Hannah Fleming doesn’t remember the first few times she was in an operating room. At eight months old, she received a liver transplant that saved her life — and it wasn’t her first surgery.
Now, the Tallmadge resident is working with liver transplant recipients like herself on a regular basis. A nurse at the Cleveland Clinic Main Campus, she often doesn’t tell patients about her personal connection. But the first time she walked into the operating room, she knew she was in the right place.
When she got a job offer to work on the liver transplant team, it was “pretty scary at first,” Fleming said. But the feeling didn’t last.
“The first time I ever stepped foot into the OR up there, and I ever saw my first liver transplant, I just had this feeling come over me, and I’m like, ‘This is where I’m supposed to be,’” she said. “‘This is what I’m supposed to do.’”
Fleming, a 28-year-old Tallmadge High School graduate, said she values working with transplant patients every day because “it’s a journey I once had too.” When she really connects with patients, she said, it helps them to know that she understands their experience and came out the other side.
Because she spent so much time in hospitals as a child, Fleming said she was always comfortable in them. She received her liver transplant at Cincinnati Children’s Hospital.
Growing up, she thought everything about hospitals was fascinating. In rotations during nursing school, Fleming found she enjoyed working in surgery the most.
“I was always interested, like, ‘What does this do? Oh, people get to be here all day, and they get paid for it?’” she said. “I couldn’t really wrap my brain around it.”
Today, Fleming is thriving. In addition to her work as a nurse, she volunteers with the American Liver Foundation and Lifebanc. She’s signed up to run the New York City Marathon with the American Liver Foundation in the fall.
It wasn’t always clear that would be the case.
Surgery, and the need for more help
Fleming had significant jaundice when she was born about five weeks prematurely in 1998. She was diagnosed with biliary atresia, a defect in bile duct development.
Alejandro Pita, a liver transplant surgeon at the Cleveland Clinic and its director of Living Donor Liver Transplantation, said when the ducts don’t develop normally, bile — produced by the liver — is unable to drain into bile ducts to travel to the intestines, which can cause liver damage.
Fleming was at Akron Children’s hospital for about five and a half weeks and had her first surgery when she was just a couple of weeks old. A Kasai procedure connected her intestine directly to the area of the liver where the bile drains. She said it’s often performed as a bridge to a transplant.
In Fleming’s case, it was a short bridge. After eight weeks she was extremely sick, was on a transplant list for a new liver and had been taken to Cincinnati Children’s Hospital.
When a liver transplant is required for a baby, there are multiple limitations, with size being the most important, Pita said. If there is a living donor, a small portion of their liver can be transplanted, but it has to be healthy.
He said the Kasai procedure can keep about half of babies off a transplant list for up to a year, but only 20% to 30% can reach adulthood without needing a transplant. Finding one can often take months if no living donor is available.
Fleming’s mother, Kimberly Fleming, remembers the doctors coming in to tell her they weren’t able to do anything else for her daughter because there was no donor available.
“I remember thinking, ‘This is just not acceptable,’” she said.
At the time of Hannah Fleming’s transplant, using living donors was still largely experimental, her mother said. Kimberly Fleming said she was a match to give her daughter a portion of her own liver and would have done so “no questions asked” had a donor liver not become available.
Receiving a transplant miracle
On the day doctors told Kimberly Fleming there was nothing else they could do, she asked if the family could stay at the Cincinnati hospital for one more night before making the four-hour drive back to Cuyahoga Falls to figure out their next steps. The hospital allowed it.
That changed Kimberly and Hannah Fleming’s future. Around 10 p.m., someone came to their room to tell Kimberly Fleming the doctor was on the phone for her.
“They took me to the nurses’ station, and I remember him telling me, ‘We have a liver for Hannah,’” Kimberly Fleming said, “and I actually hung up on him because I was so nervous and excited at the same time.
“Had we not stayed that night, I’m pretty certain that would have went to someone else, so that, in itself, is a miracle.”
Hannah Fleming’s liver transplant was immediately successful, her mother said.
“You walk in this room, and you see this little eight-month-old baby lying in this huge bed with all these machines and wires and tubes,” Kimberly Fleming recalled. “But right away, you could see … the pink in her feet, and she had color on her skin. You could tell she was alive and doing well.”
After that, Hannah Fleming’s baby teeth started growing in, and she began to thrive.
“She was just a force to be reckoned with,” Kimberly Fleming said.
‘This didn’t hinder me’
Annual checkups, screenings and regular bloodwork helped ensure Hannah Fleming remained healthy. She was put on anti-rejection medication and was able to live a normal, happy childhood.
Kimberly Fleming said she prayed for her daughter all the time.
“I said, ‘Let her live long enough for me just to hear her voice,’” the mother said. “And then it was long enough to get through kindergarten, and then it just kept going.”
For her part, Hannah Fleming said she grew up like a normal kid.
“My parents raised me to believe that I was like everybody else, like I was no different,” she said. “This didn’t hinder me in any way.”
She went on to attend the University of Akron, earning her Bachelor of Science in Nursing, and then her Master of Science in Nursing from Grand Canyon University.
“She has so many goals and aspirations, and she keeps hitting every mark,” Kimberly Fleming said.
Still, there have been challenges. Hannah Fleming had her first episode of acute liver rejection around 23 years old.
“It was a big shock,” she said. “We never really talked about [liver rejection] in my family — that was always the ‘R word’ — it was like, don’t talk about that, it’s not great.”
To learn she was in acute liver rejection, “that was scary,” Hannah Fleming said.
She was in the hospital for two weeks, but she pulled through.
Hannah Fleming said the experience helped her with her patients. Whenever she tells them she is a liver transplant recipient, it’s emotional.
“Until you talk to someone who had a transplant, no one really knows what you’re going through,” she said. “Being able to have somebody that can just say, ‘Hey, I know exactly what you’re going through, and we’re going to get you to the other side,’ it really means a lot.”
How to learn more about organ donation
The Fleming family’s insurance didn’t cover Hannah Fleming’s transplant, so the family raised about $70,000 through spaghetti dinners, car washes and collecting cans at stores. Local businesses held fundraisers, raffles, dinners and sidewalk sales.
Knowing she was supported by her community from the day she was born leaves Hannah speechless, she said.
“It means the world to me, and I know that that’s why I’m so passionate about giving back to the community because I wouldn’t be here today if it wasn’t for the community support I got,” she said.
April is National Donate Life Month, and Hannah Fleming encourages everyone to register as an organ donor through their local Bureau of Motor Vehicles or online at organdonor.gov or registerme.org.
Pita said anyone between the ages of 18 and 60 who is healthy can also reach out to the Cleveland Clinic living donor program to learn more about being a donor.
Hannah Fleming said her experience getting a transplant taught her that life is fragile but that she should live with positivity.
It’s something she can tell her patients about when they’re anxious and scared.
“‘Hey, I also had this, and look at me now,’” Hannah Fleming said she tells patients who she opens up to about her own history. “‘We’re going to get you through this.’”
