While her feet are firmly planted in northern Colorado, her adopted home for the past two years, part of Victoria Threadgould’s heart still resides in England.

It was where she was born and raised, attended college and met her husband, and where her parents still live.

And then there’s one of her kidneys.

It has been on the East Coast of the U.S., where it thrives in the body of a woman — a stranger at the time — who received Victoria’s organ donation in February 2022.

There’s also Victoria’s liver. Well, a large portion of it has been in the southwestern U.S. since June when it was transplanted into another donor, also unknown to Victoria.

Three women: None of them related, living in different parts of the country and having paths that may or may not cross again. But the common denominator for the three is Victoria, a two-time non-directed or “altruistic” donor who has twice given her organs to people she has never met.

What makes Victoria’s story even more unique is that she was the first living donor at UCHealth University of Colorado Hospital to donate part of her liver — the right lobe — through a new, state-of-the-art robotic surgery. This less-invasive procedure, unlike open surgery, requires minimal incisions, making for a recovery that is faster, less painful and requires a shorter hospital stay.

“I was really surprised by how quickly I recovered and felt back to normal. With robotic surgery, the down time was less compared to what I would have had with open surgery.” said the 41-year-old who lives in Windsor with her husband, Mike. “If more people learned about this, they might think it’s realistic for them to donate.”

University of Colorado Hospital is just one of four hospitals in the country, and the only one in the Rocky Mountain region, using this new advanced technology for organ donors. Those working in the donor medical community hope it will spur others to become live donors.

“There is always the need for more organs than the number of donors,” said Jaime Cisek, living donor coordinator of transplant services for UCHealth. “People who are non-directed donors think differently than the general public, as they see themselves as a way to contribute to a solution for this.”

Victoria, an athlete who loves to competitively run, teach Pilates, and recreationally bike, swim, and horseback ride, was quickly back to her ambitious workout regimen in what seemed like record time, within a month or so, after her donor procedure in June.

“She is a very special person,” said Dr. Trevor Nydam, new interim head of the UCHealth Transplant Center. “Victoria and other living donors we work with are amazing people. There is just something inside of them that wants to give back.”

Nydam is also a professor at the University of Colorado School of Medicine on the Anschutz Medical Campus in Aurora.

Victoria’s husband Mike calls her “amazing” and said she has never been one to shy away from a challenge.

“She is always open to following things that felt right, and this came along and felt right,” he said.

From England to Texas to Colorado: Victoria gives back along the way

Over the summer, Victoria returned to Lincoln, England, a small city in the eastern part the country where she was born, for her parents 50^th wedding anniversary. The trip came after she had fully recovered from her liver donor surgery. It was a sweet reunion, as her family had been concerned about how a liver donation would affect her health.

“Yes, they are proud of me, but my mother was worried and asked a lot of questions.”

She and Mike, who met as students at Loughborough University in Leicestershire, England, recently celebrated their 14^th wedding anniversary. The couple moved to Austin, Texas 12 years ago. While there, she learned about living kidney donation while listening to a podcast.

“I didn’t know anyone who needed a kidney or anyone with kidney disease, but I am lucky enough to have good health and a strong support system around me. As I learned more about it, I decided to do it and went through all the testing.”

Through the National Kidney Registry, a nondirected donor match was found on the East Coast, and Victoria donated her left kidney in February 2022 through a laparoscopic nephrectomy. The surgery was minimally invasive, entailing small incisions in her abdomen to retrieve the left kidney.

She was in the hospital for a few days and had no medical complications. She was back to her exercise routine, as well her job at a nonprofit, within four weeks.

“I had a really good experience with surgery and recovery,” she said. “It was a great opportunity to be able to donate and make a difference and help someone in need. The fact that someone is dying because of kidney failure … I am very fortunate and never had chronic disease or illness in my life, so the question is why wouldn’t I donate a kidney? Life doesn’t change, and I continue to live a healthy and active life with just one kidney.”

When people make a non-directed organ donation, there is no guarantee they will hear from the person on the receiving end. Donations are anonymous, although either side can let the transplant center know they want to share written communication. If the sentiment is reciprocated, contact information can be exchanged.

The mother of the kidney recipient reached out and last winter, Victoria and Mike enjoyed an emotional meeting with the family.

“It was amazing and such a bonus meeting her,” Victoria said. “We had been in touch over email, so I knew a lot about her.”

Because of that positive experience, Victoria joined a community of living donors who would meet for athletic and fundraising events. After moving to Colorado in the summer 2022, she continued to volunteer as a mentor and doing advocacy work for the National Kidney Donation Organization.

Along the way, she learned about “double donors” – people who donate two of their organs, and specifically, the need for liver donations. At the start of the 2024, she got in touch with Cisek to learn more about the UCHealth liver donor program.

“I was learning as I went along. Again, I didn’t know anyone with liver disease, but unlike kidney failure, you can’t go on dialysis indefinitely until a donor is found. You just die,” Victoria said.

People can have damaged livers for a variety of reasons: genetic or auto immune disorders, a condition called a “fatty liver” when too much fat builds up in the liver; or from hepatitis or alcoholism.

By February, Victoria had completed a two-day evaluation and met with the donor team. The preliminary workup includes a detailed psychosocial-medical questionnaire that is part of the rigorous prep work organ donors face. Donors also complete a full medical checkup and numerous exams to ensure they are healthy enough to donate.

Victoria was told she qualified for the donor program. Next, she would wait until the right match came along.

More need for organs than available donors: how does living organ donation work?

The liver performs many critical functions for our body, including filtering our blood of toxins and wastes including alcohol and drugs. It helps support our immunity, metabolism and digestion to create the nutrients our body needs.

While some organs can compensate when they are damaged or removed, such as our lungs, pancreas and thyroid, the liver alone is amazing in its ability to quickly regenerate even if most of it is removed. For instance, if a donor donates 40 percent of their liver, it will grow back to about 85% of its original size within six to eight weeks, and to its full size within about a year.

University of Colorado Hospital is home to the only transplant program in the state with a living liver donor program and serves as a regional hub for patients in New Mexico, Wyoming and Montana. To be eligible for an organ donation, potential recipients must be on the UCHealth transplant list.

Nationally, there are about 9,400 people in the United States waiting for a liver transplant.

Of these, nearly all, or 93 to 95%, come from deceased donors, with the remaining coming from living donors. But at UCHealth, the number of live donors is about double the national average.

What accounts for this difference?

“It’s a culture. As a donor team, we do whatever is best for the donor. We guide and educate them on if it is right for them and if it’s not, we don’t proceed. We protect the donor, and they know that we have always have their best interest,” Cisek said.

Like all living donors, Victoria would be assigned a social worker to serve as her advocate to help her navigate the donation process. The average wait for a donor to qualify is about four to six weeks if all their medical work goes quickly; and if they are accepted, they usually wait another four to six weeks for surgery.

“We spend a lot of time talking about how things could go any which way. People who are non-directed donors are altruistic in nature and not in it for any secondary gain,” Cisek said. “They are OK with walking away after the donation and not ever hearing from the person they donated. It’s a bonus when they do hear.”

How new robotic living donor liver surgery changes the way patients recover

Over the last several years, UCHealth decided to make it a priority to become one of the leading transplant programs in the nation using robotic surgery.

“We had the program stability and field strength with our transplant surgeons to take this on,” said Nydam, also a professor of surgery at UCHealth University of Colorado Hospital.

Two years ago, he spent two months in Riyadh, Saudi Arabia to study with the world’s leading surgeon using robotics for transplant surgery.

“We are experts in living donor transplants and one of the leading programs to do robotic transplants. We have been able to pair these in a very thoughtful and safe way as we move forward.

“Safety is the priority: A significant complication for a donor needs to be a zero event,” Nydam said.

In the past, liver donors like Victoria faced an extensive and typically painful recovery lasting several months as open surgery is more invasive requiring a large abdominal incision, high on the belly and through a person’s “six pack.” This area is responsible for core strength and respiratory mechanics, so recovering and rehab can take a lot of time.

But robotic surgery for liver donation is a game changer.

The operation entails several small incisions in the lower belly and along the bikini line for the robotic instruments to be inserted. The surgeon uses a control console to move those instruments to make very precise movements.

A huge benefit of robotic surgery is how it provides a 3-D view inside the body.

One of the robot’s features is a tiny device that takes enlarged pictures that the surgeon views in real time. The robot transfers pictures while providing a view inside the body allowing for greater magnification and optics of the surgical area.

Victoria was a pioneer in that she was the first person in the program to have robotic surgery to recover the right lobe of her liver, which has always been a trickier and more intricate procedure because of its size and vascular anatomy. It is technically more challenging and a bigger operation for the donor.

While the left lobe is smaller and more easily accessed, with segment donation typically going to an infant under age 2, right lobe donations go to adults who need a larger graft.

But the robotic surgery makes the procedure much easier.

“Now, we can take some of the right lobe – a bigger portion – and donate it to an adult and meet this pressing need,” Nydam said.

Using robotic surgery comes with a slew of better outcomes for the donor and gets them back quicker to their family, job and life. Those factors include:

• Decreased recovery time, discomfort and need for pain medication.
• Lower infection/complication rate.
• Decreased time that needs to be taken off work.
• Reduced risk of a hernia.
• Less strain on family life.

“We want robotic surgery to change living donations forever and take some of the disincentives away from donating,” Nydam said. “If we can decrease length of time in the hospital and people can get back to their lives, hopefully more donors will come forward.

“Someone like Victoria did – she wanted to be a pioneer. It was the coming together of technological innovation with a special person who wanted to be a catalyst.”

Victoria prepares for robotic living donor liver transplant surgery

Victoria was ready to proceed with donating with the traditional, open surgery. The longer recovery and rehab that came with it though, made her pause.

“I think I was a bit more hesitant because at first, I thought open surgery was the only option, and I knew it would be more intense and more involved than my kidney donation, with a tougher surgery, recovery, pain and scar.”

In April, she learned that there was a match for her right liver lobe, and a month later, the UCHealth donor team told her the operation could be performed robotically.

Her husband Mike said the process from start to finish for his wife’s kidney donation took about a year, as she wanted to run the Chicago marathon before donating. Her liver donation timeline was much quicker. But with her determination, he knew she would see it through, and they worked to assuage their family’s concerns.

“The liver donation happened quickly. Convincing family and friends can be more stressful than actual surgery itself,” he said.

Victoria went in for surgery June 24.

“There were a few anxious moments while I waited, as there were a few more ‘unknowns’ than when she donated her kidney,” Mike said. “The nine hours of her surgery ticked by and those moments were restless, but we had trust in the doctors and knew she was in good hands – the whole medical team was wonderful, and we felt confident.”

For the robotic liver procedure, Nydam used the same incision from her kidney nephrectomy. along with a few new smaller ones he made in her abdomen. She was in the hospital for six days before heading home.

“I was tired. I had pain. I had brain fog. But by third week, I turned the corner. I stopped my pain meds and started getting back to my work. I was soon walking, less tired and getting my appetite back. By week four my checkup showed my main incision was healing and that my liver was recovering well, and I was not as fatigued as I had expected.”

By August, she felt like her old self: Running 20 miles a week, and cycling 40 miles a week, exercising with Mike, working and sleeping well.

“Having a great care team, a doctor who is amazing, and really compassionate people around me made it possible.” 

Victoria is back on the trails, running, riding and enjoying life

Victoria and Mike moved to Colorado for a change of climate and scenery, which they love. When she has down moments, she likes to crochet, read and cook healthy foods. She frequently travels to Austin for her job as a grant writer for a nonprofit hospital network.

She downplays the selflessness involved in being a two-time donor. Instead, she said she is grateful for her good health she enjoys and credits her family, friends and people in the transplant community who got behind her decision.

“I grew up in very loving and supportive family. I’ve had the privileges of a good education and good health; I moved to America and have had good opportunities. Working in nonprofit healthcare, I see people who don’t have insurance and access to those things.”

She will continue to live by example: mentoring and advocating for various donor organizations and hopes that sharing her story will motivate others. Her message is that you can be a living donor and lead a normal and healthy life after doing it.

“I would love others to take a look and see if it’s for them. It’s a long and thorough process but take one step at a time. My work is not done with just donating – there are so many in need – there are so many others.”

Victoria recently received a “very lovely” letter from her liver recipient – a woman who lives in the southwestern U.S. They’ve connected via email and since, have gotten to know a little about each other.

“She told me, ‘I’ll take good care of your liver.’ And I said, ‘It’s not mine. It’s yours.’”