The dilemma was this: Nicole Wells had been sick for the better part of a decade, her liver in active rebellion against her body.
The only way she would get better was with a liver transplant.
Her sister Katie, younger by two years, had a perfect liver.
What would you do?
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Katie Wells did not hesitate. She donated 56 percent of her liver to her older sister. The sisters are the oldest of the four daughters of Len and Beth Wells of Richmond.
“I went to her and said, ‘I want to be the one to do it,” Katie Wells said.
Len Wells said the experience “has been transformative for our family. Katie never really hestitated.”
The liver is a remarkable organ, the largest in the body — and the only one that can regenerate. But donor livers are difficult to qualify for, and a donation from a living subject yields a better outcome.
Although Nicole Wells had started feeling ill at 15 and was eventually diagnosed with a cirrhotic liver — the liver of a 50 year-old alcoholic, although she had never had a drink. She was later also diagnosed with autoimmune hepatitis and primary sclerosing cholangitis. PSC is a progressive disease of the liver and gallbladder with inflammation and scarring of the bile ducts.
Nicole Wells lived for years with the disease, finishing a bachelor’s degree in English and education at Eastern Kentucky University in 2015. She taught English for a year in the Virgin Islands and had nearly completed her master’s degree in English, Rhetoric and Composition from EKU.
But her liver again flared up, threatening to fail. She was too sick to complete her final paper in the master’s program or to work.
Nicole also had no health benefits, but was on her parents’ policy via the Affordable Care Act.
Ironically, Nicole Wells never made the sickness threshold to qualify for a donor liver. Yet the Eastern Kentucky University graduate was stopped short of earning her graduate degree in rhetoric by her illness, which first hit her as a 15-year-old.
Liver transplant patients are prioritized according to the Model for End Stage Liver Disease (MELD). A patient’s MELD score and the deceased donor’s liver availability in a geographic region must line up for the patient to receive the liver. About 1,700 patients in the United States die each year while on the waiting list, with about 17,000 patients on the waiting list and only about 5,000 donor livers a year.
The University of Kentucky only performs deceased donor liver transplants. So Nicole’s entire family — sister and donor Katie, parents Len and Beth, and younger sisters Sarah and Kristin, 14 and 10 — relocated to Baltimore for five weeks to be near the University of Maryland Medical Center.
The transplant surgery itself was complicated. A virtual 3D image of Katie’s liver was built prior to the surgery.
On August 23, the family had two daughters in surgery at the same time, and then in intensive care. Surgeons removed Nicole’s diseased liver, then implanted 56 percent of Katie’s liver into Nicole’s body.
Katie, who had to overcome her fear of needles during the leadup to the surgery, remembers the “surreal” experience of hearing an anesthesiologist tell her she could die during surgery. Although she knew the risks, there’s something oddly official about hearing them ticked off by a doctor who’s about to sedate you.
“The first thing Katie said when she woke up is, ‘How is Nicole?’” Len Wells said.
“I wasn’t sure what to expect in the ICU, but when I woke up, I felt remarkably better,” Nicole Wells said.
Now she is again making plans — to finish her master’s degree and go to law school, possibly at the University of Cincinnati.
Katie Wells just started a hairdressing job in Richmond. As the one who bore the burden of losing part of her liver, she is delighted that she and her sister both have healthy, growing livers.
In a family photo taken from behind, you can see Katie and Nicole post-surgery. The two are clasping hands in a hospital corridor. Another photo shows the damage to the young bodies: stitches forming a jagged pattern on the abdomens of both sisters.
At this moment, though, the sisters were re-learning to walk, just as they did when the two were toddlers. But this time, their bond was different. One had taken the risk of a lifetime to save the other.
They will never really be apart again.