Liver transplant recipient on road to recovery

April 14, 2008

When asked what’s ahead for him now, two-time liver transplant recipient Mark Blazinski quickly responded: “Everything.”

After nearly a year and a half of medical complications, Blazinski, of Silver Lake, appears well on the road to recovery.

On March 19, Mark underwent his second liver transplant in less than a year. This time, a living donor process was used with his sister-in-law, Linda Kovar of rural Mayer, donating a portion of her liver.

“My prognosis is very good,” Mark said. “I will heal to the way I was before if not better.”

There’s still a long road of recovery ahead, but Mark and his family are the most optimistic in months.

“I was living on borrowed time. My liver doing nothing but taking up space,” he said. “It was like a plugged oil filter, and then you get high blood pressure, contaminated blood, no immune system.”

Things started around Thanksgiving 2006 when Mark had his gall bladder removed. Though doctors couldn’t say for certain why, it was right after that surgery that Mark’s already compromised liver started failing, leaving him hospitalized for several periods of time, including a 37-day stretch from late July to Labor Day.

About a year ago, he was placed on the transplant list, a somewhat competitive process in which those with a need are given a ranking based on medical factors, to receive the relatively few organs that become available.

Last May 24, Mark got the call and received a liver transplant, from an unknown cadaver, at the University of Minnesota Medical Center - Fairview in Minneapolis.

Though it saved his life at the time, that liver proved not be a long-term answer.

The family was told it involved a “preservation injury,” meaning it was kept on ice for a lengthy time while being transported from where it came.

Recipients are told very few details about where donated organs are from. In this case, the Blazinskis only know it was from beyond the Minnesota-North Dakota-South Dakota area, and that some time also passed while the donor’s family was making the decision whether to donate or not.

Over the next several months, Mark underwent at least seven ERCP procedures to place stents into his transplanted liver to help drain the bile.

After the summer, Mark’s health suddenly improved in September and he was able to attend the large fundraiser event friends and family members put on in Silver Lake.

But within the next couple months, his condition again deteriorated, to the point doctors determined another transplant would be necessary.

This time, use of a living donor was a possibility because Mark was still healthy enough to be able to use a partial liver.

Immediately, four relatives stepped forward, including Mark’s wife, Deb, and son, Giles.

The first steps to be a living donor are basic lab tests to determine blood type and filling out a comprehensive health history. Only about half of the people who apply pass that step, for a variety of reasons.

From there, one person at a time goes through an extensive process of medical tests and interviews.

Initially, Mark didn’t want to have any family members involved as a living donor.

“That day, when they brought it up, family was not an option,” Mark said. “If something bad would happen to one (in the surgery), it would happen to two.”

Mark recalled the reality of the clinic visit when a second transplant was proposed by doctors: “It wasn’t said until then. But now instead of being assumed, it was said.”

At the end of that appointment, Deb and her sister Betty walked ahead through a hospital tunnel, while Mark and Linda held back and had a heart-to-heart conversation.

“They were way ahead, and we put our cards on the table. I had to tell you some things on my mind,” Linda told Mark, recalling that moment.

“It made it easier to accept that you were donating,” he answered. “I wanted no family, and to be in control.”

Linda had been deeply involved with Mark and Deb from the beginning.

“From going through it the first time around, I saw everything and how it played out,” she said. “There was no way I could let that happen again.

“No way I could let Deb be without her husband, or Giles, Sarah, and Amy – my godchild – be without their dad. I felt deep down if I passed the testing, it was meant to be and would be okay,” Linda said.

Being the donor for the transplant “was easier than to live with myself if I had not tried,” she said.

The greatest advantage of using a living donor is that the person with the unhealthy liver doesn’t have to wait for someone to die. Only about one-third of the people on the waiting list get a liver each year, according to the university, and about 20 percent of the patients on the list die while waiting.

The living donor method greatly reduces the time element of transporting the liver, improving the chances it will work correctly.

Also, every living donor transplant takes someone off the list, allowing others to move up faster.

Medical expenses for the donor are billed to the recipient’s insurance company.

Linda was so positive about the procedure from the start, Deb said. “I was very thankful for what she was doing.”

That was early December, but it took over three months to get to the actual transplant.

Linda had immediately applied and was scheduled for the medical testing. But at one point, she realized that Mark and Deb’s son, Giles, who had also applied, needed the opportunity to try to help his father.

Instead, Giles went through the testing first, but was not accepted. Unless an unrelated medical issue that needs attention is found, applicants aren’t given reasons – just a yes or no.

After that, Linda went into the testing process. As she was finishing, there was some concern because Mark’s calcium level was too high, so additional tests were ordered for him.

“They were digging around, looking for cancer,” but didn’t find anything more, Deb said.

Eventually, the transplant was set for March 19.

The day before, both couples went to the University’s Transplant Center for a final round of testing to make sure nothing had changed, as well as final preparations. “Enema day,” Mark called it.

The transplant day started with a 5:30 a.m. arrival at the hospital. Linda went into surgery about 7:30, Mark closer to 8:30, and a number of family members dug in for a long day of waiting.

Linda’s surgery was estimated to be eight to 10 hours.

For Mark’s, “they said we could go to 4 or 6, or midnight. They said, don’t worry, even if it takes a long time,” Deb recalled.

Linda had two surgeons, Drs. Abhinav Humar and Anthony Rezcalleh. Mark had three at his side – Drs. Mark Hill, William Payne, and Raja Kandaswamy – with Dr. Humar also coming over after completing Linda’s.

Because of Mark’s previous transplant, removing his old liver was a more delicate procedure that took additional time.

Shortly after 3 p.m., family members were notified that Linda’s surgery was in a waiting mode until Mark was ready. “She’s circling the airport waiting to land,” a nurse described.

At around 5:30, about 60 percent of Linda’s liver was taken to the adjacent operating room for Mark.

Several times before and after the procedure, Linda jokingly referred to the old Pannekoeken commercials where waitresses in Dutch aprons would run – “fresh from the oven to the table.”

Linda was out of recovery about 9:45 and family members got to see her, a few at a time.

Less than an hour later, barely out of surgery herself, she called her husband Dale’s cell phone to check on Mark’s status.

Doctors came out about 11 p.m. when Mark’s surgery was complete, telling family members they also had to replace a portal vein connected to his new liver. The old one simply wasn’t unusable, so they retrieved one from the hospital’s tissue bank.

Family members headed for home that night, but Deb had only gotten to I-494 when she was called back because Mark’s heart rate had dropped quite low. By the time, she arrived back at the hospital, two injections of Atropine had stabilized him.

“I don’t remember what the nurse said, but it wasn’t positive,” Deb recalled. “I thought we were going to lose him, that he wasn’t strong enough to survive the surgery. But then when I was talking with Mark’s mom, I said ‘I’m really scared, but I know he going to be okay.’”

Deb described the three-day period around the transplant as “just stressful.” She slept only about five hours in three days.

But after the first night, recoveries for both Mark and Linda went remarkably well.

The transplant was on a Wednesday. By Sunday, which was Easter, doctors already mentioned Linda going home, though she knew she wasn’t ready for that yet.

Linda did make it home that Tuesday, and Mark right behind her on Thursday.

Mark’s improvement was very noticeable to those around him, especially his eyes becoming white again instead of a yellow color, and the constant itching the plagued him before the transplant subsided.

Hospital staff commented on how quickly he improved. He was in intensive care only from Wednesday to Sunday, and when he transferred floors, he walked to his new room himself.

Now, Mark looks forward to getting on his motorcycle, hunting and fishing, and taking a family vacation.

“Last summer was just a blink of an eye. I hardly remember anything,” he said.

Mark missed Giles’ high school graduation, and daughter Sarah’s participation as Pola-Czesky queen candidate in Silver Lake.

“I need money and a job and everything that goes with that, but the other things are what I have to have,” he said. “Things have become more precious and dear – how can they not?

“We’ve got family. Without that, I wouldn’t be sitting here,” he said. “Money can’t buy a family. They’re the most important people in your life. I had people stepping up, and all they’d say is ‘You’d do the same for me.’”

Mark won’t ever be pill-free, but looks forward to reducing his medications from the current nine prescriptions to one, as well as regaining weight. He lost over 40 pounds since the ordeal began.

On being a donor, Linda said she felt she helped two people – Mark directly, as well as someone else who would get a cadaver liver instead of Mark.

“There’s a lot of personal reward in donating. I have my secret little smile inside – how can you not think about it?” she said. “But there are some awkward moments when people over-acknowledge it. They said ‘You’re so wonderful, a saint, an angel.’ I have a hard time with that. People say ‘I don’t even give my brother-in-law a birthday card, let alone a liver.

She also expressed thanks for cards and phone calls, some from people she hadn’t been in touch with for years. “It’s nice to know people sincerely care,” she said.

Linda is off for 12 weeks from her job as a registered nurse at Elim Home in Watertown. She is slowly increasing activity, and has not had any complications.

The Blazinskis credited Ann Kalis, Mark’s transplant coordinator for seeing them through.

“She was always so positive, always there for us,” Deb said. “We’d call and she’d call right back. She even told us things we didn’t want to hear, but should. She’s a wonderful lady.”

The surgeons also get a lot of credit.

“I told them ‘Do you know the miracles that you do?’” Deb said. “And they just said ‘We’re glad to be a part of it.’ They’re really humble.”

In an adult-to-adult transplant, about 60 percent of the donor’s liver is given to the recipient. The liver has two lobes, each with its own blood supply.

The recipient gets the larger portion. Both pieces regenerate to fill the original space within a few weeks.

The University of Minnesota does about 25 living donor transplants a year, the first one being in 1996. Nationally, about 500 living donor liver transplants are done each year.

As of last week, there is a national waiting list for livers of 16,385, according to the Organ Procurement and Transplantation Network web site. In Minnesota, about 548 people are currently on the liver transplant list.