THE ULTIMATE GIFT
Young Hudson Wilson went from being dangerously ill to being the youngest recipient of a liver transplant in Africa, within days. He was eight weeks old. This is how his miracle fell into place.
“We just thought it was colic. We took off Hudson’s clothes to put him in the bath, and saw he was yellow. And that, I think, was the first time we knew something wasn’t right.”
Michael Wilson and his wife, Dani, are no strangers to sick children. Having helped their eldest child Aston back to health after he was born with pneumonia that caused serious medical complications, they felt in control – they would take Hudson to the doctor, and have him treated. “But the doctors kept saying they have these concerns, they’re worried. And the next thing we knew, we were in serious trouble.”
At just eight weeks old, Hudson was rushed to hospital. Within days, the family was told he would need a transplant to survive.
“It all started when Dani sent me a message saying she’s worried about Hudson,” explains Dr Carice Goossens, the Wilsons’ family paediatrician at Mediclinic Sandton. “The thing that stood out to me in that message was when she said, he’s looking yellow. I messaged back to say ‘come to the rooms, pick up a form, and take him for a set of full liver function tests’. She took a picture of the results on her phone, sent it to me, and asked, ‘what should we do?’ The moment I saw those results, and the way the liver enzymes were so alarmingly raised, I said, ‘you need to come through to the paediatric ward, straight away’.”
Dr Goossens and her colleagues examined Hudson carefully for signs of heightened levels of ammonia, and used an international normalised ratio (INR) test to check for signs of prolonged clotting – both of which signal liver disease. Together, they made the call to send him for specialist help.
That same day, he was examined by Dr Marisa Beretta, a paediatric gastroenterologist at Wits Donald Gordon Medical Centre. “Hudson presented in acute liver failure. That means the liver is no longer working,” she says. “What does that look like? Most of our patients arrive very late – they’re confused, irritable, they become yellow, and they bleed easily and for a long time.”
Dr Beretta and her team first looked for indications that Hudson’s symptoms might be signs of a reversible condition, including viral hepatitis, prioritising them in order to calculate how and where to intervene appropriately and efficiently.
They weren’t. “For him to present with acute liver failure, and then to require a transplant in order to treat it, at his age, is very, very rare,” she says.
Rare, and difficult. South Africa suffers from a chronic shortage of organ donors. Only 0.2% of South Africans are registered organ donors, according to statistics collected by the Organ Donor Foundation of SA. This shortage places an enormous burden on hospitals across the country – causing significant surgical backlogs, and severely compromising the quality of life of patients who require organ, tissue or cornea transplants.
This is improving. In 2016, Wits Donald Gordon Medical Centre embarked on a bold new strategy to increase the number of registered deceased organ donors in the greater Johannesburg area, uplifting numbers of referrals and dramatically increasing patient consent rates.
But not fast enough. “There is a lot we can do with one liver,” says Dr Beretta. “Paediatric liver donors are few and far between – I believe we receive one every couple of years – but even beyond that, adult donors are very few and far between.” Because the liver is the only organ in the body that can replace lost or injured tissue, or regenerate, doctors can cut a donation down into smaller pieces, or split it, thereby gaining a donation for both an adult and a child.
Because South Africa does not have a large donation pool, Dr Beretta explains, many of the transplant procedures performed at the hospital are from living donors – and this is what saved Hudson.
“When they told us that Hudson would need a transplant,” says Michael, “I thought, okay, let’s get the process started; we’ll make a list of everyone who could possibly donate, and work through it, and see where we go. And they said, no, he needs to have a transplant – today.”
Fortunately, the Wilsons know people. A lot of people. And many of them were willing to help. “We called up two of Dani’s best friends – we always joke that they’re never apart. They were at the hospital half an hour later. They were so happy to help, so willing to donate, it was incredible.”
Wits Donald Gordon Medical Centre’s donation process is rigorous, as they work closely with the national Department of Health and clinical experts to determine a suitable match. A psychologist is also brought in to counsel the donor. “We didn’t want her to feel any pressure,” Michael says. “Think about it: she’s at work, it’s 2pm. By 8pm she’s going to be having surgery, giving a portion of her liver away. So that interview with the psychologist was crucial – and she came out and said, ‘yes, she’s ready’. She’s your donor.”
The surgeries were performed, successfully, later that evening. In the early hours of the morning, Hudson was wheeled out of theatre and back into his family’s arms – with a future in front of him.
Organ transplant is a rapidly evolving field, Dr Beretta says. And she would know. As a part of the team that recently performed the world’s first living donor liver transplant from an HIV-positive mother to her HIV-negative child, she is at the forefront of that change.
“There is a whole spectrum of donation options. I think many people are not fully aware of all the avenues in which they can contribute. The best way to find out is to access people who are used to it and who know about it and can help them through their journey.”
Organisations such as the Organ Donor Foundation and Transplant Education for Living Legacies (TELL) are designed and equipped to help ordinary people overcome existing hurdles to organ transplantation in South Africa – including stigma around it that’s often linked to religious and cultural misconceptions.
Dr Beretta and her team at Wits Donald Gordon are approaching their 300th paediatric liver transplant patient in children. “As a centre, we are among some of the busiest in the world,” she says. “By European and American standards, we see a medium to high volume rate of patients. It’s only the tip of the iceberg. We should be seeing more and we should be doing more. We’re not getting all the patients we should be getting.”
Hudson’s story is proof that donation is the ultimate gift of life, Dr Beretta says, and Dr Goossens agrees. “We worked as hard as we could, and as closely as possible, but the way the organ donation process all fell into place – that is just unbelievable. It really is a miraculous story. That’s the honest truth of it.”