How Vital Are Your Organs? Could you live without a small and large intestine, stomach, liver, spleen, and pancreas? By Howard LeWine, M.D., Harvard Health Publications Q: I just read about a girl who had six organs in her belly surgically removed during a cancer operation. Could she have survived if doctors were unable to put her organs back in, or to transplant another person's organs into her body? A: According to news reports, the young girl's small and large intestine, stomach, liver, spleen, and pancreas were removed as part of a 23-hour cancer surgery. The surgeons replaced her liver and small and large intestines. Her spleen, pancreas, and stomach could not be saved. What if none of the six organs could have been replacedand transplanting another person's organs wasn't a possibility? Of the six, the only organ that is an absolute for survival is the liver. She couldn't have survived if her entire liver was removed, unless she received a liver transplant. But healthy liver tissue has impressive regenerative abilities, so if a little of her liver was healthy and could have been left in, she could have survived. Of the other organs, the absence of a spleen and a stomach pose the fewest problems. The spleen acts as a filter to remove red and white blood cells that are old or damaged. It also helps us fight infections. But it is not an essential organ. Thousands of people walk around without a spleen, usually because they required emergency surgery when the spleen ruptured after a trauma. As part of the immune system, the spleen acts to boost antibody production when a person gets a vaccine or acquires an infection. Antibodies are molecules that block bacteria and viruses from entering healthy cells. The immune system can work without a spleen, but not as efficiently. In non-emergent situations, doctors give patients who need their spleens removed a host of immunizations. With these immunizations, the body will likely be able to produce normal amounts of antibodies. As the surgeons did in this case, a pouch to hold food can be created to substitute for a stomach. If the small intestine had not been put back in, she would not have been able to eat or drink. So there would be no reason to create the "false stomach." Normal adults have about 20 feet of small intestine. To absorb sufficient calories and nutrients, at least 5 feet of small intestine would need to be saved. If less than that is able to be saved, a person would only be able to survive with intravenous feedings. Moving down to the large intestine, the main function of this organ is to reabsorb water that is mixed with food. It's not essential for survival. For example, the only option for some people with severe ulcerative colitis is surgery to remove the entire colon. Many people today live without a functioning pancreas; however, it's a huge challenge. The pancreas produces digestive enzymes and hormones, including insulin. This young girl will always need insulin injections to keep her blood sugars in control. Also, since she won't be making the digestive enzymes that break down food products in the intestines, her diet will need to be adjusted. She will probably only be able to eat simple sugars and proteins, and just the essential fats. She will also take pills containing digestive enzymes, which will surely help. Howard LeWine, M.D. is a clinical instructor of medicine at Harvard Medical School and practicing internist with Harvard Vanguard Medical Associates and Brigham and Womens Hospital in Boston, Massachusetts. He serves as Chief Medical Editor of Internet Publishing at Harvard Health Publications.