A rare living-donor transplant exchange performed by Keck Medicine of USC’s Transplant Institute allowed one set of siblings to save the other.
Joselin Casillas, a 28-year-old teacher from West Covina, had been dealing with symptoms of biliary atresia, a rare and incurable liver disease, since the day she was born.
The condition causes blockages in the liver’s bile ducts, leading to liver failure. Most patients who survive beyond early childhood ultimately require a liver transplant.
“It had always felt like I lived my life on pause,” Joselin says.
By 2023, Joselin had developed cirrhosis, permanent scarring of the liver, as well as gastrointestinal bleeding that repeatedly hospitalized her. A doctor had referred her to Keck Medicine of USC for more specialized care.
Doctors at the USC Transplant Institute, part of Keck Medicine, determined that the time for a transplant had arrived.
“Once GI bleeds start,” Joselin says, “it goes downhill fast.”
Her brother, Saul, 21, a college student and first-aid instructor, volunteered to donate part of his liver, but tests revealed their organs were incompatible.
While Joselin and her family waited and hoped, the team continued looking for a match.
When do you need a kidney transplant?
Meanwhile, Jaime Rocha Fernandez, a 39-year-old father of three from La Puente, was in urgent need of his own transplant. His kidneys were failing and doctors had placed him on dialysis, a short-term solution.
“I was always tired, and even my skin tone looked different,” Jaime says. “I was scared.”
After his doctors referred him to the USC Transplant Institute, Jaime met with his family members to ask if any would be willing to donate a kidney to help save his life.
His youngest sibling, Kathya Rocha, 28, the married mother of a young son, offered to help. But like with Joselin and Saul, tests revealed an incompatibility.
Both families, unaware of each other, were staring into the unknown.
However, their Keck Medicine treatment teams soon found them a reason for hope.
Living-donor liver transplant and living-donor kidney transplant
Navpreet Kaur, MD, surgical director for the living-donor liver transplant program at the USC Transplant Institute, realized in July 2023 that an exchange between the Casillases and the Rochas, who did not know each other, was possible.
She explains that, in their case, “a female-to-female liver transplant and a male-to-male kidney transplant” would be a perfect fit. Kathya could provide a partial liver transplant to Joselin, while Saul’s kidneys were a match for Jaime’s.
Jim Kim, MD, the kidney transplant surgeon who would later operate on Saul, says while paired kidney exchanges are common, kidney-liver exchanges are not. “A lot of it was timing,” he says. “It’s rare to find two people who can’t donate one organ, but the other organ lines up.”
“It was like the stars aligned,” says Aaron Ahearn, MD, the liver transplant surgeon who operated on Joselin. “It seemed like it was meant to be.”
For Joselin and Jaime, it provided a life-saving opportunity; for Saul and Kathya, the chance to save their siblings.
“At first it didn’t seem real,” Kathya says. “After they explained more of how it would all work, I wanted to do it.”
“There’s always going to be fear,” Saul says. “But I didn’t want to see Joselin struggle anymore.”
All four signed on, crediting their treatment teams for helping to build their confidence in such a unique plan. Their surgeries were set for August 31, 2023, at Keck Hospital of USC.
Kidney and liver transplant surgery
Keck Medicine’s status as a pioneer in living-liver donation, and the only institution in southern California currently offering it, made the team uniquely qualified to complete such a complex paired exchange.
In addition to Drs. Kim and Ahearn, the surgical team included Hamid Shidban, MD, who operated on Jaime. Dr. Kaur and Yuri Genyk, MD, focused on Kathya.
The four procedures were coordinated on a precise schedule, with four operating rooms running simultaneously. According to Dr. Kaur, the experience of the institute’s support teams in managing multiple daily surgeries proved beneficial.
“When you have an exchange like this, all four surgeries have to go off without a hitch to be successful,” Dr. Ahearn says. “It reflects the resiliency and strength of the program that we were able to make it all line up.”
Joselin recalls that, while she nervously awaited surgery, Dr. Ahearn visited her.
“He said, ‘When you wake up, you’ll have a brand-new liver.’ Those words were so comforting to me.”
The surgeries, for all four patients, were a success.
“Everyone who took care of me was excellent,” Jaime says. “The kidney was working right away.”
It was like our lives had been intertwined. We realized we had grown up in the same area and had similar childhoods.
Joselin Casillas, patient, USC Transplant Institute
Joselin’s new liver also began functioning well. After a lifetime struggle with biliary atresia, she could now look forward.
“I’m eternally grateful I was referred to Keck Medicine,” she says. “I can live life normally now.”
Following the initial recovery period — which often takes several weeks — all four patients are feeling well and pursuing favorite activities. Saul has gone snowboarding a few times; Joselin is hiking; and Jaime and Kathya are enjoying time with their children.
“My kids are so excited we can do all kinds of things together now,” Jaime says.
Their doctors say all four can expect to live healthy lives. “They’re all young people,” Dr. Kaur says. “I’m glad they can all move on and start a new chapter.”
Meeting your organ donor
Three months after the transplants, the Casillases and Rochas met for the first time during a visit at Keck Medical Center of USC, where they also reunited with many of the physicians and staff who cared for them.
The families were able to learn more about each other.
“It was like our lives had been intertwined,” Joselin says. “We realized we had grown up in the same area and had similar childhoods.”
“They felt like family the instant we met,” Kathya says.
They remain in touch.
“Not many people go through this kind of experience,” Saul says. “So it’s meaningful to know we always have someone else to share it with.”
All four patients say they hope their journey gives faith to others who await transplants, as well as inspires others to consider donation.
“Don’t give up,” Jaime says. “I always tell people now: Our story is proof that there are options.”
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