Teen Faces Liver-Kidney Transplant With Positivity and Grit

Celebrating multiorgan transplant recipients during Donate Life Month

Despite having kidney disease since she was young, Marlow Hoel, age 14, has always had tons of energy and a good attitude. Her family knew she would need a kidney transplant, but even after she learned that her liver was failing as well, Marlow’s happy-go-lucky mindset stuck.

“Marlow has always remained positive. She never felt an energy change from before or after the transplant. Her doctors couldn’t believe she was doing as well as she was with both organs failing,” says her mom, Leah.

Marlow was born with a rare type of polycystic kidney disease where cysts form on the kidneys and can also form on the liver. Her kidneys were slowly failing as she grew.

Coming to Stanford Children’s for a liver-kidney transplant

In 2021, when Marlow was 11 years old, the Oregon family came to Stanford Medicine Children’s Health for a transplant evaluation, which showed a need for kidney transplant but not an immediate one. In 2023, they returned because her kidney markers were worsening and she was reevaluated and placed on the active donor waiting list.

“At that time, our liver transplant team took a second look and determined that she needed a liver transplant as well,” says Gerri James, RN, BSN, transplant coordinator.

Marlow was put on the active waiting list for both organs. Multiorgan transplants can involve a longer wait than single organs. Luckily, her kidneys and liver were working well enough that she didn’t need dialysis and was able to go home and wait.

“Since early on when we first talked about transplant, I knew I wanted Marlow to go to Stanford Children’s,” Leah says. “We were impressed by the volumes of kidney and liver transplants that they do, and it was important for us to go somewhere that frequently performs transplants.”

The Kidney Transplant Program at Stanford Children’s is No. 1 in the country for volumes, with excellent outcomes. The Pediatric Liver Transplant Program is also one of the busiest in the country, offering several types of transplants and implementing the latest innovations to improve outcomes.

Getting the call that a donated kidney and liver were available

The family waited just over a year for the call that would change Marlow’s life. “You can do all you want to prepare for that phone call, but you never expect it when it actually happens,” Leah says.

Marlow describes the timing as divine because the call came just two days before the end of the school year. The Oregon family quickly arranged to get to Stanford Children’s within 24 hours so the multiorgan transplant could take place the day after arrival.

“I just wanted the transplant to happen over summer break so I wouldn’t miss volleyball in the fall,” says Marlow, whom her mom calls a talented all-around athlete.

Undergoing a multiorgan transplant at Stanford Children’s

A large team of experts participated in preoperative huddles to plan out the details of Marlow’s surgery and prepare for every scenario so they could act quickly in the moment to ensure the best possible outcome. Experts included nephrologists (kidney specialists), hepatologists (liver doctors), transplant surgeons, specialized transplant nurses, and the family.

Marlow’s new kidney and liver came from the same donor, which is beneficial. “The liver is immune protective for the kidney, so the rejection rate is lower than taking the organs from two different donors,” says Varvara Kirchner, MD, Marlow’s kidney and liver transplant surgeon.

Dr. Kirchner teamed up with Marc Melcher, MD, PhD, chief of Abdominal Transplantation at Stanford Children’s, to perform Marlow’s multiorgan transplant. Dr. Melcher took out one of Marlow’s worn-out kidneys and liver, and Dr. Kirchner placed Marlow’s new kidney and liver.

“Communication and collaboration amongst our large team of experts is key for the success of multiorgan transplants and complex cases. It’s what helps us achieve high-quality outcomes,” Dr. Melcher says. All of the transplant teams within the Pediatric Transplant Center at Stanford Children’s work closely together, helping multiorgan transplants run smoothly.

In order to provide a liver to two children rather than just one, Dr. Kirchner split Marlow’s donated liver, meaning she got one piece of the liver and a younger child got the other. Doing so helps address the shortage of donor livers available for children in the United States. Remarkably, split livers regrow to fully functional livers.

“Less than 10 pediatric transplant centers in the nation split livers, so this made for a more complex operation with added steps, but it was worth it to take care of more children,” Dr. Kirchner says. “We also bring in donor livers on a perfusion pump, which is novel, which preserves their quality.”

The transplant surgery went perfectly, with no complications or concerns. Waiting nearly 14 hours from start to finish to see Marlow afterward was hard for the family. “We were the first ones there and the last ones there,” Leah says.

Marlow powers through recovery

From the minute Marlow woke up, her goal was to recover as fast as possible. Within a few days, a physical therapist came to her bedside and gave her homework to complete over the next three days.

“She got it all done in an hour,” Leah says. “Marlow was a rock star. She hit the road running. She didn’t stop to feel sorry for herself.”

“All I wanted to do was walk again—it was hard lying in bed,” Marlow says. “And I just wanted to go home and cuddle my dog, Arrow.”

Marlow recalls the kindness of the nurses. One, Mercedes, washed her hair and gave her detangler and hair clips. “I loved the nurses in the pediatric intensive care. They were all so caring and sweet and kind,” she says.

Dr. Kirchner describes Marlow as a very mature teenager who did great with the whole experience. The family describes Dr. Kirchner as their hero.

“I saw Marlow outside the hospital afterwards. It was fantastic to see her, as a young teenage girl, getting back to everyday activities,” Dr. Kirchner says. “It’s a special moment when I see my patients recovered and living their normal lives.”

Going home and returning to her happy, active life

The family had to stay near the hospital after discharge to make sure the transplanted organs were doing well. After six weeks, they were able to go home to Oregon. Marlow took Dr. Melcher’s advice to be as “active as possible after transplant.”

“I went to volleyball camp just two days after I returned home,” Marlow says.

Marlow’s wish to return to school in time for the new year came true. It’s been nearly 10 months, and her new liver and kidney are doing great. There are zero signs of rejection, and her labs are all trending in the right direction.

“There are no words that describe my gratitude toward the donor family. I put myself in their shoes, having lost a loved one, and I hope I would have the grace they had,” Leah says.

Both Dr. Melcher and Dr. Kirchner believe Marlow will do very well in the future. They are pleased that she is back to her active life of volleyball, dance, school, and friends.

“The great gift of organ transplant is that Marlow can lead a pretty normal life,” Dr. Melcher says. “It’s a lot for any child to go through, but thankfully there is a big payback when they get through it successfully.”