Transplant Chief Was an Organ Recipient Herself

Though it wasn't so long ago that Sara Kathryn Smith, MD, was a liver transplant patient herself, last year she became the medical director for pediatric liver transplantation at Johns Hopkins Children's Center in Baltimore.

Smith's unique perspective on patient care has primed her for the role, and for advocating for the importance of organ donation and transplantation throughout the calendar year, but especially in April -- National Donate Life Month.

"At the end of the day, the message is that organ donation and transplantation are successful," Smith told MedPage Today. "They save lives and provide hope to families."

Indeed, Smith's commitment to entering and practicing medicine has always been strong. Though her own family isn't one of physicians, she recalled, "I always wanted to be a doctor as far back as I can remember." Smith even drew a picture of herself as a doctor when she was just 3 or 4 years old.

However, Smith's path to entering the field of medicine wasn't as smooth as she may have envisioned. She first became ill during her junior year of high school, which "turned into a bigger production" than she ever could have imagined, she said.

One day, when she was 17, Smith began having pain in her stomach and threw up blood the next morning. Johns Hopkins detailed her experience in a feature published in Hopkins Children's Magazine last fall. The underlying diagnosis was cirrhosis caused by autoimmune hepatitis.

After initial treatment with a shunt, Smith needed a liver transplant early in her college years. However, her first transplant failed due to hepatic artery thrombosis, a fairly common complication.

A second transplant also failed due to a rare thrombosis in her superior mesenteric artery. Smith then needed a major, life-saving operation, including a new stomach, pancreas, kidney, and small intestine, as well as her third donor liver.

During a months-long recovery, Smith had to relearn how to walk, talk, and feed herself, the Johns Hopkins story noted. All the while, she became close with her medical care team at Jackson Memorial Hospital in Miami, who helped guide her in her pursuit of a career in medicine.

"I don't think I ever changed my mind about being a doctor," Smith told MedPage Today.

She initially thought she would be limited in terms of the specific area of medicine she could pursue, due to her immunosuppression, she said. But her transplant team was fully supportive of her pursuing any specialty she liked.

"I ended up really enjoying pediatrics," Smith said, though it had never been on her radar. In fact, she recalled thinking that the specialty may not be the best idea, given the inherent plethora of germs.

Ultimately, however, Smith completed a pediatrics residency at Jackson Memorial Hospital in 2012, as well as fellowships in pediatric gastroenterology at the University of California San Diego School of Medicine in 2015, and pediatric transplant hepatology at the University of California San Francisco School of Medicine in 2016.

Having been a young transplant patient herself was "impactful," Smith said. "It does make a difference."

In her current work at Johns Hopkins, Smith noted that no 2 days are the same. Depending on the day of the week, she is on service and making rounds, and taking care of all the pediatric liver patients in the hospital, she explained. There are also regular transplant care team meetings to discuss all of the patients getting ready for procedures and those who have recently received transplants.

Smith also sees children with liver disease who may not yet be ready for transplant, teaches residents, and works on clinical research in her field. She further tackles ways to expand the reach of the pediatric liver transplantation program in the community.

"Patients need to have access to a transplant center within several hours of them," she said of the critical nature of the program at Johns Hopkins.

When someone receives a transplant, it is a very intense experience, she added. "The pre-transplant process is very involved, and the post-transplant process is even more involved."

When it comes to children, the process is even more intricate.

"Kids are not just little adults," Smith said. There is a reason pediatricians often note that "their bodies are different, their immune system is different."

Conditions that may lead to the need for liver transplant in kids are wide-ranging, she explained, and include biliary atresia, which can lead to cirrhosis, acute liver failure, Alagille syndrome, liver cancer, and certain metabolic and autoimmune conditions.

Patients can range from just several weeks old to 18 years old, and the hope is to get many years out of transplanted organs, she said. "The management and care of a child after transplant is a lot more detailed, and it requires a lot more attention."

When teaching residents, Smith said that she is able to share some of her personal experiences with them, including advice beyond medical information alone.

An important part of care is "how you interact with families, how you interact with patients, and how you carry yourself as a physician when you're dealing with patients who are in the hospital for a very long time," Smith said. These are young patients who are "scared and nervous," and who have led regular lives outside of the hospital and before they became very ill.

This is a "challenging, but very rewarding field," she added.

"The message is that this month is a time to honor donors, honor families that decide to donate, and educate people about the importance of organ donation," Smith said.

She herself is an example of just how successful transplantation can be.

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