In what can only be billed as a heroes reunion, two groups of families and friends, strangers to each other, met Friday at Intermountain Primary Children’s Hospital to celebrate life.
Two specific lives, in fact.
A baby, Elieanna “Elie” Tibbs of St. George, was in dire need of a liver due to biliary atresia, a condition that causes the contents of her bile ducts to back up into her liver, putting her life in grave danger. Her parents couldn’t help her. Justin Tibbs, her dad, 36, was more than anxious to share part of his own liver with his daughter and it would have been a match, but surgeons said it was simply too big for her tiny body.
Meanwhile, further north in Lehi, Tara and Earl Kauffman were becoming increasingly anxious for their daughter Marissa, then 15, because she needed a new liver due to primary sclerosing cholangitis, which unchecked leads to irreversible liver damage.
You can’t live without a liver.
At first, Marissa’s family wasn’t worried, Tara Kauffman said. They have seven adult children, too, and with a large family, how hard could finding a match among them be?
Impossible, it turned out.
But doctors told the Kauffmans they still had a mystery donor in the wings (donations are typically anonymous) and there was another test to get past, but things looked hopeful.
The mystery donor turned out to be their neighbor, 33-year-old Annie Larrabee, who’s been tested without their knowledge. And the day after Larrabee admitted she was that donor, she learned taking enough of her liver to provide what Marissa needed would be too much. They’d just discovered she had a fairly common heart condition that involves a small opening in the wall between the upper heart chambers. Taking that much liver could put too much strain on her body.
Too bad she wasn’t donating to a baby, she said she was told. That could work.
The search would continue to find a suitable donor for both girls, whose families knew nothing about each other.
An inspired answer
But when you take two people with opposite needs and two others with opposite abilities to help, lives can be saved. That’s what the Intermountain transplant team did, performing what’s called a “paired” liver transplant exchange. It’s magical math: one incompatible pair plus another incompatible pair that heals two people.
The two days of surgery, performed in July by transplant surgeons Dr. Jean Botha and Dr. Zach Kastenberg, put Annie Larrabee’s smaller liver donation into Elie’s little body and anxious dad Justin Tibbs’ larger donation into Marissa Kauffman on separate days. It kept both families not only intact but everyone involved feeling grateful.
Larrabee said she’d felt a spiritual prompting to donate to her teenage neighbor and could not figure out why she felt that if it wasn’t going to work out.
“God was in every single detail of this and he led us where we are today,” said Larrabee.
The surgeries are believed to be the first pediatric paired liver exchange in Utah.
The kids are thriving, the adults have healed and they all met for the first time at the hospital to celebrate the groundbreaking event. Elieanna, now barely 9 months old, seemed content to be cuddled by Larrabee, who saved her life. Marissa Kauffman, now 16, told Deseret News she’s ready to go back to school next week, albeit a bit late, for her junior year. She’s feeling much better.
Tara Kauffman and Jasmyn Tibbs, two very grateful moms, were misty-eyed as they hugged.
What the doctors, others say
Earl Kauffman spoke of the selflessness of the liver donors.
Larrabee said she felt grateful to be part of the process that kept two families intact.
Jasmyn Tibbs said when her husband was coming out of anesthesia, his first words were: “Has anyone heard anything about my daughter?” She told Larrabee and the Kauffmans, “You are now part of the family, which means you are Kansas City Chiefs fans.”
And no one doubted she was serious about the family part.
“What a privilege it is for us to be part of something like this,” Botha said as he looked at two of the lives he and Kastenberg saved with very long, technical surgeries. “Incredible.”
Kastenberg acknowledged that needing a liver transplant and the process involved are “a rollercoaster of emotions and physiology.” He said, “I want to acknowledge the selflessness of all of you.”
Elie? She was content and even interested as she was passed around a little, looking curiously at those in the room and staring at Botha as if they were old friends. Toward the end of the gathering, she smiled.
About pediatric transplants
Botha said that the “sobering reality” is that between 5% and 10% of children on the pediatric transplant waiting list will die without getting one. And for those who do receive one, the results are better if the transplant happens earlier, which is something paired exchanges with living donors can allow.
There’s a natural lag in getting national numbers, but pediatric liver transplants accounted for 5% of the nearly 11,000 liver transplants in the U.S. in 2023. And the number of living-donor transplants is growing. They made up nearly 15% of pediatric transplants that year.
It is possible to take part of the liver and transplant it. The donor’s liver rejuvenates and can resume function as if it hadn’t happened, which makes the liver a unique transplant organ. Typically, in adult transplants, a smaller section stays behind with the donor and a bigger one is transplanted to the person who needs a liver. With pediatric patients who are smaller, that’s usually reversed and the smaller portion is transplanted. In all cases, the donated liver has to fit the recipient.
Being able to take a section of liver from a living donor greatly increases the likelihood of receiving a transplant because the practice grows the donor pool.
A study published in the journal Clinical Liver Disease in 2023 said size is particularly an issue for children younger than 1, like Elie. The same study said living donor transplants provide the best survival outcomes for pediatric patients, but they are still in the minority.
