Two women share the same liver in rare transplant: 'We share a piece of each other'

The call Maria Contreras received in July 2020 was one she'd waited six long and painful years for. "I will never forget the day my coordinator said they found a liver donor for me," the 53-year-old told PEOPLE. "My heart started beating so hard—I had been waiting for such a long time." The mother of four and grandmother of two from Cleveland, Ohio, was diagnosed with cirrhosis of the liver in 2014 after she started feeling painful itching on the palms of her hands and the bottom of her feet, prompting doctors to perform a liver biopsy. It was around this same time that 59-year-old Monica Davis, also from Ohio, started experiencing agonizing stomach pain.

In January 2014, Davis too was told she had cirrhosis of the liver. "The diagnosis was really life-threatening," she told The Washington Post. However, unlike Contreras—who was informed that she would probably be on the transplant list for 10 years or more—Davis initially wasn't interested in a transplant, despite knowing it was the only available treatment for end-stage liver disease. "My children were all grown, and I didn't think my husband would need me around. He is so self-sufficient," the mother of three and grandmother of four shared. "In hindsight, I know I shouldn't have been thinking like that." Her family members, Davis revealed, were "in disbelief" at her stance and were "praying I would change my mind."

To their relief, Davis did have an "epiphany" in a few years and realized she still had a life worth living. In May 2019, her name was added to the national list of prospective organ recipients, managed by the United Network for Organ Sharing (UNOS), the nonprofit that runs the country's transplant system. Meanwhile, Contreras—who did not know Davis at the time—had almost died while waiting for a new liver. She'd needed to get a stent in her heart to address a separate health condition in 2019 and had a near-fatal reaction to the blood-thinning medication she was prescribed because her liver couldn't properly process it. "My body wasn't able to heal," Contreras said. "It was back and forth to the hospital."

Finally, on July 1, 2020—after six years of waiting and doing everything she could to stay healthy—Contreras received a call from her transplant coordinator that it was finally her turn to receive a lifesaving liver. Since the transplant would take place later that same day, she was told she'd have to commit to the surgery immediately. However, there was a caveat: Her transplant coordinator informed her that she would be sharing the organ with another patient, through a rare and potentially risky medical procedure. "I was just happy because I was going to have a new liver," Contreras said. "It didn't matter if it was half or whole. I was just thinking about a new life."

Briefing her on what a split-liver transplantation entailed, her surgeon, Dr. Koji Hashimoto, MD, Ph.D., Director of Liver Transplantation at Cleveland Clinic, explained why she was a good candidate for the procedure. "The size of the patient determines the size of the liver needed," Hashimoto said. "It's also very important to take into consideration how sick the patient is. If you have a really sick patient, you need a bigger liver." In Contreras and Davis' case, both patients were considered suitable in size and illness progression to be viable recipients of a partial liver. The surgeon added that the health of the donated liver is also a crucial factor when considering a split-liver transplant—which was pioneered in Germany in the late 1980s and initially performed on one pediatric and one adult patient.

"Not all donors are good for split-liver in terms of quality," Hashimoto explained, adding that the quality of the organ is naturally diminished when it is divided, so a young, healthy donor is necessary for the procedure. "We have to use very complex techniques to divide the liver into two pieces." According to the surgeon, shild-adult split liver transplants are "relatively common" and are performed by splitting the organ into two portions of 20 and 80 percent. "A smaller piece goes to the child and a larger piece goes to the adult," Hashimoto said. Dividing one liver between two adults, he said, as of the over 9000 liver transplants performed in the US in 2021, only a small number were adult-only split-liver transplantations

"It's very labor-intensive" and requires three medical teams working at the same time, Hashimoto stated. While one team works on the donor, the other two perform the transplant surgeries. The procedure also poses a higher risk of blood clotting and other complications, he said, but the long-term survival rate is the same. However, for Contreras and Davis, "the risk would have been higher waiting. This was a better option," he added. Both Contreras and Davis' surgeries were successful and almost immediately after their operations, the two women—who now refer to themselves as "split-liver sisters"—were eager to meet each other.

"I was asking my nurse, 'Do you know about my liver sister?'" Contreras recalled. "I was so excited to see her." Although privacy policies and the pandemic made it difficult to coordinate a safe gathering, the pair finally came face-to-face in April 2022. "We share a piece of each other and feel connected," said Contreras. "I started crying because I had been waiting for this moment for a long time. In my heart, I was so happy." The woman, both of whom had smooth recoveries and are able to lead relatively normal lives, shared a tearful hug at Cleveland Clinic where Hashimoto and Davis's doctor, Cristiano Quintini, were also present for the meeting.

"We were hugging and dancing around," Davis said. "I had been praying for my transplant sister every day, just as I had been praying for my donor family. I am very grateful." Contreras shared similar sentiments. "I was so happy, and I said, 'Thank you God,' because He didn't only give me a new life, but He gave me a new sister, too," she said. The women now speak regularly on the phone and have scheduled a second meetup. They are also trying to figure out how to pay it forward. "I asked my social worker, I said, 'I know this is going to sound crazy, but if something were to happen to me, would I be able to re-donate my liver?'" Davis said, laughing. "When she said no, I said, well, then I'll have to think of something else to donate! My corneas?"