By Mark Couch
(April 2019) Hillary Yaffe, MD, is one of a kind: a living liver donor training to become a transplant surgeon with the doctors who performed the surgery.
Even more remarkable is that Yaffe donated a portion of her liver to save her father’s life.
It was 2008 when Yaffe, a medical student at the time, provided a portion of her liver that was transplanted into her father to replace his diseased liver, which was failing due to primary sclerosing cholangitis.
Elizabeth Pomfret, MD, PhD, and James Pomposelli, MD, PhD, were the transplant surgeons leading the team that performed the surgeries. Now, a decade later, they are mentors to their former patient.
“I don’t think there’s another one like this,” Pomfret said. “I think there have been different people who have had surgeries or might even have been donors and then went into medicine, but I don’t really know of another story like this.”
Pomfret and Pomposelli were faculty at Tufts University School of Medicine and surgeons at the Lahey Clinic when they met Yaffe.
“I remember her just sitting there and she was very confident that this was all going to work out and she was going to be a donor for her father and I thought, ‘Good for you,’” said Pomfret, who is now professor of surgery and chief of transplant surgery for the CU School of Medicine.
Yaffe, who grew up in Worcester, Mass., came to meet Pomfret and Pomposelli in Boston because they were at the leading transplant center in the U.S. at the time.
"She’s this teeny little thing and I remember her walking into my office and thinking there is no way this girl is going to have a liver big enough for her father,” Pomfret said.
It’s not that Yaffe’s father, Alan, was a particularly large guy. It’s just that the donor needs to be big enough to donate a portion of liver that meets certain standards. Pomposelli said that a liver graft needs to be 1 percent of the recipient’s body weight.
“So if he weighed 155 pounds, then we’d like 1.55 pounds of liver,” Pomposelli said. “The question is, can your donor give that? It’s harder to go female to male for that reason.”
Yaffe aced that test.
“I had more than enough,” Yaffe said. “I met the requirement and then when they weighed the graft when it came out, there was more than they expected based on the imaging.”
For all her confidence, though, she acknowledged that the standard was her primary concern.
“The thing I was most worried about was would I have enough liver tissue because that’s kind of an absolute. You either have it or you don’t. It’s not a matter of what your level of commitment is, how much you want to do this, how scared you are. If you don’t have enough tissue, you can’t be a donor to that particular person. This was the hurdle we had to surpass.”
Yaffe also passed third-party medical evaluations and psychiatric and social work checks that are required before making the donation.
“When we started the evaluation, when he was first diagnosed, I was in graduate school doing my Masters in Medical Science,” Yaffe said. “It was about two years later, when he was really seriously being considered for liver transplant that I underwent the living donor workup. We did that over the course of a few months while I was still working in Boston. And then I went to medical school in Israel with the plan that the following summer would be our transplant date.”
Yaffe attended the Sackler School of Medicine New York State/American Program at Tel Aviv University.
“I went to medical school in the summer of 2007 and then in 2008 my parents picked me up at the airport on the 19th of July. We went right from Logan Airport to the Lahey Clinic so that I could give them a unit of blood that they would hold for me. On July 23rd, we were transplanted.”
To minimize the disruption to her medical school training, the transplant occurred over the summer recess.
“I went back to school just about a week late,” Yaffe said. “We had six weeks of recovery before I flew back to school in Israel. We timed it correctly. They were very accommodating, Drs. Pomfret and Pomposelli. They were very understanding that we had this window and that I was going to school out of the country, so I needed to have it happen as early as possible in the summer.”
Yaffe, like most medical students, was focused on her studies and particularly determined to stay on track toward her career goal. She had decided as a high school senior that she wanted to become a physician and spent a year shadowing a neurosurgeon at the University of Massachusetts Medical Center in Worcester.
“I spent about the next 10 years wanting to be a neurosurgeon,” Yaffe said. “During the first year of medical school, I did research in neurosurgery, I did research in neurology in grad school. And even a year after the transplant, I was still pursuing neurosurgery, which is what I thought my top interest was.”
The experience of being a living liver donor, though, prompted a reassessment.
“I was back in the United States doing a follow-up appointment with Dr. Pomfret,” Yaffe said, “and I was sitting in her office waiting for her to come in, on the exam table, thinking about life, and it just really hit me. I’m not supposed to be a neurosurgeon, I’m supposed to be a transplant surgeon.”
Her friends already knew. Calling her best friend from college, Yaffe told her about the new career direction.
“And she said, ‘We were waiting for you to realize that,’” Yaffe recalled. “She said everyone had figured that out a year ago, and that they were waiting for when I was going to figure that out.”
Pomfret also remembered Yaffe’s eureka moment.
“I remember she wanted to be a neurosurgeon,” Pomfret said. “And then all of the sudden, she said, ‘I’ve decided I’m going to do transplant surgery.’ And I said, ‘You know, you still have to complete five years of general surgery before you can do transplant surgery.’”
The path to become a transplant surgeon is lengthy – medical school, residency, and fellowship. It can take 11 to 14 years. It’s an experience that Yaffe’s mentors, Pomfret and Pomposelli, had already traveled themselves with their own remarkable story
“We were high school sweethearts,” Pomposelli said. “We met on the school bus,” Pomfret said.
They went to medical school at Boston University, getting married in their final year. Then came the couples match for surgery residency, “which means we both get in or both don’t,” Pomposelli said. They matched at the Deaconess Hospital in Boston and were even featured on the cover of the Boston Herald newspaper with the tabloid blaring in its headline “Love Match” for an article about residency announcements.
Because of their expert care for her family, Yaffe’s bond with Pomfret and Pomposelli was strong. She was determined to train with them after completing her general surgery residency at the Albert Einstein College of Medicine/Montefiore Medical Center in New York.
“I decided I’m going to follow them,” Yaffe said. “At the time, they were still at the Lahey in Boston. My family is in Massachusetts, so this seemed like a logical decision to go back to Massachusetts.”
Pomfret and Pomposelli were recruited to CU School of Medicine in 2016.
“My fellowship application cycle started in the fall of 2016, so I had to make some decisions and I started thinking about coming here,” Yaffe said. “I had only been here once in my lifetime in 1994. I came out here to learn to ski with my uncle. I decided it’s literally a one in a million chance, even more, even riskier odds. It’s a once in a lifetime chance to train with the surgeons who operated on you.”
Other transplant fellowship program directors were interested in Yaffe, but they expected Pomfret and Pomposelli had first dibs.
“Every time we would go to a meeting with all of our colleagues – you know, transplant’s a small community – they would all say, ‘Well, the best applicant is Hillary Yaffe, but I’m assuming that you’re taking her because she told us she wants to train with you.’ And I’d say, ‘You’ve assumed correctly. Yes, I’m taking her.’”
The dance between applicants and fellowship program directors is delicate, though. Personal choices inevitably factor into the decisions. Yaffe’s husband, Matthew Harris, MD, is a pediatric emergency medicine physician who would need to transition his clinical practice and research interests to a new institution after having established a well-respected and prolific early career within the Northwell health system in New York. They have 5-year-old twins, Ayelet and Benjamin, who had benefitted from growing up close to family.
“She was a top applicant,” Pomfret said. “She really was. So she came out to her interview here and I said, ‘I’m assuming you want to stay in New York or on the East Coast, so that you’re close to your parents, and she was like, ‘No, I want to train here.’”
“She told me that I have to close the circle on this,” Pomposelli said. Yaffe’s two-year fellowship began in August 2018 and she’s been working constantly since arriving. The hours in transplant surgery are frequently unpredictable and the shifts in the wards and operating rooms can be long. But it’s all worth it, Yaffe said.
“I want to give back to the community that helped my Dad,” Yaffe said. “We have a lot to be grateful for, that this procedure exists and these people exist, and in general, that organ donation exists, because this really gives families a second chance.”