During Alexanders donor screening it became quite clear that if we wanted him to survive, hard choices needed to be made. For a child his age, the chances of getting a liver from a diseased donor are slim. So the only other option would be a living donor. Both me and Zuzana immediately volunteered.
But it’s not that easy. We both had to take a blood test, and see if we had matching blood types. And we both did. Then we had to make the difficult choice of who would be the donor. Only one person would go through the full screening procedure.
The choice between a live and a dead donor is a calculation of risk. Ideally you have a dead donor. Your margin for error in cutting away the parts needed is just larger than with a live donor. Also it has the practical benefit of not endangering the life of a healthy person. However, for small children it is hard to find a match. Ideally it would be a donor child of the same age, with the same size, though healthy liver.
Also the circumstances of death are important: ideally the donor child would be brain dead when arriving in the hospital. If the donor would be worked on in the hospital for too long, the liver gets considered not suitable. That basically limits your donors to children that drowned or died under similar circumstances. Thankfully, that’s rare.
A disadvantage of a dead donor is that there’s no time to do extensive tests. Every moment the liver is on ice it degrades. With a live donor you can do a lot of compatibility testing, and be really sure about a lot of factors before you begin the operation, so you mitigate the chance of complications. And as a bonus you can really limit the time the organ is outside of the body.
So the doctors hope for a diseased donor to become available, and plan the live donation in the mean time.
After all we decided that I would go through with it.
This meant I had to come to the hospital in Groningen for two days, and undergo a thorough screening. For the first time in my life I would be admitted to a hospital, and have to spend the night there.
Arriving at the hospital they took a huge amount of my blood for tests. I wasn’t allowed to eat that morning, because i’d have a CT-scan later in the day. So I almost passed out from that. Great start!
I would be based on the stomach-, intestine- and liver department. A department that knows how to handle sick people really well, but the procedures become silly when you deal with healthy patients. I wouldn’t spend much time in my room though.
The CT scan was quite an event. I got hearing protection and then shoved in a big radioactive tube for half an hour. I found it quite enjoyable. It was very noisy and it was interesting to see how everything was done. The CT creates sliced images of the body, enabling the doctors to see a 3d image of my liver. Besides a CT scan, I got an MRI done. A smaller less radioactive tube. Just like Alexander a few weeks before. I got an IV with contrast fluid and had to lie in an awkward position for a few minutes. The contrast fluid coursing through my veins was a very strange experience; suddenly all your veins become really warm. The MRI creates a map of all the protons in the body, and as such giving an idea of the state of various tissues in the body.
After that I had more blood taken, and an echo. The echo is like a sonar. By measuring the response, it can see how flexible the liver currently is. The more flexible, the less scarring and thus healthier the liver. Mine was in excellent condition. The rest of the two days was filled with conversations with doctors on what the procedure meant.
The conclusion of all of this was that my liver was in an excellent condition. The shape was a bit funny, it’s apparently quite long. They hadn’t seen that before. There were no negative results from the tests, so this allowed the doctors to proceed and pick a date for the surgery.
That would be November 14th.