With her little boy clowning in a floppy Santa cap, a beaming Dara Smith said yesterday that she'd been blessed with an opportunity few parents ever enjoy -- "to give a child two chances at life."
What she did, just 14 months after giving birth to Tyler Smith, was surrender a quarter of her liver so her son could live.
She also helped the Johns Hopkins Children's Center set a precedent locally for what could prove a significant way of easing the shortage of donor livers. The shortage is so acute across the country that 15 percent of children who are deemed candidates for liver transplants die waiting.
The operation, which takes advantage of the unique regenerative powers of the liver, works like this: Surgeons remove a lobe from a parent's liver and transplant it into the child, whose diseased liver has already been removed. Each section, functioning as a whole liver does, soon begins to grow and, within months, completely fills the appropriate space within the body.
"As Tyler recovers, he should be able to do everything -- anything he wants to do," Dr. Paul Colombani, director of the the pediatric transplant program, declared at a news briefing yesterday. In the meantime, he said, Mrs. Smith should suffer no ill effects from her surgery.
In liver transplants, the traditional donor is a brain-dead accident victim who is kept on life-support equipment so the vital organs can be nourished by circulating blood. But in recent years, there have been too few donors to meet demand. The shortage has been particularly acute for infants, who need tiny livers to fit their tiny dimensions.
The problem has been partially alleviated by the technique of shaping portions of livers from adult cadavers to fit infants. In the last year, most of the pediatric liver transplants at Johns Hopkins have been accomplished in this manner.
But the Smith-to-Smith transplant on Nov. 19 was the first liver transplant at Hopkins involving a living donor, and the first in the Mid-Atlantic Region. Another is scheduled Jan. 7, and two other families are considering the option.
Despite an early bout with rejection, Tyler is faring very well and should be discharged from Hopkins in time to return to New Jersey with his family for Christmas, doctors said. Mrs. Smith was released six days after the operation, and said she was feeling great.
The Smiths, who lived in Baltimore for many years, moved to Matawan, N.J., last spring but have continued to bring Tyler to Hopkins. Yesterday, the giggling, gurgling Tyler appeared with his 3 1/2 -year-old sister, Alexi, while his parents and doctors chatted with reporters.
The liver, the largest of the body's organs, manufactures and regulates many of the chemicals that are essential for human life, while at the same time filtering toxins from the bloodstream.
Tyler suffered from biliary atresia, a congenital disorder in which scarred ducts render the liver unable to drain bile into the intestines. When the boy was just 28 days old, surgeons tried to correct the problem by connecting an intestinal loop directly to the liver -- thereby bypassing the defective bile ducts.
But the operation failed, and the baby soon developed cirrhosis, a degenerative liver disease that probably would have killed him.
Pioneered two years ago at the University of Chicago, the practice of transplanting livers from living parents has been tried 62 times at transplant centers in the United States and an undetermined number of times worldwide.
To date, about 85 percent of the patients have survived at least a year
after transplant. There have been no complications involving donors.
When the operation was first tried in Chicago, some ethicists argued that parents might feel pressured, perhaps against their private feelings, to submit to the operation. But the Smiths said the dilemma didn't exist for them when doctors told them last summer that the option would soon be theirs.
"To us, it seemed the logical thing to do," Andrew Smith, Tyler's father, said yesterday. One of the most attractive features, he said, was thesurgeons' preference to operate before the child becomes very sick.
Mr. Smith, 35, said he immediately offered to become the donor. But Mrs. Smith, 35, said it made more sense for her to donate because her husband was earning the sole family income at a pharmaceutical company in New York City while she took care of the children at home. As it turned out, her blood type was the same as Tyler's and her tissues matched well enough to make her an excellent donor.
The 12-hour operation was performed by Dr. Colombani; Dr. Andrew Klein, director of the liver transplant program; and a team of five nurses and eight surgeons and anesthesiologists.
Within a few months, Tyler's liver is expected to reach a size appropriate for his age. Then, it should grow along with the rest of his body. In contrast, it should take about a year for his mother's liver to regain its previous size.
"I'm happy when I can sit here and hear people say my child can have a normal life," said Mrs. Smith.