After surviving his third liver transplant, a kidney transplant, brain surgery and numerous other complications, holiday celebrations mean more than ever this year to Will Fleming and his partner, Mary Wright. To the Wilmette couple, it doesn’t seem that long ago that transplant hepatologist Josh Levitsky, MD, shared crushing news.

“Will, I’m sorry but we have to take you off the liver-kidney transplant list right now.”

Fleming had become too weak to survive a liver-kidney transplant surgery, and Dr. Levitsky gave him direct but hopeful discharge instructions: Go home. Gain weight. Get stronger.

While it was frustrating to hear he wasn’t eligible for a transplant, Fleming, 68, understood the realities more than most. It was to be his third liver transplant. The first had been in 2005, and within a year that liver failed. His second liver transplant went smoothly, and Fleming lived a full life for 12 years, even returning to cycling 40 to 50 miles at a time. He was an active member of the Evanston Bicycle Club and traveled the country to cycle in scenic locations.

It was after one of his 50-mile rides in 2021 that Fleming rapidly began to feel ill, and he asked Wright to take him to the hospital. Tests showed blood clots in the artery that supplied blood to the liver, and Fleming learned he would need a third liver transplant.

“I was in the best shape of my life when they said I needed another transplant, so it was really hard to believe when they told me,” Fleming, a Wilmette resident, said. “I was cycling, lifting weights and doing calisthenics regularly. I’d been so healthy for so long it took a while to realize I was actually sick again.”

Fleming was placed on the liver transplant list, and his health continued to decline. His kidneys failed, and he began dialysis. Then, he was told he’d also need a kidney transplant at the same time.

“He got down to 99 pounds, and he’s 5-feet-11,” Wright said. “When he became too sick for transplant surgery, a number of his physicians began suggesting different options. They didn’t use the word hospice, but I knew they were talking about just keeping him comfortable.”

Wright asked Fleming if he understood what his physicians were saying. He thought about it for a minute, looked at her and said, “I’m not ready.”

That was the turning point for Fleming, who committed to eating a little more each day. As he gained weight, he gained energy, which he used for light workouts to regain his strength. He put on 15 pounds and went to see Dr. Levitsky for a follow-up appointment.

“It’s a lot to be invested in a patient and then have to make a difficult decision to take them off the transplant list, but we’d discussed it as a transplant team and knew the risks were too high for Will,” Dr. Levitsky said. “Then he came into my office, and it was obvious he’d been working hard to get healthier. I’d set parameters for nutrition, weight, physical function and frailty, and over three or four months he was able to get there. That just showed the will he had to live and that he was a fighter.”

During that appointment, Fleming noticed he wasn’t the only one who had changes to his health.

“Dr. Levitsky was looking good,” Fleming said. “He looked a bit leaner, and he had the light tan of someone who spends a lot of time in the sun. He said he’d started cycling more and promised me he’d go for a ride after I got a transplant and recovered. I told him he had a deal.”

After the appointment, Dr. Levitsky began a campaign to get Fleming back on the transplant list.

“He went to every surgeon on the liver transplant team and talked to them about Will and his recent improvement, and he got them all to agree that they would do Will's transplant,” Wright said. “It was remarkable that he did that.”

Dr. Levitsky said he had to try because Fleming had been tenacious and he’d shown great improvement.

“Our transplant team has very high standards and there was still a lot of nervousness about Will, but we decided to go ahead,” Dr. Levitsky said. “There were people who were in his corner and there were people who were worried about him not surviving the third transplant.”

A week after he was relisted for a liver-kidney transplant, Fleming was called to Northwestern Memorial Hospital for the 14-hour surgery. Then came a recovery that was filled with complications.

Fleming suffered a rare brain bleed and an uncommon disease that forced him to lose the ends of his toes. He needed a feeding tube to provide extra nutrition, and he broke his neck, hip and arm after falls at home.

His recovery took longer than he had expected, but eventually Fleming won the fight and felt strong enough to ride a stationary bike. This fall, he rode his first outdoor miles and shared the good news with Dr. Levitsky, who was delighted to share the news with his colleagues.

“He took a picture with us and showed it to everyone on the transplant team,” Wright said. “He was so proud of Will’s recovery.”

The Northwestern Medicine Organ Transplant Center is now one of the largest transplant centers in the Midwest to use both warm and cold liver perfusion to make more livers available for lifesaving transplants. These advanced technologies improve donor liver quality and enhance the recovery process for patients at Northwestern Memorial Hospital.

To perfuse a donor liver, surgeons attach it to a machine that circulates either warm, oxygenated and nutrient-enriched blood or a cold, oxygen-rich solution. The technology helps transplant teams optimize the liver while it is being transported to its recipient.

“Our team has pioneered some of the first clinical trials as this rapidly evolving technology has been introduced in the United States,” said Daniel Borja, MD, a national leader in liver perfusion and a transplant surgeon at Northwestern Memorial Hospital. “Northwestern Medicine is among the leading transplant programs that are heavily investing in perfusion technologies because we have seen how patients recover faster and better when their livers have been perfused.”

The need for liver transplants in the United States far exceeds the supply of viable organs. More than 10,000 people are on the waiting list for liver transplants in the United States. In 2020, three patients died each day waiting for liver transplants. In the first six months of 2023, about half of the people who needed livers were able to receive them, according to the Organ Procurement & Transplantation Network.

“We are already the most experienced cold liver perfusion team in Illinois, and now that we are introducing warm perfusion, more patients will benefit,” Dr. Borja said. “They choose Northwestern Medicine for transplant care because they know we will do all we can to improve their health. When you’re suffering from liver failure, you want a team that will use the latest research and technology to make a healthier life possible.”

During warm (normothermic) perfusion, surgeons attach the donor liver to a machine that pumps warm, oxygenated and nutrient-enriched blood through the organ. While the liver is on the pump, the team assesses its function to ensure it is ideal for transplantation. This is especially important when the donor liver is classified as “marginal” or considered suboptimal for transplantation due to various criteria. While many transplant centers are forced to discard these organs, Northwestern Medicine’s team carefully evaluates them and is often able to find an appropriate patient match, thanks to perfusion technologies.

“Our team already has short liver waitlist times and low waitlist mortality rates, and warm perfusion will enable us to transplant even more patients, faster,” said Zachary Dietch, MD, transplant surgeon at Northwestern Memorial Hospital. “Now we’re able to expand our program because we can travel farther to procure a liver, place it on the pump and monitor its performance as we travel back to Chicago.”

A Northwestern Memorial Hospital team led by Dr. Borja is also part of a clinical trial using cold (hypothermic) perfusion to preserve livers for transplantation. For the study, surgeons attach the liver to a precision-controlled pump that circulates a chilled, oxygen-rich solution into the hepatic artery and portal vein. The liver’s mitochondria have a chance to repair as the solution circulates and the organ rests.

“The solution helps preserve and repair the liver so that by the time we place it in the patient, it is ready to work faster and starts working better,” Dr. Borja said. “So far, patients who have received perfused livers seem to be recovering faster and better than patients who received similar livers without machine perfusion.”

Dr. Borja said the team will continue to monitor patient outcomes for the FDA-approved warm perfusion and the cold perfusion clinical trial. Each patient will have a personalized treatment plan to achieve the best-possible results.

The heart, lung and kidney transplant teams at Northwestern Memorial Hospital also use warm perfusion technologies to preserve and assess organs. As the demand for organ transplantation grows, Northwestern Medicine continues to develop new ways to expand the pool of viable donor organs.

“The same diseases that are damaging the organs of our recipients are also affecting the donor population,” Dr. Borja said. “Diabetes, obesity, hypertension and other chronic conditions all affect the health of our donors, and we do all we can to make those organs usable for transplantation.”

Transplant surgeon Juan Carlos Caicedo, MD, says every scientific advancement is possible only because individuals and families make the selfless choice to donate organs.

“Organ donation, whether from a living donor or a deceased donor, is the greatest gift a person can receive,” Dr. Caicedo said. “We honor donors when we make more organs viable for transplantation. Research and innovation are helping our team maximize the possibilities.”

Surgeons and staff at Northwestern Memorial Hospital have performed their 2,500^th liver transplant surgery, becoming the first health system in Illinois to reach this milestone. The hospital performed its first liver transplant surgery in 1993 and has since become a destination for lifesaving liver care.

“We celebrate every life that has been saved because of our team’s dedication to exceptional patient care,” said Juan Carlos Caicedo, MD, surgical director of liver transplantation at Northwestern Memorial Hospital. “Transplant surgeries change the lives of patients, their families and their communities. As physicians, nurses, social workers and staff, we are fulfilled by this work and celebrate the gift of life. We are also thankful to the real heroes of transplant surgery, the patients and family members who choose to donate their organs to save the lives of others.”

Northwestern Medicine is home to the largest organ transplant and living donor organ transplant programs in Illinois. It was the first to offer programs that focus on the unique needs of Hispanic and African American patients, and continues to have the largest such programs. It is home to more than 90 current clinical trials related to transplant and receives $8 million in federal funding for transplant research. As a result of this advanced approach, the team can transplant marginal livers that other transplant centers may have to reject.

“We are able to optimize organs through perfusion and surgical techniques to make them appropriate for patients who would be otherwise unlikely to receive transplants,” Dr. Caicedo said. “This makes even more organs available to the many patients who are on the waiting list.”

The liver transplant program’s capabilities extend to patients in Chicago’s suburbs, downstate Illinois and in Indiana. Transplant hepatologists from Northwestern Memorial Hospital travel to 17 satellite clinics so patients can receive care closer to home.

“More than 77 percent of patients who receive liver transplants at Northwestern Memorial Hospital come from ZIP codes outside of Chicago,”  said Laura Kulik, MD, clinical practice director of hepatology at Northwestern Memorial Hospital. “About a quarter of them are hospitalized at the time of their liver transplants, but the vast majority require frequent outpatient visits for physician appointments and laboratory testing. We partner closely with primary care physicians, gastroenterologists and community hepatologists to coordinate each patient’s care and create personalized plans.”  

A new inpatient unit at Northwestern Medicine Central DuPage Hospital provides highly specialized pre- and post-transplant care to patients who need liver transplants and want to stay closer to home.

“Many patients who are waiting for liver transplants live unpredictable lives because of the seriousness of their disease,” said Sean Koppe, MD, network director of transplant hepatology at Northwestern Medicine. “By extending our inpatient services to the suburbs, we hope to keep patients closer to home while they wait for their lifesaving surgeries.”

Dr. Caicedo said the 2,500^th liver transplant milestone was made possible by innovation, collaboration and a shared commitment to leading-edge patient care.

“We are thankful to every organ donor and their family, and to each member of the team that has referred patients, performed research, coordinated transplants and provided bedside care to the people we serve,” Dr. Caicedo said. “Our support staff has helped create a culture of compassion that defines our team. We encourage each other to do more, celebrate every win and never forget the beauty of sending a patient home with a healthy new liver. It is an honor to care for these patients every day.”

“Physicians from Northwestern Memorial Hospital travel to 17 satellite clinics throughout the suburbs and downstate Illinois to treat thousands of patients with liver disease,” said Justin Boike, MD, a hepatologist at Northwestern Memorial Hospital. “We knew from experience that it can be difficult for patients to travel to the many medical appointments that are required before and after a liver transplant.”

The expanded inpatient services will complement the advanced liver care that is already offered at outpatient Northwestern Medicine locations throughout the suburbs, said Ken Hedley, president at Northwestern Medicine Central DuPage Hospital.

“Our hospital has always been recognized for providing high-quality care, and we’ve seen an increased demand for a higher level of inpatient liver disease treatment,” Hedley said. “Now, patients will be able to access all the care they need without traveling into the city for anything other than the actual surgery.”

More than 77 percent of patients who receive liver transplants at Northwestern Memorial Hospital come from ZIP codes outside of Chicago. About a quarter of them are hospitalized at the time of their liver transplants, but the vast majority require frequent outpatient visits for physician appointments and laboratory testing.

“Many patients who are waiting for liver transplants live unpredictable lives because of the seriousness of their disease,” said Sean Koppe, MD, network director of transplant hepatology at Northwestern Medicine. “By extending our inpatient services to the suburbs, we hope to keep patients closer to home while they wait for their lifesaving surgeries.”

The liver transplant team at Northwestern Memorial Hospital partnered closely with the team at Northwestern Medicine Central DuPage Hospital to add the highly specialized care that is required for patients awaiting liver transplantation. In addition to expanded testing and screening capabilities, the team dedicated an inpatient nursing unit to patients with liver disease and an outpatient clinic was opened for physician appointments. Transplant hepatologists and transplant surgeons from Northwestern Memorial Hospital have joined the medical staff at Northwestern Medicine Central DuPage Hospital to provide inpatient care to patients with liver disease.

“Northwestern Medicine Central DuPage Hospital is now providing the same level of inpatient transplant care that we have always offered in Chicago,” Dr. Boike said. “In the past, some of these patients already received care at Northwestern Medicine Central DuPage Hospital, but they were spread throughout the building based on the severity of their illnesses. Now, they will receive care on a dedicated nursing unit where the staff specializes in the treatment of patients with liver disease.”

In the past, hepatologists have been disappointed to hear patients have declined further treatment because they lack access to transportation or because they do not want to travel into the city for care.

“We hope that by bringing this care closer to home, patients will be diagnosed and treated earlier in the disease process and before they become very ill,” Koppe said. “We want our patients to spend more time with their families and friends and less time traveling for medical care.”

Physicians and staff members at both hospitals collaborated to ensure patients receive seamless care no matter which location they choose, said Satish Nadig, MD, PhD, chief of the division of abdominal organ transplantation and the director of the Northwestern Medicine Comprehensive Transplant Center.

“Our goal at Northwestern Medicine Transplant is to be patient-centric with every decision we make,” Dr. Nadig said. “To that end, expansion of our liver program to Northwestern Medicine Central DuPage Hospital allows us to provide our world-class transplant care closer to where our patients live and work.”

John Pandolfino, MD, chief of the division of gastroenterology and hepatology at Northwestern Memorial Hospital, said the expanded program is a result of the close relationships between patients and their physicians.

“For several years, our hepatologists have asked patients how we could better meet their needs as they deal with chronic liver disease,” Dr. Pandolfino said. “They told us they want to receive care at a hospital that provides trusted, high-quality services. It is our privilege and honor to partner with the team at Central DuPage Hospital to provide top-notch liver care to our patients.”

When Kathy Fiandaca and Daniel Ganger, MD, met nearly 35 years ago, she was a single mom who had been told her liver would fail by the time she was 30. He was a young transplant hepatologist who looked her in the eye as she shared her worst fear, that her baby girl would grow up without a mother. From the start, Dr. Ganger listened to his patient, but there was no arguing with him when it came to her future. She’d get a new liver, she’d be healthy, and she’d watch her daughter grow into adulthood.

The path to getting a new liver was rough. Today, at 58, Fiandaca still remembers the worst moments before she received her transplant, when autoimmune hepatitis and primary biliary cirrhosis had ravaged her liver. The surgeries, the medications, the times when she was too weak to care for her child. But more than anything, she remembers Dr. Ganger looking her in the eye and pushing her to go on.

“He just took me under his wing, and if it wasn't for him, I probably wouldn't have fought as hard as I did,” Fiandaca, a Midlothian, Ill. resident, said. “He made me feel like life was worth living. He was also concerned about my daughter, since I was a single parent. Six weeks later, I got the call that they had a liver for me.”

More than 30 years after that, Dr. Ganger continues to provide Fiandaca’s transplant hepatology care. There is an ease in their relationship, a familiarity that has grown through decades of their patient-physician partnership. Dr. Ganger says he doesn’t want praise for doing his job, but patients like Fiandaca are why he’s still a full-time transplant hepatologist at 71 years old.

“A lot of people say, ‘I owe you my life, but of course not.’” Dr. Ganger said. “They owe their lives to a team of people who work with them, and they owe themselves because they've done the right things since they received their transplants.”

Through the years, Fiandaca often had a companion at her appointments with Dr. Ganger – her daughter, Ashley Barretto. She was just eight years old when her mom received the transplanted liver.

“I think it was a 13-hour surgery,” Barretto said. “We were constantly getting updates, and I remember the nurse who was there for us so many days in a row. They acted as though we were their family, and the nurses were showing me things and answering questions so we didn’t feel afraid to bring her home. My grandma and I learned how to be sterile, and we had to help with mom’s wound care at home. We made such great connections with the nursing staff and the physicians that when I grew up, I wanted to give back.”

Now, at 38, Barretto is a nurse at the Northwestern Medicine Cancer Center in Warrenville, something that makes Fiandaca and Ganger equally proud. She said she models her conversations with patients after the interaction she’s seen between her mom and Dr. Ganger.

“There are so many physicians with great bedside manner, but he’s more than that,” Barretto said. “He takes the time, and he gets to know you as the whole individual. It’s such a banter between Dr. Ganger and my mom, he makes her feel so comfortable. It literally brings me joy because I know she’s in such great hands. He doesn’t give her grief. He just tells her how it is.”

In the 30-plus years since her liver transplant, Fiandaca has never had to be hospitalized for liver-related issues. She and Dr. Ganger have worked together to manage her health through life changes and through a scary experience with COVID-19.

“He trusts me like I trust him,” Fiandaca said. “He says I know my body, so if I say something is wrong, he knows it’s wrong. I trust him with my life. I know if I got into any situation, he’d be there to get me through it. I couldn’t have done it without him. He is the best.”

Dr. Ganger said patients like Fiandaca have benefited from the transition from protocol-based care to precision medicine, which focuses on individualized care. He is excited about latest developments in transplant care that will help patients live better with fewer medications.

“I love those meetings with longtime patients, and I love seeing Kathy well,” Dr. Ganger said. “She’s the story of how people can live with a liver transplant for a long time.”

As he looks back on his more than 40-year career as a transplant hepatologist, Dr. Ganger remembers the personal details that patients have shared with him through the years. He continues to love the science of medicine and measures his success in the memories his patients can make as a result of their care at Northwestern Medicine.

“I don’t have a Nobel Prize, but that’s OK. I have Kathy and so many other patients. These have been relationships that have fueled a healer’s dream.”

“I heard you’re a Cubs fan, but how does it feel to be part White Sox fan now,” Staehlin asked, while the room filled with groans from both families.

Droszcz laughed through grateful tears as they learned more about each other and the remarkable gift that brought them together.

Droszcz, a 52-year-old father of three from Tinley Park, Illinois, was diagnosed with advanced liver cancer in April 2021. After assessing his body’s response over time to radioembolization, surgery and systemic biological oral therapy, he was deemed healthy enough to be put on the waiting list for a donor liver. When none of his family members matched as his donor, Droszcz’s family used social media and traditional fliers to try and improve his chances of finding a willing donor.

Frankfort, Illinois resident Sarah Staehlin saw the social media posts several times and realized her 35-year-old husband met the basic liver donor criteria. She mentioned Droszcz’s story, and within weeks, Staehlin was being tested as a potential donor.

“It was a simple decision,” Chris Staehlin said. “He has three kids, and I have two. Kids need their dad. I realized that I could help him have more time with his family.”

On Aug. 24, still strangers, both men underwent surgery. Two days later, Staehlin was already walking five miles in the hospital halls. Droszcz’s recovery would take longer, but his medical team was celebrating with him after his successful surgery.

“Living donor organs are the highest quality we can provide because they are coming from a healthy donor, immediately implanted into the recipient and they start working for the patient right away,” said Juan Carlos Caicedo, MD, a transplant surgeon at Northwestern Memorial Hospital. “An altruistic donation, when the donor has never even met the patient, is not something we often get to do. It is tremendously moving to have the donor join our efforts to save a patient’s life.”

During a living donor liver transplant, surgeons remove part of the donor’s healthy liver and place it into the recipient. Within 12 weeks, most donor livers will regenerate and return to normal size.

“Living liver donors are a great blessing because they provide a liver graft when it is the right time for the recipient to receive a liver transplant,” Dr. Caicedo said. “It is a tragedy to see patients dying while they are waiting for a liver from a deceased donor. There are not advantages waiting for a deceased donor, there are only risks. Patients who receive organ donations from living donors typically have great outcomes.”

Justin Boike, MD, a hepatologist at Northwestern Memorial Hospital, said he and his colleagues were thrilled to see Droszcz receive a second chance at life because of Staehlin’s gift.

“Dan has been a fighter every step of the way,” Boike said. “He remained positive at the early point in his diagnosis and treatment and has remained proactive with his care. He is also a family man and thrives on the support of his amazing family. Liver transplant can be a definitive cure for liver cancer with the lowest risk for liver cancer recurrence, compared to other treatment options. His new transplanted liver graft will likely last him his lifetime, as liver transplants can function for the entire life of the patient.”

Nearly 6,000 people received liver donations in 2022, however less than six percent of those were from living donors. There are currently more than 11,000 people on the U.S. waiting list for liver donation. Each year, about 16 percent of people on the waiting list die while awaiting transplant.

“It took a multidisciplinary liver tumor program team to treat Dan’s cancer because initially he was not eligible for transplant. Our transplant and hepatobiliary surgeons, hepatologists, oncologists, interventional radiologists and nurses worked for almost a year to make Dan eligible to receive this transplant. This was not an easy task.” Caicedo said. “Beyond surgery, we also used specialized therapies to inhibit the cancer’s growth and to prepare him for surgery. It’s that combination of innovative medicine and selfless organ donation that have made his experience so special.”

Staehlin and Droszcz clasped hands as they sat together in the hospital and shared surgery stories. Family members alternated between crying, laughing and hugging as the men established a banter that was part fun, part heartfelt.

“How's my liver treating you?” Staehlin asked.

“It’s treating me good,” Droszcz said. “I love you, man. You're family now.”

ORLAND PARK, Ill. - A new Northwestern Medicine multi-specialty clinic is enhancing access to high-quality subspecialty care in the south suburbs. The 5,523-square-foot clinic, located in Suite 210, Northwestern Medicine Orland Park, 15300 West Avenue, is now offering neurology services. Esophageal and hepatology subspecialties will be added this summer.

“One of the biggest benefits of this multi-specialty clinic is the seamless integration into the rest of the Northwestern Medicine system,” says Neuro-oncologist and Neurology Regional Ambulatory Director Rimas V. Lukas, MD. “With the well-established framework at Orland Park, our team is thrilled to focus on further developing need-based specialties and identifying what additional services are most valuable to this patient population.”

As part of the broader Northwestern Medicine expansion and clinical integration strategy, the new clinic will provide access to Northwestern Memorial Hospital’s top-ranked neurology program, including fellowship-trained specialists in epilepsy, movement disorders, headache, sleep health, multiple sclerosis, neuromuscular and more. Neurologists in Orland Park will collaborate closely with the Neurosurgery team at Northwestern Medicine Palos Hospital, which is also expanding.

Stephan U. Schuele, MD, head of the Epilepsy Division at Northwestern Medicine, says the clinic will provide an easier entrance to subspecialty services for people in south suburban communities. "The patients I see with chronic epilepsy often cannot drive, and patients with seizures typically want care more quickly," says Dr. Schuele. "This clinic will allow us to provide a more accessible epilepsy program in the south suburbs, whereby these patients can now be seen by Northwestern Medicine specialists who provide world-class care."

Continued Growth at Northwestern Medicine Orland Park

To complement existing and general gastroenterology offerings in the south suburbs, esophageal and hepatology subspecialties will be available at the new clinic in the coming months.

“Data supports that overall survival in patients with end-stage liver disease, for example, is directly related to proximity to care," says General Hepatologist and Transplant Hepatologist Justin R. Boike, MD. "By bringing esophageal and hepatology subspecialty care closer to this population of patients, we can help to eliminate one of the biggest logistical challenges to receiving care that can improve patient outcomes.