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‘I see the present in a different light,’ after a double transplant

One of the few double liver-kidney transplants performed in the past 15 years was done in Greece. September 2 was the 12th anniversary of the transplant, which was also one of the most successful, since the patient is still alive. Elissavet Floka, now 60, suffered from polycystic kidney disease. Her prognosis was death unless she had a transplant. An organ donor herself, despite advice to the contrary from those close to her and even her doctors, Floka decided to take the chance after receiving encouragement from Dr Evangelos Hadziyiannakis, then director of the first Surgery Clinic and Transplant Unit at Evangelismos Hospital. «It was an extremely difficult moment,» Floka told Kathimerini. «It was something I had to decide alone. I realized that I was taking the risk of my life, and I counted on the odds God gave me. I never asked them to tell me what the chances of success were. It would have been stupid. I told myself that the transplant had to be done; I had a child I couldn’t leave on his own, since my husband had died. And I knew that death was inevitable if I didn’t have the transplant. Finally, I thought that science might take another step forward through my own death.» «The first attempt at a double liver-kidney transplant on a patient who suffered from polycystic kidney disease was in 1990, in Pittsburgh, by the ‘father’ of liver transplants, Thomas Strazl,» Hadziyiannakis, now head of surgery at the Athens Medical Center, told Kathimerini. «The patient survived for just 16 days.» The second attempt was made by my teacher, Sir Roy Calne at Cambridge, and the patient lived for 22 days. On September 2, 1992, we operated on Mrs Floka.» There have been 50 double liver-kidney transplants in the world of which only seven were on patients with polycystic kidney disease. «The operation was an odyssey,» said Hadziyiannakis. «Every two-and-a-half hours I took a five-minute break for a cold shower, a glass of water and a slice of apple. I was keen to finish it. We had superb equipment and the team of doctors worked like a well-oiled machine.» «The days following the operation were very difficult,» said Floka. «From the third day onward I tried to be calm and to focus on myself so my mind could persuade my body that the new organs belonged to it now. God served me a tough deal in my life. But I never said, ‘Why me?’ I just asked for the strength to bear it. What struck me was how many people in the hospital wanted so much to help me. The love and strength I got from them was the lucky part of my life.» Learning lessons Floka gained wisdom from the experience. «You can’t be negative in your life and live. You have to want to live, to have a reason for living. Of course I don’t make long-term plans now, but that helps me see the present in a different light. «I want to work. For me work is a blessing and tiredness a daily test that I’m alive. I was bored in hospital. I got to the point where I was jealous of those who worked and got tired so they could enjoy sleeping afterward. Now I want to experience everything. I want the day to dawn. I want to see the sun that I missed when I was in the unit – not just see it but enjoy it. Now I feel the years I live are a gift and they have a different value for me. They’re a gift from both God and man.» That is the message Floka wants to pass on. «Greeks must be persuaded to espouse the idea of organ donation. Besides, nobody knows what will happen tomorrow. Nobody thinks that tomorrow they may need a transplant. The great thing about a transplant, especially of the liver, is that another person gives you life. And through death another life continues. When the relatives get over the pain and think that the one who died can give life, they rise above the human and get a little closer to God.» «Transplants need support,» said Hadziyiannakis. «After all, the results have been excellent in Greece. But there still aren’t enough transplants.» As he pointed out, some 300-400 people a year are diagnosed with terminal liver failure, but there are no more than 10 transplants due to a lack of organs. The figures are similar for heart transplants, and some 500 people die of heart failure every year. «I hope,» said Hadziyiannakis, «that the new leadership of the Health Ministry and the Greek Transplant Organization will pave the way for transplants at major private clinics, in an attempt to stem the flow of patients going abroad to transplant centers of dubious quality.» Myths about the liver «Liver transplants may be the most difficult of all organ transplants,» says Professor Evangelos Hadziyiannakis, head of surgery at the Athens Medical Center, «because this organ is very sensitive.» Ever since antiquity, people have recognized that the liver was the life of the human body. First were the Babylonians, who believed so profoundly in the powers of the liver that they established the famous liver oracles. Nobody – no king, army commander or ruler – made a major decision unless they had consulted those oracles. «The ancient Greeks also had remarkable knowledge of the liver’s regenerative properties, as evidenced by the myth of Prometheus, described by Hesiod (750 BC) and Aeschylus (500 BC). For 30 years, Prometheus was bound to a rock in the Caucasus. During the day a vulture would come and gnaw at his liver, which would grow again overnight. The regeneration of the liver was attributed to the chilly nights of the Caucasus, which protected it from further damage and helped it grow again. It’s extraordinary how many years it took us to understand the importance of keeping organs chilled to protect them from ischemia [restricted blood flow to a part of the body].»