A Young Couple’s Life-Saving Decision Strengthened Their Bond and Their Vows
Roughly 2 years ago, Lauren O’Reilly became jaundiced and started losing weight. She had received an earlier diagnosis of primary sclerosing cholangitis (PSC)—an incurable chronic disease that slowly damages the bile ducts, which become blocked over time due to inflammation and scarring.
Lauren’s gastroenterologist, Dr. Robert Brown, Vincent Astor Distinguished Professor of Medicine and Chief of the Division of Gastroenterology and Hepatology at Weill Cornell Medicine, broke the news to her years earlier: A liver transplant was in her future.
But Lauren and her then-fiancé, DJ Toby, were only in their 20s at the time. They wanted to get married and start a family, and they have since done both: The couple got married in 2019, and their son Donovan was born in 2020.
Soon, though, Lauren’s health took a turn for the worse. The time was right for her to start thinking about a transplant.
It might have taken years for her to qualify for a liver from a deceased donor, and she’d need to get much sicker for that to happen. That’s why Dr. Brown advised her to consider the living organ donor option. She did just that. And her donor turned out to be none other than her husband.
All in the timing
Luckily, Lauren wasn’t very sick during the years in the run up to her transplant this past January. That gave the couple time to plan for their deepest desire: a child.
Balancing that desire with Lauren’s medical needs was priority number-one. That’s because pregnancy in transplant patients is considered high-risk, says Dr. Danielle Brandman, Medical Director of the Center for Liver Disease and Transplantation at Weill Cornell Medicine.
“It is generally recommended that women defer pregnancy for at least one year following transplant surgery,” she says. “That delay helps to ensure that patients are medically stable. But there’s another reason to put off getting pregnant: Patients are on lower levels of immunosuppression one year out compared to the higher doses that are required earlier in their post-transplant care.
“Women may need adjustment of their immunosuppression regimen,” she continues. “For example, CellCept (mycophenolate mofetil), one of the most commonly used medications, cannot be used in pregnancy due to the risk of teratogenicity—the ability of a drug to cause fetal abnormalities or deformities. Azathioprine, an older immunosuppressive agent, can be used instead, and it’s safe for use in pregnancy.”
The one-year mark and the degree of immunosuppression are also important with respect to infection risk. Certain viral infections, such as cytomegalovirus (CMV), can affect transplant recipients when they’re on higher doses of immunosuppressive drugs, and some of these viruses are harmful to a developing baby.
“Pregnancy itself is a relatively immunocompromised state under the best of circumstances,” Dr. Brandman says, “so the use of anti-rejection medications makes pregnant patients even more immunocompromised than usual.” For that reason, and for the other reasons cited above, the best thing a hopeful mother-to-be can do is to plan her transplant a year or more before attempting to get pregnant or after giving birth.
Before, during and after transplant surgery
When she was pregnant with Donovan, Lauren experienced severe itching—a symptom of liver dysfunction. Her PSC was getting worse too. “I turned yellow. My bile ducts were starting to close, so I had stents inserted to open them up. I didn’t have cirrhosis just yet,” she says, but it was only a matter of time before she’d develop that potentially life-threatening condition, in which her liver would undergo permanent damage. Typically, as cirrhosis gets worse, the liver begins to fail.
In early 2022, she met with Dr. Benjamin Samstein, Chief of Liver Transplantation and Hepatobiliary Surgery, Professor of Surgery and Surgical Director of the Living Donor Liver Transplant Program at Weill Cornell Medicine, to discuss the ins and outs of a liver transplant. DJ was soon approved as her donor.
“He’s twice her size,” Dr. Samstein says, “and he had plenty of liver to donate. As for matching, that process is much easier nowadays than it used to be. Contrary to a widespread misconception, it isn’t a ‘miracle’ when two genetically unrelated people match. A significant majority of two randomly chosen people will turn out to be a match.”
He goes on to explain that Weill Cornell uses strict criteria for donors. Beyond a compatible blood type, donors need to be relatively young (under 59) and healthy, plus they need to be able to donate a sufficient portion of their liver. “Both the donor and recipient need to be left with enough liver to function well over the long term.”
DJ met all these criteria to a tee.
In January 2023, he underwent surgery to remove one-third of his liver via a minimally invasive laparoscopic approach—another fairly recent advance in organ transplantation. And his wife received a portion of his liver almost immediately after his procedure.
It took a while for the couple to bounce back. That’s to be expected, says Dr. Samstein, but DJ’s recovery was harder than he anticipated.
“For more than a month after my procedure, my energy was depleted,” he says. “I was regrowing my liver to its original size, and that takes energy. I took lots of walks to rebuild my strength. I was also warned not to lift anything that weighed more than 10 pounds, but that wasn’t easy with a 25-pound toddler in the house!”
Asked whether he ever questioned the decision to donate part of his liver to his wife, his answer was “absolutely not. It was the best thing to do for her and for the family.”
Predictably, Lauren would need to stay in the hospital a bit longer than her husband—2 weeks compared to one week for him. “DJ is an athlete and a coach,” she says, “and he coached me to keep moving. It makes a world of difference when you get up and move. It was the only way to get through it—especially my post-surgical back pain. You can’t use your abs after surgery, so my back muscles were working overtime to compensate. After a couple of weeks, though, I turned a huge corner.”
Little Donovan was only 2 at the time of his parents’ procedures, and the young family couldn’t have managed without the help of Lauren’s parents, who moved in, dealt with cooking and cleaning and played with their grandson—a special treat for all concerned.
“I couldn’t love him more!”
Through it all, DJ remains Lauren’s rock, her rescuer and the love of her life.
Having long since recovered from their respective surgeries, they have both returned to work.
Lauren works for an engineering firm, in charge of issuing work permits to companies responsible for construction and demolition. And DJ is a harbor pilot—a seaman with specific knowledge of dangerous or congested waterways who is able to coordinate traffic and dock ships safely.
The couple recently celebrated their 4th wedding anniversary, and they’re enjoying their lives to the hilt, spending plenty of time at the beach and feeling grateful to the surgeons and all the healthcare staff who took care of them at Weill Cornell Medicine.
They’re also starting to think about having another child. But they’ll need to wait for at least a year after Lauren’s transplant. That’s the best way to ensure the likelihood of a healthy pregnancy for both mother and child.
“DJ saved my life,” she says. “I couldn’t love him more!”
To connect with the liver transplantation services team at Weill Cornell Medicine, please visit here.