Since his birth, Andrew Morrissey has held a central place in the affections of the adults who surround him. And now the bonds of a family are drawn even closer: The 17-month-old from Maryland has received a combination liver/kidney transplant, with organs donated by his father and a grandmother.
Speaking yesterday afternoon, Dr. George V. Mazariegos, the child's surgeon, said Andrew was recovering well.
The three patients, all from suburban Baltimore, continued to be closely watched in intensive care yesterday after 14 hours of surgery Wednesday at both Children's and Montefiore hospitals.
Andrew, born March 27, 2006, suffered from a congenital kidney and liver disorder known as autosomal recessive polycystic kidney disease. He had both kidneys removed by the time he was a month old. He had developed severe complications from inflammation of the bile duct.
On dialysis since his second kidney removal, Andrew also had a diseased liver.
For much of his young life, he has been in and out of the hospital, mostly because of liver infections. His nephrology team at the University of Maryland Medical Center referred his case to Children's.
"There was a question of whether one or two transplants would be needed," said Dr. Mazariegos, director of pediatric transplantation at Children's Hospital's Hillman Center for Pediatric Transplantation. "He clearly needed the kidney. The risk of ongoing dialysis is very high."
If he had only a kidney transplant and was put on immunosuppressant medication, the doctor said, his risk of infection in the bile duct would rise.
The transplant cures Andrew of the disease he was born with, Dr. Mazariegos said.
Michael Morrissey, 29, a mechanical and environmental engineer, gave one-quarter of his liver to his son, said Dr. Mazariegos. Dr. Rakesh Sindhi, co-director of pediatric transplantation, and Dr. Amadeo Marcos removed the liver at Montefiore and carried it to Children's for the transplant, performed by Dr. Mazariegos and another transplant surgeon, Dr. Kyle Soltys.
Dee Papania, 53, who works for the archdiocese of Baltimore as a pastoral associate, gave one of her kidneys to her first grandchild.
The operation was only the second of that type done by the transplant team at Children's, Dr. Mazariegos said. The first patient, a 6-year-old boy received a kidney and liver from living donors in April and is reportedly doing well.
Living donors -- almost always family members -- give the patient the advantage of avoiding a long waiting list for deceased-donor organs and receiving organs that more closely match their own.
Dr. Mazariegos said that the team has worked with 10 live donors this year, about one-third of its total transplant cases.
"The results of adult-to-children [transplant] have been exceptional," he said.
He said Andrew will likely be on some immunosuppressant drugs for life, although "we try to wean it to the lowest level possible. We have noted that in living-donor transplants, the need for immunosuppressants is minimal. Up to 10 percent of the patients can have it withdrawn. That is an encouraging possibility. We're working on predicting which patients fall into that category."
He predicted that Andrew will spend at least a week in intensive care, the next stage of a journey that began 17 months earlier.
"Supposedly, Andrew should have died in 48 hours after his birth," said John Papania, his maternal grandfather. "He's a miracle. We believe God's got a plan for him."
The Papania and Morrissey families were first evaluated for transplantation in June. They found out they had matches on July 18. On Aug. 2, Andrew's father and maternal grandmother, Dee, were evaluated to make sure they were healthy enough to donate.
Andrew's mother, Jess, said her husband was chosen for the liver because he was more fit and could better stand the arduous liver surgery. Dee's kidneys were smaller and deemed more suitable for the baby.
"We were always very nervous," Jess Morrissey said, "But [Tuesday] it started to get a little scary. We had our day-to-day routine. Now the unknown is a little scary."
Tuesday night, Andrew had a high fever, she said, but after a medication was changed, he was back to his cheerful, playful self and stayed up till 3:45 a.m. Wednesday -- hours before surgery was to begin.
Family members expect to remain in Pittsburgh for four to five months.
The unknown affected the whole family, Mr. Papania said.
"But we're seriously people of faith. I don't see how other people manage without faith. The stress does zap you. But God has a plan."
Jill Daly can be reached at firstname.lastname@example.org or 412-263-1596. First Published September 21, 2007 4:00 AM