Father John Mack Jr. prefers a certain kind of donor for the liver transplant he needs.
“Somebody who has prayed every day and never drank a drop liquor.”
He also hopes for a living donor, someone willing to give part of a liver that will grow to full size in weeks.
Yet Mack, a man of devout faith, is under no illusions.
Circumstances in just the past few weeks explain why.
The Catholic Diocese of Buffalo, in which he has served for 35 years, filed for bankruptcy protection in late February to lighten the financial burden of a priest sex abuse scandal.
Diocesan leaders also announced they will close Christ the King Seminary, where Mack lives and works as chairman of the East Aurora school's pastoral theology department.
Then came Covid-19.
Mack saw Holy Week as an opportunity to measure his life, accept his frailties and wade gratefully into whatever waves come next.
Not that it's easy.
“I don't have the stamina I’d like right now,” he said. “I've almost forgotten what it feels like to be normal.”
Five years ago, doctors diagnosed Mack with nonalcoholic cirrhosis of the liver. He is on the national liver transplant waiting list and hopes to receive a new organ in the coming months at Strong Memorial Hospital in Rochester.
The novel coronavirus ended organ transplant surgeries around the world involving living donors – including at University of Rochester-affiliated Strong, as well as Erie County Medical Center – though procedures using organs from deceased donors continue.
Generally, the sickest of patients with the greatest immediate need receive organs that way. Mack, who will turn 66 at the end of April, is not among them, though liver disease can worsen quickly.
“The best moment in transplantation is when patients are stable,” said Dr. Roberto Hernandez-Alejandro, chief of solid organ transplant surgery at Strong.
A life of service
Mack became a priest in 1985, the year after he graduated from Christ the King. He served parishes in West Seneca, Kenmore, Fredonia and Oakfield, and helped administrate Catholic high schools in Batavia. He also served from 1981 to 2009 as a chaplain in the U.S. Air Force Reserve and New York Air National Guard, including two tours in Iraq.
He was thrilled with the opportunity a dozen years ago to return to the seminary, this time as a teacher. He became a force in the classroom, a trusted collaborator and a familiar presence to campus visitors, many of whom he invited for special events including Christmas and Easter celebrations.
“My kids still refer to the seminary as Father Mack’s house,” said Eric Mabry, an assistant professor of systematic theology at the school since 2013.
Mabry, a Houston native, met Mack in Toronto a year earlier while studying for his doctorate. In the months that followed, the priest convinced the married father of six to become part of the Christ the King faculty.
“He's a relationship builder,” Mabry said of his mentor.
An August 2018 Pennsylvania state attorney general’s report, which included details of sexual abuse cases involving former Western New York priests, crushed Mack and others on campus, Mabry said.
Mack’s health slipped in the months afterward. His hepatologist told him he would need a transplant if his liver test scores didn’t improve.
He turned to the transplant team in his native Rochester, the only one of its kind in upstate New York.
Hope and longing
The transplant team, led by Hernandez-Alejandro, encouraged him to put together a group of “champions” to help find a donor. They include members of Against the Storm, a Buffalo foundation formed last fall to fight blood cancers and support other causes. Others tied to the Catholic church also enlisted.
“There's an awkwardness about this for Father Mack,” Mabry said. “He would sooner give his own liver to somebody who needed it more than he would go around asking somebody for even a lobe, which is how the living liver transplant process works. He's a behind-the-scenes kind of person and he couldn't do this on his own.”
It was easier for Mack to put on his game face in a classroom after he was diagnosed with liver disease. The last year has been harder.
“Sometimes the students don't get to see it but I know how tired he is from the day, from the struggles and the physical limitations he experiences,” Mabry said.
Cirrhosis is a blanket term for several conditions that cause scarring of the liver. Fatigue, confusion, muscle weakness, gastrointestinal discomfort and jaundice are among symptoms that medications can often, but not always, relieve.
Transplants become a last resort.
Mack hoped for a living donor during much of his journey. If his health remains steady, that’s possible, though he fully understood before the last several weeks that preferences don’t always coincide with reality.
Last year, he rushed to Strong Memorial from Christ the King when a deceased donor liver became available. He was admitted and began surgery prep before the transplant team determined another end-stage liver patient also called to the hospital was a better match.
“They have a whole group of people who desperately need a liver,” Mack said, “and never have enough deceased donors. Nobody wants to talk about organ donation because you're going to start talking about death. But as somebody said, ‘Why take it with you?’ ”
That near-surgical experience, and the tumult in his beloved diocese, has bettered prepared him for the latest twists on his transplant journey.
Still, it can get unnerving.
“I go to the clinic every three months now and I am on my phone with a coordinator regularly,” Mack said. “They say, ‘Don't get the flu, don't get pneumonia, don't fall and break a bone. Those three things could send you into liver failure right now.’ ”
The coronavirus effect
Mack needs a donor with an A or 0 blood type. An organ recipient and deceased donor also must test negative for the novel coronavirus, a process that adds several hours to the transplant process.
Living organ donations were stopped during the Covid-19 pandemic to prevent a donor from contracting the virus, to preserve two ventilators that might be needed for other critically ill patients and to better protect health care providers, Hernandez-Alejandro said.
Strong Memorial – where heart, liver, kidney and pancreas surgeries are performed – and ECMC, which handles kidney and pancreas procedures, are among 250 transplant programs nationwide impacted by Covid-19.
“We’re able to provide transplants but in a more cautious way,” Hernandez-Alejandro said. As is the case with almost all hospitals, loved ones need to drop off those undergoing transplants in the medical center lobby and wait to see them again until it’s time for patients to go home.
Even in the best of times, more than 100,000 people are on the national transplant waiting list and many die while waiting for an organ, said Liise Kayler, director of the Regional Center of Excellence for Transplantation and Kidney Care at ECMC. That’s why organ donors are so important.
The Strong transplant team performed six liver transplants thanks to deceased donors during the last month. The team conducts 45 to 50 such surgeries annually.
“When Covid-19 is over, this hospital is going to be crazy busy,” Hernandez-Alejandro said.
Time to be still
Mack – whose champions established a website, liverformack.com – has learned that more than 20 potential donors have reached out to Strong for prospective testing, an intense medical and psychological process that takes several months.
His liver function numbers have improved, buoying his patience, but Covid-19 has cast a pall over prospects for surgery.
Mack cloistered himself on St. Patrick’s Day at his family homestead in Rochester, a five-minute drive to Strong Memorial. He spends his isolation talking by phone or FaceTime with fellow priests, his two health care proxies and his transplant champions. He reads, tackles odd jobs and tries to go on walks when he feels up to it. He wishes it was more often.
“I miss people. I pray a lot more," he said. "I don't know if ever again in our lifetime we're going to watch everything just come to a stop. I would call it almost a global sabbath.”
Mack celebrated Easter twice in war zones. Then, as now, he yearns to celebrate the Eucharist with others in church. He will appreciate it all the more in times to come.
As he went through Holy Week, he wondered what might come next.
So did Mabry.
In separate interviews, on different days, both said the guidance they valued most this Easter season came from the "Urbi et Orbi" address Pope Francis gave March 27 in the midst of a pandemic in an empty St. Peter’s Square. The pope talked of Christ and his disciples adrift in a turbulent storm on a lonely sea. Panic gripped his closest followers while Jesus slept. When they stirred him, he asked, “Why are you afraid? Have you no faith?”
He then calmed the waters.
“It’s a lot,” said Mack, “to reflect on.”
Become an organ donor
Become an organ donor at ConnectLife.org, one8fifty.org or donatelife.ny.gov or when you renew your driver’s license. Learn about the ECMC transplant center at ecmc.edu/kidney-transplantation or call 898-5001 or 888-894-9444. Learn about the University of Rochester medicine transplant program at urmc.rochester.edu/transplant or call 585-275-5875.