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t m c » p u l s e | n o v e m b e r 2 0 1 7 27 27 Photo caption goes here be permanently limited from the surgery. In addition, the procedure would not extend Marian's life. She had an aggressive tumor, but because her type of sarcoma typi- cally doesn't metastasize to other organs— such as the liver, lung and bones—it wasn't life-threatening, Torres explained. There were risks for Mary Jane under- going such a major surgery, as well. Doctors planned to cut out a mass of flesh from her abdomen to graft on to Marian's back. "When you counsel donors, you don't tell them, 'This is great. It's all going to go well.' You tell them what the risks and the benefits are," Gaber said. "You may come across like you're not sure you want them to do this, but I was from the very first moment really secure in the fact that this was a really good option." One thing was certain: If the surgery was successful, it would greatly improve Marian's quality of life. When the doctors asked the twins one last time if they still wanted to go through with the surgery, Mary Jane responded: "What is life without quality?" The twins were resolute. "In my mind, from the beginning, going down [to MD Anderson], there was no other choice than some radical kind of surgery," Marian said. "This was going to solve all of our problems. It was all good from the minute we went down there." Not only was the surgery risky, but it would be the hospital's first living related donor transplant and the hospital's first vascularized composite allograft (VCA)— a transplant of tissue other than an organ. It would also be one of the few VCAs ever performed between identical twins, and certainly the most extensive. It was "one of those lightning-striking-in-a-bottle type of situations," Selber said. "When I first proposed the transplant plan in detail, that it was going to require two simultaneous operating rooms, it was going to be a transplant that's never been done for cancer reconstruction, everybody got a little nervous," Selber said. (continued) When I first proposed the transplant plan in detail, that it was going to require two simultaneous operating rooms, it was going to be a transplant that's never been done for cancer reconstruction, everybody got a little nervous. — JESSE SELBER, M.D. Director of clinical research and associate professor in the department of plastic surgery at MD Anderson Top: Jessie Selber, M.D., in the operating room. Above, Marian Fields at a post-operative appoint- ment with Selber. Credit: The University of Texas MD Anderson Cancer Center