Ornithologist Is the First to Receive a Liver Transplant at The Mount Sinai Hospital Using a Donor Liver Enhanced by Pump Technology

Eduardo Iñigo Elias, PhD, is an ornithologist from Ithaca, New York, who has dedicated 41 years of his life to the study and conservation of birds and their habitats, working primarily in the rainforests, deserts and islands of Latin America, in the Caribbean, and in Africa. On Memorial Day 2016, while he was carrying out research on the Tortugas Bay islands in Baja California, Mexico, he experienced severe gastrointestinal internal bleeding. He immediately called his doctor. He told him to seek urgent medical help, but advised against flying.

It took 18 hours to reach the nearest local hospital by land. “We drove and stopped every 45 minutes, just to get rid of the blood that was coming out internally in my stomach,” Eduardo recalls. He was able to reach the hospital but was in a serious condition and suffering from severe blood loss. After being stabilized, he was transferred to a major hospital in San Diego, where they stopped the bleeding and saved his life. He spent the next 10 days recovering.

When he returned to New York, his doctor referred him to Leona Kim-Schluger, MD, Associate Director of The Recanati/Miller Transplantation Institute at Mount Sinai and Sydney J. Zweig Professor of Medicine, with a suspected diagnosis of Metabolic Dysfunction-Associated Steatohepatitis (MASH). MASH is caused by having risk factors of being overweight, diabetes, and/or hyperlipidemia with a probable underlying genetic predisposition and a metabolic dysfunction syndrome. Dr. Kim told Eduardo that his condition was severe enough for him to need a liver transplant. However, a number of factors stood in the way of him getting a transplant in the near future.

“Liver allocation is based on a MELD (model for end-stage liver disease) scoring system that incorporates several laboratory values to assess the severity of liver disease,” says Dr. Kim-Schulger. “In some patients, the MELD score does not always correlate with the clinical complications of cirrhosis and the urgency of the need for liver transplantation.”

Over the next few years, Dr. Kim and her team managed his symptoms. Liver cirrhosis can lead to esophageal varices, where the veins in the esophagus can become enlarged and cause bleeding, and fluid retention can also develop. “We treated him with diuretics to manage his fluid retention, and additionally we carried out endoscopies to assess his varices and managed them with a procedure called banding,” Dr. Kim explains.

The likelihood of Eduardo’s being given a donor liver through the conventional allocation process would remain very low until his condition and MELD score changed significantly for the worse. However, fortunately for Eduardo, Dr. Kim and her colleague Zeeshan Akhtar, MBBCh, Assistant Professor of Surgery, Liver Transplant at Icahn Mount Sinai, are involved in research of a new pump technology that enables the use of a wider range of donor livers in transplantation. The technology, called normothermic machine perfusion, pumps the organ with blood and oxygen at normal body temperatures, so it does not need to be maintained cold storage with ice. This extends the amount of time the liver can be kept prior to implantation. The pump also helps to purify and restore the liver’s function, meaning that a donor liver that would previously have been inviable can be considered for transplantation. The device received FDA approval in December 2021.

On July 28, 2022, Joseph DiNorcia, MD, Associate Professor of Surgery at Icahn Mount Sinai, and the on-call transplant surgeon on that day, received a call regarding a possible donor organ. The liver was inviable for transplant in its current state, but was potentially a good fit for the pump technology. He immediately spoke to Sander Florman, MD, Director of The Recanati/Miller Transplantation Institute, who agreed for them to go ahead and use the pump—the first time it would be used at Mount Sinai outside of clinical trials. Dr. Kim identified Eduardo as a good candidate for the transplant, and Dr. Akhtar immediately went to retrieve the organ and have it set up with the pump.

“This is a moment where you're thinking a human being just died or he's dying,” Eduardo says. “I am so thankful to the donor, and I'm thankful to his family for this wonderful opportunity to extend my life.”

By the next day, the liver had made enough improvement for Dr. DiNorcia to carry out the transplant surgery. “We brought the patient to the operating room and began the procedure,” says Dr. DiNorcia. “His case was hard because he had a total clot of his portal vein, which is the main vein that feeds the liver. But having the liver on the pump, and not on ice, meant we were able to take our time to take out that clot and reestablish flow through his main portal vein. The procedure went great.”

“A few days after my transplant, while I was still in the intensive care unit, I met Dr. Akhtar,” Eduardo says. “During our conversation, he told me, ‘You are the first patient that we have carried out this procedure with at Mount Sinai, with this pump’.”

There were some initial issues immediately after surgery—Eduardo needed temporary kidney dialysis for a few days—but the liver transplant was a complete success. His liver is in great condition, and he has started to return to his career and to leading a normal life. In May 2024, he assisted his colleagues in person at the 7th International Albatross and Petrel Conference in Baja California, Mexico.

“He made an amazing recovery,” Dr. Kim says. “The liver right now is perfect. From his last blood work, his liver tests are completely normal.”

“It is very important for patients to keep an open dialogue with their doctors and create mutual trust,” Eduardo says. ”From my point of view, the partnership between patients and doctors is an integral part of successful treatment. The doctors at Mount Sinai built that relationship with me.”

In February 2024, Dr. Kim and the Recanati/Miller Transplantation Institute received a $5 million gift from the Blavatnik Family Foundation. The donation will go toward establishing a national and international organ registry, as well as funding further research into the use of normothermic machine perfusion, with the potential for expansion into cancer research.

“I have learned that there have now been over 100 patients treated at Mount Sinai using this system to save other lives,” Eduardo says. “Research, innovation, dedication, and training—you can do all those things in one place at Mount Sinai. As a scientist, I find it wonderful.”

Watch the video on Eduardo’s journey.