Giving the gift of life — to a total stranger
LISA PRIEST Globe & Mail
Kevin Gosling was sent to three psychiatrists to see whether he had a death wish, was seeking atonement for a past sin or was just plain crazy when he offered to do something no other Canadian had ever done: donate part of his liver to a stranger.
The 46-year-old man’s wish was answered last year when he underwent a six-hour operation at Toronto General Hospital to have two sections of the left part of his liver dissected and transplanted into a child.
At a news conference today, the product developer will tell his story of what drove him to become a Good Samaritan to someone he had never met.
It was a process that was not only lengthy, but also cost him thousands of dollars in associated travel costs and lost time off work.
“I’ve had people say to me, ‘Are you crazy?’ ” Mr. Gosling said in a telephone interview from his home in Cornwall, Ont., southeast of Ottawa near the U.S. border.
“It’s difficult to explain. . . . I just wanted to help. I’m young, I’m capable, I’m willing. It’s very heartbreaking to know people on the wait list are dying.”
Knowing many patients die on the waiting list — 100 out of 400 people waiting for a liver at Toronto General Hospital died last year was a key motivator for Mr. Gosling.
The death rate for patients on the liver transplant waiting list is far higher than for those who queue for kidneys, many of whom can be kept alive through dialysis.
Last year, 713 patients were waiting for a liver and 141 died while in the queue, said Margaret Keresteci, manager of clinical registries for the Canadian Institute for Health Information.
Though live liver transplants have been performed in Canada — about 60 were done last year alone — they have always been part of a directed effort: a wife donating to a husband, a parent donating to a child, one relative donating to another.
A more unique version of that happened two years ago when playwright Michael Healey donated part of his liver to author Tom Walmsley, a man he scarcely knew.
But Mr. Gosling’s case is different: Up until his donation, no Canadian had ever provided a live liver donation to a complete stranger.
Stranger-to-stranger donation has been done with kidneys, with three anonymous donor transplants performed in British Columbia during the past two years, said Bill Barrable, head of the British Columbia Transplant Society.
Donating a portion of liver, however, is a technically challenging operation that, according to the medical literature, carries a 1-in-200 risk of death.
Consequently, hospital officials had to be able to justify what benefits Mr. Gosling would incur. While benefits of organ donation are obvious when a donor helps a relative, the benefits were intangible in Mr. Gosling’s case.
“We can’t harm one person just for the benefit of another person,” said Linda Wright, the bioethicist at University Health Network, comprising Toronto General, Toronto Western and Princess Margaret hospitals. “. . . We had to be sure that we felt that there was a benefit to the donor as well as to the recipient.”
Mr. Gosling spent months persuading hospital officials that his motives were pure: He had no book deal, he was not some crazy person who liked to be operated on, and no, he had not done something heinous for which he was trying to get back into God’s good books.
In fact, Mr. Gosling describes himself as an ordinary man who attends his Anglican church every Sunday, the 11th of 13 children, who grew up in a household where money was tight.
“It’s very rewarding knowing you did something to help someone,” said Mr. Gosling, who regularly donated blood and put himself on the bone marrow registry as a willing donor. “It’s special, there’s no doubt about that.”
Though it was special, it was not easy. After Mr. Gosling, a father of three adult daughters, sought out the hospital to make his donation, he was subjected to examinations by a raft of health specialists, including physicians, surgeons, social workers and psychiatrists.
A series of medical tests were performed to ensure he was healthy enough to undergo the operation. He was instructed to lose 20 pounds (nine kilograms) to reduce the risk of surgical complications to himself and the recipient. Mr. Gosling did even better, dropping 44 pounds to 169 from 213.
Though his theoretical risk of death was 1 in 200, in actuality it was far lower at Toronto General Hospital, which has the largest liver transplant program in the country. The institution has performed more than 200 living liver transplants with no fatalities, said Gary Levy, director of transplantation at University Health Network.
“We spent time trying to understand what his mindset was,” Dr. Levy said in a telephone interview. “Did he really understand that he was putting his life in jeopardy? It turned out that he was a very together human being.”
And the transplant was a smashing success. A letter from the recipient’s family said the child is doing extremely well.
“They’re extremely grateful to this individual for the kindness and the gift,” Dr. Levy said. “It turned out to be a win for both, but especially for Kevin who wanted to make a difference.”
Ms. Wright described Mr. Gosling’s donation as the “purest form of altruism.”
But it is an altruism many would find difficult to comprehend: He risked complications of liver failure, uncontrolled bleeding, a bile leak and infection, not to mention possible death.
During the operation, transplant surgeon Ian McGilvray removed left segment 2 and 3 of Mr. Gosling’s liver, about one-third of the organ, during a six-hour operation. That’s less than is required for an adult-to-adult liver transplant, where one-half to two-thirds of the right part of the organ is removed. The recipient’s transplant, performed by another surgeon, took eight hours.
Despite the risks associated with the transplant, Mr. Gosling suffered no complications from surgery. And the liver regenerates: within 12 weeks of the transplant, it typically grows back to 90 to 95 per cent of its original volume, Dr. Levy said.
Today, Mr. Gosling said he feels terrific, both physically and spiritually, having done what he set out to do. And although he had planned to remain anonymous, he decided to allow his story to be publicized because he wanted to promote living liver donation, knowing that it may not be for everyone, but it certainly is for more than just one man.
“Everything was worth it. I’d do it again, if I could,” Mr. Gosling said. “I have no regrets.”