Divide and survive: How a split-liver transplant saved two lives
May 8, 2025
Luna Rose Sifuentes, “a smiley bundle of joy,” desperately needed a new liver. She was born in West Texas in December 2022 with biliary atresia, a rare, life-threatening condition. Her parents were referred in 2023 to Children’s Medical Center Dallas and UT Southwestern Medical Center, where she was diagnosed and later approved for the United Network for Organ Sharing (UNOS) liver transplant waitlist.
Rachel Peeples, 54, a massage therapist from Garland, was also in need of a liver. Her organ had been severely damaged by advanced cirrhosis and she endured several hospital stays. Rachel was placed on the UNOS waitlist in summer 2023.
Their fates would cross on Nov. 19, 2024, when they each received liver transplants – from the same donor.
Thanks to a highly specialized split-liver transplant surgery – and the liver’s remarkable capacity to regenerate – Luna received about 30% of the deceased donor’s organ and Rachel received the other 70%. Both patients’ new livers reached full size within about two months.
Children’s Health and UT Southwestern are the only health systems in North Texas offering split-liver transplants, a procedure that saves two lives and reduces the perilously long wait for pediatric liver patients and their families.
“At first, we were going to say no (to a transplant) because we thought Luna was doing really good," said Sam Sifuentes, holding his daughter Luna at Children's Medical Center during a recent trip to Dallas. "But we understood it could turn back around. So, after we prayed and slept, we woke up and said, ‘We should do it. It’s the best shot she’s got right now.’” (Juan Pulido/Children's Health)
Yong Kwon, M.D., led the surgical team at Children’s Health in a six-hour surgery that gave the left lobe of the donor liver and new life to Luna – who celebrated her second birthday three weeks later. The same night, Parsia Vagefi, M.D., and his team at UTSW’s William P. Clements Jr. University Hospital transplanted the right lobe into Rachel – who became the first adult patient to undergo a split-liver transplant at UT Southwestern.
“It doesn't seem like I even had surgery. The scar is so minute, it's crazy,” Rachel said recently. “My energy is over the top. I feel like a different person and about 20 years younger.”
Luna’s parents, Ashtin and Sam Sifuentes, who live with their three young daughters in Lamesa – over 300 miles from Dallas – are equally grateful about how their second-oldest child has progressed since the operation.
“She woke up from transplant and it was like a switch turned on,” Ashtin said. “She started talking in sentences and running around. She gained over 10 pounds in less than a month. It’s been awesome.”
Dr. Kwon said it is imperative that public awareness be heightened about the benefits of split-liver procedures to help reduce waitlist mortality.
“The pediatric patient less than a year old on the waitlist is three times more likely to die than the remaining pediatric patients (2-18 years old),” he said. “The reality is that they wait longer because not many centers are doing split-liver transplantation.”
Dr. Vagefi, Professor of Surgery and Chief of Surgical Transplantation at UT Southwestern, said Dr. Kwon has had an “immense impact on the children of North Texas and beyond” since becoming Associate Professor of Surgery at UTSW and Chief of Pediatric Abdominal Transplantation at Children’s Health in October 2024.
“He’s bringing a technique in split-liver transplantation that very few places have,” Dr. Vagefi said. “We’re getting kids transplanted instead of them having to fly to Los Angeles or New York. This is critical, and in doing that, he's also expanding the donor pool for adults. It’s really a win-win for all of us having his expertise here.”
‘Leave now. Come straight to Dallas’
The first two months of Luna’s life, she was a healthy, breast-fed baby with no apparent problems. When her parents started seeing jaundice in her dark-brown eyes and skin, they thought she’d outgrow it. Their pediatrician told them to switch her to formula, but they had no luck with three brands because of acid reflux. At 3 months, as Luna became fussier and her stool turned a grayish-white, worry mounted.
After blood tests, the doctor told them Luna likely had one of two conditions: portal vein hypertension or biliary atresia (BA), in which her liver’s tiny bile ducts were undeveloped, blocking drainage and causing irreversible damage from stage 4 cirrhosis. She said they should go to Lubbock (about an hour north of Lamesa) for an ultrasound.
But after an inconclusive test, their pediatrician suggested they consider making the trek to Children’s in Dallas.
Sam called and spoke with Isabel Rojas Santamaria, M.D., a gastroenterologist and hepatologist at Children’s Health and Associate Professor of Pediatrics at UTSW. “She was very, very helpful. As soon as I told her what was going on, she said, ‘Leave now. Come straight to Dallas.’ When we got there, they already had a room for us.”
The family drove six hours from Lubbock, not even going home to pack, and arrived at 1 a.m. A cholangiogram, in which dye injected into the gallbladder provides clear X-ray views of the bile ducts, confirmed Luna’s condition. Biliary atresia is diagnosed annually in the U.S. in only 400-500 babies, often those who are premature, female, and non-Caucasian (Luna was born at 38 weeks, and her father is Latino). BA is the cause of most pediatric liver transplants in this country.
Within hours, on March 30, 2023, 4-month-old Luna had a portoenterostomy, or Kasai surgery, in which the gallbladder and blocked bile ducts are removed and a portion of the small intestine is connected to the liver to help restore drainage. However, because her liver had already sustained so much damage, it became clear to her care team during the weeks after her Kasai procedure that Luna would need a transplant.
“Luna unfortunately had a late diagnosis,” said Lesli McConnell, M.P.A.S., PA-C, in UTSW’s Department of Pediatrics-Solid Organ Transplantation, who joined Luna’s treatment team in June 2023. “Her Kasai surgery attempted to improve the bile flow in her liver, but this surgery is usually performed much earlier to have a better chance of success.”
Amal Aqul, M.D., met Luna in the hospital at Children’s Health when she was 7 months old. Luna had a nasogastric tube to feed her supplemental formula and needed multiple diuretics. She also developed ascites, a buildup of fluid in the abdomen that is common with liver disease, and required paracentesis several times to drain it.
Dr. Aqul referred Luna for transplant evaluation.
“There is a risk of death with liver failure, and our goal was to keep Luna as stable as possible until a suitable organ offer was available,” said Dr. Aqul, Associate Professor of Pediatrics at UTSW and Medical Director of the Pediatric Liver Disease Center and Liver Transplant at Children’s Health.
But Luna was also hitting milestones, playing with her big sister Chloe, slowly gaining weight, and entering a Head Start preschool program. Their parents learned a third baby girl, Octavia, would arrive in January 2025.
The Lamesa community rallied around the family, holding barbecues, bake sales, and other fundraisers to build emotional and financial support. Organizations, including the Children’s Organ Transplant Association and Oilfield Helping Hands (Sam is an oilfield lease operator), along with Sam’s work colleagues, also lent aid.
When they received a call from Children’s Health on the morning of Nov. 18, letting them know a donor liver might be available, Ashtin and Sam struggled with the decision.
“We were scared to death,” Sam said. “At first, we were going to say no because we thought Luna was doing really good. But we understood it could turn back around. So, after we prayed and slept, we woke up and said, ‘We should do it. It’s the best shot she’s got right now.’”
‘Transplant is the only curative option’
In the spring of 2023, Rachel was 52 and suffering from cirrhosis, gastrointestinal bleeding, and a buildup of fluid in her abdomen. She also was later diagnosed with hepatitis C after being admitted to Texas Health Presbyterian Hospital Dallas, where UTSW providers treat patients with gastrointestinal and liver diseases. That’s where Rita Lepe, M.D., became Rachel’s transplant hepatologist and quickly initiated the process of transplant evaluation.
“Cirrhosis doesn’t have to be a death sentence,” said Dr. Lepe, Assistant Professor of Internal Medicine at UTSW. “Transplant is the only curative option, and unfortunately many patients are not given the opportunity of an evaluation. Not everyone will qualify, but everyone deserves to be considered. Rachel had never been approached or discussed the possibility of a transplant until she met me, and she was a very good candidate.”
During the months after she went on the waitlist, Rachel’s disease produced some problematic recurring symptoms. She experienced hepatic encephalopathy, caused when the liver can’t metabolize ammonia that builds up in the blood and reaches the brain, leading to disorientation and personality changes. She also underwent several endoscopies to control varices, enlarged veins in her esophagus.
Rachel – who’s been legally blind since she was 17 from a type of inherited macular degeneration – focused on navigating these hurdles. She worked with Dr. Lepe to adjust medications, eat healthy foods, and not skip meals – doing whatever it took to be in the best condition possible for transplant, the doctor said.
That included monitoring her Model for End-Stage Liver Disease (MELD) score, based on the results of several blood tests including bilirubin, albumin, and creatinine. MELD ranks disease severity on a scale of 6-40, with higher scores indicating a lower likelihood of patient survival within three months. Rachel’s score fluctuated but never rose above the 20 range.
“Rachel initially was very ill, but we found the right combination of medicines, and she was able to continue to work until her transplant,” Dr. Lepe said. “Once she was on the list, it was a matter of time, luck, and her MELD score that determined when that phone call would come.”
Transplant teamwork, expertise make the difference
Split-liver transplants, first performed in 1988, are a vital tool for addressing the shortage of pediatric donor livers and reducing the number of patients who die each year awaiting a transplant. But the surgical technique and expertise remain relatively rare.
Dr. Kwon, who serves as Chief of Pediatric Abdominal Transplantation at Children’s Health, said that about 10 of the approximately 55 pediatric liver transplant programs in the U.S. – including Children’s Health – do them routinely. That’s partly because splitting the organ requires specialized training and expertise, making the procedure more technically demanding than whole-liver transplants and similar in complexity to living-donor liver transplants, Dr. Vagefi said.
Finding the right-size liver is a significant challenge for pediatric liver transplant surgeons, so providing more opportunities to obtain suitable organs for their patients – whose median age is only 1.5 years – is another essential component, Dr. Kwon said. He performed split-liver transplants at Children’s Hospital Los Angeles and Seattle Children’s before arriving in Dallas. In just that short time, Dr. Kwon has done seven split-liver transplants, including two with Dr. Vagefi operating on the adult recipient, and the liver waitlist at Children’s Health has dropped from 19 active patients to six.
By nature, there’s not much advance notice for deceased-donor transplants. Luna’s and Rachel’s transplants started with Dr. Kwon traveling to a hospital several hours away to procure and split the donated liver. After that, the sooner the new organs are transplanted, the better the outcomes will be. Planning and teamwork are essential.
“It takes a lot of cross-communication and partnership with our colleagues at Children’s Health, which we’re used to,” Dr. Vagefi said. “We’re very fortunate to have such great teamwork between our two institutions.”
Related reading: 'Heart in a box' technology expands transplant capabilities
The big day for both patients
When the phone rang at 1 a.m. on Nov. 19, Ashtin and Sam learned the split-liver was a go and they needed to get Luna to Children’s Medical Center Dallas within eight hours. With Ashtin seven months pregnant, the family drove through the dark to Dallas.
As Rachel’s cellphone rang that morning, she was about to leave for an appointment with Dr. Lepe at the UT Southwestern Digestive and Liver Diseases clinic at Texas Health Dallas. She didn’t immediately recognize the number and almost didn’t answer the call.
Thankfully, she did.
“I said, ‘Wait, I’m on my way, I’m not late for my appointment’! And the lady says, ‘No, no, no, we need you to come to the other UT Southwestern,’” Rachel said, referring to Clements University Hospital. “I said, ‘Oh, why is that?’ She said, ‘Well, because we’ve got a liver for you.’”
When the caller told Rachel that not only had a donor liver been identified for her but also for a little girl as part of a split-liver procedure, she was ecstatic. “I was more happy for the baby than myself,” she said. “I was like, yes, right on! It was pretty great that two lives were saved because one was kind enough to donate their liver.”
After learning that Luna's old liver was covered with infected pockets and cirrhosis scarring, her parents were relieved about the path they’d chosen. The surgery was a success.
“I’m glad we changed our minds because that could have been the turning point where she needed it, and we could have messed it up,” Sam said. “We trusted in our doctors and our faith.”
Amid cheers, smiles, and an ovation from caregivers lining the hall for her “transplant walk,” Luna was released from the hospital on Nov. 27, the day before Thanksgiving. The family spent time at the Ronald McDonald House of Dallas, where they’d stayed during previous visits for Luna’s treatment, before returning home. Rachel went home only four days after her transplant, and Dr. Vagefi points out that Clements University Hospital has one of the nation’s shortest median lengths of stay after liver transplants – five days compared with the national median of 10.
Rachel applauds her UTSW team members for their outstanding care.
“Everybody was so awesome, from the nurses to the physical therapists, as nice as they could be,” she said. “They made sure I was OK at every little step and have given me a great start at my new life.”
Honoring new life and sacrifice
These days, Luna spends her days playing house, blowing bubbles with her big sister, and proudly holding her baby sister. You’d never know the medical journey she’s been on.
Luna was treated for minor organ rejection after her transplant, which occurs in up to 30% of liver transplant patients in the first few months, according to the Scientific Registry of Transplant Recipients.
But Luna’s immunosuppressants are working, and her outlook is as bright as her smile.
“Luna has been doing really well,” said Ms. McConnell, whom Luna sees on her monthly visits to Children’s Health. “She’s gaining weight and enjoying her childhood like any other child. As she grows up, we will have to teach her why her liver did not work and why she needed a transplant. We will have to teach her about her medications and why she takes them.
"If Luna takes her medications and checks her labs regularly, she could easily make it with this liver the rest of her life.”
It’s a life her parents are thankful for every day, and they hope to get the chance to express their gratitude to the donor’s family soon.
“We are eternally grateful to the donor and donor’s family for this amazing gift of life, to be able to watch our daughter’s life blossom as she grows,” Ashtin Sifuentes said.
And Rachel? She not only has a disease-free liver that has posed no rejection issues – she also is rid of hepatitis C, courtesy of the antiviral medications she took daily for three months after transplant. She returned to work in February. And some days, it still feels like she’s living in a dream.
“I don’t think it’s gonna truly hit me until I get to thank the family of the person who donated their organ,” she said. “I’m not gonna let them down. I’m gonna honor them. This is the best miracle anyone could receive.”
Dr. Vagefi holds the Ernest Poulos, M.D., Distinguished Chair in Surgery.
