In 2016 Angela Zivkovich of Denver saw a news story that caught her eye. In it, a woman interviewed described the search for a donor kidney match for her ill husband. Was there anyone who would be willing to donate a kidney to help save his life?
Zivkovich, then 36, wasn’t aware that there were living organ donors. But she did her research and discovered that living donation is an important way for people needing transplants to shortcut what can be years on waiting lists for deceased donor organs.
Zivkovich fit the living organ donor bill. She was young and healthy, with a solid job and a strong support system. She looked into where she might make a kidney donation and settled on UCHealth University of Colorado Hospital on the Anschutz Medical Campus and its well-regarded Transplant Center. Over a period of three years, Zivkovich became one of just six people to make a non-directed (altruistic) living donation of her kidney and a portion of her liver at UCH. Another seven made their non-directed living liver donation at UCH and their kidney donations elsewhere.
There are many reasons that Zivkovich made a great donor. Perhaps most importantly, she possesses a strong and longstanding will to help others – those she knows and those she does not.
Meeting the tests for living organ donation
Her road to double-donation began with a lengthy testing and evaluation process at UCH to ensure she was in good health both physically and emotionally and would have support for her recovery from the kidney donation. A living organ donor advocate from the hospital assisted her with the decision, said Dana Parker, one of those who holds the position at UCH. She is also a licensed clinical social worker, another key member of the living donation team.
Living organ donor help for the tiniest among us
University of Colorado Hospital and the University of Colorado have a long and distinguished history in the field of liver transplant. Dr. Thomas Starzl performed the first liver transplant in 1963 at what was then the University of Colorado Health Sciences Center. In 1997, a UCH team led by Dr. Igal Kam performed the first adult-to-adult living donor liver transplant in the United States.
But many infants need liver transplants, heightening the importance of living adult donors. To that end, Anschutz Medical Campus neighbors UCH and Children’s Hospital Colorado collaborate to save the lives of any child who needs a liver, said CU chief of Transplant Surgery Dr. Elizabeth Pomfret.
“With our living (organ) donor program, we’ve been able to essentially eliminate the waiting list at Children’s Colorado,” she said. “We can transplant livers for every child who [needs] one.”
“Living (organ) donor advocates ensure that every living (organ) donor is given the information necessary to make an informed decision,” Parker said. That includes letting donors know that they can reconsider their choice right up to the time of being wheeled into surgery, she added.
Those requirements satisfied and Zivkovich donated her left kidney to a recipient she did not know on Sept. 17, 2017.
Identity questions about organ recipient
After a three-day hospital stay, she made a full recovery, with considerable help from her friends, coworkers, employer and especially her mother, Marianne, whom Zivkovich calls her rock. She went on with her life – a steady, fulfilling job with plenty of time for hiking, running and traveling. That’s the norm for living kidney donors, Parker noted.
In fact, she said, “Those who donate kidneys tend to live a little longer. We take the healthiest people and they also do healthy things and get regular medical care.”
But one question lingered for Zivkovich.
She learned from her transplant surgeon, Dr. Thomas Bak, that her anonymous beneficiary was recovering well with the donated kidney. But Zivkovich nonetheless yearned to meet the person she had helped and wrote a letter to that effect. For six months, she waited without a reply. Then came “a lovely card” from the woman whose life Zivkovich’s selfless act profoundly changed.
“The card described the impact it had to get a kidney on her and her kids’ lives,” Zivkovich recalled. “It changed everything for her to get off dialysis and it had a ripple effect on her support network.”
Zivkovich and the recipient, who lives in Georgia, have never met face-to-face, but still exchange emails periodically.
It turns out that the recipient also changed Zivkovich’s life and set it on yet another new course.
“Hearing the impact of my kidney donation and the clear, positive impact it had on someone’s life made me think, ‘If I could do that again for someone else, I would,’” Zivkovich said.
On to the next living organ donation
A year or so later, that chance arrived. Zivkovich and Marianne were attending a UCHealth Donor Appreciation event when a liver transplant coordinator mentioned to Angela that she could be a liver donor. Her mom had a succinct response: “Don’t even think about it.”
But she did. She studied up on liver donation, a more involved surgery with greater short-term risk. A donor like Zivkovich can live just fine with one kidney, but there is but one liver to give. Zivkovich learned that in a living donor liver procedure, one surgical team takes a portion of the donor’s liver, which a separate team uses to replace the recipient’s diseased liver. Over time, the donor’s liver regenerates, while the recipient’s grows.
After careful research, bolstered by her positive kidney donation experience with the UCH team, Zivkovich decided to embark on the process to become a living liver donor. Marianne cried when she heard the news.
“She said, ‘Please don’t do it, but if you do, you know I’ll support you,’” Zivkovich recalled. “She was 100 percent with me through it all. She knew how important it was, she was just worried about me.”
After another long period of preparation, including imaging of her liver, blood tests, and psychological questions that probed her reasons for consenting to a second donation, Zivkovich was ready for another procedure. Her motivation had not changed since the kidney donation.
“I felt for a very small risk to myself, there is a very clear benefit to someone else’s life,” she said.
The lifesaving lobe donation
On June 10, 2019, Zivkovich rolled into an operating room at UCH for the procedure, with Dr. Elizabeth Pomfret, chief of Transplant Surgery at the University of Colorado School of Medicine. The recipient, whom Zivkovich again did not know, lay on a table in an adjacent OR, awaiting a lifesaving portion of liver with a separate surgical team.
Pomfret took the left lobe of Zivkovich’s liver, about 40% of the whole liver volume. That decision, she said, is based on anatomy.
“We take the least amount possible from the donor, depending on the size and illness of the recipient,” Pomfret said. “The left lobe was sufficient in Angela’s case.”
The surgery also involved removing Zivkovich’s gallbladder, a small pouch that stores bile made in the liver and releases it into the intestine to help digest food. Without the gallbladder, bile simply flows continuously into the intestine, Pomfret said.
Following the successful procedure, Zivkovich spent four days at UCH. Having donated the kidney, she had a better idea of what to expect from her recovery, but her ICU stay was longer and she had more pain from larger surgical incision – the kidney procedure was done laparoscopically. But once again, her support system, led by Marianne, rallied to her aid, delivering meals, mowing the lawn, walking the dog and generally helping keep life on an even keel.
Her employer allowed her to take two months for recovery – a month longer than she needed for the kidney procedure because of fatigue. That was to be expected, Pomfret said.
“Fatigue is very typical. All the body’s energy is going toward liver regeneration,” she explained. Most donors regain the majority of their liver function after two or three months, Pomfret added. As for Zivkovich, her liver had regenerated to 94% of its original volume at one year, and was functioning at 100%, she said.
Meanwhile, her UCHealth team, including surgeons, nurses, coordinators and social workers, responded quickly when she had questions about her recovery.
“Their support was amazing through both procedures,” Zivkovich said. “I wouldn’t have done the second one if I’d had any questions about how things had gone with the first one.”
Recipient reaches out
Zivkovich’s living liver donation once again changed the fortunes of a very ill person. But this time, she got an even closer look at the results of her altruism.
Her recipient insisted that she meet her donor and pushed to do so. After two months to ensure healthy recoveries of both donor and recipient, the transplant teams at UCH arranged a meeting. Angela and Marianne walked through a door and found Raynette Gore, healthy because of Angela’s gift, and her son waiting for them.
“We looked at each other and started crying,” said Zivkovich. She and Raynette have since maintained their connection and attended a Donor Appreciation event together.
Without Zivkovich’s donation, Raynette faced a grim future. The waiting list for a liver transplant is based on illness – those who are sickest, as determined by their high MELD (Model for End-Stage Liver Disease) scores, are at the top. Patients with lower MELD scores face the terrible prospect of improving their chances for transplant only by getting sicker. With a living liver donation, Raynette averted that course.
“I saved her life,” Zivkovich said. “How many people get to make that decision to change a life?”
A life of helping others leads to donation
Perhaps it’s going a bit too far to say Angela Zivkovich was destined to make that decision, but not by much. She grew up in Cheyenne, Wyoming, where she said she volunteered at a homeless shelter as a high school student.
“I have always looked for how to give back and contribute to society,” she said. “It’s something I always found was important to incorporate in my life.”
Her actions before her living organ donations support that. After graduating from the University of New Mexico with a chemical engineering degree and earning a master’s degree from the University of California, Santa Barbara, Zivkovich volunteered with the Peace Corps in Uganda for two years. She worked in an orphanage to teach reading and life skills to children and also helped widows of AIDS victims. That work used a grant from the U.S. government to finance the purchase of 12 pregnant cows that produced milk for nutrition and market sale for much-needed financial support. Another community project focused on helping communities build water wells close to home.
After her Peace Corps stint, Zivkovich spent two years in Savannah, Georgia at the Anderson Cancer Institute, which invested in research to find biomarkers for melanoma. There she worked on genomic sequencing and data analysis. Ten years ago, she moved to Denver, where she does regulatory and policy work for an energy company. She chuckles at the mention of her varied career.
“Where my life has led me, I go,” Zivkovich said. The two women whose lives she’s touched are no doubt grateful for that philosophy.
The case for living organ donation
She strongly urges those considering living donation to do their homework, evaluate the risks, be ready for short-term health setbacks, and make sure they have a strong support system. But she emphasizes the powerful benefits awaiting people who qualify to become donors.
“Consider what you can do for someone and really weigh that,” Zivkovich said. “We do riskier things on a daily basis with no clear benefit. If it is the right fit for you, you won’t regret it.”
Pomfret lauds her commitment, as well as others who have decided to become living organ donors.
“Living donation is absolutely critical,” she said. “We don’t have enough organs to meet the needs of people awaiting transplant. If we didn’t have living (organ) donors and special people like Angela who are willing to do something without knowing who it is benefiting – just out of the goodness of their hearts – we would have many more people die without a transplant.”
For more information about becoming a living kidney or liver donor, visit the UCHealth website.