A race for his life
How a dedicated marathon runner’s adventure to Bali led to an urgent combined liver transplant and open-heart surgery.
David Johnston boarded a plane to Bali in May 2025, enthusiastic and eager to run a 9-mile race through volcanic peaks, ancient mountains, and hidden waterfalls.
But David never got to experience the lofty feat. Instead, he returned home two weeks later on an emergency transport to AHN Allegheny General Hospital for a lifesaving liver transplant and open-heart surgery.
His journey begins, then takes a frightening turn
The 55-year-old tennis coach from Imperial, Pennsylvania, had enjoyed running for decades. Before his wife of 17 years passed in 2017, they often traveled the world to run marathons and other races. In 2024, he decided to explore Bali on his own, planning his trip around the mountain race.
When he arrived, David felt energized and ready to explore. But after a few days, he wasn’t feeling himself. He thought it might’ve been jet lag or the start of a cold. As the week went on, he felt sicker with extreme exhaustion, chills, and a headache. What ended as a blessing in disguise, David couldn’t arrange for transportation to the race and had to skip it.
“I never would have made it off that mountain had I gone,” David said.
He began his journey home, and by the time he was at the Qatar airport for his connecting flight, he knew he couldn’t board the plane.
“It’s all pretty blurry, but I couldn’t keep my balance and felt so extremely sick and knew I couldn’t make it through an 18-hour flight,” David said. “I got help from the airport staff to get to the nearest hospital.”
Doctors at the Qatar hospital diagnosed David with liver failure and sepsis, a life-threatening infection that had attacked his heart and caused two of his heart valves to leak. His failing heart had worsened his existing liver disease, triggering his liver to fail as well.
He needed a combined liver transplant and open-heart surgery. As dire as the situation was, David wanted to return home for care. This required the U.S. Embassy to step in, helping arrange for David’s brother-in-law to escort him from Qatar to Pittsburgh. Once they landed in Pittsburgh, an ambulance was waiting at the airport to take David to Allegheny General.
AHN experts meet the challenge
The difficulty with needing both major heart surgery and a liver transplant is that the heart cannot function properly if the liver isn’t working, and vice versa.
“David’s surgery was risky and challenging, but he’s relatively young and was in good physical condition before getting sick, so our team believed his body could handle the demands,” said Masaki Tsukashita, MD, AHN cardiac surgeon who operated on David. “It was his only chance for survival.”
AHN liver transplant surgeon Tadahiro Uemura, MD, who performed David’s transplant, explained how this type of dual surgery wasn’t an option even just a few years ago because of the time limits on preserving the liver.
“The open-heart portion of the surgery takes five or six hours, and a donated liver is typically kept cold on ice to preserve it,” Dr. Uemura said. “But the liver wouldn’t last through heart surgery without receiving blood flow.”
Patient grateful for extraordinary care
In 2021, the Food and Drug Administration approved a groundbreaking way of storing and preserving a donor liver as it’s being transported to a transplant recipient. It’s known as normothermic machine perfusion, a so-called “liver in a box.”
“This liver perfusion pump continuously circulates oxygenated blood through the organ, preserving its function far beyond the limits of traditional cold storage,” Dr. Uemura said.
AHN doctors believed that this innovative technology made combined open-heart surgery and liver transplant possible. At the time, AHN had never used one before, but because of David's critical condition, Dr. Tsukashita and Dr. Uemura requested emergency approval to use the device.
The surgery took about 12 hours and was ultimately lifesaving.
“Extraordinary,” is how David described the care he received from the AHN experts and care team. “They were totally honest with me that I had a 50/50 chance, and they got me through it.”
While David faced some challenges during his recovery, spending time between the hospital and a rehabilitation center, he eventually returned home in August. Waiting for him was his best fur buddy, Zoe, a Redbone Coonhound.
“I looked forward to getting back to her,” David said. “And there also a walker waiting for me at home that I ordered online. I used that until I could crawl up the steps, and then I moved on to taking one step at a time and then to running again.”
Finding his way back to the starting line
Today, David’s focus is no longer on surviving the ordeal, but on enjoying the active life he loves. He’s running, coaching tennis, and training his new canine companion, Arley, a Great Pyrenees. With a heavy heart, he said his Zoe passed in November.
“She was my running and mountain biking partner for 15 years, and there was such a void in my life,” David reflected. “So I went back to the same shelter. I rescued Arley, and she’s coming along. She steals the toilet paper, and I had to put child locks on the kitchen cabinets, but it’s all good.”
David said he feels blessed making it through a near-death experience and looks forward to trekking back to Bali someday.
“I had a few good days while I was there. I want to check out some really cool waterfalls and take a surfing class.”
About the AHN Cardiovascular Institute
AHN cardiovascular specialists focus on providing expert care for conditions like heart attack and heart failure, as well as preventive medicine. The AHN Cardiovascular Institute is renowned for its expertise, talent, and capabilities.
From common heart conditions to rare diseases, AHN heart experts use evidence-based medicine and a team-based approach to deliver high-quality cardiovascular care. The institute has highly focused programs, including electrophysiology, cardiovascular imaging, heart failure and transplant treatment, and general cardiology.
About the AHN Transplant Program
The AHN Surgery Institute’s Organ Transplantation Program provides expert care and a tailored approach to its patients. Transplant services offered include kidney and pancreas, liver, and heart transplants.