A Matter Of Life Or Death

Kumoli Ramakrishnan is pictured with daughters Varsha Monick (left) and Vani Ramakrishnan.

VERMILLION — Vani Ramakrishnan quickly gets to the point in a message she posted to Facebook last Tuesday, July 30.

“Hi friends,” she states in the opening sentence. “Any chance you might donate part of your liver to my dad and save his life?”

Her father, Kumoli Ramakrishnan of Vermillion, is well-known on the campus of the University of South Dakota. Now an associate professor emeritus at USD following his 22-year career there, Kumoli still lives in the family’s home near the Missouri River.

He’s not enjoying a peaceful existence as a retired university faculty member, however. Life has become difficult for him and his family as he battles end-stage liver disease caused when he became ill with jaundice as child.  

His failing liver makes it necessary for him to travel to Sioux Falls twice a week to have fluid drained from his body.

He’s grown weaker, Vani said, and worst of all, her father’s mind, which beautifully designed and developed, along with other faculty members, the finance major curriculum at USD, now at times leaves him confused and disoriented because of his malfunctioning liver.

As Vani stated on Facebook, “I love my dad. I can’t tell you how awful this has been — fluid builds up in him so fast that they drain five liters, twice a week. He’s tired and disoriented, and seeing my dad unable to think clearly is just heartbreaking. We’ve watched as things got worse and worse. It’s been so hard, for him and for us.”

Somewhere, there’s a person who can help things get better. The Ramakrishnan family is on a quest to find that individual.

Somewhere, there’s a person who is of the right blood type and other physical characteristics to serve as a living liver donor for Kumoli.

“It’s not cancer,” Vani said in a phone interview with the Plain Talk of the disease affecting her father’s liver. “It’s just not working anymore. It’s end-stage because his liver is not repairable. You have to find another one, if you can.”

Unlike kidneys, humans only have one liver. Remarkably, however, a living person may donate a portion of his or her liver to another. If all goes well, the donor’s liver regenerates and the portion of the organ transplanted into the recipient also grows and becomes fully functioning.

As Vani wrote in her Facebook post, “The amazing thing about the liver is that it regenerates, so you’d donate a part of yours to my dad, and they’d both then grow back to normal size in eight weeks!”

Kumoli began his teaching career at USD in 1992, moving to Vermillion that year. He and his wife, Malathy, raised a son, Kaushik and daughters Vani and Varsha here.  Malathy passed away in 2012 and Kumoli retired in 2014.

Kumoli served as the finance, management and marketing division chair for several years at USD prior to filling the position of executive education dean at the university. He also administered the MBA program at USD.

 “Unfortunately, none of us immediate family have the right blood type, so we’re looking for someone now to be a living donor,” Vani states in her Facebook message.

Ideal donor candidates are between the ages of 18 and 60, and have O or A type blood, negative or positive.

People who aren’t sure of their blood types who are willing to see if they may be a suitable living liver donor may contact the Mayo Clinic at 866-227-1569 regarding Kumoli or fill out a questionnaire that can be found by logging on to https://survey.livingdonormc.org/approach/?service=mayo.mn.transplant.combined%3Aliver.prereq.1&%3Fljs=en&fbclid=IwAR0z_agTUsjnD_Yy8UzSLKtLiJq91WF5bf8VoNRdVcgaaV5yHn8ywUaMR8A#__

“He had jaundice when he was a kid and his liver was damaged from that experience,” Vani told the Plain Talk. She added that for most of his life, he successfully dealt with higher than normal liver enzymes. Last September, however, he began feeling discomfort and he eventually was diagnosed with end-stage liver disease.

Vani said her father traveled to India to seek medical advice. Due to other problems he experienced while there that required medication, his liver became “decompensated,” she said. “Basically, his liver stopped working and there started to be a fluid build-up in his abdomen”

He returned home in late March. “It’s gotten worse and worse,” she said, noting that her father now travels to Sioux Falls twice a week for a paracentesis procedure to drain fluid from his abdomen.

“His body isn’t processing things the way it was,” Vani said and the paracentesis procedure may be followed by other steps to restore proteins that’s he lost.  Each procedure can take at least two hours.

Kumoli suffered a setback last weekend that required he be hospitalized in Sioux Falls.

The questionnaire referred to above is the first step one can take to get into the Mayo Clinic’s system and be considered as a possible living donor.

“They contact the person, possibly they just get more specific information,” Vani said. “A couple of my friends have gone through it and have been told they’re not good candidates. It’s fairly stringent because it is major surgery and they want to make sure that those people are able to go through it and recover — both my dad and the donor.”

The questionnaire is just the first step. Other steps in the process include blood-typing to make sure the donated liver is compatible with Kumoli. Potential donors will be asked to have other tests done by their local physicians and if those look good, they will be referred to the Mayo Clinic’s Rochester, Minnesota facilities to be further evaluated.

Social media, including Facebook, have helped Vani spread the word about her father’s need for a liver transplant. She likely won’t ever know, however, just how many individuals decide to see if they may be a suitable match.

“I don’t know how many people have filled it (the questionnaire) out or are being evaluated by Mayo, because one of the things with any organ donor situation is the medical facility keeps both sides of it very separated,” Vani said. “It’s a big decision donating an organ that way. They don’t want any undue influence and they won’t both sides to have their own medical advocacy system.”

According to a Mayo Clinic web page, living-donor liver transplants were initially used for children needing a liver transplant due to the scarcity of appropriately sized deceased-donor organs. Now, it has also become an important option for adults who have end-stage liver disease.

While access to deceased-donor liver transplant is determined primarily by the severity of the patient’s liver disease, access to living-donor liver transplant is determined primarily by identification of a living donor who is healthy and able to safely undergo a major surgical procedure and is also the right size and blood type.

Most living liver donors are close family members or friends of the liver transplant candidate, according the clinic’s web information.  Living-donor transplants have good results, just as transplants using livers from deceased donors. But finding a good living liver donor match is difficult due to restrictions on the donor’s age, blood type, size and health. The surgery also carries significant risks for the donor, the web page states.

Vani said the prospects of her father becoming eligible to receive a transplant from a deceased donor have not improved even though his condition is worsening.

“It’s really hard to see how things have changed for him,” she said, “and how much harder things are.”

Kumoli’s wife, Michelle, Vani said, “is doing so much work in taking care of him and taking him to all of these doctors’ appointments and things. There are friends who are very supportive and have taken him to appointments in Sioux Falls and spent time with him.

“He has at-home care now … and it’s just that he gets disoriented enough that he shouldn’t be by himself,” she said. “It’s so hard … he was a professor at USD for all of those years and he’s an incredibly intelligent man. It’s really hard to see him have trouble logging into his computer sometimes.”

Vani noted that when her mother was ill before passing away in 2014 “she was physically ill but she stayed herself and stayed clear … until she was in hospice … for my dad, it’s been really hard. It seems he’s slipping away so much faster. And I know that’s incredibly hard for him.”

In her Facebook message, Vani urges her friends to share her message with their friends to help spread the word about the need for a living liver donor.

“My awesome friends have awesome friends,” Vani said, “and maybe you know someone who can save my dad.”

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