Photographer and writer Rick Nahmias spent several months “on call” with the.
Comprehensive Transplant Center's talented team to chronicle the exceptional ...
1 & 3 Jesus Gonzalez has been admitted to Cedars-Sinai in chronic liver failure. He has been waiting many months for a transplant. Toni Wright is undergoing evaluation, and hopes to get on the liver transplant list. She attends an educational session at Cedars-Sinai designed to inform candidates on the A-Z of transplants: from surgical procedures to how to manage the average three- to five-year wait. 2 & 4 Toni undergoes a series of medical
The Long Journey 1
tests: a pulmonary function exam, which assesses whether a candidate will have problems coming off a ventilator after surgery, and an echocardiogram to measure heart function and evaluate any heart abnormalities. 5 Kristine Baker, clinical program coordinator for the Comprehensive Transplant Center, awaits Toni’s test results. 6 Social worker John Pappas meets with Jesus. During this intake session, everything from the candidate’s medical and substance-use histories to their family support and post-op care is candidly discussed.
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The fact that vital organs can be successfully transplanted from one human being to another
is nothing short of miraculous. From surgeons and procurement coordinators remaining on call any hour of the day or night, to the patient awaiting the perfect match, the incredibly delicate and often long and arduous process leading up to a successful organ transplant is a complex symphony in which every participant plays a vital role. Photographer and writer Rick Nahmias spent several months “on call” with the Comprehensive Transplant Center’s talented 3
team to chronicle the exceptional work of the physicians, surgeons, nurses, social workers, coordinators, and volunteers, and tells the stories of two patients waiting for a liver transplant. This photo essay is a glimpse into their intense —and intensely moving—world.
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Photos & Text by Rick Nahmias
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1 Several times a day Kristine Baker connects with UNOS DonorNet, a national databank that runs 24/7, and notifies the Center of organ availability and acceptable donor matches. 2~3 Jesus Gonzalez, increasingly weaker, continues to wait for an acceptable organ match with the support of his family, including daughter Brenda and wife Eva. 4 Randi Swersky and Lori Dunn are transplant recipients who volunteer in the Transplant Ambassadors Program. They guide patients through the long evaluation process, providing much-needed support and sharing their experience along the way. 5 Toni pals around with Transplant Ambassador Ken Link at the end of a long day of tests and seminars. Her handmade sock puppets represent a sad liver and a happy liver. 6 Dr. Steven Colquhoun (second from right), surgical director of liver transplantation, leads the weekly patient-selection committee meeting, an essential part of the constant reassessment of the transplant wait list. Nurses, social workers, surgeons, and psychiatrists discuss each patient’s particular case after testing is completed. A mathematical
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score based on the results is then used to rank patients from least to most critical, which determines their position on the transplant list.
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SURGERY AND TRANSPLANTATION
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CEDARS-SINAI DISCOVERIES
1~6 10 p.m.: A donor organ has become available and is a match for Jesus. The transplant recovery team, Dr. Sid Rath, procurement specialist Robert Iuga, and Dr. Atta Nawabi, meets at Cedars-Sinai just before midnight and then travels by car to an Orange County, CA, hospital to recover the liver in a three-hour-long surgery. Since the donor, a gunshot victim, was young and otherwise healthy, his other organs will also be procured for transplantation by other regional hospitals.
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1 As Jesus enters what will be an eight-hour-long surgery, a team of 10 comes directly into play (L-R: Jimmy Howard, attending surgeon Dr. Nicholas Nissen, Dr. Jennifer Cutler, Joe Pineda, Dr. Atta Nawabi, Dr. Sid Rath, and perfusionist Ray Osborn.) 2 Dr. Cutler and Joe Pineda prep Jesus for his surgery. 3~4 In a routine but incredibly delicate procedure, the blood supplies of the donor organ are modified to match that of the patient’s. Surgeons use high-magnification glasses to see the fine vascular structures of the liver. 5 Dr. Nissen makes a final check of the liver to ensure it is completely ready, just moments before it is placed in Jesus.
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1 Dr. Shi-Hui Pan has prepared for Jesus an intricate medication profile, laying out a regimen of between 15-20 medications, ranging from anti-rejection to antibiotics that he must diligently take for months, even years, following the transplant. 2 Jesus has the staples over his incision removed. 3 Jesus’ post-op checkup shows excellent outcomes. Dr. Colquhoun goes over Jesus’ complex medication schedule with Eva before he can return home in good health. 4 Exactly a month after receiving a new liver, Jesus is weak, but back on his feet and happy to resume his favorite activity: tending to his garden. 5~6 Although she has moved up the candidate list in recent weeks, Toni and her husband are still awaiting word of a matching organ, as her health deteriorates. Nearly 17,000 Americans are currently on a waiting list for a liver transplant.
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Epilogue: Four months after the last photo was shot for this story, Toni received a liver transplant at Cedars-Sinai. She joined the ranks of the more than 850 men and women who have received a liver transplant at the Medical Center since 1988. She is doing very well.
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