Ted and Fran Yoch
After a long journey to a lifesaving transplant, a Minnesota couple wants to help othersBy Mayo Clinic Staff
After recovering from her liver transplant, Fran Yoch discovered a new passion for golf.
Fran Yoch saw her situation as win-win. "Either I would get a liver and have a new life," she says, "or I'd die and be in heaven." She had been battling liver disease for decades, but it kept hammering away.
She and her doctors tried new tactics here and there, and some showed signs of promise. For instance, she enrolled in a Mayo Clinic clinical trial studying the effectiveness of the immunosuppressant cyclosporine in treating liver disease. The trial didn't prove the drug worked for everyone; however, it seemed to help Fran, and she maintained good health for about 15 years.
But the disease was relentless. Eventually her body's immune system turned against her, attacking her liver cells. Doctors prescribed prednisone, but it was a losing battle.
Over the next decade, Fran's condition grew slowly worse. In August 2010, Mayo Clinic's Russell H. Wiesner, M.D., her longtime doctor, told her and her husband, Ted, it was time to consider a liver transplant.
"That was one of our harder nights," Fran says. "We sat in the sunroom holding each other and cried."
But the Yochs aren't the kind of people who stay sad long. Instead, they figure out the next step. Ted began applying his talents as the founder of an Internet content company to research liver transplant facilities across the country.
Nearly 150 U.S. hospitals offer liver transplants, and not all are equal. He quickly focused on the four best, based on wait times and outcomes.
Fran continued to decline. The ammonia levels rose in her bloodstream and brain, causing moments of confusion. Her family remembers her trying to do a load of laundry, but the washing machine buttons confusing her. She got lost coming home from the store. At that point, doctors told her no more driving, and Ted made sure she was never alone.
Finding the best for Fran
A number of factors can affect a patient's wait time for a new organ. One is the patient's Model for End-Stage Liver Disease (MELD) score. Fran's MELD score was a bit low.
Another wait-time factor is the hospital's location. To make transportation distances as short as possible, America's Organ Procurement and Transplantation Network breaks the country into 11 regions. Some regions have more organs available. For instance, in region 9, which covers New York City, hospitals performed 354 liver transplants in 2012 with nearly four times as many patients still waiting for organs in 2013.
By comparison, hospitals in region 3, where Mayo Clinic in Jacksonville, Fla., is located, performed more liver transplants (1,097) in 2012 than are waiting for organs in 2013 (1,084).
Florida simply has more organs available and fewer patients on the waiting lists.
Beyond that, Ted's research revealed that median wait times for liver transplants at Mayo Clinic in Florida were among the lowest in the nation and its survival rates among the highest. Since its inception in 1998, Mayo Clinic's Florida liver transplant program has delivered more lifesaving liver transplants than any other hospital.
Ted discovered that two of the best places in the country to get a liver transplant were Mayo Clinic in Rochester, Minn., and Mayo Clinic in Jacksonville, Fla. And, even though Fran's MELD score was low, they both put her on their lists.
Just wanting it to end
Fran and Ted loved their home and lives in a Minneapolis suburb, but Fran needed help as quickly as possible. To give her the best possible chance of receiving an organ, they rented a condo in Jacksonville Beach and moved to Florida. They hedged their bet and stayed in the Rochester system by coming back every four months for a checkup.
Ted said they should think of their time in Jacksonville as an extended vacation, but Fran was getting worse — sleeping three times a day, frequently ending up in the hospital and becoming confused more often.
Fran wanted it all to be over with but at the same time wondered what that meant. "Really, what does it mean to have a transplant?"
Ted was as aggressive as he could be, admitting he probably became a pain to the transplant teams. He called them frequently and sent emails asking when Fran would get her liver. Doctors assured him that Fran was at the top of the list in Jacksonville, so Ted and Fran became confident that it would happen there.
As the days passed, Fran's family became worried that she wouldn't make it. Her son had written a book and shared an early draft with her. He thought she wouldn't live to see it published.
The call comes
One day, while Fran was having an unrelated procedure that required sedation, Ted got an unexpected call from Mayo Clinic in Rochester — an organ was available for Fran. They had to be in Minnesota in five hours. Though the scenario was unlikely, Ted had planned for it. As soon as he got the call, he sprang into action.
His first challenge was getting Fran out of the hospital in Jacksonville, where she was having a routine procedure and was very sedated. After Ted explained the call to the nurses, they brought him into the procedure room, and he tried to wake her up. No luck. So they sent Ted home to pack and said they would take care of Fran.
When Ted returned to the hospital, Fran was awake, if a bit groggy, in a wheelchair and ready to go. Ted loaded her in the car, drove out to the airport and right onto the tarmac. A pregnant wife of a pilot helped Fran up the gangplank.
Fran had always wanted to fly on a private plane. As she sat down, she looked around and said, "This is nice. Do you have a blanket?" Then fell fast asleep.
Progress and setback
To Fran, the whole day was a blur. She doesn't remember much of the flight, and as soon as they landed, Ted whisked her to the hospital, where they skipped admissions and went straight to the transplant floor.
Fran received her liver through a rare domino procedure, in which one organ saves two lives. The operation went smoothly, and Fran was moving around the next day. For the first two weeks after the transplant, she surprised her care team with the speed of her recovery. Ted emailed family and friends, "The light is back in Fran's eyes."
"I was doing really well," Fran says, then laughs. "I was a superstar. I was a little prideful about how well I was doing." And then, two weeks later, a bile duct leaked. "It was harder than the transplant surgery, but again the same dedicated liver team saved my life. I was less prideful this time around about my recovery."
Ted and Fran now live life with a new appreciation, valuing every day, every moment.
"What a gift for both of us," Fran says. "We wonder, what should we be doing with this wonderful gift?"
One of the areas especially important to them is Mayo Clinic.
"We believe so much in liver research and opening the market for more people," Ted says.
They see that in the next five to 10 years, liver transplant could change dramatically. They increased their philanthropy to advance Mayo's research and to help more patients battling liver disease.