Separated After Sharing a Liver: How Nima and Dawa Became Two

Nima and Dawa Pelden were born joined at the chest and abdomen — a rare form of conjoined twinning in which two babies share skin, abdominal wall, and, in their case, a liver.

They arrived by caesarean section on July 13, 2017, in Bhutan. Doctors and family had expected twins. They had not expected one body.

Bhutan did not have the surgical experience for a safe separation. With help from the Children First Foundation, the girls and their mother, Bhumchu Zangmo, were brought to the Royal Children’s Hospital in Melbourne. The Victorian government offered to cover the operation and recovery, expected to cost at least $350,000.

The surgery, planned for October 2018, was delayed when last-minute checks showed the sisters needed more nutritional support. On Nov. 9, a team of about 18 people — color-coding Nima green and Dawa red so nothing would be mixed up — began work.

Lead paediatric surgeon Dr. Joe Crameri later said the best part of the day was how uneventful it felt. “It was all very calm.”

The critical step was the liver. The girls shared the organ, but surgeons were able to divide it without major bleeding and found no significant shared bowel. Then they reconstructed each child’s abdominal wall and skin so that, for the first time, each sister had a body of her own.

The operation lasted about six hours. Neither girl went to intensive care. Within weeks they left the hospital in a pram, separately, still wanting to stay close.

Years later they were photographed walking hand in hand at home in Bhutan, in school, offering to help their mother. The surgery did not invent their bond. It gave that bond room.

Conjoined twins are uncommon, and not every pair can be separated. Nima and Dawa could — because the anatomy allowed it, because a hospital far from the Himalayas took them in, and because a team treated a historic case like a job to be done carefully, without drama.

Two girls. Two recoveries. One shared beginning.

Sources: The Guardian, The Sydney Morning Herald, University of Otago, Kids News, and CNN notes on the Nov. 9, 2018, separation of Nima and Dawa Pelden at the Royal Children’s Hospital, Melbourne.