The Sacrifice

Debate Over Risks And Benefits Of Living Donor Liver Transplants

More than 17,000 Americans with serious liver disease are on a waiting list for a new liver; nearly 2,000 of them will die within a year, still waiting.

Mount Sinai Hospital in New York City has been a leader in performing a transplant operation that may save them. It is both daring and dangerous: the patient gets a new liver, not from someone who recently died but from a perfectly healthy person willing to sacrifice his or her own life for a person they love. But Mount Sinai has been shut down from doing these lifesaving operations because of the death earlier this year of one man who was trying to save the life of his brother. Dan Rather reports.

"My husband wanted to do this. He felt he had no choice. This is his only family member left. His parents are dead, and he has no other siblings. And he didn't want his brother to die," says Vickie Hurewitz, the widow of Mike Hurewitz, the man who died in January after donating part of his liver to save his brother, Adam.

The two brothers always stood together. When Mike married Vickie in 1991, Adam was the best man. Earlier this year when Adam was dying of liver disease, Mike volunteered try to save him. Vickie agreed with the decision.

At the time, Adam was 54, a doctor on Long Island. Mike was 57, and a reporter at the New York Post.

"If he could save his brother's life, there wasn't a question. It had to be done. It wasn't something to weigh, it was something he would do," says Mike's colleague Deb Orin.

The operation is called a living donor liver transplant. Surgeons must first remove over half the liver from the healthy donor, place it into an ice-water bath for preparation, and then transplant the liver section into the sick recipient. Both liver sections should grow back to normal size in both patients but for the donor, losing a majority of the liver poses immediate dangers - about a 10 percent risk of serious complications and a one percent risk of dying.

The surgery for the Hurewitzes was performed at Mount Sinai, which had done more of these operations than anywhere else. The surgeons who performed the operation declined to speak to us. But hospital President Dr. Larry Hollier agreed - as long as he followed his lawyer's advice not to talk about the specifics surrounding Mike Hurewitz's death.

This is a relatively new procedure, even for modern medicine, he says. "It is a more complex procedure, and it is somewhat challenging for the patient and the surgeon, because you're taking someone who is in essence perfectly healthy and subjecting them to a margin of risk," Hollier says.

"There are not enough cadaver livers available for the massive need that is there. At Mount Sinai, we have over 800 patients waiting for a liver transplant. Last year, we did about 200. Roughly 20 percent of the patients die waiting for a liver, a liver that never comes," says Hollier.

Both brothers were looking good, coming out of their operations. Twenty-four hours later, Vickie was still happy with Mike's condition.

But a day later, Mike took a turn for the worse: "He was hiccuping, he was nauseous, he was - he was uncomfortable. He looked horrible. His color was like greenish yellow." By the next day, she says, he was spitting up blood.

Adam's wife ran down to the intensive care unit to find a doctor. But the physician in charge couldn't be located, and by the time a doctor did come up, Mike was unconscious and his lungs had filled with blood. He died.

Mike's death helped prompt an investigation by the New York State Department of Health.

Dr. Antonia Novello is the health department commissioner, and the Mount Sinai investigation became the largest in her department's history. In a scathing report, Dr. Novello found that the surgery – which is the difficult part - was first-rate, but that the aftercare – which should be routine – was "woefully inadequate."

The commissioner found that Mike's vital signs were poorly monitored, that the first-year resident on duty, who had been on the transplant unit for less than one month, was caring for 34 patients, and confessed to feeling "overwhelmed." When that senior doctor was finally found, he saw another patient instead of Mike.

"It surprised me very much that, according to the record, the first-year resident had contacted the higher up, which was the fellow in charge. And apparently there was a delay in connection between both of them for three hours," says Novello.

Mount Sinai said it would voluntarily suspend the operation. Novello gave them six months to take corrective action. But then she heard so many other complaints that she extended the ban indefinitely. Hollier says his hospital has taken actions to ensure patient safety and is cooperating fully with the state investigation.

Vickie Hurewitz is suing Mount Sinai for malpractice. She also wants the operation suspended not just at Mount Sinai, but everywhere.

Others disagree with her idea – strongly. They say the operation has saved many lives, and one mistake shouldn't cost others their lives.

John Vilardi, who received a liver from his sister Felicia, worries that people are dying while the Mount Sinai program has been suspended. Whether or not people are dying is open to question, because Mount Sinai's cases now are being referred to other hospitals.

Donors are willing to take huge risks. According to a medical survey, potential donors will accept a risk of dying as high as 21 percent to save the life of a loved one. Sixty percent say they would prefer to die offering a liver if it means a loved one will live.

"To be honest with you, there wasn't a number that was going to change the way I felt about it," says Vincent Betts, a delivery driver and salesman for Frito-Lay. He gambled with his life to save his friend Harvey Davis, a fourth-grade teacher.

"Vince didn't hesitate," says Harvey. "He stepped right up and said, 'I want to do this for you. You're a good friend of mine. I love you. You've helped me out in the past. I want to help you out. Let me do this for you.'"

Tony Scro was 55, dying of liver cancer. Tony's oldest daughter Elyse volunteered for her father, only 10 weeks after delivering her second child.

What did Elyse's husband think of her decision? "He knew being in my position, he would do the same thing. I mean, if you look at the other option. I'm supposed to sit there and watch my father get more and more sick and die?" she says.

That seems to be how Mike Hurewitz was feeling about his brother.

Now though, his widow is angry: "He understood that there were risks involved with the surgery. What he did not understand or was never told, that there was to be no care offered to him after the surgery."