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Patrick Caldie & Stephen Fowler

Work of Love

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Stephen Fowler and Patrick Caldie have more in common than teaching at-risk high school students at the El Dorado County Office of Education. On Feb. 1, 2007, Fowler donated part of his liver to Caldie at UCSF Medical Center's Liver Transplant Program, one of the nation's leading centers for adult and pediatric liver transplants.

Fowler underwent a new procedure, called a living donor transplant, which allows a living person to donate a segment of their liver that then grows or regenerates to full size in the recipient. UCSF liver transplant surgeons are among the most experienced in the nation in performing this procedure on adults and children.

Living donor transplants are one strategy to help decrease the shortage of livers needed. Currently, 15,000 to 17,000 people are waiting to receive a liver transplant in the United States, yet annually there are only enough available livers for about a third of them.

"What I did really surprises people, especially because I donated part of my liver to someone who is a co-worker and not a relative," says 37-year-old Fowler, a computer and digital media teacher. "I hope that my actions will not only have a profound effect on Patrick and me, but also on the entire community. Hopefully it will inspire other people to do something good for others that's outside their comfort zone."

Eight years ago, Caldie, now 60 years old, was diagnosed with cirrhosis of the liver, which is considered "cryptogenic" because it does not have any identifiable cause. With severe liver impairment, toxic substances normally removed by the liver can accumulate in the blood. About six months ago, Caldie started experiencing "ammonia" comas, in which he couldn't remember anything for days at a time. It was then that his doctors recommended a liver transplant.

Caldie and Fowler had only spoken a handful of times, but despite this, Fowler decided to undergo testing to determine if he was a good match for Caldie when he saw how sick he appeared at school. Some of Caldie's family members also underwent testing, but none of them qualified as donors.

"When deciding whether to donate part of my liver to Patrick, everything just fell into place and I knew it was meant to be," says Fowler, who viewed his decision as an opportunity to exercise his deep religious faith. "I thought of the story of the Good Samaritan and believe it was God's will for me to donate my liver."

Caldie shares Fowler's faith and believes it was part of "God's incredible plan" that brought the two men together, though he says Fowler's decision did raise some concern.

"I thought, 'Do I really want someone to risk their life for me?'" says Caldie, a social sciences teacher and former youth pastor, who describes himself as a "giver," not a "receiver." "But then Stephen told me his decision was not so much about me, but rather about his relationship with God."

"Listening to these two men speak of their motivation and experience makes us all appreciate the power of spirituality," says renowned organ transplant surgeon Dr. Nancy Ascher, who performed the transplant and is the chair of the UCSF Department of Surgery.

Typically, living donors donate their right lobe to adult recipients—around 60 percent of the liver. However, when evaluating Fowler for surgery, doctors discovered that his right lobe made up 75, rather than the usual 60 percent of his liver, and his left lobe made up 25 percent. Transplanting Fowler's right lobe would have left him with an insufficient amount of liver and his left lobe, as it was, was too small for Caldie. However, UCSF organ transplant surgeons Ascher and Dr. John Roberts determined a way to transplant Fowler's left lobe and make it work for Caldie.

"Stephen was the second adult to have a piece of liver that was originally too small transplanted at UCSF. We are one of the few medical centers in the world doing this cutting-edge surgery," says Roberts, chief of the UCSF Transplant Service. "Stephen's left lobe was still too small of a liver for Patrick, but he didn't have any other donor options. When a liver is too small, it can be damaged because it receives too much blood, so we created a shunt in Patrick to divert blood. As the liver grows, the shunt will become superfluous."

Because of the liver's ability to regenerate itself, the partial organ increases in size after transplantation. And the remaining portion of the donor's healthy liver regenerates itself to full size within a few weeks.

During surgery, doctors made another discovery—Fowler had a previously undetected tumor on his liver. Although the growth was benign, it could have become cancerous so surgeons decided to remove it.

"This reinforced my belief that the experience was meant to be," says Fowler. "In a way, I should thank Patrick, rather than the other way around."

Fowler describes his experience as a "work of love," though doesn't omit the severe physical and emotional pain he experienced the days following surgery, or the stress put on himself and his family, especially his wife of six years, Terri. He adds that it is critical to prepare your partner and family for the transplant process.

"When I was going through it, I was so scared and in so much pain, I wished I hadn't done it. The feelings came flooding over me," says Fowler. "It was work, but also love. Real, true love gives until it hurts. Despite the pain and trauma, I wouldn't trade those things for anything, and I'd do it again if I could."

Miraculously, after spending time in the hospital after surgery, Fowler returned home without pain medication and only took Advil. Recovery was difficult, he says, but he did not experience any complications and recently returned to work.

Since the transplant, Fowler and Caldie have kept in close contact and Caldie believes a lifelong relationship has been born. "You can't really 'pay someone back' for donating part of their liver," says Caldie. "My way of thanking Stephen is to use my new gift of life, rather than squander it."

Caldie, an active skier, backpacker and swimmer, plans to participate in those activities again as soon as he fully recovers. So far, he feels great and a liver biopsy recently showed that the liver is healthy and growing.

"I have a brand new appreciation for the details of life," says Caldie. "Now I pay attention to the specialness of the things and the people around me."

Story written in May 2007.

Abby Sinnott is a freelance writer in San Francisco.

Tags: CirrhosisLiver TransplantLiving Donor Liver Transplant
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