Fighting Biliary Atresia with Hope and Help from COTA
Noah James Hallford entered the world on November 14, 2024, weighing 8 lbs 7 oz and measuring 21.5 inches long — a big, beautiful baby boy with no complications at birth. We were overjoyed to bring him home, but just before discharge, we noticed something wasn’t quite right. His eyes and skin had taken on a yellow tint. We mentioned it to the nurse, who quickly informed the neonatologist. A flash bilirubin test revealed a concerning jump in his levels overnight. Though the total bilirubin was elevated, it wasn’t high enough to require phototherapy, so we were told to follow up with our pediatrician.
At that visit, Noah’s bilirubin was still high. A direct bilirubin test showed a level of 3.69 — far above the normal of less than 1. We were immediately referred to a pediatric GI specialist who, understanding the urgency, connected us with the team at Children’s of Alabama in Birmingham.
At our first visit, Noah underwent an ultrasound and an extensive panel of labs. Doctors decided to admit him for further testing, which included a liver biopsy and cholangiogram — both performed invasively due to the complexity of his condition. That’s when we received the diagnosis that changed everything: biliary atresia, a rare but life-threatening liver disease in which the bile ducts are absent or blocked. This causes toxic bile to build up, damaging the liver and leading to cirrhosis and liver failure if untreated.
At just four weeks old, on December 16, 2024, Noah underwent the Kasai procedure. In this surgery, a section of his small intestine was connected directly to his liver in hopes of bypassing the damaged ducts to allow bile to drain. Unfortunately, as is the case for many children with biliary atresia, the Kasai was not successful. Over the following months, Noah’s lab results worsened, and his jaundice became more severe.
By April, Noah was admitted again for complications of liver failure and began transplant evaluation at Children’s of Alabama. He was officially placed on the liver transplant list, and we are now also working with UPMC Children’s Hospital in Pittsburgh, where we will complete further evaluation. UPMC offers additional transplant options, including split-liver and living-donor transplants, which may provide Noah a faster path to the gift he so urgently needs.
Noah received his life-saving transplant on June 18, 2025. While this was a moment of profound hope, it was just the beginning of a long and challenging recovery journey. Our family continues to navigate countless medical appointments, medication adjustments, and the emotional toll that comes with caring for a child post-transplant.
Throughout this entire experience, both of Noah’s parents have experienced a significant loss of income in order to provide full-time care. Hospitalizations, travel, temporary relocation, and everyday living expenses have added up quickly — and we are far from the finish line.
This is where the Children’s Organ Transplant Association (COTA) comes in. COTA is the only national organization solely dedicated to fundraising in honor of children and young adults who need transplants. COTA provides 100% of funds raised to help with transplant-related expenses — from medical bills to travel to basic daily needs during recovery. These services are provided to families at no cost, and all gifts made to COTA are tax deductible.
Noah needs your help. Every dollar donated to COTA in honor of Noah goes directly toward his care. Your support allows us to focus on what matters most: giving Noah the chance to grow up strong, healthy, and full of life.
Please consider donating to COTA for Noah James.
Thank you for walking this path with us. Your kindness, prayers, and generosity mean the world.
With heartfelt gratitude,
The Hallford Family
