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Arab Israeli Sisters Await Transplants

7/27/2006

Two Arab Israeli children, just 8 and 19 months old, are now in Miami awaiting lifesaving transplants at the University of Miami/Jackson Memorial Medical Center. Both girls suffer from a rare digestive disorder.

Janna Awad and her sister Halla were both born with microvillous inclusion disease, which inhibits their ability to process food. Both have been nourished intravenously since shortly after birth, but that process can cause liver damage. Now the only option for both girls is a multi-organ transplant. “I did a search of transplant centers all over the world and that’s when I learned about UM/JMH,” said Hala Awad, the girls’ mother. “Our doctor also recommended that we come here,” said Awad, who is a junior high school English teacher.

“About 250 of these operations have been done worldwide,” said Andreas G. Tzakis, M.D., Ph.D., director of the Division of Liver and Gastrointestinal Transplantation at the University of Miami Leonard M. Miller School of Medicine. “We’ve done about 130 of these procedures here. Still, this surgery is very dangerous.”

Tzakis pointed out that when surgeons began doing these multi-organ transplants in 1994 the one-year survival rate was about 50 percent. Now patients have an 80 percent survival rate, which improves even more as patients live beyond the first couple of years.

Because these girls are so young they can only receive organs donated from very small children. Also, because of the liver damage, Janna and Halla have trouble building muscle tissue, leaving them more fragile than healthy peers. Still, all in all, Dr. Tzakis says the Awad sisters have obviously been well-cared for and are strong enough for the procedures. The hope is that organs will become available before they become so sick they will have to be hospitalized while they wait. Because Janna is older, her disease is more advanced. Her condition is expected to become critical over the next month or two. “One or two months is about how long it usually takes for us to get organs for young children,” said Tomoaki Kato, M.D., director of pediatric transplant surgery at the UM Miller School of Medicine. “Janna is really sick. She needs a transplant as soon as possible.”

Should organs become available things would move very quickly. As soon as a donor is matched to one of the girl’s needs, arrangements would be made to get them to Jackson Memorial Hospital within a few hours. The parents of the two girls would be notified and Janna or Halla would be prepared for surgery soon after. The procedure will take between 6 and 12 hours and involve a large team – three or four surgeons, an anesthesiologist, nurses and technicians. “In many cases it is really safer to transplant a whole block of organs rather than doing it in pieces,” said Tzakis. “They will receive the entire package of digestive organs.” This could include some combination of the stomach, pancreas, spleen, intestines, liver, kidneys and abdominal wall. UM/JMH surgeons have transplanted as many as eight organs at one time in the past.

The Awads have health insurance at home, which is in Tamra, a village just outside of Haifa, Israel. Because this is considered a life-threatening condition the insurer agreed to pay the maximum amount on the policy - $1 million. Hala and Hatem Awad – the girls’ father, an auto mechanic – began a fundraising campaign that took them around the country for several months. That still didn’t provide enough to cover the surgery and months of recovery for both girls, and they also faced substantial travel hurdles, so they appealed to the Israeli government, which agreed to help. “In Israel we like to take care of our people, whether they’re Israeli, Arab, anyone,” said Dr. Yitschak Ben Gad, the Israeli Consul General in Miami. “When they arrived here in Miami I greeted them in Arabic.”

The International Kids Fund, which supports children’s needs at Jackson Memorial, is also helping the family, which is staying on the UM/JMH medical campus at the Ronald McDonald House.

The Awads left Israel just before the outbreak of the latest violence between Israel and Lebanon, but the safety of their loved ones is clearly on their minds. Hala’s grandparents moved from their home in Haifa to the Awads’ house in Tamra to be farther from the violence.

Hala and Hatem began raising donations at the beginning of April but didn’t learn for sure they would be coming to the United States for three months.

On the Fourth of July.

As grateful as they are for the blessings they hope to receive here, and despite the current tensions in Israel, their hearts are at home. “We’ll return as soon as possible,” said Hala, the mother. “We need our families.”