SEVERN, Md. — Alyssa Riggan hasn’t dwelled on being the first person in the U.S. to successfully receive part of a liver from a living donor 25 years ago, a medical procedure that paved the way for routine live-donor transplants.
The anniversary fell on Thanksgiving this year. Riggan was 21 months old when her mother, Teri Smith, donated more than a third of her liver to save her daughter from a disorder called biliary atresia. She has lived a normal life, almost untouched by what was often a fatal disorder.
“Most of the time, I didn’t think about it,” Riggan, 26, said this week, noting her good health has enabled her to enjoy ballet and tap dancing since age 5. “All of my anniversaries are really big, so that’s when you really think about it the most.”
The procedure expanded the options for children with liver disorders, many of whom died while waiting for a liver from a deceased donor. It was first used only in small children. It’s now used for older children, and, in some places, for adults.
Biliary atresia is a disease that blocks liver bile ducts, backing up bile in the bloodstream and the liver. Before Riggan’s operation, liver transplants from living donors had been performed only four times — in Brazil, Australia and Japan. Those surgeries involved desperately ill children. Riggan’s transplant was the first on a child with time to wait.
An adult liver grows back to normal after the operation. The segment transplanted grows within the recipient.
“I can tell you we were all extremely concerned about the safety of the mother, Teri, who was just a trouper throughout,” said Dr. Dick Thistlethwaite, a member of the University of Chicago team that performed the surgery on Riggan. “The feeling when Alyssa’s operation was finished … was a feeling we had really done something worthwhile that would help not just this patient, but others, as well.”
Using parents as living donors posed complex ethical questions. With a parent willing to risk anything to help her child, how could the doctors be sure they were upholding the ethical standard of informed consent?
Before the first surgery, the University of Chicago team published a paper in the New England Journal of Medicine on how they intended to answer ethical questions as they selected patients and donors. The landmark paper helped shape ethical standards still used today.
