Kacy O'Connell with her baby son
Transplant

She’s Alive Because Einstein Fought to Give Her a Transplant

By on 01/19/2022

Kacy O’Connell will be 39 years old this month (January 2022). For some people, approaching the age of 40 can be traumatic. But not for her.

O’Connell would not have seen past her 32nd birthday and would have become a tragic memory rather than a thriving wife, mother and daughter – if not for a liver transplant performed in 2015. 

O’Connell was acutely ill with alcohol hepatitis and was transferred from a community hospital to Einstein Medical Center Philadelphia to be assessed for a possible liver transplant. Fortunately for her, Einstein evaluates each patient individually to determine their treatment and transplant eligibility.

The Staying-Sober Rule

That may sound like a hospital’s fundamental obligation. But a lot of health systems would have put O’Connell on comfort care and let her die. Not out of malice or malpractice, but out of adherence to a policy that’s increasingly being recognized as arbitrary and archaic: the requirement that a patient be sober for six months before becoming eligible for a transplant.“She didn’t have six months,” O’Connell’s mother says with a vengeance. “She didn’t have six weeks.”

That isn’t much of an exaggeration. According to Donna McGill, Einstein’s chief liver transplant coordinator, O’Connell’s condition started out dire when she was admitted on June 12, 2015, and then got worse.

“She had severe alcohol hepatitis, she had jaundice and fluid in her abdomen,” McGill says. “She was confused and drowsy and her kidneys were starting to fail.”

Medication didn’t help. The scoring system for severity of disease – the MELD score (Model for End-stage Liver Disease) – ranges from 6 to 40. She was at 40.

“With a score of 40, there’s a very high three-month mortality without a transplant,” McGill says.  

Top of the Transplant List

After discussions with O’Connell’s family and other assessments that predict the likelihood of recovery and sustained sobriety, Einstein’s transplant team unanimously agreed to put O’Connell on the list for a new liver. Indeed, the severity of her condition put her at the top of the list, says McGill.

Then Einstein had to convince O’Connell’s insurance company to cover the surgery. The insurance company, citing the six-month rule, said no.

O’Connell remembers little of those days while she lay critically ill.

She remembers very well the days preceding it, though. She’d known for a while that her drinking was out of control, but “I was overwhelmed to think about how I’d get sober,” she says.

“I was a very high functioning alcoholic in the sense that I had money and I had a job and I didn’t drink during the day,” she says.

Unemployed and ‘Off the Rails’

Then she lost her job in 2014.“It was like all the rules were off the table,” she says. “I’d drink vodka at 7 in the morning. I went off the rails.”

O’Connell had been warned all of her life about drinking, because her biological grandmother died of alcoholism at the age of 41. Still, she partied in college like most people do, and continued drinking as a young professional. Ten years later, here she was, in full-blown addiction.

On June 9, she collapsed at home and was taken to a community hospital, then later transferred to Einstein.

Einstein responded immediately to the insurance company’s denial of O’Connell’s transplant. Victor Navarro, MD, now Chair of Medicine, appealed to the company’s medical director. And then Donna McGill began telephoning every 10 minutes – literally – to hound them.

Not Taking ‘No’ for an Answer

“Donna is the unsung hero; she saved my daughter’s life,” says Judith Hayner, O’Connell’s mother. “She put on a timer and she called them every 10 minutes. She wasn’t going to take no for an answer.”

For decades, all transplant centers, including Einstein, adhered to the six-month guideline, out of a belief that transplant patients would relapse at a greater rate without it.

The guideline also no doubt reflected society’s attitude that alcoholics had self-inflicted disease and shouldn’t be entitled to organs that were in short supply.

Things began to change after a European study published in 2011 showed patients who received transplants without the waiting period were no more likely to relapse after transplant than those who did.

A subsequent Johns Hopkins study and other research affirmed the results, as noted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), that “the 6-month rule does not predict long-term recovery.” And as the disease concept of alcoholism began to change attitudes, some hospitals began loosening automatic adherence to the policy.

Now, says McGill, patients with alcohol hepatitis at Einstein and other progressive hospitals are evaluated for transplant based on other criteria: patients’ insight into their alcoholism, a commitment to undergoing treatment, severity of illness and strong family support.

O’Connell met the thresholds and was also young and otherwise healthy.

A Transplant at Last

“As her score creeped up and her condition worsened, it was a no-brainer,” McGill says. “There was no reason to deny her a transplant based on some random rule.”

Thanks to Dr. Navarro’s appeal and McGill’s relentless phone calls, the insurance company relented and O’Connell received her transplant on June 26, 2015.

O’Connell was living in Conshohocken with her husband, Sean, when she had the transplant.

A year later, after the acute recovery phase was over, the couple moved to Detroit, Michigan, to be close to family. They now have a 3-year-old daughter and an infant son who was born in July 2021. O’Connell is a project manager for a software company.

O’Connell has had many challenges since the transplant. She had several miscarriages. Her newborn son has Down Syndrome and complex medical problems that have required multiple surgeries. But, she says, “I’ve never had any thought to drink again.”

“I have a life now that I never thought I’d ever have in all those years I was drinking,” O’Connell says. “I never thought I’d have kids and a home and a happy marriage.”

Women and Alcohol

O’Connell and her mother are distressed at the way pop culture depicts women downing wine to soothe their stresses, and the general sense of frivolity and social liberation associated with female drinking.

The truth is, women absorb and metabolize alcohol differently than men, and are more vulnerable to alcohol-related organ damage than men, according to NIAAA.

“I want to fight against the alcohol-infused version of women I see these days,” O’Connell says.  “I’d love to help even a single person say, ‘I’m not going down that path.’ There’s such a slim, lucky chance that I’m even here.”

Under the circumstances, she doesn’t mind turning 39.

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2 Comments
  1. Reply

    Lisa Coins

    02/24/2022

    Einstein saved my life in 2020 under similar circumstances stances after even I huge, pretigous hospital system based in Baltimore sent me home on dialysis and hospice. I am so appreciative for the life that was given to me in the form of a liver and kidney! Congrats Kacy!

  2. Reply

    Mary Conaway

    02/24/2022

    My story is very similar to Kacy’s (except I’m much older)! Almost a year to the day, in June 2016, Einstein’s amazing surgeons saved my life with a new liver. I also did not have six months sober. After my transplant, my life is so amazing. Sober for six years this April, I will be forever grateful to them for seeing how much I wanted to live. Thank you SO MUCH for sharing this story.

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