When Bobby Click learned from his wife, Kristie Click, a staff member in the University of Colorado Department of Medicine, that a person could donate a slice of their liver to save a stranger’s life — particularly a young child’s life — his wheels began turning.
Always on the look for ways to give back to others, he began researching the Living Donor Liver Transplantation Program at the University of Colorado Hospital, led by transplant hepatologist and CU faculty member Whitney Jackson, MD. The more he researched, the more convinced he became that he wanted to donate part of his liver.
“My philosophy is that people should always look for chances to help others, and I try to teach my kids that it’s not always about doing what is easy,” says Click, a 40-year-old father of two sons, ages 7 and 9. “This is an opportunity to have a huge impact on someone’s life, and that means a lot to me. It’s also a chance to spread the message about this process and hopefully inspire more future donors, because the need will always be there.”
Thousands of people need a liver transplant for a multitude of reasons. A major issue with liver transplants is that, unlike patients in need of a kidney who can go on dialysis until they get a transplant, for patients with liver failure, there is no bridge to transplant, explains Jackson, an associate professor in the CU Division of Gastroenterology and Hepatology.
“Once a patient is on the waitlist, there is still a huge gap between the number of people waiting and the number of organs available. Unfortunately, almost 20% of people die while waiting for a liver,” Jackson says. “A living donor adds to the organ pool and offers transplant candidates access to an organ without them having to wait to get so sick. Often, living donors step forward for a specific recipient, but non-directed donors like Bobby allow a piece of his liver to go to someone in need based on their size and blood type matching. It’s a game changer and an amazing gift.”
Determined to improve the transplant process for donors and recipients alike, CU has built a reputation as an innovative leader in transplant hepatology. The institution is widely recognized as having the longest-running liver transplant program in the world, with Thomas Starzl, MD, a former CU faculty member, performing the first successful liver transplant in 1963.
“That’s the amazing thing about working here. When I’m talking to a potential donor, I can tell them with complete confidence that they are in the best hands possible,” Jackson says. “This is the best place to do this.”
For decades, liver transplants traditionally consisted of patients getting a new liver from a deceased donor. However, because the liver has the unique ability to regenerate itself, physicians discovered it was possible to remove a portion of a living person’s liver and transplant it into a person needing a new liver. To be a match, the donor and recipient need to have a compatible blood type and liver size. In 1997, the first adult-to-adult living donor liver transplant in the United States occurred at CU.
Many living donors know who they are giving part of their liver to, but there are other donors — known as non-directed donors, altruistic donors, or anonymous donors — who will donate part of their liver to a stranger. In 2017, CU was approached by its first non-directed living liver donor, and since then, at least 55 non-directed donors have completed a donation at CU.
Jackson explains that living non-directed donors are especially helpful in getting liver donations to people who traditionally struggle to find a donor match, such as adult petite women, adults with autoimmune disease, and young children. To help care for children who need a liver transplant, Jackson and her colleagues work closely with Children’s Hospital Colorado to coordinate donations.
“Children, especially those under the age of 2, are so small that they can’t receive most livers that become available through deceased donation because the liver is too big, and it is very difficult for surgeons to cut it down to the right size,” she says. “Living non-directed donors are saving these children’s lives.”
After spending a few months researching the non-directed living liver donor process — the risks, recovery, impact on the donor, and impact on the recipient — Click and his wife began the process of seeing if he could qualify as a donor. Although there is a need for more living liver donors, not everyone will be a match. The transplant program has a thorough and diligent vetting process that assesses people’s physical and mental health.
“This is a major abdominal surgery that we take very seriously,” Jackson says. “We aim to keep the risks as low as we can, and we will be honest with a donor if we don’t think it’s the best thing for them, so there is a reasonably high rule-out rate.”
To become a living non-directed donor, a person will first complete a questionnaire online and will be contacted by the program’s living donor coordinator.
“If it appears they may be a good candidate, we will invite them to come in for a two-day evaluation where they will meet many members of our team, including our living donor coordinator, a social worker, nutritionist, psychologist, pharmacist, hepatologist, and transplant surgeon,” Jackson says. “This is a stressful procedure. We want to make sure that you're in a place that's as stable as possible and determine if there is a specific way that you need support.”
Potential donors are also assigned an independent living donor advocate, which is someone who works separately from the recipient team to check in with the donor and advocate on their behalf, she explains.
“We never want someone to feel coerced. This has to be a decision that they come to on their own, and we want the donors to know that they can withdraw from the evaluation process at any time,” she says.
During the two-day assessment, the team will also perform a series of tests, including an MRI and CT scan that are sent to Europe for 3D reconstruction so the team can digitally see what the donor’s liver looks like and where it can be safely surgically divided.
“If we see something that looks like it’s higher risk, then we will do a biopsy,” she says. “We may also do heart testing or lung testing for people with certain risk factors, because we want to be very careful. This surgery does have risks.”
Click has been pleasantly surprised at how thorough the vetting process has been, saying he appreciates that Jackson and other members of the transplant team have been honest about the difficulties the surgery poses. He has completed the two-day assessment, and the initial tests indicate he may be a good candidate, but there were some concerns about potential markers for an autoimmune disease. He will get a liver biopsy to ensure that he is able to proceed with becoming a donor.
If he is ultimately approved, the transplant team will work to find the best possible recipient match on the CU Anschutz Medical Campus. Click expects his transplant surgery will occur later this year if he is approved. It usually takes up to three months to recover. Although there are some nerves about undergoing serious surgery, he says the fears are worth it.
“I know there will be a few months of discomfort and pain, but this will be absolutely life changing for the recipient. I can’t think of a more impactful way to give back,” Click says. “I’d love to see more people understand that this is an option, and I encourage anyone who is interested to reach out to learn more.”
Photo at top: Bobby Click smiles with his wife, Kristie Click, and his two sons. Image courtesy of Kristie Click.