On the morning of June 15, Beth Bernard and Kevin Looper lay in adjoining operating rooms in San Francisco, far from their Northeast Portland homes.
Bernard is executive director of the Oregon Trial Lawyers Association.
Looper is perhaps Oregon's most influential Democratic political consultant.
They both faced complex surgical procedures that could lead to infection, organ malfunction or other complications, including a small but not insignificant chance of death.
For Looper, 49, the upside was absolute. He was dying. A rare surgical procedure offered him his best and maybe only chance to see his 4-year-old son grow up. For Bernard, the upside was more difficult to explain. She was a vigorous 54-year-old in perfect health.
Her reason for surgery? To save Looper's life.
Three years ago, Kevin Looper awoke at 2 am feeling nauseous. His wife and infant son were sleeping, so he stumbled to a bathroom downstairs, where he vomited.
When he turned on the bathroom light, blood was everywhere.
It was early 2015, around the time then-Gov. John Kitzhaber would be inaugurated for an historic fourth term. Looper's job had been to devise a plan to get Kitzhaber enough votes to win in 2014, and he delivered.
Looper usually delivered. Although he keeps a low profile, Looper has been a campaign strategist for the past three Oregon governors and the architect of more than three dozen successful ballot battles.
"He is the most sophisticated political consultant in Oregon and maybe the best I have ever been around," says former Gov. Ted Kulongoski. "Much of the Democrats' success and influence in state politics over the last 10 to 15 years is due to his skill set."
But Looper wasn't thinking about politics that winter's night. "I hadn't eaten much before bed, I'd had nothing to drink, and I wasn't sick," he recalls. "But I was vomiting a lot. And then I saw it was blood."
An ambulance rushed him to Kaiser Sunnyside Hospital, where he underwent emergency surgery to halt internal bleeding.
Doctors determined the problem was Looper's liver. Blood was supposed to flow through the organ, where it would be cleansed and replenished. Instead, Looper's blood flowed into tiny vessels around his liver. The flow overwhelmed those vessels, causing them to burst and flood his stomach and esophagus with blood.
"He would have bled to death within 12 hours," says Dr. Sharon Meieran, then a Kaiser emergency room physician who treated Looper—and now a Multnomah County commissioner. "I thought, 'Wow, here's this young guy who has this really serious liver condition. It's the kind of thing you learn about in medical school but never really see."
The diagnosis: end-stage liver failure.
Looper, an amiable bear of a man, grew up in Omaha, Neb. In a rare combination, he was both a defensive end and pole vaulter in high school. But his real skills lay in the classroom. He graduated from Yale, where he won the top sociology prize.
Looper moved to Oregon in 2002 after nearly a decade as an itinerant political campaign consultant. His specialty: registering new voters and getting them to the polls.
In 2005, Looper became executive director of Our Oregon, the public employee union-financed advocacy group that waged war—always winning under his leadership—against conservative ballot measure activists Bill Sizemore and Kevin Mannix. In 2010, he persuaded voters in the depths of a recession to approve income-tax increases in Measures 66 and 67.
Among Democrats, no consultant earned more respect. "He's dedicated to doing the right thing for the right reasons," says Gov. Kate Brown, who has hired Looper for three of her campaigns.
Even Republicans praise his skills.
"His clients are lucky to have him in their corners, no matter how misguided his politics are," says Dan Lavey, president of Gallatin Public Affairs and one of the state's leading GOP strategists. "He's right at the top of his field."
But all Looper's tactical wizardry couldn't help him with the challenge he now faced.
Most liver failure is caused by hepatitis, drug use or alcoholism. For Looper, the cause was genetic, but the diagnosis was the same: His liver would cease to function and he would die, probably from a catastrophic bleeding event like the one that landed him at Kaiser.
As Looper's liver deteriorated, his body began recycling the impurities blood picks up as it circulates through the body. "Sometimes you literally have shit for brains," he says. "And it's as bad as it sounds."
He periodically found himself unable to remember names of people he'd known for years. His motor skills deserted him at times, preventing him from driving. His speech slowed and he struggled with strategic decisions. He tried to compensate for his infirmities to continue serving clients who'd hired him for his mental acuity.
"When your whole life has been about using your brain, that's scary," he says.
Looper's wife, Jillian Schoene, also a longtime politico, says his decline was noticeable and jarring. "He just wasn't himself," Schoene says. "It was a slow-motion death sentence."
Kaiser doctors treated Looper's symptoms, but he feared they'd never clear him for a transplant. In September 2016, Looper sought a second opinion in New York from Dr. Jean Emond, a liver-transplant pioneer, who said he needed a new liver as soon as possible.
Liver failure presents an unusual challenge. For other life-threatening medical conditions, such as cancer, doctors may suggest chemotherapy, radiation or surgery. For heart disease, medication or surgery. Treatment options are available for almost anybody who needs them and has insurance.
But with organ failure, the only option is a transplant. And even with insurance, those in need often cannot get replacement organs because demand far outstrips supply.
Nearly 115,000 Americans are currently on a waiting list for an organ transplant. Some will wait for years. Some, forever. At least 20 Americans who are waiting for an available organ die every day, according to federal statistics.
People with kidney failure can be kept alive with dialysis, and there are mechanical devices that can preserve the lives of people with heart, lung or intestinal failure. Not so with the liver.
"We have no machine or therapy that will keep patients alive other than liver transplantation," said Dr. Willscott Naugler, director of Oregon Health & Science University's liver transplant program. "This phenomenon adds an urgency to liver transplantation that does not exist compared to some of the other solid organs."
Looper's doctor told him he'd probably die before he qualified for the transplant list. Even getting access to a diseased liver, one infected with hepatitis that could be transplanted and then treated, could take many months.
One other option existed: a transplant of a portion of a liver from a live donor. Humans have only one liver, but unlike other organs, the liver can be surgically divided and part of it transplanted into a recipient.
Both sections of liver can then regenerate themselves in as little as two months. The key is finding someone whose blood-type matches, who is very healthy—and who is willing to undergo six hours of surgery and all the risks that entails.
Live liver transplants are extremely rare: Last year in the U.S., for example, federal statistics show that surgeons performed 19,849 kidney transplants and 8,082 liver transplants, but just 367 of those transplanted livers came from live donors.
"The problem," Looper says, "is who the hell do you ask?"
Looper and Bernard got to know each other a dozen years ago. Conservatives had brought forward ballot initiatives that threatened, among others, the interests of Bernard's employer, the Oregon Trial Lawyers Association.
One proposed measure would have capped payouts on lawsuits, a limit plantiffs' lawyers don't like. Looper reached out to Bernard and suggested she hire him to investigate signature-gathering fraud, which could help keep such measures off the 2006 ballot.
"She said, 'Fuck you," he recalls. "'Even if I were foolish enough to buy your shit, how am I ever going to sell it to my guys?'"
Looper challenged the entire slate of conservative initiatives without funding from Bernard's group. Ironically, only the anti-trial lawyer measures failed to make the ballot.
"She got a total freebie," he says. "She called me up after to apologize. That's when we became friends."
Bernard had moved to Oregon in 1995 to run the unsuccessful U.S. Senate campaign for Democrat Tom Bruggere.
Like Looper, she'd been a political nomad, running congressional campaigns nationwide. "In 1994, I moved six times," she says. "I was ready to settle down."
Bernard wears an ever-present smile beneath a shock of silver hair. But she's tough. When she lifted weights, she used to bench press 250 pounds. Then she took up running and exercised so hard she wore out a hip. After a surgical replacement, she was in the office the next day.
"My mom's badass," says Bernard's older daughter, Lilly, 19. Bernard's toughness is a big asset for her employers. So is her political acumen.
"She's incredibly savvy," says Jane Paulson, a Portland trial lawyer and past OTLA president. "She's also totally selfless. She'll do anything for you, but she hates praise or attention."
Bernard raised two daughters (Lilly and MJ, 15) as a single mom near Looper's home in Hollywood. Their paths often overlapped on political issues, and Looper would periodically stop by for dinner. (The two never dated, and their relationship has always been platonic.)
As she watched Looper deteriorate over the past couple of years, Bernard also dealt with her brother's terminal illness. "He became trapped in his body and couldn't speak or swallow," Bernard says. "He basically choked to death."
Bernard hated not being able to help her brother, who died in January. So earlier this year, when Looper started telling close friends that a live-donor transplant might be an option for him, she decided to act.
Looper mentioned he'd visited the University of California, San Francisco, the leading live liver donor transplant program on the West Coast (OHSU doesn't yet perform the procedure). He'd decided against that option, though, because he didn't think he could ethically ask anybody to donate part of a liver.
Without telling Looper, however, Bernard made an appointment at UCSF to see whether she was a match.
In late April, she flew to San Francisco. "From 7 am to 7 pm, I went through a battery of tests: Every organ ultrasounded, CAT scan of my liver," she says. "I talked to a social worker to determine I wasn't crazy. At every turn, they asked me, 'You are not getting paid or pressured to do this?'"
In a way, Bernard had been preparing to be an organ donor her whole life. She grew up in Yankton, South Dakota, where her mother was a high school biology teacher.
"She was all about the science," Bernard says. "She loved dissection." Her mother was also a staunch Catholic who believed in service, and she was, well before organ transplants were widespread, an organ donor. "She always said she wanted her body to go the med school because she thought she'd be an excellent cadaver," Bernard adds.
In May, UCSF's transplant team gave Bernard the thumbs up—with caution.
"They told me there were risks: Three donors [none at UCSF] have died since they started doing this procedure," Bernard says. "I can't let myself go there. It's all about having a positive attitude. My mom taught me that."
After receiving the news, Bernard called Looper.
"I was in my car," Looper calls. "She says, 'Congratulations, you've got a match."
Looper thanked her profusely but said no. "I just wasn't sure I was comfortable with her doing that for me," he says. She told him to take a week to think it over.
After consulting his wife and a couple of friends, he stopped by Bernard's house. Over a dinner of chicken casserole and carrot cake, he told her he had changed his mind and was ready to accept.
"You damn well better be," Bernard said. "I'm either going to hound you until you die, or you'll be my bitch until the end of time."
"She's from South Dakota. I'm from Nebraska, so there wasn't a lot of hugging and tears," Looper recalls. "Beth was, 'Chop, chop, let's get on with it so we can be ready for the fall elections.'"
Some people couldn't believe what Bernard had chosen to do.
"I told her I thought she was crazy," Kulongoski recalls.
But Bernard says she only had one moment of doubt.
"A close friend asked how I could do this to my girls," she recalls. "That absolutely freaked me out. Lilly and MJ have been my focus, my life for the past 19 years."
She checked in again with both daughters. Lilly gave her unconditional support. MJ was quieter. Then, in June, shortly before Bernard was due to fly to San Francisco for the surgery, MJ came home with a present.
"She gave me a key chain with a liver on it," Bernard recalls. "It said, 'I'm a liver not a fighter.' That's when I knew she was fully in."
Looper and Bernard went under the knife in side-by-side operating rooms on June 15. For her, the risk of death was one in 500, according to Dr. John Roberts, one of their surgeons.
For Looper, the biggest risk was rejection of the liver. UCSF's outcomes are better than average, but about 10 percent of live liver recipients die in the year after surgery.
The operation required massive incisions. Looper had 80 staples in a horseshoe running from hip to sternum, Bernard a slightly smaller but similarly shaped cut.
Bernard was out of the operating room after about six hours; for Looper, it was nearly 11.
The surgeries went as planned, with one major complication. While Bernard was in the intensive care unit, her heart stopped.
"My heartbeat was irregular, then it flatlined," she says. "I hear 'Code blue, room 921,' and I'm like, 'Holy shit, that's me." Doctors and nurses rushed to the room. Her heartbeat soon returned to normal.
Bernard spent an extra day in the ICU. But Bernard and Looper were soon competing in the recovery ward for T-shirts given to patients who walk a mile in the hallways.
Bernard flew home July 5 and shortly after was able to resume one of her favorite vices.
"I finally could drink a cup of coffee, and it tasted great!" she wrote in a July 8 text message to WW. "FREEDOM."
Bernard is back at work, easing into a campaign season where she'll help on ballot measures and try to get Gov. Brown re-elected.
Brown stopped in at UCSF hospital the night before the transplant to visit Bernard and Looper.
"I was in California anyway," Brown says. "The question is not why I went down to the hospital to visit them, it's why wouldn't I?"
Looper is still in San Francisco, recovering and going to the hospital for thrice-weekly testing. He had a minor surgical procedure July 16 to repair a routine transplant complication.
He and Bernard are already sparring about just how much of his body is actually hers.
"Kevin keeps telling people he got 30 percent of my liver," she says. "He is on the crack pipe."
She says because Looper is much larger than she is, he actually got about 60 percent of the organ. (Looper's surgeon, Roberts, says Bernard is correct.)
Both of them should have fully regenerated livers by mid-August. In order to block his body from rejecting the new organ, Looper will take medication every 12 hours for the rest of his life. And he'll never be able to eat his favorite food again, because of the risk of parasites.
"They tell me I have to give up sushi," Looper says. "If I'd known that ahead of time, it might have been a deal-breaker."
Neither Bernard nor Looper is much inclined toward sentiment. They speak the language of hardened political pros, masking their feelings with humor. That makes the generosity of Bernard's gift all the more remarkable.
Bernard says despite the disruption to her life and the ICU scare, she is a zealous advocate for organ donation. "I used to think I'd only do it for my daughters or a close friend," she says. "But the way I feel now, I'd do it for a stranger."
Looper is grateful she picked him. "In a race between death and a political consultant," he says, "I'm not sure many people would be rooting for the political consultant."
Wanted: One Organ, Slightly Used
In 1954, doctors in Boston performed the first organ transplant, a kidney.
Since then, however, there has been a shortage of organs. Nearly 115,000 Americans are on the United Network for Organ Sharing lists, waiting for a transplant. The most common organ transplanted is the kidney (most people have two and only need one) followed by the liver.
Livers, like other vital organs, are in short supply. Right now, nearly 14,000 patients are on the list for a liver transplant, for instance. But only about 6,700 livers become available each year. (Liver transplants are expensive: The average cost in the U.S. last year, according to Oregon Health & Science University, was $812,000. Looper's will probably cost more because of Bernard's role. Looper's Kaiser insurance covered the costs for both.)
Policymakers have long debated ways to shorten the wait for transplants.
Mike Seely, director of the Pacific Northwest Transplant Bank, one of 11 regional organizations chartered by the federal government to manage organ distribution, says our region, which includes Oregon and parts of Washington and Idaho, does fairly well: About 55 percent of Oregonians opt to be donors, well above the national rate of 49 percent.
The U.S. uses an "opt-in" system in which people affirmatively choose to be organ donors, typically when they obtain their driver's licenses. Some countries, including Spain, Belgium and Portugal have "opt-out" systems in which adults are automatically presumed to be donors. Spain, the world leader, has a donor rate significantly higher than the U.S.'s.
Lawmakers in Washington, Connecticut and Texas sought to mimic Spain's success, pushing for opt-out legislation. They failed. Seely and others say that's probably for the best—the donation rate might decline if states adopted an opt-out system.
Pilot projects in two states showed that large numbers of people concerned with privacy and property rights will choose to opt out. "We would cut the number of organs available by half," Seely says.
Seely says since he entered the transplantation field more than 30 years ago, doctors have aggressively increased the age limit of donors and decreased the time it takes to test for matches. He's optimistic that technological advances will expand the supply of usable organs.
One practice some countries allow that he thinks won't happen here: trafficking in body parts.
"It is not acceptable to sell an organ," Seely says. "It's against federal law. A hospital would lose Medicare funding, and that's a death sentence."