- Associated Press - Monday, June 22, 2015

BULL SHOALS, Ark. (AP) - Twenty-year-old Zackery Fox always knew that someday he would need another liver.

The organ transplant was bound to happen since Fox was nearly seven weeks old, due to a life-threatening liver disorder called biliary atresia.

And when the time came for the 12-hour transplant surgery in St. Louis, Fox knew three things about the anonymous donor who saved his life: He was a man, he was close in age and he had been to jail.

Fox, of Bull Shoals, underwent major surgery in February and is due for a check-up later this month to see how the “new” organ is doing. In the meantime, things, as he has experienced, are going much better compared to seven months ago, the Baxter Bulletin reported (http://bit.ly/1QnvS90 ).

For most of his life, Fox battled biliary atresia, and with the help of a complex surgical procedure, it kept the problem at bay - until last October. The disease affects openings of the bile ducts that carry bile from the liver to the gallbladder for storage and to the small intestine for use, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

“The way (I was) hooked up inside was completely different from a normal person.”

“I was born and my mother brought me home, and I was jaundice, so I was really yellow. I never went back to a normal color, so they called the doctor,” Fox said. “They took a closer look at me and they found out my liver was underdeveloped. When they found that out, I had to go to the children’s hospital in Little Rock.”

That’s when Fox had a Kasai procedure. It’s best described by his transplant surgeon, Dr. Peter Horton of Saint Louis University Hospital, as a tree with no trunk, but only branches. Doctors had to connect the bile ducts Fox did have to his bowel. The operation got him through until the age of 20.

“The way (I was) hooked up inside was completely different from a normal person,” Fox said.

At that time, Fox was on the list to receive a transplant, but he wasn’t in desperate need until age 18 and starting his first year of college at Lindenwood University in St. Charles, Missouri. He was at the college for two weeks in 2012 when his liver, again, was failing. He was at risk of becoming “acutely unwell,” according to Horton.

Because of the condition, Fox dropped out of Lindenwood to be home with his family. He attends classes now at Arkansas State University Mountain Home and hopes to one day fulfill a degree in computer science.

Fox is one of about 500 people in the region who has received, or will receive, an organ transplant in 2015, according to Mid-America Transplant Services (MTS), a St. Louis-based organization that facilitates the organ and tissue donation process. The MTS service area covers northeast Arkansas, eastern Missouri and southern Illinois - about 4.7 million people.

Fox got the call from Saint Louis University Hospital at his Bull Shoals home when a liver became available the night of Feb. 5. Someone else had passed up the opportunity, leaving him next on the waiting list.

Less than 12 hours later, the St. Louis hospital transported the liver from another state and prepped Fox for the operating room. Horton served as the transplant surgeon.

The liver Fox received had been labeled “CDC high risk” because of the donor’s history.

“CDC high risk can mean a variety of things. It can mean that the donor has an infection, like Hepatitis C. In this particular case, there was no infective element,” Horton said. “The donor had spent somewhere between 72 hours and a week in a county jail within the last 12 months.”

According to MTS, organ donors are people who suffer brain death, but their body is kept functioning by artificial means. Brain death is diagnosed as an irreversible loss of blood flow to the brain, causing a stop in its function.

“Whenever that call did come, it’s like you hold your breath and you’re not sure,” said Vickie Fox, Zack’s mother. “You’re not sure whether it’s going to be a go or not. It’s an emotional roller coaster.”

Vickie often shared Facebook updates about her son’s condition, though these days, the updates come less often since his condition has improved.

“I was pretty nervous. It was just one of those things. I kind of wanted to turn it down, because it was ‘CDC high risk’ and you just don’t know,” Fox said, remembering the night of Feb. 5. “When they explained to me exactly what made this person high risk, I wasn’t really worried about it.

“It was just, do I want to do this now or should I wait?”

Nonetheless, he agreed to take the liver and stayed in the operating room Feb. 6-7. To Fox, it felt strange, an end to a long-term problem he dealt with his entire life.

Horton says he was able to get the old liver out and the “new” liver functioning within five hours. The operation was successful, and a check-up of Fox’s old liver showed no cancer.

“That’s always a concern, that you find something that you’re not expecting,” Horton said, though he had no doubt that Fox underwent a “life-saving procedure.”

Fox currently takes anti-rejection drugs, what the hospital says “suppresses the immune system.”

“Zackery no longer has the problems that he had before the liver transplant. He no longer has the recurrent infections, the cancer risk from having his old liver,” Horton said. “He has, in essence, a normal liver, but he has to take the anti-rejection drugs.”

Physically, Fox will be OK. He’s due for another check-up in St. Louis later this month. Fox may never know the identity of the anonymous organ donor who saved his life, but sometimes, he thinks of him.

“I’ve always wondered about it. I don’t know how to describe my feelings about it, but I’m obviously thankful - extremely thankful,” Fox said, adding he could not have done it without his parents, grandparents and friends.

“I would like to have known a little more about him.”

Now that Fox is better, he hopes to become more physically active. He wants to ride a bike - something he was unable to do before.

A shortage of organs is always a major concern for doctors, like Horton, and organizations, like Mid-America Transplant Services.

Horton says more people in the U.S. are in need of a kidney transplant than anything else. The most common solid-organ transplant tends to be kidneys with livers coming in second, he noted.

For patients like Fox, there’s no doubt in their mind: Consider becoming an organ donor.

___

Information from: The Baxter Bulletin, http://www.baxterbulletin.com

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