Two weeks ago, two strangers lay in side-by-side operating rooms at the University of Maryland Medical Center in Baltimore. Donald Guyton had come east from Middletown, Russell Ward west from Salisbury. Each had a defective liver that he feared would soon lead to death.
But one man's liver, although destructive within his body, could offer the other a new chance at living.
The men met for the first time yesterday to celebrate the success of their "domino" transplant, which began on the morning of May 19 when a cadaver liver arrived for Guyton and concluded 18 hours later as the final connections secured Guyton's old liver in Ward.
The rare sequential surgery never had been performed before in Maryland. It still has not been done in the District or Virginia and has been done only several dozen times in this country since the first attempt in 2000.
"Glad to meet ya," Ward, 74, said, offering a hand during a news conference at the hospital. Guyton, 10 years younger, reached over, and the two shook heartily. "I'm grateful," the older man continued, struggling to keep his composure. "I think I'll make it now."
The medical circumstances that brought them together were vastly different. Guyton, a former electrical contractor, suffered from a genetic disease called familial amyloidosis, which is caused by an abnormal protein produced in the liver and leads to gradual paralysis throughout the body. There is no cure other than transplantation, which halts but does not reverse the physical deterioration.
An unusual cluster of familial amyloidosis has been identified within Frederick and Washington counties, dubbed "the Maryland kindred" by medical researchers. "Come to find out, there are other people in our little valley that have the disease," Guyton explained yesterday. He was the first in his family to be affected and, after several decades of symptoms, had virtually lost his ability to walk.
Ward, a former property manager, was much sicker on the eve of his operation, suffering from cirrhosis caused by a form of hepatitis. He had been hospitalized repeatedly in recent months as his liver failed and ammonia built up in his body. "I was on a downhill slide," he recounted.
The domino transplant offered both men unusual opportunity.
"It was somewhat amazing that my liver was good enough to be used again," Guyton said. "Somewhat mind-boggling."
He had no qualms giving it. But would Ward accept an organ that had caused a paralyzing disorder in its donor and over time would probably do the same in him?
With doctors' assurance that the time involved might be 30 years, Ward said yes. He doesn't intend to worry at 104, he joked yesterday.
Given the limited number of organs for transplant nationally, this two-for-one approach helps stretch the supply. Little detail was available on the other donor who was the third critical link in this case, only that the individual was a middle-age Maryland resident whose family stepped forward after the person was injured and then declared brain dead.
The transplants themselves were fairly straightforward, surgeons Benjamin Philosophe and Luis Campos said. Guyton's liver required an hour or so of "microvascular reconstruction" after it was removed from his body but exhibited little of the scarring or ill effect of its disease. Once in their new owners, "both livers . . . worked immediately," Campos said.
The two patients were accompanied by their wives, Dee Ward and Louise Guyton, for their return trip to Baltimore and their turn in the spotlight. All four talked quietly, modestly, before the television cameras, both honorees by happenstance wearing green. Dee Ward confessed that she had prayed "every night for this."
"It's like I got him back," she said, beaming. "He's the same old Russell."
Guyton gave Ward a metal bracelet intended to identify him as a transplant patient.
"I'll get it engraved right away," Ward said.