Seth Webb, a 30-year-old man from Macclesfield, NC, and Scott Owen, a 72-year-old man from Cameron, NC, were both in need of a new liver. Surgeons at UNC Hospitals made the most of the opportunity: performing a rare domino liver transplant at UNC Hospitals to save their lives with the least number of organs possible.
The Story of Seth Webb
When Seth Webb was born, he faced many challenges.
He was first diagnosed with a rare genetic disorder, known as maple syrup urine disease. His body was missing essential enzymes that are crucial for breaking down amino acids, the smallest components of proteins. If he consumed any protein. amino acids would overwhelm his body, and it could put his health in immediate danger. He spent his entire life monitoring the amount of protein he consumed each day.
Webb was later given another diagnosis: Type I diabetes, a condition in which the body’s own immune cells attack the cells that produce insulin, a crucial glucose hormone in the pancreas. Webb adjusted his diet once again, adding insulin to his daily regimen. He sustained himself on vegetables and a protein supplement to help keep his nutritional balance in check.
But Webb didn’t let his conditions slow him down. He, and his family, adapted instead. Growing up, his mother would carefully prepare his meals to make sure he ate enough and avoided trigger foods. Other than that, Webb has led a normal and fulfilling life. He has worked at a flower shop in the small town of Pinetops, NC for the past fourteen years and has a wife and a young son.
But despite his best efforts, Webb experienced multiple medical complications in 2023. As a result, he and his wife were always packed and prepared to drive 90 minutes to the intensive care unit at UNC Hospitals in Chapel Hill. It greatly disrupted his livelihood, often forcing him to call out of work for weeks at a time.
During his most recent visit, he asked his metabolic specialist if he could speak to somebody about receiving a liver transplant. A new liver would allow his body to metabolize proteins again and he could reduce his lengthy list of dietary restrictions. Because his condition was genetic, his old liver was otherwise healthy and could go to someone in need.
“I said, ‘Before I leave here, somebody’s got to talk to me about a transplant,’” Webb said. “Dr. Oren Fix had this caring look in his eyes, a look that said he really wanted to help me get to candidacy and go through all the testing.”
The Story of Scott Owen
Scott Owen was diagnosed with a common form of liver cancer in 2010, when he was a resident in California.
At 58-years-old, Owen had gone through at least 14 different surgical procedures to remove cancerous tissue from his liver and to limit its spread. However, he was told that there would come a time when the surgical procedures would no longer keep the cancer at bay and that he needed a new liver altogether.
“Doctors told me that I had to wait for the cancer in me to get up to two centimeters before I could get on the transplant list in the state of California,” said Owen. “I was told at that time, because of my age and because of the high demand for viable livers in the state of California, that I would probably pass away before I received one.”
Owen moved to Cameron, North Carolina in 2021 to be closer to his daughter and son-in-law, who was stationed at Fort Liberty. As soon as Owen set foot in the Tar Heel state, he was placed on the organ transplant list and performed all of the necessary testing. A year later, he received a call that he would never forget: a new liver was ready for him.
The Domino Liver Transplant
Chirag Desai, MD, FACS, an abdominal organ transplant and hepatobiliary-pancreatic surgeon at UNC Hospitals, Oren Fix, MD, the medical director of liver transplantation at the UNC School of Medicine, and the transplant team at the UNC School of Medicine’s Department of Surgery, were given the opportunity to perform a rare domino liver transplant at UNC Hospitals last November.
It was going to be the first time in two decades that the procedure had been performed within the operating rooms in Chapel Hill.
The first part of the procedure is identical to a classic cadaveric liver transplant. Webb’s healthy liver was carefully removed, “flushed,” and then placed into a special cooler with ice to keep the organ at the proper temperature for preservation. Immediately following the removal of his liver, a new liver from a deceased donor was carefully placed into Webb.
At the same time, Webb’s original liver was quickly taken into the adjacent operating room, where Owen was having his scarred liver removed. With time of the essence, Owen’s new liver was surgically and safely implanted.
Desai and his team performed the meticulous procedure over the course of twenty hours and without needing to use any blood transfusions. It was an incredible feat, given that abdominal surgery involves disconnecting and reconnecting the complex vascular networks that go in and out of the liver.
Recovering After Receiving the Gift of Life
Approximately ten days after the procedure, both patients were able to leave hospital and go back to their families.
“I’m getting a little choked up here,” Owen said. “The service and kindness that I was treated with, and the concerns that everybody had to get me well, were remarkable. I can’t tell you enough how happy I am and with the process through UNC.”
And then began the at-home recovery. As is the case with every patient who receives a new organ, Webb and Owen were given a host of pain medications, anti-rejection pills, and strict instructions about how to keep their new liver systems purified and in working order. Owen’s wife, Lori, described what it was like to help her husband through the recovery process.
“When you are given all these medications and instructions, you start to realize this man’s life is now in my hands,” she said. “Your role is very important, but difficult. You’re loved one is recovering, but you feel left out.”
“Just know that it gets better, and they appreciate everything you are doing, no matter the recovery pain, sleepless nights, and long days. There is a light at the end of the tunnel for caregivers and patients.”
Now A Year Out…
Since receiving his new liver, Webb’s life has improved in ways he never imagined. For the first time in his life, he’s been able to eat a staple of North Carolina cuisine: barbecued meat. He was most excited to try a cheeseburger alongside his young son.
“It is a tremendous gift to not have to think about what to eat at every meal,” he said. “My menu has grown from just salad and vegetables, and now I can try new foods along with my growing son. In a way, it feels so good to not have to struggle and find foods that you can eat.”
And, perhaps more importantly, he doesn’t feel like a burden to others.
“Before I got my new liver, I did everything I could to just feel good so I could go to work and be there for my family,” he said. “I’m one that does not want to bother anyone. I would rather go without than to have someone help me, otherwise, I feel like I’m bothering them.”
Owen, the now 72-year-old and former carpenter, has returned to woodworking and is now helping to plan and constructing a new building at their local food pantry. He takes special care of his new liver and advises others to be in the absolute best of health going into surgery, as it also helps the recovery process, and to not give up hope.
“Keep the faith,” he said. “If you’re in the program, there’s an angel sitting on your shoulder and there’s a liver out there for you. You have a chance of having a normal life again.”
Domino transplant surgeries are becoming more common after a new national policy called the Acuity Circles Policy has changed the way in which organs are shipped to hospitals throughout the United States. Livers are harder to get than ever before, especially in rural communities.
Due to the high demand and limited supply of livers, many patients must wait until their conditions worsen before being added to a transplant list high enough to receive a new organ. Domino liver transplants are needed now more than ever to help alleviate the nation’s liver shortage.
“I am extremely satisfied that our team has the ability to execute such complex procedures safely and effectively,” said Desai, who is also the division chief of abdominal transplantation and surgical director of the Liver Transplant Program at UNC Hospitals. “These surgeries give North Carolinians access to transplants and cutting-edge technologies.”
Media contact: Kendall Daniels, Communications Specialist, UNC Health | UNC School of Medicine