CORINNE, Box Elder County — Kelton Bronson is taking an unexpected detour into his past, back farther even than his own memory stretches.
A few weeks ago, he got sick — so sick he ended up first at his local emergency room, which sent him to the emergency department at University of Utah Hospital. There, doctors poked him and prodded him before checking him into a room where he was told he’ll need a life-saving liver transplant to survive.
Lying in the hospital bed, Bronson, 29, looked thin and delicate, belying his occupation as a sheriff’s deputy in Box Elder County. His skin appeared to be papery and so yellow that his wife — perhaps used to watching cartoons with their sons Mason, 4, and Winston, 2 — made an offhand reference to Spongebob Squarepants.
Bronson’s been here before, fighting for his life while vexed with a liver that doesn’t do its job properly. Just shy of three decades ago, when he was 9 months old, he became only the third person in the United States to receive a section of liver from a living donor.
He had been diagnosed with biliary atresia, a rare liver and bile duct disease that, untreated, kills. His mom, Yvonne Bronson, just 27 at the time, gave a small portion of her liver in what was then an experimental procedure at University of Chicago Hospital.
Using a section of a person's liver to spare someone who would otherwise die has been refined since then and has saved many children and lots of adults, too.
That gift from his mom bought him 28 years and a mostly normal childhood. When they'd each healed from their part of the transplant surgery, Kelton Bronson became a busy little boy and his mom and dad, Corey, took on the tasks of managing the drugs he needed to prevent organ rejection and making sure he made all his aftercare appointments, which included numerous blood draws.
So Bronson and his wife of nearly seven years, Kelsee, 26, don’t know much more about what to expect than most of the 13,712-plus Americans now waiting for a liver transplant, the vasty majority of them for the very first time.
The Bronsons are acutely aware, though, that one thing is most certainly different now: Kelton Bronson has plenty of loving relatives who'd be very happy to try to save his life as his mother did in 1990. But his survival this time will hinge on the goodwill of a stranger who chooses to leave something behind after death.
About the time Kelton Bronson was born, the Chicago hospital was making news for its experimental approach to saving babies in dire need of a liver — a coincidence his mother now calls a “miracle, just a big tender mercy.”
The process was so new that insurance companies weren't on board yet. His folks knew that getting little Kelton a living-donor transplant would be a long shot. But Corey Bronson worked at Nucor Steel and that employer was enthusiastic about helping the young family, which also included three little girls.
“They stepped in. And somehow it happened,” Yvonne Bronson said.
"Miracle" is not a bad way to describe the liver itself. The organ, which weighs 3 to 4 pounds in an adult, is extraordinarily complex in both function and design. And it is unique in its ability to rejuvenate and grow. A section can be taken from one person and put in another. Over time, if all goes well, both sections grow to full size and function.
More amazing still is what a healthy liver does. The Organ Procurement and Transplantation Network's guide to transplantable organs says the liver is key to processing carbohydrates, fats and proteins. It’s a holding tank for vitamins, while transporting nutrients absorbed as food passes into the intestines, which it turns into materials the body needs, like blood clotting factors. The liver plays a role in breaking down fats and toxins like alcohol and drugs.
When the liver doesn't work well, one common effect is encephalopathy, which creates an altered mental state. "Brain fog" is how Kelsee Bronson described the mild confusion her husband experienced in the hospital. It's potentially deadly if it's not controlled.
Yvonne Bronson remembers it took her a while after the surgery to feel like herself again, but it was worth it to see her then-youngest begin to thrive. Kelton is the fourth Bronson child — behind Kami, who's now 36; Kylie, 33; and Kelsey, 31. Kelton has a little sister, Kabrie, who's 24. He had a little brother, Kade, who died of SIDS when he was 4 months old in 1993.
That first transplant granted Kelton Bronson the freedom to run and laugh and play and just be a kid. He was naturally slight in stature, but active and healthy, if not athletic. The anti-rejection medication everyone who gets a transplant takes didn't bug him; he'd never known anything different. His mom said nothing held him back.
When his sister Kylie and his dad were asked to describe him as a child, their memories were so identical one of them might have held the paper while the other wielded the pen: Kelton liked to play Army and make all kinds of movies, including scary ones. If young Kelton was outside playing, Patch, his Great Pyrenees guard dog, or Pepper, his red heeler, were always close at hand. He's always been a tinkerer, too, someone who likes to take things apart and put them back together, including computers and electronics.
He was a funny boy before he was a funny man — and that's the first thing anyone says about Bronson, including the man himself, who admits he likes making people laugh. His family said he liked performing, dancing and generally showing off.
"He could emcee a show, make up comedy routines and jokes and imitate his favorite comic, Chris Farley," his father said. His mom and Kylie called him a class clown who sometimes distracted his classmates from their more serious tasks, to his teachers' chagrin — and amusement.
And so he chugged along for many years, hitting meaningful milestones. He graduated from Bear River High School and married Kelsee and had kids and moved into a new house and changed his role with the sheriff's office from working in the jail to patrolling. He went target shooting and played video games and hung out as often as possible with his extended family.
One of his colleagues in the sheriff's office, Dale Ward, who knew his folks when he was sick all those years ago, described Kelton Bronson's wit and his work ethic and his burgeoning investigative skills. And he declared him universally likable.
The folks who know him, Ward said, would do just about anything for him. They think he's great. "We think this is just devastating," he said of his young co-worker's serious illness.
It was in September that the first hint of real trouble appeared. Bronson's leg started aching and was swollen, which he didn't recognize might be related to his liver. His wife said he was losing weight and didn't feel good.
A couple of weeks ago, he was hospitalized with end-stage liver failure and doctors worked to stabilize him so they could send him home to wait. His mother's gift gave him a good long run, but it's about finished now.
There's a hierarchy of need when it comes to a new liver. Top priority or "status one" is reserved for those with acute, not chronic, liver disease who are likely to die in less than a week without a transplant.
About 7,800 liver transplants are performed nationwide each year, though nearly 14,000 U.S. patients were listed with the United Network for Organ Sharing earlier this week. Experts say the number of livers that are transplanted has been comparatively flat given the way the need has grown over time.
Transplants only happen at qualified transplant centers. In Salt Lake City, there are three: University of Utah Hospital, where Bronson is listed; Intermountain Medical Center and Primary Children's Hospital. Network spokeswoman Anne Paschke said centers are usually in large population areas. For example, Chicago and Philadelphia each have six centers. Some do multiple types of organ transplants while others specialize. For instance, one of three centers in Richmond, Virginia, only transplants kidneys.
Since Kelton Bronson got his first transplant, a lot has changed. Techniques and medications have improved, so even more people can now donate, including sometimes people once deemed too old to be donors. In certain circumstances, people who are HIV-positive agree to receive a liver from a donor who was HIV-positive. A liver from someone who had hepatitis C can be transplanted if the recipient's willing and everything else looks good; the disease can be cured post-transplant. Hepatitis C accounts for a lot of the people who need a liver transplant.
“Transplant teams consider donors they wouldn’t have a decade ago,” said Paschke, “and they might transplant into people they wouldn’t have. Some centers are more aggressive than others.”
Perhaps most important, treatment and medication improvements mean liver disease can be managed better, buying people more time to wait for a compatible donor liver.
But as people prepare for a transplant, there's a steep learning curve, and Kelsee and Kelton Bronson are beginning to master a new language and see that his future hangs to some degree on numbers decoded from his blood: The “prothrombin time,” which is a fancy way of saying how fast his blood clots. The concentration of bilirubin, creatinine, sodium and albumin in his blood, which combine for a super score called Model for End-stage Liver Disease (or MELD score) that, along with his blood type, will determine where he is on the transplant list at any given time. Patients move up and down the roster as new people enter or exit and individual blood values change.
"The higher the MELD score, the more likely one is to die within the next few months if no transplant occurs,” said Paschke.
Although using a segment of liver from a live donor is possible, it's not always the best option for a patient. Live donor transplants account for only about 5 percent of U.S. liver transplants. It's more common for adults in other countries, said Dr. Robin D. Kim, professor and chief of the Division of Transplantation and Advanced Hepatobiliary Surgery at the University of Utah.
The vast majority of liver donations come from people who have passed away, though parents and other relatives sometimes donate a segment of liver to seriously ill children.
“I think probably more than half (of live donors) are relatives, but we’re seeing more close friends,” said Kim, who noted the U. has done 14 live donations, two-thirds of them blood relatives, the rest close friends. “We look for an emotional link, though Samaritan donors can be considered, too."
Medical teams try to honor the spirit of live donation: Perhaps one wants to benefit a young mother, or someone who has the same ailment as someone they knew who died, he said.
There are benefits to live liver donors, including that ability to schedule the surgery and to designate a recipient. But while all major surgeries carry some risks — and liver transplant is a very major surgery — live donation carries some risk for the donor, too.
“We are very careful,” Kim said.
But there are benefits to having a deceased donor, too, including that a larger section of liver can be transplanted to help someone who’s deathly ill.
“Death” for organ donation typically means brain death. When hearts and lungs have stopped, say at the scene of a car crash, individuals are unlikely to become liver donors, though they may donate other tissue.
United Network for Organ Sharing divides the country into regions — Utah is in region 5, with California, Nevada, New Mexico and Arizona. Would-be recipients mostly receive liver donations from within their regions, based on that MELD score. Changes to the system are coming, though, said Paschke.
On April 30, regions will disappear and instead a system of “circles” will be used, where an available liver is looked at in terms of how sick and how close someone who needs it is, without the artificial geographic border of a region. Paschke likened the upcoming process, already used with some organs, to a telescope that looks closer and further out — she calls them acuity circles — depending on MELD scores of people waiting to receive a compatible liver.
Other factors matter, too, like the height and weight range a patient’s doctors deem suitable.
Transplant centers — hospitals with approved transplant-specialty programs — set some of their own rules. A patient turned down at one center might be accepted at another.
Dr. Terry Box has a particularly deep perspective. He treats patients before and after liver transplant — and he had his own liver transplant 16 years ago. “It sure beats the alternative, obviously,” Box told the Deseret News, “but it is not a bump-free ride."
One reason is the anti-rejection medication recipients must use for their entire life. It makes them vulnerable because they are immune suppressed by design. Otherwise, their bodies would turn on their transplanted organ. But a weakened immune system makes it harder to fight off infections, for example.
The outcomes continue to improve, Box said, courtesy of expanded classes of immunosuppression drugs, better surgical techniques and more awareness "of what we need to focus on both before and after transplant to improve long-term survival."
Kelton Bronson's sense of humor took a brief break while he was in the hospital, but it's back, his wife says. And that humor is how they are getting through the day-to-day uncertainties.
While he was in the hospital, some members of their local ward of The Church of Jesus Christ of Latter-day Saints decorated the front door of their split-level house in Corinne. It's a town of just around 725 residents, nestled near a mountain range a few miles from Brigham City. One of its defining features is a year-round bird refuge.6 comments on this story
The other is heart. And that was a bit of a theme as church members hung a large, flower-bedecked heart-shaped wreath on the door, then added a bunch of smaller paper hearts, some with messages.
Most of the smaller paper hearts have blown away in an especially gusty recent weather pattern.
But one paper heart hangs stubbornly on the door, a bit of scripture written in angular penmanship: “For God hath not given us the spirit of fear, but of power and of love and of a sound mind. 2 Timothy 1:7.”
For the Bronsons, that pretty much sums it up.
To learn more about becoming an organ donor, visit organdonor.gov.