Transplant trailblazers

By John Miner

Copyright 2008 The London Free Press

July 12, 2008

They were young, scared and knew they were near death. Twenty-five years later, they're regarded as heroes -- the first women to receive liver transplants and survive in Canada. "They stared death in the face and came out winners. Each one of them was a pioneer and a heroine in her own way for what she did," said London transplant surgeon Bill Wall. They also put London on the map as an international transplant centre at a time when many other hospitals were suspending their transplant programs because of early failures.


The London Health Sciences Centre, which now includes University Hospital where the surgeries took place, hopes to bring the women together this summer to celebrate their historic surgery and the lives they went on to live.

Two of the women came through the surgery to pursue careers as nurses, one still working in London and the other in Thunder Bay.
A third is an X-ray technologist in LHSC's cardiac program and the fourth returned home to Cape Breton, N.S., to raise a family of four.


"Some days you have drudgery and disappointments and I just think of those ladies. You chat with them on the phone, and they serve as such an inspiration, not only to myself, but to all of us who come in contact with them," said Wall, who performed the life-saving surgery on the women. "They are spectacular examples of what can be accomplished with transplantation."


Going into their operations, the four women were very aware the first three attempts at liver transplants in Canada had ended with the patient's death. But without the surgery, the women faced certain death. "It was pretty scary, it was really scary," said Jane Johnson, who was 25 when she had her liver transplant. "Because I was first, it was just uncharted waters for everyone. We just had to keep going on the faith."

Wall said he's not surprised the women were fearful. "Absolutely, it was experimental," he said.


While other medical centres in Canada that tried liver transplants had suspended their programs by the early 1980s, London kept going.


The breakthrough that helped the women survive 25 years ago came with the discovery of cyclosporine, an anti-rejection drug.
"Cyclosporine represented a quantum leap in transplantation because of its selective effect on the immune system in preventing (organ) rejection," said Wall. "But we didn't have effective ways of monitoring the blood levels of the drug. We were basically flying by the seat of our pants in the way we dosed it."

Today, with additional anti-rejection drugs and sophisticated monitoring techniques, transplant patients no longer face the daunting prospects the four women did a generation ago. "Transplantation is very reliable today, it is no longer experimental," said Wall. "The results are such that we expect success in 90 per cent or more of cases for most organ transplants."


The problem now is one that didn't exist for the women -- a shortage of organs. "When those ladies had their transplants, there was enough donated organs because the numbers being done were relatively few. "Now, there are so many patients waiting for organ transplants," said Wall. "The disappointing thing today is we have this wonderful, life-saving treatment and we can't give it to everyone who needs it."


HEATHER FISHER
Occupation: Nurse
Home: London
Transplanted: April 23, 1983
Age at time: 29
Quote: "It truly does give you a second chance at life and you make the most of it. For me, it honours the person that gave me their liver."


Heather Fisher knew two things in 1983 when she worked as an intensive care nurse at a London hospital.
She knew the city's fledgling organ transplant program had done several liver transplants with only one patient surviving. She also knew that without a transplant, she had only a short time to live. "When you are told that, you take the bull by the horns and move forward," she said.
Fisher first became ill with an auto-immune disease that attacked her liver when she was 14. Ending up in a coma, she almost died. The disease left her with a liver so badly damaged, it could never repair itself. By age 29, her liver had deteriorated to the critical stage.
The first time Fisher was called to the hospital for a transplant turned out to be a trial run. "They said, 'Sorry, Heather, not a match.' " The next time, she was transplanted. Fisher said the operation went "fabulous, absolutely fabulous," but she still had a few bumps in her recovery. It was two months before she was discharged from hospital.


Now, liver transplant recipients are discharged in about two weeks.
Fisher said she's never looked back since her operation. Seven months after the surgery, she was back on the job working 12-hour nursing shifts. "I went back to a normal life, able to work, able to do all kinds of things, any sporting activities I wanted to do. "I really don't feel I have anything that prohibits me from doing what I would like to do,"she said. Fisher continues to work as a nurse clinician for acute pain at Victoria Hospital.


JANE JOHNSON
Occupation: X-ray technologist
Home: London
Transplanted: Nov. 17, 1982, the first to survive a liver transplant in Canada
Age at time: 25
Quote: "It was pretty scary, it was really scary. Because I was first, it was just uncharted waters for everyone. We just had to keep going on the faith."


When Jane Johnson fell ill with auto-immune hepatitis at 23, she was told she might need a liver transplant a long time in the future.
"They discussed it with me, but said, 'Don't worry, it is 10 years down the road. By then there will be so many advances, there will be an easier process in place to have this done," she recalled. Two years later, she received the shocking news she needed a transplant right away because of her rapidly deteriorating liver. There'd never been a successful liver transplant in Canada, and few had been done anywhere. "It was pretty scary, it was really scary," said Johnson. "Because I was first, it was just uncharted waters for everyone, we just had to keep going on the faith. "I kind of thought, 'If I am going to die, I am just going to sleep and I won't wake up.' "
The good news was that the fast onset of her illness meant the damage was isolated to the liver. Unlike earlier transplant patients who'd died, her other organs were in good shape. "I would have been the prime candidate to survive if one could survive," she said. Johnson survived, but it was rough going.

After her first transplant, an artery to the new liver clotted. When surgeons operated to bypass the clot, they found parts of the liver were dead. On Nov. 27, she had a second transplant. Johnson remembers the surgeon, William Wall, visiting every morning and night and her family every day from St. Marys and Dorchester. "That is what got me through. I just felt I couldn't disappoint everyone who worked so hard to save my life," she said. Johnson was four months in hospital before being well enough to be discharged. She now works as an X-ray technologist at LHSC. "I am not a daredevil, I've tons of friends, love football, sports, going to shows. I just try to live my live so the person who gave me this opportunity would be proud of the life I am living."


JANE NEUDORF
Occupation: Nurse
Home: Thunder Bay
Transplanted: June 17, 1983
Age at time: 29
Quote: "June 17 is actually a second birthday for me. I can't help but remember it every day."


An ailing Jane Neudorf was on her way to vacation in Hawaii with her mother when she stopped in Winnipeg to see a specialist.
She didn't get any farther. "He said, 'You can't go to Hawaii.' I said, 'Yes I can, I am going with my mother. She has the ticket.' "Then he called my mother into the waiting room. He said, 'You can't take her, she is going to die on the flight.' " Following rounds of medical tests, Neudorf was given a prognosis she couldn't easily accept. "He told me there was no hope for me, that I would be passing away. It was basically, you are going to die, accept it." Neudorf had read an article in Life magazine about pioneering liver transplants performed in Boston. When she raised the possibility of a transplant, with her doctor, she was told the work was just on the edge of discovery and there wasn't much real hope. "I said to him, 'What do you mean hope? I don't have anything now, so what do I have to lose?" She insisted the doctor write to the Boston surgeon. The next time she saw him, he was excited to tell her he had a reply and there was a surgeon in Canada who was actually doing liver transplants, a William Wall in London. "I was so excited, I was quite overjoyed. I said, 'Wow.' I thought if I'm going to die, I may as well die in Canada. This is my home.' " After her surgery in London, Neudorf returned to her home in Dryden and became a nurse. Later moving to Thunder Bay, she now works full time on a rehabilitation floor with patients who have had hip and knee surgery.


MARJORIE KEATING
Occupation: Homemaker
Home: Cape Breton, N.S.
Transplanted: Aug. 28, 1984
Age at time: 34
Quote: "They were just excellent," she says of the caregivers at University Hospital.


On the flight to London from Nova Scotia for her liver transplant, Marjorie Keating lost consciousness.
"I had got really bad," said the Cape Breton mother of four children who were six, 10, 12 and 13 years old at the time. She was 34.
As her condition deteriorated in the weeks before her transplant, Keating's husband pushed medical officials to take action. At the time, London was the only place in Canada performing liver transplants, an operation many viewed as entirely experimental. "It was scary," said Keating. But like other early transplant recipients, she had no other option. It didn't go smoothly.


Keating's body rejected the first liver transplant and she required a second transplant. Decades after her surgery, Keating still has praise for the medical care she received at University Hospital. Keating said her health has been great in the years since the transplant.


A TRANSPLANT LEADER
Within six months of opening in 1972, University Hospital performed its first kidney transplant. Added to that were liver transplants in 1977, heart transplants in 1981, small bowel transplants in 1988 and lung transplants in 1989. The first bone marrow transplant was performed in 1989 to treat a patient with leukemia. By 1987 the hospital established itself internationally as a centre for multi-organ transplantation.
Transplant firsts at UH:
1977: First liver transplant in Ontario.
1981: First heart transplant in Ontario.
1983: Canada's first heart-lung transplant.
1983: First pediatric heart transplant in Ontario.
1984: First pediatric liver transplant in Ontario.
1988: World's first liver-bowel transplant.
1993: Canada's first parent-to-child living donor liver transplant.
1997: World's youngest multi-organ recipient.
2000: Canada's first adult-to-adult living donor liver transplant.

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