How a rescued liver rewrote one patient’s prognosis.
Five years ago, doctors told Meghan Moore to get her affairs in order. She was 42, with stage IV colorectal cancer and an estimated 18 months to live. Today, her scans are clear, her bloodwork is normal and this spring she watched her younger son cross the stage to receive his high school diploma — a milestone she once feared she wouldn’t live to see.
Her survival marks a shift underway at WashU Medicine, where physician-scientists are demonstrating that a late-stage diagnosis doesn’t have to be a death sentence. With unparalleled clinical expertise and a dedication to pursuing bold research, they are redefining what’s medically possible for some patients who, a decade ago, may have been offered little more than palliative care.
The lifesaving treatment plan
Meghan and her husband, Mark, got married in 2021, just days after her diagnosis. Their closest friends stood with them that day knowing about the diagnosis, but they didn’t have the whole story. “We didn’t tell our friends the tumor staging before the wedding because we didn’t want everyone crying the entire time,” Meghan said. “My sons, who were 13 and 20 at the time, have been a major reason I was determined to do everything possible to fight this.”
After her diagnosis from a local hospital, Meghan and Mark sought a second opinion at Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine — the only National Cancer Institute (NCI)-designated comprehensive cancer center in Missouri and southern Illinois. That led them to WashU Medicine oncologist Kian-Huat Lim, MD, PhD, who proposed a personalized plan that went beyond the standard of care for Meghan’s case.
“I recommended combining several chemotherapies to give Meghan a stronger regimen,” Lim said. “This was a relatively new strategy at the time, but she was young and otherwise healthy, so we felt we could start with an aggressive plan. We have the science and multidisciplinary expertise to think outside the box while staying guided by data and experience.”
After intense chemotherapy that shrank the tumors, Meghan underwent a complex surgery to remove the main colorectal tumor and as many liver metastases as possible. The surgeons also implanted a hepatic arterial infusion pump, a device that administers a specific form of chemotherapy directly to the liver. Such pumps are generally available only at large, specialized cancer centers, where multidisciplinary teams have the extensive experience needed to manage them safely.
After more than another year of combined treatment, Meghan’s tumors were confined to her liver — but had stopped responding to chemotherapy and begun to grow. As her options narrowed, her team began discussing a liver transplant.
The WashU Medicine and Barnes-Jewish Transplant Center is among the few centers globally to perform liver transplants carefully selected for patients with liver cancer, bile duct cancer and stage IV colorectal cancer that has spread to the liver — pushing the envelope of what’s possible in late-stage cancer care.
“We have taken care of cancer patients with a very short life expectancy and seen them return to a full life after liver transplantation,” said William C. Chapman, MD, the Eugene M. Bricker Professor of Surgery, surgical director of the Transplant Center and chief of the Section of Transplant Surgery. “It can dramatically extend survival and restore quality of life in ways that haven’t been possible until recently.”
Five opinions in the room
At Siteman, every patient with a more complicated disease course or need is discussed at a multidisciplinary tumor board — a standing meeting where specialists weigh in on a coordinated treatment strategy. For colorectal cancer patients with liver involvement, that includes medical oncologists, radiation oncologists, surgical oncologists, GI specialists, liver specialists, interventional radiologists, imaging specialists and transplant surgeons. The consensus for Meghan was to move forward with a liver transplant.
“I tell patients that the tumor board is like having not only a second opinion but a third and a fourth and a fifth opinion, because everyone involved in their treatment has extensive expertise and is collectively deciding the best possible treatment strategy for their specific situation,” said Maria B. Majella Doyle, MD, the Mid-America Transplant/Department of Surgery Distinguished Chair of Abdominal Transplantation who performed Meghan’s transplant.
“We’re a very aggressive program in liver transplantation for cancer,” Doyle said. “I think that’s part of why we see so many patients travel great distances to have those procedures here.”
Meghan’s case reflects a broader — and still not fully understood — shift toward more people in their 30s and 40s being diagnosed with colorectal cancer at advanced stages. Liver transplantation has emerged as a transformative option for patients whose cancer, however aggressive, has confined itself to the liver. While the option has expanded to more patients, it remains a relatively uncommon solution to treating late-stage colorectal cancer.
From rejected to lifesaving
After Meghan’s tumors began growing, her team added her to the national liver transplant waiting list. But because she wasn’t in immediate liver failure, patients with more urgent needs were prioritized ahead of her.
At the same time, WashU Medicine investigators opened a clinical trial testing a device that keeps donated livers at body temperature — rather than on ice, the standard for decades — in conditions that mimic the body’s own physiology, delivering oxygen and nutrients to help sustain the liver until transplant. The trial assessed whether livers other centers had declined, often for treatable issues such as fatty liver disease, could be reconditioned and made viable again.
The early results are promising. The clinical trial data are pending publication, but interim data published in 2023 by Chapman and colleagues found that 16 of 22 livers initially declined for transplant were ultimately suitable — a 73% rescue rate. Sixteen patients who would otherwise have stayed on the donor waiting list, or fallen off it, received a liver instead. Meghan was one of them. The completed trial results are slated to be presented at the Western Surgical Association’s annual meeting in November.
“I feel so lucky that this trial happened to be available at this exact time and place,” she said. “I said that even if it didn’t work for me, I would at least contribute data that could help people in the future.”
Meghan still thinks about the wedding, when she stood in front of her closest friends, carrying a heavy diagnosis and determined not to let it steal the day. Five years later, she got to stand in a different crowd, watching her younger son cross a stage in a cap and gown, and this time there was nothing to hide. The 18 months she was originally given have stretched into a life again — one with hope, gratitude and cherished time doing the things she loves.
Published in the Autumn 2026 issue