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Jim’s Story

Liver Transplant

Jim Orr had just walked into his home, shopping bags in hand, when the phone rang. It was 3:30 in the afternoon. Dr. Shimul Shah, Director of Liver Transplantation at the University of Cincinnati Medical Center, was on the phone. A donor liver – a Gift of Life – had become available from a healthy donor who had unexpectedly passed away.

“Today’s the day,” Dr. Shah told Jim. “Can you be here by 5 o’clock?”

Jim said yes and set down the phone, his heart thumping. As his wife, Cathy, looked at him expectantly, he broke into a broad, thumbs-up smile.

Thus began the final leg of a year-long journey that took Jim Orr, the retired Chairman and CEO of Convergys Corporation and a founding board member of the UC Gardner Neuroscience Institute, from a diagnosis of advanced, inoperable primary liver cancer to a life-saving liver transplant at his own UC Medical Center, where 60 to 70 liver transplants are performed each year.

Jim and Cathy are sharing their story of hope and perseverance in an effort to help educate others and to encourage all of us to make ourselves available as organ donors.

“Jim never gave up, and I hope he continues to tell that story to all patients with cancer,” Dr. Shah says. “He is a true inspiration and a reflection of his mindset, faith and fortitude. He offers a lesson to us as health providers: that we should try to treat each patient individually and not always rely on data, algorithms, protocols. There are exceptions to every rule, and Jim is one of them. He is a miracle case in many ways, because his response was amazing.”

“We are still stunned by the incredible outcome of Jim’s transplant, his amazing recovery and the expertise, dedication and compassion that has been shown to Jim and our family by the transplant team and the UC staff,” Cathy says. “The view we both share is that if anything coming from our experience would be helpful to another person, we would be only too happy to help.”

The routine checkup

Jim’s story began without a symptom or complaint. Lab tests conducted as part of Jim’s annual physical showed an elevation of two liver enzymes. Dr. Jeff Craig, one of Jim’s two internists, pursued the finding. Because Jim was taking a statin, and because statins can have an impact on liver function, Dr. Craig cut Jim’s statin dose in half. A follow-up lab showed no change in the liver enzymes, so the internists cut Jim’s statin dose completely. Still no change. They told Jim to completely abstain from alcohol. This time, three readings came back elevated. It was time for action.

An ultrasound revealed irregularities; a PET scan suggested an active tumor; and a biopsy revealed primary liver cancer: hepatocellular carcinoma. At this point, Jim recalls, one of his internists gave him life-saving advice. “He said one thing you need to know: with primary liver cancer, the only people who have any chance of long-term survival are those who go through surgery, either resection of the cancerous part of the liver or transplant. Your objective is to try get to surgery.”

Getting to surgery would prove as challenging as reaching the moon. The cancer, Jim and Cathy were told, was extensive and prevalent in both lobes of the liver. In short, it was inoperable. Their only hope, they learned, was to “down-stage” the liver cancer, to coerce it into remission via endovascular placement of cancer-killing spheres, or beads. The procedure would be significant and risky, as the largest tumor (12 centimeters) was encroaching on the portal vein, a vital blood vessel that conveys 75 percent of the liver’s blood flow. Without treatment, Jim had about 6 to 9 months to live.

But in the words of Dr. John M. Tew, Jr., the neurosurgeon and former clinical director of the UC Gardner Neuroscience Institute, Jim Orr is a man of “true grit.” With the foresight and assertiveness he used to found Convergys, he took the future into his own hands.

The due diligence

Jim and Cathy first visited a famous hospital in New York. They were referred to a young interventional radiologist who, with the backing of his hospital’s tumor board, was to treat Jim. But the day before the surgery was to take place, perhaps hearing the words “do no harm” in his head, the young specialist backed away, saying, “This is a higher risk than we routinely take on.” He did give Jim a ray of hope, however: he recommended Dr. Riad Salem, a pioneering interventional radiologist at Northwestern University who was writing the book on how to treat liver cancer with radioactive beads.

A few days later Jim and Cathy traveled to Chicago and saw Dr. Salem. Jim told him he wanted aggressive treatment, the kind that might give him 12 extra years of life, rather than 6 to 12 extra months. Dr. Salem did not promise that he could eradicate the cancer and transform Jim into a candidate for transplant surgery, but he said he would try.

Dr. Salem and his team mapped Jim’s tumor and, in a bold and unusual move, used a catheter to deposit high doses of radiation beads at all tumor sites on both sides of Jim’s liver. “It looks like a video game,” Jim recalls. “They go up through the femoral artery, lay the catheter next to the tumor and shoot it with beads.”

In addition to localized treatment with radioactive beads, Dr. Salem also prescribed oral chemotherapy, believing the treatments would act synergistically.

The window of opportunity

Over the next several months, Jim’s liver enzymes gradually returned to normal and the cancer vanished. At the four-month mark, Jim’s oncologist, Dr. Douglas Hawley, told him he had arrived at his window of opportunity. “Now is the time to start seeking a transplant,” he said. “If this cancer has any intentions of coming back, let’s go get a new liver now while we can.”

Once again, the Orrs did their research. The learned that most donor livers go to people with cirrhosis or hepatitis, not cancer, because people with cancer are generally viewed as having a higher risk of losing the liver. A recipient’s place on the waiting list is determined by his or her MELD score (Model for End Stage Liver Disease). MELD scores range from 6 (less ill) to 40 (gravely ill), as determined by three lab test results. Most transplants occur in people with a score of about 30. Patients also may qualify for a transplant under “Milan criteria” if their cancer is minimal and has not metastasized. They are given an initial MELD score of 22, with a 10 percent point increase for every three months on the waiting list. Three additional MELD points are given for every three months on the list without recurrence.

Despite the eradication of his cancer, Jim was still considered a risk. “His initial scan had about 10 or 11 tumors, which is why most programs would not consider him,” Dr. Shah says.

One prominent Midwestern health system the Orrs consulted offers a new liver to a cancer patient only if the aggregate tumor load is no more than 5 centimeters and no single tumor is greater than 3 centimeters. Although Jim’s largest tumor – 12 centimeters – was now only a mass of dead (necrotic) tissue, the center turned him down. Says Jim, “They wouldn’t consider giving a liver to someone who started out with my tumor.”

But others said yes. In mid-December, three hospital systems listed Jim for a transplant: UC Medical Center, John’s Hopkins University and the University of Maryland.

UC Health’s Dr. Shah, in particular, wanted Jim to be treated in Cincinnati. “As a new resident to the Cincinnati area, I am a firm believer we should take care of our own here in Cincinnati. I wanted him to get transplanted here because he lives here and we provide a great service here compared to others around the country.”

“Based on the statistics I had read, UC’s transplant program was a high-quality program that had made significant strides,” Jim says. “Their numbers were in line with, or better than, the national averages. That is a tribute to Dr. Shah and his team. It is a tribute to Dr. Steve Woodle, Chief of the Division of Transplant Surgery at UC Health. We felt comfortable with UC. We were prepared to go wherever we needed to go. But if we could get it done here, that would be optimal for our family.”

In the weeks ahead, Jim turned down two transplant opportunities – one at UC and one at Maryland – because the livers were from higher-risk donors. “They were good matches,” Jim reflects, “but they had some possible issues, and I was concerned with taking further risk, given how far we had come.”

The stars align

The call would come, as fate would have it, on April 15, 2014. “It was his mother’s birthday,” Cathy says. “It was one year to the day of his diagnosis. It was a full moon. It was Holy Week. The stars were aligned.”

Waiting for a transplant, Cathy says, is like waiting for a baby to be born. “You have absolutely no control over the timing, and in many ways it’s a rebirth for the recipient. Unfortunately — and we are ever mindful of this — it involves a loss to another family.”

After speaking with Jim at 3:30 p.m., Dr. Shah went home to visit with his family for a few hours. He knew he had a long night ahead of him. Then he returned to UC Medical Center.

The transplant team’s first task was to perform a laparoscopy to ensure that Jim’s liver cancer had not returned. At 8:30 p.m. Cathy received word from the operating room that the laparoscopy had been completed and the specimen was “pristine.” The transplant team could now move ahead.

By 9:45, Dr. Shah and his team were ready to remove the old liver. By midnight the old liver was out, and they were ready to implant the donor liver. At 2:45 a.m., Cathy received her last call from the OR: they were closing Jim back up.

Only one last hurdle remained: the pathologist’s report from a more complete study of the old liver. Recalls Cathy: “Dr. Shah looked at us and said, ‘The news doesn’t get any better. There is no evidence of cancer anywhere.’ And I think we were both stunned. It took us so long to get there. You have to prepare yourself for anything, even though you are hoping. It was the best possible outcome we could have had.”

Less than a month later, still amazed, Cathy and Jim Orr are savoring everything around them. “When your life is threatened,” Jim says, “you realize there are a lot of things on a day-to-day basis to celebrate, whether it’s people you love, or the place where you live, or the birds. Everything.”

“It’s like having cataract surgery on both eyes,” Cathy says. “Everything is brighter, clearer, richer, more beautiful. If you’ve developed any bad habits or bad thinking, it’s a correction: don’t take anything for granted, don’t waste time on things that are trivial.”

Jim’s oncologist left him with another thought. “I think you’re supposed to be here,” he said. “That means you have more work you’re supposed to do.”

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