Epilogue : Hemodienamics

EPILOGUE : HEMODIENAMICS

‘El Toro’ and I have been on Interstate 80 — for more than a day now: we left New Venice shortly after my dialysis session in our main Voyager facility. The song ‘Jacksonville’ is playing on the radio: this playlist is the one I created when I thought I had to travel several days to Florida for a liver transplant.

Different regions of the United States — distribute ‘deceased donor’ livers within that region. Livers can only survive a limited period after the death of the host, so they need to be within relatively short travel times: they need to be in a new host within 24 hours. So there is not a national liver bank because a liver in Boston couldn’t make it to Palo Alto in time. Each deceased donor’s liver has a destination within about a 12-hour travel-perimeter for a patient that is prepped for the transplant upon the helicopter flying it in. Human organs travel in style.

Within a region, liver transplants are not based on a first-comefirst-served or a highest-bidder model. Instead it is based on how needy a patient is, which is calculated as a MELD (Model for Endstage Liver Disease) score. The higher the score, the more and sooner you need a liver. The lower the score, the more time you potentially have before death. It is a little more complicated in that if you get too sick, you can’t handle the transplant. Not exactly a catch-22, but requires luck or sophistication to play the transplant game optimally.

California and Arizona are in Region-5 — so all livers ‘produced’ within that region are distributed to patients within that region, with the transplant priority based on the patient’s MELD score, compatibility, ability to be ready for surgery, covid test result, and a few more aspects. Most of these aspects a patient cannot control, or ideally they are making ‘worse’ (as in dropping their MELD score). If you get in better health, your MELD score can

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drop significantly. So for some there is no hope of getting a liver in Region-5.

My playlist was created — when I thought moving to Jacksonville, Florida (Region-3) would dramatically improve my chances of getting a liver. The balance of donors to recipients is dramatically different in Region-3, potentially due to the lack of helmet laws. Turns out crashing a motorcycle into an 18-wheeler rarely harms the liver, nor do lesser injuries like simply tipping your bike over and hitting your head on the curb. To get to Florida would take several days by land, and I expected to drive ‘El Toro’ so I could continue to do hemodialysis along the way, and would have a car when I arrived. It was a 72-hour playlist, so was perfect for any significant road trip.

Then I became a vampire.

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ABOUT THE AUTHOR

Mark L. Fussell lives (or lived) with his wife Rebecca, and two daughters Maya and Katrina, in Palo Alto, California. He makes a living through consulting for companies including Apple, Intel, Sony, and HP. He makes a life through the loving relationships he has with family, friends, and even mere acquaintances. He was a little strange before this adventure, and now he is even more so.