Calculating life

Our church is praying for a liver.

That is, we're praying for a liver to be successfully transplanted into one of our members who contracted Hepatitis C (and other complications) through a bad blood transfusion back in the early 1980s. This brother (I'll call him "Jim") shouldn't even be alive, according to any law of averages-he's been near death several times, most recently in March. But alive he is, even though time is running out.

His body is now in desperate balance between the other organs, which are gamely struggling on, and his liver, which is rapidly giving up. The protocols for getting on a transplant list are daunting; once on, even more so. His position on the list (No. 1 being first in line) is determined by a rubric called Model for End-Stage Liver Disease (MELD). Even though I have Jim's explanation in writing, I won't try to explain. But the formula looks like this:

MELD = 3.78 [Ln bilirubin (mg/dL)] + 11.2 [Ln INR] + 9.57 [Ln creatinine (mg/dL)] + 6.43

Pretty impressive. But the bracketed letters and numbers don't cover all the physical factors of liver disease, as we learned in March when Jim's near-death episode did not alter his MELD score. It doesn't make sense that a person has to be in such bad shape that radical surgery is risky before he receives the nod for radical surgery. Steve Jobs received a liver transplant only a year and a half before he died of pancreatic cancer-shouldn't that liver have-theoretically, anyway-gone to Jim, who isn't 41 yet and shows no signs of cancer? How are these things really determined?

Jim has finally moved up to No. 1 on the list, so he and his wife are staying in a hotel close to the hospital. (Anyone have Marriott points they'd like to donate?) They expect a call any day now. Any day, any hour … all the months and years of anxious waiting are collapsing in a single moment of incredible density. He'll live, or he'll die.

But for him to live, someone else has to die. The donor liver has to be whole and healthy, and preferably young, taken from a life cut short, from someone walking around this moment, perhaps, with no idea that his time is almost up. Jim's focus is a constant readjustment of scores and blood and fluid and medical terminology, and right now it depends on a single person whose dominant thoughts may be buying a speedboat or planning the twins' next birthday party. Who lives, who dies? Hospitals, insurance companies, and government agencies pare lives down to formulas, because they have to. But we belong to One who knows all factors, and needs no formulas.

God doesn't calculate: He died; we live. That's what Jim can count on, whatever the next month may hold. The ultimate decision is not ours, and that's ultimately a comfort.