Multi-organ Abdominal Transplant Gives Preteen a New Future

Stanford Children’s says yes to extremely difficult surgery, finding inventive ways to overcome roadblocks that often make transplant impossible

Flynn Butler, age 13, has lived his entire life without working intestines. Since birth, he was in and out of hospitals, always tethered by medical lines that kept him alive. Thanks to his extraordinary family and a groundbreaking multi-organ transplant at Stanford Medicine Children’s Health, Flynn is finally free to eat, move, and enjoy his life.

“He’s stronger now, more energized, and happy,” says his mom, Rachel. “He’s really excited to learn to ride a bike and skateboard with his older brother, Logan.”

When Flynn was born, everything seemed fine. Then, on his first night home he began projectile vomiting. His family took him back to the hospital near their home in Reno, Nevada, where he was diagnosed with intestinal malrotation—when the small intestine doesn’t develop correctly during pregnancy and becomes twisted. That was the start of a long, challenging journey to keep Flynn alive.

“It has been terrible dealing with this his entire life,” Rachel says.

During the following years, Flynn spent months at a time in hospitals and 12 to 14 hours a day connected to an infusion pump to receive IV nutrition called total parenteral nutrition. It kept him alive, but it also kept him from attending school in person or reaching regular milestones, like learning how to ride a bike.

When Flynn was 6 years old, doctors said that his only chance at survival was an intestinal transplant. He was referred to the Stanford Children’s Pediatric Intestinal Transplant Program, one of just two intestinal transplant programs in the West. Stanford Children’s is known for caring for children with highly complex needs, providing the latest innovative care, and transplanting very sick children and very tiny babies. To care for Flynn, they assembled a large team of pediatric specialists.

Flynn arrived at Stanford Children’s in rough shape. He had a yeast infection in his TPN line that had traveled to his lungs. “The amazing doctors at Stanford saved him. It took a lot of work to help him recover,” Rachel says.

TPN had scarred Flynn’s liver, turning his intestinal transplant into a multi-organ transplant. He needed an intestine, liver, and pancreas, all from the same donor, transplanted at the same time.

Overcoming challenges to make transplant possible for Flynn

“Flynn had so many complications coming in that I doubt any other center in the nation would have agreed to transplant him. Because of recurrent infections, he had lost all vascular access for TPN except one. He arrived with an access point through his belly, which is not standard and not ideal,” says Ke-You (Yoyo) Zhang, MD, pediatric gastroenterologist and medical director of the Pediatric Intestinal Transplant Program.

During transplant surgery, doctors need open access to healthy arteries and veins to deliver vital fluids, including TPN, medicine, and electrolytes to keep the child alive.

“Without vascular access, there is no transplant, and no chance at life,” says Avnesh Thakor, MD, PhD, radiologist with the Pediatric Interventional Radiology team at Stanford Children’s.

Before the care team could even consider transplant, they had to solve the issue of vascular access for Flynn. It seemed like a minor detail, but transplant hinged on it, and his multidisciplinary care team took time to consider an ideal approach for Flynn so he would have the best outcome while he waited for transplant, and after.

“Every decision has short- and long-term consequences, and in a non-ideal state it takes the whole team to figure it out. The back-and-forth between our many specialists only happens with trust and open communication. We rely on each other’s expertise,” Dr. Thakor says. “When it comes to medically complex children, our default is to say yes. That’s very unique. We ask: ‘What can we do to save this child?’”

Dr. Thakor used several innovative approaches to salvage Flynn’s last remaining venous access in his belly. Flynn’s incredibly complicated vascular anatomy required Dr. Thakor to very carefully manipulate and guide a specialized catheter (tube) in his remaining healthy vein during a multi-hour procedure to keep stable access for fluids and TPN.

Waiting for a multi-organ intestinal transplant

Flynn’s many complications meant a much longer time on the transplant waiting list. In total, the family waited nearly six years for the phone call that would change their lives. Dr. Zhang was with them every step of the way, helping to coordinate Flynn’s many care providers and ensure that the family had everything they needed to care for him.

“Dr. Zhang was a huge part of Flynn’s care. She was his advocate and champion on everything,” Rachel says.

While in the hospital awaiting transplant, Flynn played a lot of video games. His favorite is Pokémon. One of his nurses bought him a Pokémon T-shirt, and many of the nurses would come and play with him. He also enjoyed drawing and other activities with Child Life and Creative Arts.

Rachel recommends Stanford Children’s “100 percent.” “Everyone is so competent and caring. They do everything in their power to make sure things are done the right way,” she says.

Getting the call that donor organs were available

The Stanford Children’s care team went the extra mile to ensure a good donor match for Flynn. They traveled to examine the donor organs to make sure they were an excellent match, which would make for a better outcome.

“When I got the call, I almost didn’t believe it. We had been waiting for so long that I trained myself to not expect it,” Rachel says.

She will never forget that day. Rachel was in the hospital in Las Vegas with her husband, Eric Murphy, who had just suffered a mini-stroke. The call came at 7 o’clock at night.

“I noticed my phone ringing and I was in shock. I said to my mother-in-law, ‘It’s Stanford!’ and she said, ‘Answer it!’ It had been so long that when it finally happened, I panicked and felt excited and terrified at the same time,” Rachel says.

That call set off a whirlwind of activity. Rachel and Flynn flew out early the next morning, and Eric, who has been a big part of Flynn’s care, did everything he could to get there the following day.

Using Flynn’s heart in an innovative way to deliver vital fluids during surgery

Having an intestine-liver-pancreas transplant is a huge ordeal in itself, but Flynn’s surgery was complicated by needing to create another access point for fluids, besides the access in his belly. During such long and complicated surgeries, a number of access points are needed to manage a variety of fluids, including nutrients, medicine, electrolytes, and blood.

Because of Flynn’s many years on TPN, nearly all of his veins were compromised, so his large care team had to get creative. First, they attempted to establish access in the spine, without success. Then, they turned to their Pediatric Heart Surgery colleagues.

“The intestinal transplant team reached out to us and asked, ‘Can you help in any way?’ and our team discussed it and said, ‘Yes, we can give you as many access points as you want,’” says Arvind Bishnoi, MD, pediatric heart surgeon.

Dr. Bishnoi consulted with several members of his team, including Michael Ma, MD, chief of pediatric cardiac surgery, to come up with a unique plan, one that could likely be the first for an intestinal transplant. Because all of the body’s blood goes to the right side of the heart, that’s where the team needed to place the lines. Heart surgeons regularly place lines in the heart for monitoring, but they are small, and even small lines can cause scarring. Yet, to deliver TPN and other fluids, the team needed to place much bigger lines.

“Placing large lines directly into the heart would have required making a large hole that would likely bleed when we removed the lines after surgery. As a solution, we made a graft out of artificial material and sutured it on the heart,” Dr. Bishnoi says. “We then placed the lines through the graft, which could handle the lines.”

A successful intestine-liver-pancreas surgery

Dr. Bishnoi was first up on Flynn’s surgery day. He opened Flynn’s chest with a small incision so he could access the heart. Then, he placed lines directly into the heart. He was successful, giving anesthesiologists plenty of lines to deliver vital fluids to Flynn during his long transplant surgery.

“When we have a difficult case, we take it personally. We see ourselves as just one step in a plan that others can build on. At Stanford Children’s, we do not find excuses to avoid doing something difficult; rather, we find reasons to do it,” Dr. Bishnoi says.

Performing a multi-organ intestinal transplant is a very long and arduous process. Kazunari Sasaki, MD, abdominal transplant surgeon, performs hundreds of transplants each year at Stanford, and he was a key member of Flynn’s surgical team.

“Every multi-visceral (abdominal organ) transplant is very difficult, but fortunately Flynn’s surgery was easier than I expected, since his scar tissue was minimal. It went very smoothly,” says Dr. Sasaki.

Three transplant surgeons worked side-by-side during Flynn’s operation, including Thomas Pham, MD, surgical director of Pediatric Kidney Transplant, and Stephan Busque, MD, interim director of Pediatric Liver Transplant. They were able to accommodate Flynn’s abdominal central line, something the team thought might have to be sacrificed during surgery.

During the operation, Dr. Sasaki had to be extremely focused to complete the surgery during the window when the donated organs were most vital, and to ensure minimal risk of bleeding. He carefully placed the new organs to achieve an optimal fit, which required meticulous sewing of Flynn’s veins and arteries to his new organs for good blood flow. After the surgery, his intestines turned pink immediately, and within minutes his bowels began to contract, showing they were back to life and working.

“It took a lot of innovative, out-of-the-box thinking to come up with plans that had never been done before: First, with Dr. Thakor from Interventional Radiology painstakingly working to maintain Flynn’s venous access while he awaited transplant. Then, with our partners in heart surgery creating the innovative approach of placing lines directly into the heart,” Dr. Zhang says.

Flynn’s surgery took 14 hours from start to finish. While Rachel waited, she received regular updates.

“When Dr. Zhang came out after surgery and told me it all went well, we both cried,” Rachel says. “Everything went beautifully—I don’t think it could have gone any better.”

Flynn spent a few weeks in intensive care, where Dr. Bishnoi helped the nurses learn how to handle the unique lines in his heart. The heart surgery team had planned for an option that didn’t require a second heart surgery to remove the lines. Dr. Bishnoi was able to remove them and suture the graft closed right at Flynn’s bedside.

Flynn’s surgery was in mid-September 2025, and remarkably he was home by Thanksgiving. The Stanford Children’s care team partnered closely with Flynn’s local gastroenterology providers to help him return home early, and they are still actively guiding his care today.

“We were surprised how fast Flynn recovered. They prepared us for a three-month hospital stay and spending six months near the hospital because the transplant was so complex, but he recovered so quickly, and did so well, that there was no reason to keep him there,” Rachel says.

Home and digesting just fine

Many babies who are on TPN struggle with learning to eat by mouth. Luckily, Flynn was not one of them, thanks to his family, who used a pacifier and encouraged him to eat through the years, even though the food would not be digested or provide nutrients. The first time Flynn felt full after surgery was a funny surprise for Rachel. He didn’t understand the feeling.

“Flynn’s family deserves most of the credit for his good outcome. From his first day of life, they have worked diligently, every single day, to care for him and his medical needs. They are the only reason he was able to survive through transplant,” Dr. Zhang says. “Rachel was his safe place, and she was a constant through everything.”

Rachel has just finished nursing school. She was inspired to become a nurse from watching all the nurses care for Flynn through the years. Flynn’s big brother, Logan, and big sister, Amelia, are thrilled to have Flynn home and his transplant finally behind him.

“They have always been there for Flynn; they have gone through so much their entire lives because of his medical complications,” Rachel says. “And they have done it without ever becoming resentful or upset about the extra time and attention Flynn needed.”

Flynn recently took a big step in his transplant journey. He and his stepdad, Eric, returned to Stanford Children’s in March 2026 to have an ostomy takedown surgery that closed his colostomy and reconnected his bowel, making it possible for stool to pass normally. Gregory Tiao, MD, director of the Stanford Children’s Pediatric Transplant Center and director of Pediatric Liver Transplant, performed the takedown.

Losing the colostomy bag was a big deal for Flynn, allowing him to finally shed the last evidence of his medical past and step freely into his future.

“Recently, my older son, Logan, announced that 2026 was going to be a good year for our family,” Rachel says. “He said, ‘We have been stuck waiting for Flynn’s surgery, and for you to get through nursing school, and now we can move forward.’ I think he’s right.”

Learn more about intestinal transplant at Stanford Children’s >