Transplant recipient's incredible guilt after his brother dies giving him a liver... and now the new organ is failing
By DAILY MAIL REPORTERA Colorado man is dealing with incredible guilt and loss after the liver transplant he received killed his younger brother, the liver's donor, who died shortly after surgery.
Last updated at 3:04 PM on 19th November 2010
Last updated at 3:04 PM on 19th November 2010
Worse, the surgery may have been for nothing as the tranplanted liver is now failing.
Chad Arnold was 38 years old and in liver failure when his younger brother Ryan, 34, became determined to help.
Ryan Arnold, left, died following surgery to give brother Chad, right, part of his liver. This photo was taken in early 2008, before Chad went into liver failure
Chad had something called primary sclerosing cholangitis (PSC), cause unknown. There is no cure.
A transplant became his only chance for survival.
Chad hoped to wait for a cadaver transplant. But at any given time, close to 16,000 patients nationwide await a liver transplant, while only about 4,500 cadaver livers become available each year.
His best option was a living-donor transplant, a rare procedure in which a segment of the liver is taken from a healthy donor and transplanted into the ailing recipient.
In just weeks, both the old liver and the transplanted liver regenerate and grow back to a normal size, providing long-term, regular function for both donor and patient.
In the more than 4,100 living-donor liver transplants conducted in the United States since 1989, just three donors had died from complications related to the surgery.
Blood tests showed Ryan, a father of three sons who was married to his high school sweetheart, was a match.
Now Ryan is dead.
Chad Arnold shows the scar from the liver transplant he received from his younger brother
There is a movie that plays over and over in Chad's mind. It starts with the urgent call from down the hall: 'Code blue. Room 601.'
Down the hall was brother Ryan, also a married father, who had just undergone surgery to give Chad part of his healthy liver.
Chad, still a jumble of IVs after the liver transplant, wresting himself from his bed and making his way just a few doors down to the room of his brother, his savior.
From the hallway he watched it all. And so the horror is forever ingrained in his memory.
What makes it worse is that they'd both made it out of surgery just fine, that until that moment the entire process had been a celebration of life - not something to fear, really, but something with a happy ending.
Everything had moved quickly after Ryan received the phone call at their July family reunion confirming he was a match for the liver transplant surgery needed to save Chad's life.
A week and a half later, the family was back in Colorado preparing for surgery. The night before, they read scripture, shared communion and prepared to keep friends and family informed with updates on a website.
Chad, here with his wife Christine and sons Luke, left, and Jake, felt incredible guilt when he first came home and hugged his children, knowing Ryan would never again hug his own three kids
The next morning at the University of Colorado Hospital, the brothers swapped jokes.
Just before Ryan was led into surgery, Chad walked into his brother's pre-op room and wrapped his arms around him.
'I owe you my life,' he whispered to Ryan, who tried, as always, to reassure. 'Piece of cake,' he said.
By 5 p.m., it was done. Two-thirds of Ryan's liver was removed and placed into Chad, whose own diseased organ was taken out in chunks.
Almost immediately, Chad's jaundiced skin returned to its natural color; the potbelly caused by his swollen liver was gone.
Chad felt the best he had in years. Through family members, he sent messages to Ryan. 'Tell him I'm feeling good. Tell him I love him.'
It was as if they'd switched places. While Chad was up and walking, Ryan was having a harder time.
The day after the surgery, a Friday, Ryan was groggy but okay. On Saturday he was in pain.
In this July 31, 2010 photo provided by the Arnold family, Ryan, in the doorway, visits his brother Chad lying in bed in his hospital room after the transplant surgery. Their father Robert is at right. Two days later Ryan was dead
Sunday Ryan went code blue and was resuscitated, which left him in critical condition.
Monday he died.
Their father chose to deliver the news to Chad, after tests showed that Ryan's brain was no longer functioning.
He entered the room where Chad slept and grabbed his toes to wake him, the way he did when Chad was a boy. And then he said, ever so gently: 'Ryan's brain is dead, but we still serve a good God.'
When Chad went to say goodbye, he promised Ryan he would go on, that he would live fully, that he would 'live for both of us.'
His entire existence became about healing, the healing not just of his body but of his heart, too.
All of the rituals of grieving that are meant to help find closure - the funeral and the burial, one final goodbye - Chad got none of that. He was discharged just before Ryan's service but wasn't well enough to travel to South Dakota to attend.
Then complications sent him right back to the hospital. For several weeks, he was just two doors down from Ryan's old room, walking past it as part of an exercise regimen meant to help him 'heal.'
He recalled how Ryan lived his own life 'selflessly and positively,' how he even texted Chad a few days before the surgery to say, 'I believe in you.'
The day before surgery: The Arnold siblings, from left, Rod, Ryan, Janelle and Chad, pose at Chad's home. Janelle was also a blood match but Ryan insisted he would undergo the surgery to give Chad a new liver
Chad fought to stave off that demon. 'Why Ryan, God? Why not me? What about all the prayers? ' he wrote. 'If you think I haven't asked these questions - you're wrong. ... If you think I haven't yelled at God - I'm sorry and you're wrong.'
He kept wondering: What if he'd just waited for a cadaver donor instead of having Ryan give? Then a hospital worker told him his was one of the most diseased livers she'd seen and he likely had only months to live. That helped, some.
He regretted his father having to come out of retirement to keep open his orthodontics practice, which Ryan had been taking over.
When Chad was released the second time from the hospital, he was so happy to be home with his wife and two sons again, to hold his boys tightly and kiss them goodnight.
Then the realization hit that Ryan, and his wife and three boys, would no longer have those moments.
He tried to focus on healing his body. Mornings on the treadmill, twice-weekly checkups, lab work. He eased back into his work coordinating with churches to assist children in poverty, and he approached his job with new vigor and perspective; he now knew what it meant to suffer.
He also set new priorities for his life, guided by the things that were once so important to Ryan: Faith, family, friendship.
He vowed to spend more time with his kids, be more patient and loving to his wife, visit his parents more often, lean on his friends more.
A few weeks after Ryan's death, Chad sat one morning in his living room with his sister, Janelle, as their children played. It was, health-wise, a good day. Emotionally it was quite different.
A few weeks after surgery Chad was walking on a treadmill, trying to keep healthy and overcome his grief knowing that surgery to save his life killed his brother
'Today's a hard day for me.'
'Reality?' Janelle asked softly, and tears formed in Chad's eyes.
'I think when I start to feel better, they're harder days. For some reason I like to hold onto the pain. When I don't feel the pain, there's a tinge of ... '
He stopped, and then: 'I say I don't feel guilty, and I don't spend a lot of time on it, but there is that tinge that you start to feel a little bit. And then, later on, I'll be fine.'
Ryan's autopsy report called his death natural due to a lack of oxygen to the brain following cardiac arrest. It said 'poorly delineated' complications of the surgery may have put undue stress on the heart, and it found that Ryan had a slightly enlarged heart, which may have made him susceptible to irregular rhythms.
Both the hospital and the medical examiner agreed that until the cardiac arrest, Ryan seemed to be stable.
The University of Colorado Hospital, which had temporarily halted live-donor liver transplants, has since resumed the program.
Reviews found no deficiencies in the program itself, but personnel will now continuously monitor donors post-surgery with machines that sound an alarm if blood oxygen levels drop and a patient stops breathing. In a statement, the hospital said: 'Ryan's passing will not be in vain.'
Chad still makes the same pledge to himself, despite ongoing complications that recently brought devastating news:
He may not be able to keep Ryan's liver.
This photo, taken one month after Ryan's death, shows Chad back in the hospital being tended to by wife Christine. Chad is back on a waitlist for a cadaver liver as Ryan's is failing
Within the last two weeks, due to a buildup of fluids that indicates the transplanted liver isn't yet functioning properly, Chad was placed on the waiting list for a cadaver liver.
He is taking things day by day, still hoping that, in time, Ryan's liver will work. But if a cadaver liver becomes available, Chad has decided to undergo another transplant.
In that, he feels he has no choice. The one thing he can control: Chad refuses to ever again accept a live donation; the responsibility is just too great.
'I'm not going to put that on anybody else,' he says. 'If I don't make it waiting for a cadaver, I'd rather have that than to have anything else.'
The strong faith that always helped his family conquer adversity is helping them all endure, still. Chad may ask 'why' and 'how,' but he knows those questions don't really have answers. Faith, he wrote in a blog passage, is 'the thing you cling to when you're taking your last breath in a freezing river whose current is too strong. Well, the current is too strong for me right now, and so I'm clinging.'
And so his journey goes on, a process that involves hard work, more prayers for healing and days filled with memories, some happy, some haunting.
Chad can't help feeling as though he'll have failed, somehow, if he has to accept another liver.
Having that piece of Ryan forever with him had helped ease some of the pain of his brother's loss. As he wrote in a blog entry last week: 'I am faced with the cold hard truth that I may not get to keep what has been the only redeeming thing in all of this.'
Then again, he knows Ryan wouldn't want him to feel that way. He knows what his little brother would have said about the possibility of a second transplant.
'At the end of the day, if I have to to live, I have to to live,' says Chad. 'Ryan would tell me to do that.'