A heartbreaking diagnosis for two identical twins led to an agonizing wait for their mom to find out if her boys would survive.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

When Nick and Devin Coats were diagnosed with cirrhosis of the liver, there was apparently only one way they could survive: both twins needed a liver transplant. But the wait for suitable donors was agonizing, with the boys’ health deteriorating all the while. And then a doctor provided the brothers’ mom with some devastating news.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Nick and Devin’s diagnosis had initially come in March 2017 – and from the outset the prognosis didn’t look good. For starters, there appeared to be only one real option for treatment: the liver transplant. And as waiting lists for the procedure were excruciatingly long, time was not a friend to the teenagers.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Yet the twins had a goal to keep them going – even against the odds. In particular, the aim for both of them was to reach their graduation, which was due to take place just over a year on from their diagnosis. Yet the months that lay ahead ultimately proved harder for one twin than the other.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

And if Devin and Nick failed to receive new livers, the doctors believed that their health would likely continue to worsen. Naturally, it was also important to find not just one, but two suitable matches – one for each of the brothers. As the pair were waiting for a donor to become available, however, complications sadly arose.

And less than a year after Devin and Nick’s diagnosis, their mom, Margi Coats, was given truly shattering news. Specifically, she was informed that although a liver donor had been located for both twins, doctors were able to perform only one transplant. Then, heartbreakingly, medical professionals told Margi yet another thing that no mother should ever have to hear.

In 1999 Margi, who resides in Slidell, Louisiana, was actually already a mom to girls Heather and Melanie when she went for a routine scan during her third pregnancy. But what she learned that day may not necessarily have been a huge surprise.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Yes, Margi was informed at the scan that she had been blessed with twins – just like her mom before her. And, happily, on October 20, 1999, the Louisiana woman would grow her family by two when she gave birth to two healthy baby boys: Nick and Devin.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Like many twins, Devin and Nick shared a special connection. In fact, they weren’t just twin brothers; they were also best friends and were as close together in life as they had been in the womb. Their mom sometimes watched, too, as they slept in the same crib with parts of their bodies always touching.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

And throughout their young lives, Devin and Nick had always been healthy children. Sure, they sometimes had coughs and colds – as well as a bout of strep throat on one occasion – but fortunately anything more serious seemed to evade them. But all that would change suddenly and dramatically in the twins’ late adolescence.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

In September 2016 Nick was at school when he was forced to call his mom. During the conversation he spoke of searing discomfort in his leg, explaining that the ache was so intense he could barely stay seated at school. As the twins were becoming men, though, Margi chalked it up to nothing more than growing pains.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Yet Nick’s agony was seemingly unrelenting. As Margi recalled to the Lafayette-based The Daily Advertiser in 2018, “The following day, [Nick] called me again almost in tears saying that [the pain] was so severe he couldn’t stand it any longer. [I was] working at the [Slidell Memorial] hospital, [so] I left work and brought him to the emergency room.”

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Once at the ER, Nick underwent routine blood tests that ultimately showed his platelets were low. But the doctor responsible wasn’t altogether sure what that had to do with the agony the teenager was suffering through, so they referred him to a hema-oncologist. And with that, Margi’s thoughts immediately turned to blood cancer.

Fortunately, further assessments at the Ochsner Hospital for Children didn’t reveal cancer. The tests did show some abnormalities on Nick’s liver, though, and so he was referred to a specialist. And after Margi had mentioned that her son was one half of a set of twins, Devin underwent examination, too.

Early analyses then showed that Devin had a platelet count of around 40,000. That’s abnormally low when you consider that a healthy range is anywhere between 150,000 to 450,000. So he and Nick each had ultrasound scans. And at this point, the doctors discovered irregular nodular growths on both of the brothers’ livers.

After that, Devin and Nick were both sent for biopsies, from which it was learned that the pair had cirrhosis. Cirrhosis of the liver is a condition that develops gradually over several months or even years. When the organ is healthy, it regenerates itself with normal liver tissue; with cirrhosis, however, this process produces scar tissue.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Typically, cirrhosis is thought of as being caused by excessive drinking. Yet there are other known causes, such as hepatitis B and C as well as non-alcoholic fatty liver disease – the latter of which may develop as a result of obesity, diabetes, high blood pressure or high blood fats. Puzzlingly, though, the cause of Nick and Devin’s cirrhosis supposedly had no external influence.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Instead, Nick and Devin’s cirrhosis was apparently the result of an abnormality in their genes – a relatively rare origin. And, heartrendingly, the bad news didn’t end there for the teenagers. With their disease already diagnosed as being at stage four, the boys’ condition was particularly advanced.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Cirrhosis, by its definition, itself involves progressive damage to the liver. And while the disease itself currently has no cure, management can be achieved through certain treatments. At stage four, though, the twins’ cirrhosis was particularly serious. The only way the boys could apparently survive, then, was by each undergoing a transplant.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

However, the waiting list for new livers was a long one. And even though their respective diagnoses were grave, Devin and Nick were in otherwise relatively good health – and therefore quite low on the pecking order. So tragically, the boys’ health would need to worsen before they qualified for transplants.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Doctors thus continued to observe the twins’ blood work over the following months. Margi later described to The Daily Advertiser, “Once their levels got bad enough, they could qualify to get listed for a liver transplant. That’s what I have a problem with – that they had to get sicker in order to be considered for new livers.”

But the deterioration of one twin’s health would occur much more quickly than in the other. “One day, [Nick] came home from his job… in excruciating pain,” Margi recalled. “We took him to the emergency room, and then we were transported to Ochsner Medical Center in New Orleans.” This day, August 31, 2017, would forever become etched into her mind.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

You see, it was then that doctors discovered Nick’s liver was riddled with hepatic angiosarcoma – meaning, in short, that his blood vessels’ inside lining had developed cancer. A particularly aggressive form of cancer, hepatic angiosarcoma has no known cure. And, naturally, Margi was shocked at the news. In fact, she later described the diagnosis as “a death sentence.”

Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

So in addition to his cirrhosis, Nick had cancer. And given the sudden onset of the disease and its aggressive and incurable nature, he finally qualified for the liver transplant waiting list. Furthermore, with Devin’s tendency to mimic his twin’s illnesses, he too was placed on the list.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Nick’s prognosis was not encouraging, either. “I thought it was the end,” Margi later admitted. “[Hepatic angiosarcoma is] so rare and aggressive, and without treatment doctors said he had six months to live. With treatment, he had up to a year.” As a result, then, Nick immediately underwent chemotherapy and a course of medication.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

But, thankfully, the situation looked more encouraging for Devin. He was soon matched with a compatible liver donor and approved for a transplant. Then, on January 11, 2018, he underwent an operation to receive his new liver. And unless his body rejected the organ, he could look forward to a healthy life ahead.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Nick was offered a glimmer of hope, too, when he was given the green light for a transplant of his own. But the family’s optimism was short-lived, as his aggressive cancer made performing the procedure to implant a new organ difficult. Operations were initially scheduled and then repeatedly cancelled, in fact.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Margi recalled to The Daily Advertiser, “Nick had four opportunities for a transplant, but he was turned down each time. Once [it was] because of the cancer, then [again] in Texas when they saw the cancer had progressed outside his liver. And [it occurred] a third time in Massachusetts because his insurance didn’t cover out-of-state procedures.”

Then, finally, Nick’s transplant was scheduled for a fourth occasion on February 21, 2018. But when surgeons eventually opened him up, they saw that the lesions had spread to the teenager’s stomach. In essence, the operation was pointless, and the family’s sense of optimism turned to utter devastation. Tragically, Margi knew that her son’s time was up.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

At around this time, Nick’s thoughts turned to his twin brother – as, indeed, they would continue to do throughout the remaining course of his illness. Margi herself, on the other hand, had worries about both her boys. She wrote on Facebook in March 2018, “Devin continues to have his own personal, internal battles that consume his brain daily.”

Margi continued, “It’s been very hard for [Devin] to watch his brother, who has always been his strength, slowly lose his battle when they both were in this together. It’s hard for me to watch one son lose his battle physically and the other lose himself mentally. I feel as though I’m losing both my boys [in] two different ways.”

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

However, Margi knew that Nick was dying. With all treatments and medical possibilities exhausted, Nick’s condition would continue to worsen day after day. The only hope the Coats family had left was that he could enjoy the remaining time he had and make it through to his graduation in May.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Then, one night in March 2018, as Margi and Nick shared a private moment by his bedside, the mom was taken aback when her son started to openly discuss his own funeral. He also talked of gifts that he wanted others to have in his memory. Most of all, though, Nick’s thoughts were of his twin.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Yet Devin and Nick were more than siblings; they were best friends and sidekicks. Margi would recall how Nick had mentored his brother and regularly acted as a guiding voice. In a March 2018 Facebook post, she would also describe her son as “strong” and “courageous.” And, she further noted, “Nick showed others his genuine heart and was a good friend to many.”

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Plus, Nick apparently loved the outdoors and spending time with his family. In early March 2018, then, the Coats clan took a weekend trip to the Gulf Shores – an area Nick called his happy place. And after the family had returned home several days later, they held a traditional Louisiana crawfish boil. This event, as it turned out, would prove to be Nick’s final social gathering.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Tragically, Nick lost his battle against cirrhosis and cancer on March 19, 2018, and he was ultimately laid to rest at the end of the month. As a devout Christian, though, Margi believes that her separation from Nick is temporary and that they will meet again in another life. She takes comfort in nature, too, as she believes it sometimes provides signs that her son is always watching.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Now, Margi continues to support Devin. In a Facebook post made after Nick’s passing, she wrote, “Prayers for continued strength and healing so Devin can continue to press on and navigate through this journey called life with his new liver, the anxiety that comes with fear of rejection and all the meds and for learning to live without his sidekick.”

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

And in May 2018 Devin finally graduated. His brother was there, too, as Nick had previously requested that his closest friends and family carry red crosses containing his ashes at the ceremony. Devin’s twin was also awarded his own posthumous diploma.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

Yet Margi believes that her son would have been saved if more donors were registered. She wrote on Facebook in March 2018, “[The] bottom line is we have way too many people in this country for there to even be a waiting list. No one should have to watch their loved one pass because of lack of organs.”

And statistics from the Department of Health And Human Services seem to bear the mom’s assertion out. It’s said, for example, that 20 lives are lost daily among the 116,000 or so patients registered on the organ transplant list. And while nearly 8,000 livers were donated in 2016, some 14,000 more would have been required to fulfill demand.

Image: Facebook/Teen Twins Transplant: Nick and Devin's story — Image: Facebook/Teen Twins Transplant: Nick and Devin’s story

So, in the wake of Nick’s passing, Margi wanted her son’s organs to be donated. And although his illness prevented much being passed on, his eyes were nevertheless put to use. Of this generous gift, Margi told The Daily Advertiser, “I feel like Nick can still see life through the eyes of someone else now. My son is living through someone else and helping their life.”