The prognosis for John Middleton isn’t good.

The 43-year-old engineer from Asheville, North Carolina, has a type of bile duct cancer hidden inside his liver called cholangiocarcinoma . It’s rare, diagnosed in about 8,000 people each year in the U.S., according to the American Cancer Society.

And it’s deadly. The National Cancer Institute says that just 22% of patients live five years after their diagnosis.

Middleton has maybe 18 months.

“I know we’re not promised tomorrow,” he said, “but I feel like I’m watching a stopwatch that has an expiration on it. It’s very frightening.”

His oncologist, Dr. Martin Palmeri of Messino Cancer Center in Asheville, says Middleton’s best hope is a liver transplant . Middleton has a willing donor: his identical twin brother, James.

“Theoreticall

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