Hoping that something - anything - could save her daughter, Sharon consented to the surgery. "The doctor said that Belinda could die on the way to the operating room, that she probably would die on the operating table," Sharon recalls. The doctor added that if Belinda survived, there was a strong likelihood of severe brain damage. Sharon held hope that Belinda would defy this prognosis. "I sat in the lounge and waited and prayed." She said.
The liver provides nutrients to the brain. A normal liver breaks down toxins. A severely diseased liver loses its ability to remove toxins from the bloodstream. Additionally, in end-stage liver disease, blood cannot reach the liver, so it diverts into the general circulation. Blood levels of toxins increase, compromising brain function and damaging the nervous system. This complication is called hepatic encephalopathy. It can cause anxiety and depression and behavioral changes that range from mild to severe. It can cause altered reflexes, altered consciousness and motor incoordination. Eventually, the condition can carry its victim into a coma. Sometimes, the coma is fatal.
It would have taken a miracle for Belinda to return to the young vibrant woman she was. Even modest recovery would have been miraculous. From the moment Belinda arrived at UCLA, doctors held little hope: "[The] chance of no recovery is 96 %, severe disability 4%," dictated doctor Melissa Przeklasa, who examined Belinda Nov. 2. Belinda had no gag reflex. Moving a breathing tube in an out would make a comatose patient gag. She had no corneal reflex. A cotton swab across an open eye would make an intact brain want to blink. She did not respond to deep pain. Belinda could feel no pain.
"Given the lack of brainstem reflexes at this time, we feel it prudent to repeat the exam tomorrow morning to complete brain death criteria," Przeklasa stated. Dr. Albert Lai did come by the next morning to exam Belinda, but he couldn't. Belinda was in the operating room.
Dr. Ghobrial looked at Belinda. He shined a bright light in her eyes. "Pupils are equal round and reactive to light," he noted. That won't happen if the brain stem is dead. And there was the blood flow study. A radioactivity counter over the head measures the blood flow to the brain. No blood flow to the brain means the patient is brain dead. "The flow study was not conclusive for the presence of brain death" he noted. Nevertheless, the extreme brain edema offered the doctor little hope. "Chances of recovery are extremely poor," wrote Ghobrial. "However ... we cannot conclusively show the presence of brain death. Because of that, we were willing to proceed."
The liver was blood type A, Belinda was blood type O. The mismatch was intentional "because of her severe deteriorating condition," the surgeon's notes indicate. Normally recipients are matched with donors of the same blood type, but in extreme emergencies a surgeon can use the first available organ and give the patient ant-rejection meds.
"If the patient indeed survives the operating room, her chances of recovery are less than 1%. If she does get some recovery, there is an extremely high chance that she would not regain a lot of her neurological functions," Ghobrial wrote before the operation. "All in all, the prognosis is extremely grim ...."
Belinda's body survived the surgery, but the brain damage was still a problem. While keeping Belinda in a drug-induced coma, doctors monitored the elevated spinal fluid pressure inside Belinda's head. The high pressure is a complication of the brain swelling and a major cause of death in patients with acute liver failure. Doctors administered intravenous diuretics and placed a intracranial pressure monitoring device in Belinda's head. "An assistant sympathetically handed me an envelope containing the hair they had to cut off to do this," Sharon said.