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Bruce Smith

Facing permanent brain damage, patient turns to UK for unlikely answer: a liver transplant

In 2011, Bruce Smith sat in his office preparing to make handouts for a meeting, like any other normal work day. But when he sat in front of his computer, he suddenly realized something frightening: He’d lost all understanding of how to use the machine. Bewildered at the sudden lapse in cognition, he said his coworkers thought he was joking around.

“I finally said, ‘I’m serious!'” Smith said. “‘There’s something going on here.'”

That moment was the first of many “lapses” to come. Smith was a diabetic, and his doctors initially thought his mental fog episodes were due to low blood sugar. When that was ruled out, they suspected he might be suffering from a series of mini-strokes.

“It was like I was taking a trip but never leaving the farm, you know?” said Smith, who is from Belfry, Ky. “I was awake but always taking naps.”

It wasn’t until Smith was referred to UK HealthCare that he got a diagnosis: hepatic encephalopathy, a term used to describe the mental fog that accompanies severe liver failure and a common occurrence in patients in need of a transplant. The liver’s job is to filter toxins from the body, and when it fails, the toxins accumulate in the bloodstream and wreak havoc elsewhere.

The team at UK determined that Smith’s liver was failing due to non-alcoholic cirrhosis. Although neither of his parents had the disease, one may have been a carrier and passed the gene down to Smith.

After getting a second opinion from the Cleveland Clinic confirming the diagnosis, Smith opted to remain at UK to be listed for a transplant. Liver transplant patients are assessed with a score known as the Model for End-stage Liver Disease, or MELD, which measures the amount of toxins in the blood and determines the patient’s position on the transplant waiting list. The higher the MELD score, the greater the severity of the disease and need for transplant.

Making the case for a transplant

Smith’s MELD score remained relatively stable for the next four years. However, his mental function continued to decline. As Smith’s symptoms worsened, his doctors at UK referred him to neurologists at the Kentucky Neuroscience Institute, where they diagnosed him with a much more serious condition.

“Bruce started out with hepatic encephalopathy, but then developed hepatocerebral degeneration, an extremely rare form of brain injury,” said Dr. Malay Shah, director of the liver transplant program at UK. “The exact cause of this disease is unknown, but liver transplant is the only cure.”

Many symptoms of hepatocerebral degeneration closely resemble those of Parkinson’s disease. In Smith’s case, he had trouble with speech, gait ataxia (uncoordinated movement and problems with balance) and ever-worsening dementia. Smith says he was essentially home-bound. He was unable to return to work, often couldn’t go to church and avoided going out for fear of experiencing an episode.

“I was asking, ‘Why me, Lord?'” he said. “‘What’s going on?'”

Although Smith’s liver toxicity remained stable – thus keeping his MELD score lower than necessary to receive a transplant – Shah said he knew he needed to push harder for Smith to be transplanted as soon as possible. He wrote a letter of appeal to the United Network for Organ Sharing (UNOS), a nonprofit organization that manages the nation’s organ transplant system, making the case for the severity of Smith’s situation.

“I appealed to UNOS to make Bruce’s MELD score higher than his lab values would suggest because hepatocerebral degeneration needs to be treated with a liver transplant,” Shah said. “Without an expeditious transplant, this disorder becomes permanent and irreversible. At that point, a transplant would be contraindicated because of the permanent neurologic damage from the disease.”

Shah’s appeal was successful, and on Sept. 27, 2015, Smith got a call from UK just as he was arriving home from church. He and his wife packed up and headed to Lexington to prep for surgery.

“I had all this happiness, excitement,” Smith said. “But also the fright of undergoing a major surgery.”

At 2 a.m. the next morning, Smith received his new liver – and a new lease on life. Since his transplant, things have improved drastically. He recovered fully from the surgery, and he underwent physical and occupational therapy to build back his strength and improve some of the basic skills he’d lost during his illness.

“I had to relearn how to write straight,” Smith said. “I had to use a ruler to sign paperwork.”

Becoming an organ donor advocate

As a surgeon who sees firsthand what a difference a transplant can make in the lives of his patients, Shah is passionate about raising awareness for organ donation. He notes that part of his job is making sure patients understand the gift they’ve been given.

“Our patients rely on the generosity of others to have a second chance in life,” Shah said. “And that’s exactly what I impart on my patients prior to transplant – that they and I literally owe it to the donor and their family to do the very best we can to take care of that generous gift.”

One way Smith is using his gift is by educating others on his personal experience. He is now a member and ambassador for Kentucky Organ Donor Affiliates (KODA), the organization that runs the Kentucky Organ Donor Registry, educates the public on organ donation and honors those who have given the gift of life. He was recently featured on a billboard for KODA in Eastern Kentucky and says sharing his story is one thing he can do to honor his donor.

“What a selfless decision that person, or their family, made,” Smith said. “This is my way of giving back. Hopefully, it will get folks interested in becoming a donor and ultimately making a difference in someone else’s life.”

“Bruce is a wonderful patient and a great donor advocate for KODA,” Shah said. “It’s nice to see folks like him work with the organ bank to help educate others in their respective communities about how organ donation can help their neighbors.”

Although he is unable to work, Smith has returned to an active lifestyle that includes walking, performing and creating. He plays guitar as a hobby and gives lessons to those in his community. He has a small workshop behind his house, where he dabbles in woodworking and metalworking. None of these things would have been possible without the transplant he received a little less than two years ago.

But perhaps most importantly, he says, he lived to be able to hold his first grandchild, born just over a month ago, with a second grandchild coming next month.

“You push through death’s doors and go through what I’ve been through,” Smith said, describing his thoughts when he first held his grandchild, “and I just thank God that I’m alive to hold this little thing.”

Smith holding his newborn granddaughter -- his first.

Smith holding his newborn granddaughter.


Next steps:

living donor

What does it take to be a living organ donor?

For patients with kidney disease who want to live a life free of dialysis, kidney transplantation is the best option.

Donor kidneys come from two sources. The first source is from deceased donors, or individuals who have passed away but still have viable, healthy organs. Unfortunately, the need for deceased-donor kidneys is far greater than the availability, which means patients often have to wait years for a transplant.

Living donation is the second source of donor kidneys and is an excellent alternative to deceased donation. The wait time for transplant can be a matter of weeks rather than years, and kidneys from living donors tend to work better and last longer than kidneys from deceased donors. About one third of kidney transplants performed in the United States come from living donation, which has increasingly become the gold standard in kidney transplantation.

Learn more below about who can become a living donor and what the process entails.

Becoming a living donor

Sharing the “gift of life” is a selfless act that can have a profound impact on someone else. The UK Transplant Center is committed to guiding you through the donation process, which includes the following:

  • A thorough evaluation to determine if donation is a safe option for you.
  • A multidisciplinary medical team involved in evaluation, surgery and follow-up care.

Living donor qualifications

In order to be a compatible living donor, you must:

  • Be at least 18 years old.
  • Be in excellent overall health.
  • Have above average kidney function.
  • Have a willingness to help.

You do not have to be a blood relative of the recipient. A spouse, friend, coworker or anyone who is willing to help may be eligible to donate.

Evaluation

You will be asked to complete a medical questionnaire that will be reviewed by the Living Donor Committee. If approved to move forward, you will be scheduled for a thorough medical evaluation and screening process including lab work; testing; and social work, medical and surgical consultations. If the established criteria are met, your living donor transplant operation will be scheduled at a time convenient for you.

Surgery

You will be admitted to the hospital on the day of transplant and can usually go home two to three days after the procedure. The donor surgeon uses a laparoscopic technique with small incisions, shortening the recovery time in the hospital and generally allowing you to return to work within four to six weeks.

Cost

There is no cost to you or your insurance for medical care. You will be followed by the UK Transplant Center for two years after donation at no cost.


Next steps:

  • If you’re interested in being considered as a living donor, contact the UK Transplant Living Donor Program at 859-323-2467.
  • Learn more about the UK Transplant Center, which has performed more than 2,500 kidney transplants and has developed a reputation for excellence in kidney transplantation.

Sign up now to become an organ donor and help save lives

Nearly 1,000 Kentuckians are currently waiting for a life-saving organ donation. April is National Donate Life Month, and the perfect time to think about becoming an organ donor. If you’re interested in becoming an organ donor, but not sure exactly what it entails, check out our frequently asked questions below.

How many people are waiting for an organ transplant?

More than 119,000 people nationally are currently waiting for an organ transplant. About 134 people are added to the waiting list each day one every 10 minutes. Although approximately 80 organ transplants take place every day, on average, 18 patients die each day while waiting because the organ they needed did not become available in time.

What is the difference between organ and tissue donation?

Organ donation involves the transplantation of solid organs, such as the heart, lungs, kidneys, liver and pancreas. However, tissue donation is also extremely important. More than 1 million tissue transplants are done nationally each year, and the surgical need for tissue has been steadily rising.

Examples of tissue that can be donated include skin, bone, heart valves, blood vessels and even corneas. These donated tissues can make a huge difference in the quality of life for many patients.

What is “living donation?”

Although most donations will take place after the donor is deceased, it is possible for a living person to donate some organs or tissues. The most common is living kidney donation because humans have two kidneys, it is possible for a person to donate one kidney. Additionally, lobes of the liver or lungs can be given by a living donor. Tissues that can be donated by a living donor include skin, bone marrow and blood stem cells.

Most living donations take place between family or close friends, but sometimes they do take place between complete strangers.

Am I too old to become an organ donor?

No. You can sign up to be an organ donor, regardless of your age or medical history. The transplant team will determine at the time of your death whether your organs are healthy enough to be donated.

If I’m a donor, will doctors try to save my life?

Yes! If you’re admitted to the hospital, your doctor’s priority is your health and well-being. Donation will not be considered until all other lifesaving options have been pursued.

How can I become an organ donor?

The best way to become an organ donor is to join the Organ Donor Registry. You can do this at the DMV when you renew your driver’s license, or join online anytime at donatelifeky.org.

A single donor can save or improve the lives of more than 50 people through organ and tissue donation. It only takes minutes to join the registry, and your decision could give the gift of life to a patient in dire need.


Next steps:

  • Learn more about the UK Transplant Center, which specializes in the care of patients with advanced, end-stage organ disease. Each year, we perform more than 170 transplant procedures, helping patients from initial consultation through surgery and beyond.
  • Find out more about becoming a living donor and how the UK Transplant Center can help you through the process.
UK HealthCare celebrates 25 years of live-saving heart transplants.

Celebrating 25 years of heart transplants at UK HealthCare

On April 2, 1991, Dr. Michael Sekela performed the first heart transplant in the University of Kentucky’s history.

It’s been 25 years since that first operation, and we’ve been saving lives through heart transplantation ever since. In fact, we now do more than 40 heart transplants each year, and in 2015 we set a single-year record for the most heart transplants at one hospital in Kentucky.

While much has changed since Dr. Sekela’s first transplant, one thing has stayed the same: our commitment to providing the best care for patients with heart failure.

That commitment was on display earlier this week when patients gathered with staff and doctors from the UK Gill Heart Institute and the UK Transplant Center to celebrate 25 years of heart transplants at UK HealthCare.

“It’s so rewarding to see how our program has evolved,” Sekela said at the celebration. “We want to take care of our patients, and that’s always been the driving force of our program.”

Jim Holdiness, who received his new heart on Aug. 24, 1995, said UK HealthCare gave him a second chance at life.

“If hadn’t been for those people, in this hospital, I wouldn’t be here today,” he said.

Daniel Garcia received his new heart just earlier this year, but echoed Holdiness’ sentiment.

“I haven’t had this much energy in 25 years,” he said. “When I think of UK, I think of excellence and compassion. Everyone had my well-being in mind.”

Check out some photos from the event below and visit the UK HealthCare Facebook page for a full gallery.


Next steps:

The UK Transplant Center is moving on March 14.

The UK Transplant Center is moving!

Starting today, the UK Transplant Center is moving from its current location on the fourth floor of UK Albert B. Chandler Hospital to:

Kentucky Clinic
Wing D, Third Floor, Suite J301
740. S. Limestone
Lexington

View and print directions and a map of the new location here.

Patients who are seen at the Transplant and Specialty Clinic at Norton Audubon Hospital in Louisville will continue receiving care at that facility. If you have any questions, please contact us at 866-285-4337.

Transplant Games flag stopping at UK HealthCare

The Transplant Games of America’s National Flag Tour will stop at UK HealthCare on Thursday to celebrate organ donors and recipients on its way to the 2016 Games in June.

Prior to the games, the official flags of the event travel across the country to help raise awareness of organ donation. The flags are also signed by the members of each state’s team. Members of Team Kentucky will be present to sign the flag this Thursday.

Karen Michul, a UK HealthCare employee and living kidney donor, will be participating in the Games for the second time this year, competing in several bowling events.

“Seeing the camaraderie of the donor families and recipients at the Games is amazing,” Michul said. “And some of these people are meeting for the first time! It’s an emotional ride.”

The flag will be on display and available for Team Kentucky to sign this Thursday at 10 a.m. inside the atrium of UK Albert B. Chandler Hospital Pavilion A. If you’re planning to attend, we encourage you to wear blue and green, the colors of Donate Life. Following the flag-signing and a few short remarks, you’re also welcome to stay a short photo session to celebrate the gift of life.

About the UK Transplant Center

For more than 50 years, people have turned to the UK Transplant Center to find answers to difficult problems and guidance in the face of uncertainty.

If you have organ disease or failure, we’re here to help. We specialize in the care of patients with advanced, end-stage organ disease, performing more than 170 transplant procedures every year. UK Transplant Center has clinic locations in Lexington, Louisville and Northern Kentucky, providing care for our transplant patients near the communities where they live and work.


Next steps: