About a decade ago, Heidi Caldwell sold a horse to Cheryl Oxenburg, an acquaintance in her relatively small Georgia horse community. Neither of them could have imagined that 10 years later, Caldwell would be diagnosed with cancer and fighting for her life. Nor could they have imagined that Oxenburg, through the gift of living organ donation, would be the one to save it.

In January 2023, just before she planned to head to Wellington, Florida, for the winter season, Heidi Caldwell saw her doctor for her annual physical. As she’d done annually since turning 50, she completed a Cologuard colon cancer screening test; previous results had always been negative, and this was just more box to check before heading south. But two days before she was supposed to leave, she received news that her results were abnormal, and she needed a colonoscopy. Caldwell’s doctor said she could wait until she returned from Florida, stating there were often false positives on these particular tests.

‘It Changed Everything’

On May 9, 2023, after returning to Georgia, Caldwell went for the colonoscopy. She never imagined she’d wake from the procedure to learn that she had stage IV colon cancer, with tumors so large that her doctor believed they’d likely been growing for years.

“When I was diagnosed, my world just slammed to a screeching halt,” she said. “It changed everything.”

Her medical team wanted her to start chemotherapy immediately, and initially she was on board. But just a few days after her diagnosis, she felt what she described as an “inner voice” telling her to slow down and do some research. 

Caldwell’s sister-in-law was in late-stage lung cancer at the time, and so Caldwell and her husband were only too familiar with the devastating side effects that accompanied the potent chemo medications. 

After some initial research, Caldwell agreed to the recommended surgery to remove the portion of the colon that contained the cancer, but she was hesitant to start chemotherapy to treat the disease that had spread to other organs. Her life expectancy at that point was 18-24 months with chemotherapy—and even shorter without it.

“If I was going to go down,” she said, “I didn’t want to spend my last year sick [from chemo].”

Scans revealed that the cancer had metastasized to her liver, so in July 2023, Caldwell underwent a surgery that removed 85% of her colon (most people have five feet; she now has eight inches), plus the quadrant of her liver that had metastases. Surgeons also removed her gallbladder, ovaries and appendix in hopes of limiting the places the cancer could spread. 

“It was like a clearance sale,” she said, laughing.

Post-surgery, the doctors were confident that they had removed all visible cancer but still wanted to do preventative chemo. Again, Caldwell turned it down. She adopted a vegan diet, and cut all chemicals out of her life, hopeful those lifestyle changes would help keep the cancer at bay.

But in December 2023, shortly after her sister-in-law passed away from her own fight, a CT scan showed that Caldwell’s cancer was back in her liver, with a vengeance. She remembers thinking, “I guess I’m going to die too.”

She leaned into two things that gave her strength and hope: faith and science. 

“I found so much comfort from my faith,” she said. “And it led me to follow a different path. I felt this peace come over me and felt like I was going to figure this out; I was going to be OK.”

Pursuing Living Donation

Caldwell also leaned hard into research, spending weeks around Christmas studying the disease nonstop. She came across an organization called Colontown, an online community and support group for colorectal cancer patients and their caregivers, which she says was a massive source of help and support. 

One of the moderators of the Colontown Facebook group, Betsy Post, learned the specifics of Caldwell’s cancer and asked if she’d looked into the possibility of a liver transplant. Post introduced Caldwell to Dr. Roberto Hernandez and Dr. Koji Tomiyama at the University of Rochester Medical Center (New York). For the past six years, their team has been performing groundbreaking living donor liver transplants on very specific types of stage IV colon cancer patients, with great success. 

As the procedure is so new and unknown to many oncologists, Hernandez explained that most patients—Caldwell included—are self-referrals. After learning all she could about the procedure, she reached out to URMC to find out if she was a candidate.

“The approval process was long and involved,” Caldwell said. “The cancer had to have only gone from the colon to the liver. All the strains and mutations had to be right. Only a select few can qualify for the transplant.”

She was one of those few. But the biggest hurdle was still ahead: Colon cancer patients seeking liver transplants have to find their own living donor. 

In the U.S., there’s a need-based system for liver donations; patients with lowest-functioning organs are ranked highest and will receive transplants first. Because colon cancer patients with liver metastases have relatively normal liver function, people like Caldwell will always remain low on the list, she said. 

The liver has the greatest regenerative capacity of any organ in the human body, so it is possible for a living person to donate a portion of their liver to a patient in need. Despite the months or years it can take to find a living donor, the route would still be the quickest for Caldwell to find a new, healthy liver. And to keep the cancer from spreading during the search, Caldwell would undergo 32 weeks of chemotherapy at City of Hope Cancer Center in Atlanta. 

Due to the overwhelming and emotional nature of looking for a living liver donor, her medical team in New York suggested that Caldwell hand the logistics to a friend or relative. She created a digital flyer and recruited a friend, Keirsten Sangster, to post it to social media and field questions from those who wanted to help. 

“I was extremely private about having cancer,” Caldwell said, “so some people were just finding out about my diagnosis when they saw the post, so it was very helpful to have a friend fielding all the calls and questions. It was a lot.”

Linked to that digital flyer was an initial screening questionnaire for anyone who wanted to pursue being Caldwell’s match. 

Finding A Match In A Friend

Many people responded to that initial survey, including Cheryl Oxenburg, an equestrian from a nearby town. A decade earlier, Oxenburg purchased a Holsteiner mare named Maggie from Caldwell, who she knew of through their small horse community.

“I tried the horse over the course of a few visits,” Oxenburg said, “and Heidi and I became friends. She’s one of the kindest and most helpful people I’ve ever met.”

So when Oxenburg saw the post on social media about Caldwell’s search for a liver, she said filling out that initial survey was a “no brainer.”

“The donor had to be A or O blood type,” Oxenburg said, “I’m A, so I figured I’d put my name in. I assumed hundreds of people would be on that list, so I didn’t really think much about it.”

Until two months later, when she received a call: She ranked as the highest potential match for Caldwell.

At that point, Oxenburg sat down with her husband. They had a lot to consider; their 9-year-old daughter, Cali, was their first priority. An additional concern was that the family keeps horses at home (including Maggie, the horse she purchased from Caldwell). If Oxenburg became Caldwell’s donor, she wouldn’t be able to care for her horses during recovery.

“My husband and I prayed on it,” she said, “and while he wasn’t entirely comfortable, he said he’d support me in whatever I wanted to do. I decided to move forward with the next phase and at least learn more.”

‘In God’s Hands’

Before she sat down with the medical team for a full day of virtual interviews, Oxenburg resolved to trust in her own strong faith.

“I decided I was putting it in God’s hands,” she said. “If this is what I’m supposed to do, then all the tests will line up. If it’s not, then they won’t.” Her husband agreed. 

As the team continued to evaluate Oxenburg, they conducted MRI and CT scans of her liver. The results were sent to a medical team in Germany, who evaluated the tests and scans to ensure that there was enough of the organ to sustain both donor and recipient. They also needed to make sure that the quadrant of liver that Oxenburg would donate would fit and match up inside Caldwell’s body. 

When the thumbs up was given on this final step, the team set a surgery date: Sept. 27, 2024.

The night before the surgery, Caldwell, Oxenburg, and several family members went out to dinner. And at 7 a.m. the next morning, it was game on. 

Caldwell was taken into the operating room first. The surgeons would start with her; doctors needed to inspect her abdominal cavity to make sure the cancer hadn’t spread beyond her liver. If it had, Caldwell said, “game on” would become “game over.” 

When Caldwell was cleared for surgery, it was Oxenburg’s turn.

“I was scared to death,” Oxenburg said. “I’d never had a stitch or a surgery prior to this. And talking to my parents and my daughter beforehand was really emotional. But the thorough vetting by the URMC team gave me so much peace. I felt like they absolutely would not have gone through with the procedure if they had any reservations about how it would impact me. I had complete faith in that team.”

Oxenburg’s surgeons carefully removed part of her liver, which was then painstakingly reattached inside of Caldwell, in an adjoining operating room, after her own cancer-filled organ was removed. The entire procedure required a medical team of several dozen professionals and lasted 17.5 hours.

17.5 Hours Later

When Caldwell woke around 5 p.m. the next day, she remembers—foggily—someone leaning over her bed, reassuring her that everything went well. 

“It was just the most amazing thing to wake up and be alive,” she said.

Immediately, Caldwell asked about her friend. Oxenburg, it turned out, was recovering like a champ. 

“In my head, it was going to be much worse than it was,” Oxenburg said. “When I woke up and the ICU nurse asked about my pain level, I told her honestly it was a zero. I felt some discomfort but have never felt any pain.”

Hernandez, their doctor, remembers being anxious to check on Caldwell and Oxenburg the next day. 

“I never sleep well after surgery,” he said. “I’m of course concerned about both patients, but I feel particularly responsible for the life and health of the donor. That person didn’t need an operation. They’re putting their life in our hands. But when I got to the hospital the next day, Cheryl looked better than I did. Hers was the fastest recovery we’ve seen from a donor.”

“I was so impressed with her through the whole process,” he said. “She was so humble and so brave, and she had so much clarity [about the donation process.] And the trust that both she and Heidi had in our team was just amazing.” 

Post-surgery, Caldwell and Oxenburg were discharged from URMC to the Hope Lodge, a hotel and rehabilitation facility for cancer patients. Oxenburg spent two weeks there; Caldwell stayed about a month.

Once they returned home, in typical equestrian fashion, both Caldwell and Oxenburg took their doctors’ orders to spend six months out of the saddle as mere suggestion.

“I waited a solid four months to ride!” Oxenburg said, laughing.

Caldwell was back in the saddle on Christmas day—just over three months after her life-saving surgery. 

Back In The Saddle—Together

But one particular ride this February held perhaps the most meaning: On her way back from Florida, Oxenburg stopped by the farm where Caldwell’s horses winter. Despite not having riding clothes with her, Oxenburg couldn’t pass up the opportunity to share some saddle time with her friend. 

“Words can’t express how much this means and how grateful I am for her,” Caldwell posted on her Facebook page, with a photo of the two on Caldwell’s horses.

“That ride,” Oxenburg said, “was an answer to everything we prayed for.”

Without surgery, Caldwell wasn’t expected to live more than two years. Post-transplant, and even with a stage IV diagnosis, she could live the rest of her life cancer free.

“This can be curative,” she explained. “I have a very high chance of not having cancer again in my body.”

Caldwell will continue to have regular CT scans and bloodwork, and she’ll be on immunosuppressant drugs for the rest of her life so her body doesn’t reject Oxenburg’s liver. But the hope she has for the future, she says, is immeasurable. She’d love to earn her USDF silver medal on her Dutch Warmblood gelding, Gabriel, and her Swedish Warmblood mare, Penelope. But if she doesn’t ever get back in the show ring, that’s fine too, she said. This journey has reminded her of what’s most important: more time with those she loves, both two and four-legged. She has the utmost gratitude, she said, for Cheryl and her family, her husband, Mike, her medical teams at URMC and in Atlanta, and God.  

As for Oxenburg, at five months post-surgery she’s “99.9%” back to normal. Her liver grew back to its original size somewhere around the eight- to 12-week mark. She’ll have zero lasting effects from the surgery, save for a scar and the knowledge that she saved her friend’s life. 

“Knowing that I’ve given Heidi more time, it’s incredibly humbling and has blessed me in so many unexpected ways,” she said. “This experience has made me so incredibly thankful for my health, my family and friends, and the fact that I am in a place where I was able to do it. It’s a reminder to be intentional with my time and not take any of my days for granted.”

Caldwell hopes her experience can be a lesson for others.

“I’m a very private person,” she said. “But I’m sharing my story because I really think it might save somebody’s life. If one person gets a colonoscopy or a second opinion from another doctor because they’ve read this, then it’s worth it.

“And please, get colonoscopies as soon as you’re eligible,” she continued. “The FDA just dropped the recommendation from 50 to 45. Cologuard tests give people a false sense of security when they come back negative, and false negatives are fairly common. Colonoscopies aren’t that big of a deal. They’re not painful; they’re actually a really nice nap!”

Hernandez agreed—having a cavity filled at the dentist is more uncomfortable than getting a colonoscopy, he contends.

 “Colon cancer is the third most common cancer in the world,” he said. “We’re seeing it more and more in people in their 20s, 30s and 40s. Annual evaluations with your primary care physicians are also so important; even little changes in your bloodwork might be triggers to look deeper. And don’t ignore any [gastrointestinal] symptoms or any blood in your stool. The earlier you catch colon cancer, or any cancers really, the better the prognosis.”

“And do your research, get additional opinions, and advocate for yourself,” Caldwell said. “If I’d listened to my first four oncologists, I’d be dead. I think I’m here now to remind people to take charge of your own health.”

For More Information

April is National Donate Life Month. For more information about organ donation, including living donation, visit donatelife.net. For more information on colorectal cancer, visit the Colorectal Cancer Alliance.