Sister, donating part of her liver, shows depth of love
Lisa Mazza broke into tears when doctors wheeled her from her ailing sister.
But it wasn't until she entered the operating room that her unease turned to terror.
"You see all these instruments and tools, clamps and everything, all sanitized and lined up on that blue sheet," she said. "There were so many of them. And the breathing instruments, and all the different people in there. ... It was very intimidating. It was dawning on me at that moment that I was getting ready to actually do this."
UPMC Montefiore surgeons were about to open her abdomen, slice off 50 percent to 60 percent of her liver and transplant it into her sister, Christina, who six months before learned she has hereditary amyloidosis.
"I started to hyperventilate," Mazza said. "I was afraid of not making it out. There are so many risks involved in that surgery. It was the whole not knowing -- what's going to go on in there, what's the future going to hold?"
Still, she never had second thoughts. As she drifted into unconsciousness, Mazza, 30, of Beechview thought about their mother, who died of amyloidosis when Lisa was 7. She thought about Christina Mazza, 31, who has a 7-year-old son.
"I thought about Christmas time and holidays. I knew that this was what I had to do, to make sure my sister is around for those times."
She made the decision less than six months ago.
On July 29, Christina Mazza was in her South Park condominium recovering from surgery to remove thyroid cancer when her doctor called. She needed a liver transplant within a year, the doctor told her, to give her excellent odds of leading a normal life.
Amyloidosis generally affects the heart or nervous system and is caused by amyloid proteins that build up in organs, often leading to failure. Though relatively obscure, the disease killed Pittsburgh Mayor Richard S. Caliguiri in 1988, Erie Mayor Louis Tullio in 1990, and Gov. Robert P. Casey in 2000.
It took Phyllis Rigos-Mazza in 1986. Christina, a critical care nurse at UPMC Montefiore, knew that children of victims have a 50 percent chance of carrying the mutated gene responsible for the disease. Tests cleared her two sisters.
Christina could wait for a deceased donor's liver, which likely would allow the disease to cause irreversible damage, or seek a live donor.
"I didn't have much time," Christina said. "I told Lisa the options. And she said, 'Absolutely.' "
'LET'S GET THIS DONE'
The Mazza sisters pulled into Montefiore's parking lot in Oakland at 4:30 a.m. Jan. 15. Christina hugged herself in the cold morning air; Lisa cradled a book of daily devotionals, "Promises and Prayers; A Woman of Prayer."
Surrounding them were their closest supporters: Eddie Waterman, Christina's fiance; Justin Christ, Lisa's boyfriend who three nights before tied a diamond ring around the collar of Lisa's 2-year-old bluetick coonhound, Savannah, and waited two hours for Lisa to notice before he proposed; and Rita Christ, Justin's mom.
They huddled, talking quietly, holding hands and admiring Lisa's engagement ring.
"You guys ready?" Christina said.
"Let's get this done and over with," Lisa said.
In pre-operation consultations, the surgeons explained they would remove Lisa's gall bladder, expose the liver, isolate the blood supply and then cut out the right lobe of the liver. In an adjoining operating room, surgeons would remove all of Christina's liver, and then sew in the larger half of Lisa's. Within six weeks, both livers would grow to 90 percent of their normal size, and in time regain normal function, said Dr. Abhinav Humar, chief of transplant surgery at UPMC.
"I'm scared," Lisa confessed moments before surgery.
In the moments before the operation, the sisters held hands, cracked jokes, withdrew into silent reflection, passed lip balm back and forth, and repeatedly broke into tears. They linked hands with their fiances and Rita Christ, who prayed:
"Father, we ask that your hands will lead the surgeons' hands, that everything will be precise, just as you mean it to be. Lord, we thank you for what you are doing. This is such a great gift of life."
In the operating room, Lisa lay covered in blue sheets. Two hours into the operation, Humar and his team of surgeons gained access to her liver. The doctors used a "waterjet device," not a knife, to divide the liver by shooting a concentrated line of water that safely separates the liver's cells.
In the adjoining operating room, hip hop music played at low volume as Dr. Michael de Vera and his team removed Christina's liver. In a third operating room, doctors would transplant it into a woman from Florida.
Though Christina's liver was producing amyloid deposits, it could be transplanted into a patient who did not have amyloidosis, explained Mary O'Donnell, president of the Amyloidosis Foundation in Clarkston, Mich. The disease take years to impact the entire body, so someone in critical need of a liver could gain several "high-quality" years, even with a liver that is not healthy, O'Donnell said.
At 2:54 p.m., more than seven hours into the procedure, Humar separated Lisa's liver as Dr. Roberto Lopez stood nearby with an ice-filled plastic container. With both hands, Humar withdrew the section of liver and placed it in the container. Lopez walked briskly to a table, examined the liver under bright lights, and then vanished with it to allow de Vera to complete his transplantation.
RARE GIFT OF LIFE
Justin was exhausted the day after surgery. He did not sleep much the night before, because excessive bleeding sent Lisa back into surgery.
"We didn't leave the hospital until midnight," he said. "We were worried, but the doctors said everything is OK now."
Humar had told them the surgical risks included "bleeding, infection and bile leaks."
Live-donor transplants are rare. In 2009, doctors performed 5,316 liver transplants nationwide, but only 192 from live donors, according to the United Network for Organ Sharing.
They are becoming less common, in part because of a UPMC study published last year showing a high rate of serious complications in live-donor liver transplants. Between March 2003 and November 2006, 66 percent of 121 live-donor liver transplant recipients experienced significant complications, such as bile duct leakage or blockage, that required medical intervention.
Still, UPMC is a leading international center performing liver transplants. "Where we were 20 years ago and now -- it's been a remarkable journey," Humar said.
A week after surgery, Christina sat up in her hospital bed, her best friend Andrea Schaff beside her, and struggled to explain her emotions.
She had made it through surgery. She had a healthy liver, a gift from her sister. She had a wedding to plan, and time to devote to her son, Maximus.
She gained something else from such major surgery, she said: an understanding of the depth of what her sister did for her.
"She gave me my life back. How do you repay that?"
Before surgery, Christina said, she thought her sister had a "responsibility" to help her. Now she realized Lisa acted out of love, not obligation.
"That's sinking in, and I'm glad, because you know what• I needed that," she said. "... To have someone like her do that for me is everything."
In her room one floor below, Lisa pulled up her shirt to reveal a 10-inch jagged red line stretching diagonally from her right hip to her sternum. The wound was healing nicely, and doctors had told both sisters the surgeries were successful.
But hiccups made Lisa feel as if the stitches would burst with every spasm. She was bloated, drugged and exhausted, but about to be released from the hospital.
"I told her, please don't ask me for a kidney, 'cuz you're not getting a kidney," Lisa said. Then she smiled, and added quickly: "If she needed a kidney, I'd give her a kidney."