First of two parts
When Charla Moye finally found her daughter sprawled on a friend's bed, naked and blue, she knew Liane was dying. ¶ "Call 911!" Charla screamed to her daughter's friends, who were just standing there. "Someone, call 911!" ¶ Charla planted both hands on her daughter's chest and started pumping. When that didn't work, she leaned down and covered her daughter's mouth with her own. She could taste the bile, what was left of the vomit. ¶ Charla, a 58-year-old cardiac nurse, had spent decades caring for strangers, from South Tampa to South America. But on that Saturday afternoon in April, the week before Easter 2011, she couldn't save her only child. ¶ She followed the ambulance to the hospital. Through tears, Charla asked the emergency room doctor to do something other parents might not have thought of during such a crisis: ¶ "At least save her organs."
• • •
Anyone who dies could save eight lives: two kidneys, two lungs, liver, pancreas, small intestine, heart. Add bones and tissue, and 50 more people might benefit.
Charla had worked on transplant cases at Tampa General, where her 31-year-old daughter, Liane Adgate, was now on life support. She knew how many people were waiting for organs, hoping to get a second chance.
Across the United States, 30,000 organ transplants are performed each year. More than four times as many people are waiting. Each day, 18 of them die.
In Florida, more than 5,000 people are hoping for organs. A nonprofit called LifeLink connects donors with recipients and oversees the transfer process throughout the west coast of Florida.
Usually, when a potential donor is about to die, a "designated requestor" from LifeLink talks to the family and explains donation. But on that spring Saturday more than two years ago, Charla offered her daughter's organs before anyone asked.
And because she wanted people to understand the importance of organ donation, she agreed to let the Times follow her through the worst weekend of her life — to watch her daughter's death and see how her organs were recovered.
Charla hoped that her daughter's kidneys would help someone avoid dialysis, that her skin would mend a burn victim, that her liver would let someone live.
She said she wanted to meet the recipients. Maybe, in them, she would still see Liane. One day she hoped to press her hand against a stranger's shirt and feel her daughter's heart still beating.
• • •
The swelling in Liane's brain spread quickly. Soon blood seeped into the right side. "Massive stroke," a doctor declared.
That night, orderlies moved Liane from the emergency room to intensive care.
Charla watched as a team of nurses surrounded the metal-railed bed. Someone threaded a tube down Liane's throat and taped it to her chapped lips. The tube snapped into a blue ventilator, thick as a vacuum hose, which would keep blood and oxygen flowing through her heart and lungs.
Another nurse hooked four IV bags to a pole above Liane's head, to flush fluids through her kidneys and maintain her blood pressure. Someone else squirted eye drops onto gauze squares and laid them across Liane's eyes, to keep her corneas moist.
• • •
All that night, Charla kept her vigil, praying not for a miracle but a meaningful end. All day Sunday, and that night too, she sat beside her daughter's bed, holding her limp hand.
She kept worrying. What was taking so long? She knew the longer they waited, the more the organs would begin to break down. Why didn't a doctor come to pronounce Liane brain dead so the transplant team could take over?
She didn't know then about the toxicology report or that doctors were waiting for drugs to clear Liane's system before they could make such a pronouncement.
At Liane's bedside for all those long hours, Charla kept wondering what had happened to her daughter.
Liane was much too young to suffer a massive stroke. She had been through so much. And achieved so much more than anyone ever thought she could.
Charla had gotten divorced before Liane turned 2. By then, she knew something was wrong with her little girl. Liane was late learning to crawl and walk, even later talking. In elementary school, teachers said she was so slow she would never read. But Charla put her in private schools, hired tutors, took her to therapy, signed her up for softball.
Liane thrived on the grassy diamond, became a competitive pitcher and joined a travel team. After graduating from Bayshore Christian High School, she earned a softball scholarship to Chowan College in North Carolina. She studied criminal justice and met a boy from town.
Their daughter, Kara, was premature — born at 24 weeks, weighing 1 lb. 8 oz. The dad stopped by the NICU a few times, but he and Liane didn't stay together. Liane and her baby moved in with Charla.
Liane was a security guard at Tampa General, then worked in a nursing home. During the last year, she had seemed so much happier. Pain pills were easing the ache in her knees, earned from all those years of playing catcher; antidepressants stabilized her moods. After a series of sketchy relationships, she seemed content being single, living with her daughter and mom in a house off Gandy Boulevard.
One day in April 2011, Liane cleaned the house and pool, then made dinner. "Today feels like a good day," she posted on her Facebook. "Got a lot of things done." That night, she went to a friend's house. About 3:45 a.m., she texted Charla, saying she'd had a few drinks and was going to sleep over. She promised to be home in the morning, in time to coach Kara's softball team.
When Liane didn't show up for the first pitch, Charla started calling her daughter's friends, then driving to their homes. It was almost 3 p.m. Saturday when she finally found her unconscious in that back bedroom.
• • •
Early Monday, when the nurses were out of the hospital room and Charla was finally alone with Liane, she reached into her wallet and slid out a photo of her granddaughter. With her round face and black bangs, 7-year-old Kara looked just like a little Liane.
Charla taped the picture to Liane's hospital gown, over her heart.
At 12:45 p.m. Monday, almost two days after Charla had discovered her daughter, a doctor pronounced Liane brain dead. Then another came. Florida requires a second opinion.
Outside, in the hall, a transplant team was assembling.
Charla leaned over Liane and pressed her daughter's hand against her own wet cheek. "You did good, honey," she whispered. "You're going to help so many people."
Soon, specialists started streaming into the room. Each organ had its own support squad. Ultimately, more than 100 people work on each donor.
A pulmonologist threaded a scope down Liane's throat to search her lungs for signs of pneumonia. Then he Velcroed an inflatable white vest around her chest to keep secretions from building. "Overall," he said, "it doesn't look too bad."
A kidney surgeon ordered blood tests to check for infection, and a full urinalysis.
"The liver numbers look fine," declared another doctor.
Then a cardiologist took an ultrasound of Liane's heart. "The pumping action is depressed," he said. To transplant a heart, it has to be working at a level of at least 50 percent. Liane's was 35.
"Can't you keep trying?" Charla begged. She grabbed a stethoscope to listen for herself. If they rehydrated the heart, she knew, the capacity might improve enough for it to be salvaged. She also knew that process might damage the other organs. Once the brain shuts down, machines can only regulate blood pressure and body temperature for a few hours, or days, depending on the donor. Eventually, organs begin to shut down.
"Her heart is the most important," Charla told the doctor. "It's the only way to keep her alive in someone else."
• • •
At the nurses' station, two LifeLink workers huddled around a computer, entering data, typing on their BlackBerrys. They added Liane's age, height, weight and blood type to a database called United Network Organ Sharing, attached her medical records, lab work and a 13-page donor information form.
The computer came up with matches that might be compatible for each organ.
"It takes such difficult coordination to keep all these organs viable, then to get them all placed," said Dr. Tarik Haddad, the pulmonologist. "And once the recipients are found, they have to be called in for pre-op. So we have to know where each organ is going before we recover it."
At 4:15 p.m. Monday, the specialists logged onto local waiting lists, crossed them with potential matches. They started with the sickest, and those who had been waiting longest. Those names were in red. They had to match blood type, approximate age and build. A 250-pound man can't take a child's liver.
"I'm working with a donor, a 31-year-old Caucasian woman, 5 feet 4 and 190 pounds, A-positive," Candace Skelton, the vascular coordinator, told someone in Fort Myers. "She was pronounced this morning. Her mother found her bluish, and did CPR."
The queries started near Tampa General, sometimes the recipients are close enough to drive. Each organ was offered separately, starting with the liver, which needs the fewest lab tests, moving on to the heart and lungs. The pancreas and kidneys require more specific matching, and can last longer, so usually they are placed last.
The calls and emails were quick, to the point: Here's what we have. Can you use any of these organs? If yes, a series of tests is needed to make sure the match will work. If no, the coordinator moves on to another hospital.
Kidneys, which can be transplanted up to 36 hours after recovery, can be flown all the way across the country. Eyes and tissue can be shipped overseas.
On the third query about the liver, match specialists found a recipient close enough to drive to Tampa General. On the fourth call for the kidney, they connected with a man nearby who had been waiting three years. They sent blood samples, via courier, to a transplant center in Fort Myers to see if they could place the left kidney. Once the match worked, the organs still had to be recovered safely, the transport arranged and executed, the second surgery a success.
After they had called 70 hospitals in Florida about the lungs and pancreas, the specialists started widening their range, 500 miles at a time.
By midnight, the two women had logged more than 300 calls, texts and emails.
"We're still looking for a home for the lungs and pancreas," Skelton told Charla.
"And the heart?" asked Charla. "That's the most important."
Skelton touched Charla's back. "Her heart rate is slowing," she said. "We're going to wait until the morning to do one more test. If you want to get some rest, I'll have the doctor call you."
Charla shook her head. As long as Liane's heart was beating, she was staying.
• • •
Sunrise seeped through the curtains Tuesday, a golden glow eclipsing the harsh hospital lights.
Charla glanced out the window, then turned and stroked her daughter's cheek. "She's cold," she told the nurse. "She's starting to get cold."
Above the bed, monitor lights climbed and fell. Charla knew when to worry long before she heard the warning beeps.
Blue: Liane's oxygenation level was 100 percent. Red: Blood pressure, excellent. Pink: Respiration within target.
Green was dropping fast: Heart rate.
At 7:45 a.m., an ultrasound tech came in to scan Liane's heart one last time. If doctors waited much longer, the other organs would be jeopardized.
"It looks stronger, doesn't it?" Charla asked the tech.
"A little better," came the answer. "It's borderline."
As a nurse, Charla knew an organ was just a mass of blood and tissue.
But as a mother, she remembered the first breath those lungs inhaled, how that skin felt in a bubble bath. She knew what that kind, strong heart had endured, who it loved, what it longed for.
Those memories — those organs — were all that was left of Liane.
Just before 9 a.m., the transplant coordinator came in, hanging her head. Charla whispered, "They declined the heart."
The coordinator nodded. Charla collapsed. It was as if Liane had died all over again.
"Do you want me to call a chaplain?" asked a nurse.
Charla shook her head. She knew there wasn't much time.
Once the heart stops, lungs have to be transplanted within four hours, livers within 12. Kidneys can last two days. Bones and skin can be stored for two years.
"Go home. You're exhausted," said the coordinator. "I'll call you after the surgery and let you know what was recovered."
A nurse turned off the compression vest; another turned out the lights.
In the dark, Charla leaned over her daughter's body and untaped the gauze from her eyes. She wiped each closed lid with her thumb, brushed back the dark hair, and whispered, "I love you." Then she bent and kissed Liane's cool forehead.
• • •
They wheeled the body down the hall, through double doors, into operating room 15, where a dozen masked surgeons had assembled.
The ceilings were high here, the overhead lights almost blinding. Everything was slate blue: the tile walls, the surgeons' scrubs, even the bed sheets — thin and crinkly, like disposable tablecloths.
Orderlies rolled the body — still attached to monitors and a ventilator — onto a metal table. Someone took the pillow that had been beneath Liane's head and tossed it onto the floor. The orderlies strapped the legs to the bed. A nurse holding a plastic tub began to sponge a frothy amber foam from chin to groin — Betadine, to kill bacteria, explained technician Aerika Liddington. "The recipients can't afford to risk an infection."
At 12:30 p.m., Dr. Hitesh Kaul picked up the chart and pulled out black-rimmed, magnifying glasses. He bent over the body and, with a black Sharpie, marked the corners of a square on the abdomen — where the incisions would go. Then someone handed him a yellow-handled instrument that looked like a fireplace lighter — a cautery, to slice and seal the skin. Soon, steam rose from the gash and the acrid smell of burning flesh filled the room.
He opened the body from the breastbone to the groin, folded back the flaps of skin — the cavity was 2 feet long, half as wide. "Saw," called the surgeon. The sharp whirring drowned the bleeping monitors while he cut away the ribs.
"Look at this," he said to the transplant team members, who were filling Styrofoam coolers with crushed ice. "That's a nice looking liver." Shiny and smooth, the color of raw steak, the liver was almost trapezoidal — as big as a Nerf basketball.
The surgeon tied off blood vessels with surgical string to slow bleeding, to preserve the passages. Whoever got that liver would need those vessels to attach to their own arteries and veins.
When the liver was free, Kaul cradled it, inspecting his work, then slid it into a bowl. Someone weighed it: 3 pounds. Someone else ran a cold preservation solution through the organ, to flush the warm blood and slow metabolism. Then they doused the liver in a bowl of clear saline slush, like a Slurpee.
"All right, that's clear," a transplant tech told the LifeLink coordinator. "Are you ready to package?"
They slid the bagged liver into a cooler, poured crushed ice over it, sealed the lid with clear tape. Then they carried it into the hall where seven cardboard boxes were stacked on a silver cart.
Each box was lined with a red plastic bag. Each had a color-coded label: Blue, right kidney; purple, left lung. Liver was green. The heart, of course, was red.
Transplant specialists lowered the liver cooler into the red bag inside the cardboard box, scooped in more crushed ice. In that packing, the organ could last 12 hours. "Keep upright," said the label. "Human organ for transplant. Handle with care."
• • •
Kidneys are yellow-pink, about the size of a slice of Wonder Bread. "These look good," the surgeon announced. A courier was waiting to rush the left one to Fort Myers.
When the right one was ready, a technician put the box on a cart and rolled it into the elevator. In an operating room one flight up, its new owner was being prepped.
One of Liane's lungs was filled with fluid; it was too dark and damaged to use. The other was pinker. A doctor removed it.
The recovery process was fast and complicated. Sometimes, as many as six hands worked inside the body at once.
In three hours, the team preserved the liver, one lung and both kidneys. They couldn't find a match for the pancreas or small intestine, so they left them intact. The next day, other doctors would take bones, tissue and corneas.
"Do you have a bowl for the heart?" asked Judy Bell, the surgical coordinator. Even though it couldn't be transplanted, the valves might be salvageable. She cupped it in her gloved hands, a glistening muscle mass of lavender and gold.
"I'll close her up," Judy told the surgeons.
When she was done, someone smoothed a white sheet over the body, leaving only the left foot exposed. Someone else tied a paper card — like a luggage tag — to the left big toe. Liane's raspberry pedicure was still perfect.
• • •
Charla got the call about 5 p.m. She still hadn't slept.
The final count: four organs. Her daughter had saved four strangers. "Oh, that's wonderful!" she sobbed.
"In a few weeks, you will get a letter with a little information about the recipients," Judy told her. "If you want to contact them, that's up to you."
"I want to meet them," Charla said. "I want my granddaughter to meet them too, to see the people her mommy helped."
She tried to imagine who they might be, what they would look like. "Now they'll have to love softball and chocolate fudge Ben & Jerry's," she said.
"I want to tell them about Liane," Charla said. "I want them to know the good they have inside them."
On that Tuesday night more than two years ago, she planned to write to the recipients right away. She said she wanted to meet them. She thought, then, that was a way to keep Liane alive.
But months passed, and she still couldn't pick up a pen.
Lane DeGregory can be reached at firstname.lastname@example.org or (727) 893-8825.