When Liver Disease Affected the Mind and Body, a Liver Transplant Was the Answer

Jay Duncan is a creative guy. For decades he worked in advertising in Chicago – first for big agencies like BBDO and later as the head of his own firm. So when he started experiencing cognitive problems—trouble focusing , difficulty communicating—it was devastating.

Jay Duncan, Liver Transplant Recipient“My job requires me to use my brain very actively,” Duncan says. “But when I was sick, I couldn’t keep a thought. I couldn’t stay on one subject. I slurred my words. People couldn’t understand me.”

His symptoms came on gradually after he was diagnosed in 2010 with primary biliary cirrhosis (PBC), a chronic disease that slowly destroys bile ducts in the liver. Unlike the more common types of cirrhosis, often caused by hepatitis C or heavy alcohol consumption, PBC is thought to be an autoimmune disease—a disorder in which the body attacks its own cells.

Duncan’s cognitive problems were related to the fact that his diseased liver couldn’t efficiently filter blood. When this happens, toxins build up in the bloodstream. One of these toxins, ammonia, affects nerve transmission and disrupts thought processes.

In addition to PBC, Duncan was diagnosed with liver cancer and needed a liver transplant. After being placed on a transplant wait list in Chicago, he decided to move to St. Louis to seek treatment at Barnes-Jewish Hospital instead.

He had learned about the liver transplant program at the Washington University and Barnes-Jewish Transplant Center from his daughter, who lives in St. Louis with her husband and two children. Duncan was impressed by the hospital’s reputation, and in June 2012, he and his wife, Joyce, made the move.

Duncan also has coronary artery disease, so before he could be placed on a new wait list, he was evaluated by a Washington University cardiologist at Barnes-Jewish Hospital. His coronary disease, which wasn’t causing any symptoms, was found not to be a barrier to transplantation.

“Twenty years ago, most centers would have said Mr. Duncan—in his late 60s, with a heart condition— was clearly not a transplant candidate,” says Jeffrey Crippin, MD, medical director of the Washington University and Barnes-Jewish Transplant Center. “But we have learned that with appropriate follow-up and appropriate intervention, many patients like Mr. Duncan do incredibly well after a transplant.”

In November 2012, just five months after moving to St. Louis, Duncan got the call: There was a liver available. He canceled his plans for the day and headed to the hospital.

Before he went into the operating room, he spoke to his wife, daughter and son, who were all there with him. Shortly thereafter, he was wheeled away and given general anesthesia. The next thing he remembers is waking up. His operation, performed by Maria Doyle, MD, a Washington University transplant surgeon at Barnes-Jewish Hospital, had been a success.

“I felt quite confident having Dr. Doyle as my surgeon,” Duncan says. “It’s amazing to think that she and her team put a liver from someone else’s body into my body and made it function.”
Doyle describes organ donors and their families as heroes. “The families are the ones going through the trauma of losing a loved one,” she says. “Their ability to allow their loved ones’ organs to be transplanted is so important. Without these families, there would be very little organ donation.”

Duncan has kind words for everyone who helped care for him during his post-transplant hospital stay.

“I have never had better care in my life anywhere,” he says. “The physicians and staff were hands-on, caring and highly talented. It was just incredible.”

He is especially thankful for Ruth Bander, his transplant coordinator. Barnes-Jewish Hospital’s transplant nurse coordinators are responsible for coordinating all aspects of patients’ care both before and after transplantation. They provide patient education, schedule diagnostic testing and follow-up care, answer patients’ questions, and handle any problems that arise.

“Ruth is the best,” Duncan says. “She made everything happen right and happen on time. She is an amazing, amazing lady.”

More than three years after his transplant, Duncan, at age 71, feels better than ever. He exercises daily, runs his marketing communications business from his home and sees his grandchildren regularly.

William Chapman, MD, surgical director of the Transplant Center, says Duncan’s story is an example of the outstanding outcomes experienced by the hospital’s liver transplant patients.

“He has had an excellent result. When we combine up-front treatment of a tumor with a liver transplant, which is what we did with Mr. Duncan, we are more than 90 percent likely to see a long-term cure. That’s what we’re expecting for Mr. Duncan.”

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Category: Transplant

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Barnes-Jewish Hospital at Washington University Medical Center is the largest hospital in Missouri and the largest private employer in the St. Louis region. An affiliated teaching hospital of Washington University School of Medicine, Barnes-Jewish Hospital has a 1,800 member medical staff with many who are recognized as "Best Doctors in America." They are supported by residents, interns and fellows, in addition to nurses, technicians and other health-care professionals.

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