associate professor in the CU Anschutz Division of Gastroenterology and Hepatology. “We believe that while a liver biopsy has risks, it’s a much lower risk than taking out a piece of someone’s liver without being fully confident it is as healthy as possible.”
Click explains there were three factors that led to him needing a biopsy. The first was that during his initial bloodwork tests, there was a marker for an autoimmune disorder that the transplant team wanted to further investigate.
The second contributing factor was that during his second set of labs, Click’s liver enzymes were elevated. Although this was likely due to him getting several vaccines before taking a vacation to Costa Rica, the transplant team wanted to confirm his levels were not too high. Lastly, the team wanted to check the fat content of his liver.
“I’ve never had a liver biopsy before,” he says. “It was a bit nerve-wracking and intimidating, but it ended up being a cakewalk compared to what I had in my mind.”
The procedure Click received was an ultrasound-guided percutaneous liver biopsy.
“A radiologist uses the ultrasound to identify the best location, numbs the abdomen wall, and uses a needle to get a very small piece of tissue,” Jackson says.
Click recalls that he was given minimal sedation, so he was awake for the procedure. The area right below his bottom rib was numbed, and then the doctor brought out “an intimidatingly large needle,” he says.
“It’s a spring-loaded needle, so the doctor told me I would hear and feel a bit of a jolt once he pushes the button, because the needle springs out into the liver and then retracts with a small piece of liver tissue,” he says.
The radiologist used an ultrasound machine to guide the needle into his liver, Click explains. Then, there was a loud pop as the doctor pushed the button.
“I felt it, but it was more of a dull pushing sensation. It was minimally painful,” he says.
Click estimates the procedure itself took less than 10 minutes, and afterward, he remained in the hospital for a few hours to ensure there were no complications.
“From the staff members, nurses, and physicians involved in the procedure, everyone was super helpful with walking me through the process and answering questions. They did all they could to make sure I was as comfortable as possible,” he says, explaining that even the surgical technologist put on music for him to enjoy during the procedure.
The following day, Click experienced minimal soreness, but the day afterward, he felt that he was back to normal.
“Overall, the process was easy peasy,” he says. “I was surprised.”
A day after his liver biopsy, Click got a notification that his results were in. Based on his initial scans of the results, he thought the information was a good sign. Several days later, he received a phone call from Jackson that confirmed his suspicions.
“Dr. Jackson let me know that the liver biopsy results looked great, and she thought there was a good chance I would get approved by the donor selection committee,” Click says.
The donor selection committee is a multidisciplinary team made up of surgeons, hepatologists, nurses, social workers, psychologists, dietitians, and an independent living donor advocate, Jackson explains.
“The team approves a donor when they have completed the full evaluation and are believed to be as safe as possible to proceed,” she says.
A few days later, Click got the news: The committee had approved him to be a living liver donor.
“I started this process back in April, so it was great to get the actual confirmation that everything is good to go,” he says. “It’s definitely exciting, because now we’re in the home stretch.”
Jackson adds, “It’s exciting because Bobby is excited, and we know he will help someone in need.”
Now that Click has been approved, Jackson explains the transplant team’s next steps are looking at three factors — blood type, liver size, and degree of illness — to find the best liver recipient, as it needs to be someone who will have compatibility with Click’s donated piece of liver.
“Often, we are able to approve and allocate to a recipient immediately. Other times, we have to wait for the right recipient,” she says. “In Bobby’s case, we were unable to allocate right away, but we feel hopeful we will be able to in the future.”
In the meantime, Click plans to maintain a healthier lifestyle, including eating healthier foods and regularly exercising, as he waits for a match. He is also having more conversations with his two young sons about the process.
“I can see the boys are nervous and excited. My eldest son, during his first day back at school, he told people I would be donating part of my liver to somebody, and his teachers told me how proud he is,” Click says. “For me, part of this journey is setting an example for my kids that we can do difficult things even though we might be nervous or scared. We can push through that to really help someone.”