For Wayikunda Simfukwe, life has been reduced to little more than a stalk series of ifs:
If he survived a plane flight to Denver last night; if the liver transplant team there could keep him alive long enough for a donor liver to be found; if his already transplanted kidney doesn't fail in the meantime, and if the hoped for liver transplant operation is a success, then - add only then - will he have a 50 percent chance of surviving.
Simfukwe, strapped to a stretcher and semicomatose, was flown to Denver last night on a United Airlines commercial flight after physicians at Georgetown University Medical Center determined that a liver transplant was his only hope, and a slim one at best for survival.
If the Takoma Park accountant, who turned 39 yesterday, does receive a liver transplant, he will be one of fewer than a half dozen persons in the world who have received transplants of more than one whole organ.
Dr. Thomas Starzl, the Denver surgeon who will operate on Simfukwe, said he transplanted a liver in another patient who had already had a kidney transplant, but that patient died several years ago. Another patient of Starzl, who has had both kidney and pancreas transplants, is still alive.
While kidney transplants have become relatively common - there have been more than 60,000 worldwide - the liver transplants being performed by Starzl and his team at the University of Colorado Medical Center in Denver are still considered experimental. At this time there are a total of 49 surviving liver transplant patients in the world, and 34 of them were cared for by Starzl's team.
According to Dr. Paul Rodelas, a kidney specialist at Georgetown University Medical Center, Simfukwe's liver already was showing signs of disease when his kidneys failed in 1969.
"He was showing signs of chronic hepatitis then," said Rodelas, who cared for Simfukwe on the 3 1/2-hour flight to Denver last night.
"He was admitted late last month with severe hepatitis and jaundice," Rodelas said, "and we thought that if was improving but we were mistaken. He was deteriorating."
If he does not get the transplant immediately, the physician said, Simfukwe "could go into a . . . coma and die.
According to Rodelas, Simfukwe suffers from cirrhosis of the liver as well as hepatitis. Cirrhosis usually is associated with excessive consumption of alcohol, but Simfukwe does not drink, doctors said.
Rather, his kidney disease and liver problems apparently are the result of something called schistomiasis, a parasitic diesease widespread in Africa, Asia and parts of South America. Simfukwe is a native of Malawi, on the east central coast of Africa.
Because the liver transplant is considered an experimental procedure, patients receiving it are not charged. A spokewoman for Georgetown said Simfukwe, the father of four, has insurance to cover his stay at Georgetown.
The flight to Denver, however, which cost close to $1,000 for Simfukwe, his wife, Rodelas and the extra seats needed to hold the stretcher, is not covered by insurance.
Also not insured are the expenses incurred by the family while Simfukwe is hospitalized, and his wife's expenses in Denver.