SALT LAKE CITY — At 11, Sam Hoopes began taking medication for a stomach condition.
He didn't realize then what it would lead to today, nor did he understand the number of lives it would impact.
Hoopes was the first of many successful live liver transplants performed by doctors at Intermountain Healthcare after hospitals opened back up for surgeries after COVID-19 shut down hospitals last spring. The conditions of the pandemic actually created an environment in which the organ transplant program thrived.
Intermountain reported a record 222 adult patient abdominal organ transplants in 2020, far surpassing the 186 transplants the year before, which was also a record.
"During an unimaginable year and one many would like to forget, Intermountain and the populations of Utah, Idaho and Nevada through organ donation created a record number of opportunities to save the lives of others," said Dr. Richard Gilroy, a transplant hepatologist and Intermountain's liver transplant medical director.
"And despite the barriers and challenges of COVID-19, transplant patients were a population that saw a rare silver lining to the pandemic."
Gilroy said Intermountain's Transplant Services reported 79 liver transplants in 2020 when there were 53 in 2019.
Multiple factors helped increase transplants
Many things made that possible, he said, including the fact that more people died in 2020 — not because of COVID-19, which also claimed hundreds of thousands of lives, but makes a person ineligible for organ donation — but because critically ill people did not seek medical help when it was needed.
"There was a delay in people seeking care," Gilroy said, adding that it led to an early death for some, particularly people experiencing cardiovascular issues or stroke.
In addition, organ procurement services, such as DonorConnect in Utah, have continued to improve their ability to identify potential donors for transplant centers around the country. Many organs that would have been passed up are being used.
The increased number of available organs hasn't really made a dent in the demand, as Gilroy said more and more people are seeking organ transplants in order to live longer lives.
"We are now transplanting older patients, patients with other disease states we didn't consider before," the doctor said, adding that using more of the available livers leads to outcomes that are the same, but "more patients are alive and not dying on the waitlist."
Intermountain is unique in that it accepts organ offers from procurement services that others might have declined. And, as Gilroy said, if it gets someone off the waitlist and increases their quality of life, even for the time being, it is worthwhile.
"We could not have given so many people new leases on lives without the generosity of so many deceased and living donors and their families," Dr. Diane Alfonso, another transplant surgeon and medical director of Intermountain's abdominal transplant program, said. "We're honored to be stewards of these selfless gifts."
Another thing that helped Intermountain surpass its reach was that COVID-19 forced hospitals and clinics to reevaluate how they provide care. For a short time last spring, when COVID-19 first hit Utah, transplant patients could not be seen in person. And waiting rooms for people who were already at the brink of death were all of a sudden off limits.
"We changed the way we practice to address the needs of the community," Gilroy said. And at least for the liver transplant team, the logistics were completely changed to incorporate virtual clinic visits almost overnight.
Because those visits were being done virtually, staff was able to increase the number of times they checked in on patients, lessening the likelihood of those patients needing to be hospitalized, as one of the greatest concerns for hospitals was keeping hospital beds open and preventing health care systems from becoming overwhelmed.
"The greatest determinants of health care and health care delivery are access," Gilroy said. "Our institution has as part of its vision is that we will provide access to patients."
The increase in organ donations last year wasn't just experienced in Utah.
The United Network for Organ Sharing, which manages organ donation across the United States, reported a 6% increase in organ donations from deceased donors last year — the 10th consecutive year of record donations. The nonprofit reports a total of 12,587 people donated one or more organs to save or improve the lives of others, resulting in more than 33,000 people receiving life-saving transplants.
Despite the increase in organ donations, there are still more than 110,000 people on organ transplant waiting lists in the U.S. — 773 in Utah. Across the U.S., more than 8,000 people die each year waiting for vital organ transplants.
About 78% of Utahns age 16 and older are registered organ donors, and 58% of all Americans are.
Donor kept him from being 'yellow, grumpy guy'
Living donors have greatly helped hurry things along, especially for liver and kidney donations, and particularly so for 32-year-old Hoopes, who lives and works in Duchesne.
The high school counselor and girls basketball coach had reached a point where he was battling not one, but two autoimmune diseases. More than a year ago, he was diagnosed with primary sclerosing cholangitis, where the bile ducts in the liver become inflamed and blocked. That, on top of his existing ulcerative colitis forced doctors to give him a much shorter life expectancy.
"My liver got worse and worse," Hoopes told the Deseret News.
While doctors had given him 15 to 20 years to live — that is, if he didn't succumb to cancer first — it was just two years later that he landed himself pretty high up on the organ transplant list.
In addition to a failing liver, Hoopes said he felt "drained." His thinking wasn't clear. His eyes were yellowed. He wasn't himself and he didn't feel good about it.
"I was in trouble for sure," he said. And the father of three young children didn't want to be remembered as that "yellow, grumpy guy."
Blessed with three biological brothers, he was certain at least one of them would be a good match, but it turned out that his brother-in-law, Derek Herrera, had the optimal liver for Hoopes.
"It's something you don't want to ask for," Hoopes said, but when he found out Herrera was more than willing to help, Hoopes said he was "speechless."
"It's a cool thing because you find out how much someone really cares for you, and it's not just words," he said. "He literally put his life on the line and on hold to help me so I could help raise my kids."
On May 11, 2020, the two men, who were lifelong friends, underwent life-changing procedures. And while Hoopes isn't out of the woods yet, the former college athlete said he feels like a "whole different guy."
"My energy level, my thinking, I just want to learn and grow," he said. "When I was sick, I just wanted to make it through the day and get home. ... I feel like I'm back and am myself again."
With Herrera's help, and the expertise of Intermountain's team of doctors, Hoopes said his new liver should outlive him — "it shouldn't be the reason I die," he said.
There are risks of infection and other things that threaten to hold him back, but Hoopes said, "I owe too much to my wife, to my kids, to Derek, to let something go wrong."
"It's the people behind the scenes that made this happen," Gilroy said of the record number of lives saved in an otherwise difficult year. "We would've had more deaths, but more are living as a consequence of the offers."
An organ donor can save as many as eight lives, including liver, kidneys, lungs, heart, pancreas and intestines. Eyes and tissue donations can help enhance the lives of up to 75 others.
Gilroy said Utah, Idaho and Nevada — the areas served by Intermountain's transplant program — have "incredibly giving communities in the face of tragedy."
"I'm proud to be a part of the process of saving more lives," Gilroy said.
For anyone considering organ transplantation, he said doing it "just to be alive" isn't enough.
"Truly live after you do it. Do it so you can have the life you want to have," Hoopes said.