A future physician faces cancer

At the end of his third year of medical school at the Medical University of South Carolina, Hayden Braun should have been focused on becoming a doctor.

Instead, he could barely leave his apartment.

Persistent stomach pain, exhaustion and an inability to eat had taken over his life. Braun told classmates he was busy studying for the Step 2 Clinical Knowledge exam – a key milestone in medical training. In reality, he was simply trying to get through each day.

“I was mostly lying on the floor of my apartment in pain,” he said. “I kept telling myself I’d deal with it later.”

Like many medical students working long hours under intense pressure, Braun blamed stress, maybe an ulcer or burnout. Finishing rotations and preparing for residency felt far more urgent than investigating vague symptoms.

But his body kept sending stronger warnings.

During an away rotation in Austin, Texas, his health rapidly declined. Braun began running constant fevers and experiencing worsening pain. He struggled to stand during clinical activities and nearly passed out during a skills lab.

Finally, urged by his fiancee, now wife, Catherine, he agreed to seek further testing.

Months later, an extraordinary path forward would give Braun not only a chance to survive but to continue the career he had been training for.

Facing a devastating cancer diagnosis

A colonoscopy revealed colon cancer that had spread extensively to his liver. At just 25 years old, Braun was diagnosed with Stage 4 colon cancer.

“They lost count after 50 tumors,” he said.

For colorectal surgeon Colleen Donahue, M.D., who treated Braun at MUSC Hollings Cancer Center, the case reflects a troubling national trend.

“Unfortunately, we’re seeing more patients like Hayden, presenting with cancer at younger ages and often with more advanced disease,” she said.

Because the cancer had spread throughout his liver, surgery was not initially possible.

“When the burden of disease is that extensive, the first step is chemotherapy to see how the cancer responds,” Donahue explained.

Too weak to travel home, Braun began chemotherapy in Austin while staying with family. Within weeks, the treatment began working. His appetite returned, and his strength improved.

His family rallied around him as he worked to get well enough to return home. Friends stepped in as well, delivering meals and moving his belongings, including a large saltwater aquarium, to a new apartment.

“It sounds small,” Braun said, “but that aquarium meant a lot. It all meant so much to me.”

A team willing to push further

Once Braun was healthy enough to return to South Carolina, he transferred his care to Hollings, where medical oncologist Craig Lockhart, M.D., chief of the Division of Hematology and Oncology, oversaw the next phase of treatment.

Braun resumed aggressive chemotherapy while finishing medical school – an exhausting balance that required carefully timing treatments around his academic and clinical schedules.

“The chemotherapy worked well for him,” Lockhart said. “The bleeding stopped, and we started seeing signs that things were heading in the right direction.”

As the tumors responded to treatment, the team began exploring options that once seemed unlikely. There were too many tumors in Braun’s liver to be removed by surgery. But one possibility stood out: a liver transplant.

“He really listened to what my goals were,” Braun said of Lockhart. “And he pushed for what might give me the best chance.”

Transplants are rarely used to treat colorectal cancer that spreads to the liver. Although about 30% of liver transplants in the U.S. are performed for cancer, most are for primary liver cancer. But newer research indicates that this procedure can benefit carefully selected patients whose tumors cannot be removed through traditional surgery.

“Historically, liver transplantation for colorectal cancer metastases wasn’t done,” said transplant surgeon Steve Hanish, M.D. “But in the right patients, it can lead to excellent long-term survival. For Hayden, removing the entire liver was the only option.”

For Braun to be considered, however, several steps had to happen. First, Donahue performed surgery to remove the primary tumor in Braun’s colon. After recovering, Braun then resumed chemotherapy under Lockhart’s care.

“If there was no change for six months, he could qualify for a transplant,” Donahue said. “The goal was to show that the cancer was under control and confined to the liver.”

Braun’s case was reviewed by multiple tumor boards at Hollings, where oncologists, surgeons and transplant specialists carefully evaluated his eligibility. Over the following months, he met each of the required criteria.

According to Lockhart, Braun was an ideal candidate: His primary colon tumor had been removed, chemotherapy had successfully controlled the disease and scans confirmed there was no cancer outside the liver.

“He was young, otherwise healthy and someone we could really partner with in making complex decisions about his medical care.”

Then came another unexpected moment: Braun’s younger brother Zach volunteered to be his donor.

A rare and complex transplant surgery

Braun’s transplant marked a milestone for MUSC: the first adult-to-adult living donor liver transplant and the first transplant for colorectal cancer that had spread to the liver.

It was also an unusually complex procedure.

Unlike most transplants, which rely on organs donated after death, Braun’s transplant came from a living donor. Those account for only about 600 of the roughly 12,000 liver transplants performed in the U.S. each year.

The procedure required two surgical teams working simultaneously. Hanish led the donor operation, carefully removing part of Braun’s brother’s liver, while MUSC Health Surgical Director of Liver Transplantation Diego di Sabato, M.D., removed Braun’s diseased liver, transplanted the donated organ and connected it to critical blood vessels and bile ducts.

“It’s an intricate and highly coordinated effort,” Hanish said. “Two operating rooms, two teams, two anesthesiologists – everything happens in parallel.”

Hanish stressed that protecting donor safety is a top priority throughout the process. Potential donors undergo extensive medical testing and meet with an independent donor advocate – a social worker whose role is to ensure the decision is voluntary.

Living donor transplantation relies on the liver’s ability to regenerate. Surgeons removed about 70% of his brother’s liver and transplanted it into Braun. Both men recovered quickly and were discharged within a week, and their livers grew back, returning to full function in the weeks that followed.

Hanish said the case reflects what is possible when specialists across disciplines work together to push the boundaries of cancer care.

“All the things that make a National Cancer Institute-designated cancer center what it is came together for this.”

For Braun, the surgery accomplished something equally important.

“I needed a treatment option that would give me the energy to complete residency,” he said. “This gave me that opportunity.”

Supported every step of the way

Doctors continue monitoring Braun closely, as Stage 4 cancer carries uncertainty. But the transplant accomplished something critical: It allowed him to move forward without more chemotherapy and return to the goal that cancer had nearly taken away.

Throughout treatment and recovery, Braun said he never faced the journey alone. Friends and family provided constant support, while faculty advisors reorganized medical school requirements so he could graduate on time.

“When they heard that I wanted to stay and graduate with my class, they moved heaven and earth to make that possible,” he said.

At Hollings, nurses quickly recognized complications, once identifying a dangerous drug reaction before symptoms escalated. Staff also spent hours talking with Braun during long infusion days.

“It really does take a village to manage something this complex,” Lockhart emphasized.

“They didn’t just treat the cancer,” Braun added of his care team. “They wanted to know my story. They treated me like a person.”

Cancer has reshaped how Braun thinks about success. Before his diagnosis, scores and metrics dominated his attention. Now, those measures feel smaller compared to what he experienced. Uncertainty about the future also shifted personal priorities.

“The most important thing I did this past year wasn’t graduating from medical school,” Braun said. “It was marrying Catherine.”

Rather than waiting months, the couple decided not to postpone, marrying in a small ceremony last year with immediate family, before later celebrating with friends.

Braun currently works in the MUSC Emergency Department coordinating a hepatitis and HIV screening program while preparing to begin residency in emergency medicine at Dell Medical School of the University of Texas, Austin, in June.

His experience as a patient has already changed how he plans to care for others.

“Often people receive life-changing news completely out of the blue,” Braun said. “Having gone through that myself, I feel more prepared to have those conversations with patients.”