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Elena Dimitrova needs an urgent lifesaving transplantation of the small intestine.

She suffers a rare inherited disease - Familial adenomatous polyposis (FAP). Five years ago, she had her colon removed. On 23 January, 2010 during a new procedure she suffered obstruction of the arteries of her small intestine and the followed infarction caused its almost complete removal. Eli's condition does not allow her to take in food through her mouth. What little is left of her small intestine makes it impossible for the adequate absorption of proteins, fats, vitamins, iron or any other normal nutrients in food, for that matter. Elena is in intensive care and receives all these nutrients, and even water, intravenously. At the moment, this is the only possible way to feed her but it is completely unnatural and puts stress on the other organs in her body. In the following months, the intravenous nutrition will bring irreversible damages to her liver, kidneys and other vital organs. For her to be able to taste food again, Eli needs an urgent transplantation of the small intestine. This operation cannot be carried out in Bulgaria and can only be done abroad.

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Elena’s Current Condition

Eli’s condition is still not completely stable, she is under constant medical supervision. The only way she can be fed is intravenously and she will have to stay in the Military Medical Academy until her departure for the surgery.
The medical specialists strongly advise that Elena’s relatives and friends shouldn’t visit her too often. At the moment, Elena’s body is in a state of shock. Two of her most important vital organs are missing and there is a huge risk of infections. Do not visit Elena if you are experiencing any signs of illness; including coughing, fever, cold sores, or any other symptom, or if you have a sick child at home. Exposure to any of these things could kill Elena.
If you intend to visit Elena, please have a facial mask, avoid direct physical contact, and don’t stay too long in her room. At the same time, Elena has a need to see and hear her friends. She is reachable and has a phone. She isn’t able to speak all the time, but can read her phone text messages.

Elena’s Transplant

Most probably Elena will have the transplant surgery in Paris, but we are still waiting for offers from clinics in Bologna and Birmingham. She will have to stay in the clinic for months, maybe even a year or two. There are differing opinions among leading specialists regarding the timing of the procedure. Some believe it is best to perform the surgery immediately, while others believe the procedure should be delayed until Elena is completely stabilized.

Elena’s Transplant

There is not very effective communication between responsible the Bulgarian organizations (Executive Agency for Transplants at Ministry of Health, Military Medical Academy) and transplant centers in Paris, Bologna and Birmingham. According to the Executive Agency, the communication with the clinic in Bologna is in the most advanced stage, but the clinic in Paris is delayed in producing documents. According to the Paris doctors (Dr. D. Azoulay), they have been ready since March 1st to receive Elena for preliminary examinations. Doctors from Bologna (Prof. Pinna) have been waiting since February 18th for an official invitation to examine Elena in Sofia. We expect to receive an official invitation from the Birmingham clinic in the next few days.
Now we don’t know who is wrong and who is right, but the fact is that two months have passed with no preliminary examinations by the small intestine transplant specialists. That’s not even to mention waiting for a donor. Elena will not be able to rely on a Bulgarian donor because our country doesn’t have experience with small intestine transplants. In Italy, the waiting period for a small intestine donor is usually 3 months.
There is a disagreement among the leading world specialists regarding what is most dangerous. According to some, every month of parenteral nutrition damages Elena’s organs and within a month or two there is a huge risk that she can lose her liver due to venous feeding. According to other doctors, if the transplant is done so soon after the last surgery, there is even a greater risk to Elena’s life and the transplant should be done in a few months when she is completely stabilized. However, without preliminary examinations, there is no way to assess which scenario is better.