Delaware doctors to help 2 babies with Jamaica's first liver transplants

Nemours/A.I. duPont Hospital for Children doctors will travel to Jamaica in July to perform the country's first-ever liver transplants.

Dr. Stephen Dunn, a Nemours surgeon, will transplant two livers in Kingston, Jamaica, one in a 9-month-old boy and the other in a 13-month-old boy. Both babies have biliary atresia, a disease that if untreated can lead to liver failure.

The babies will each receive a donation from a respective family member, said Dr. Christopher Raab, a Nemours doctor who also will travel to Jamaica.

"In the developing world, liver transplants are not something that's done," he said. "You need a certain level of medical technology and sophistication and access to medicines."

Doctors say the goal is to teach and assist the Jamaican doctors with liver transplants over the next couple of years, with the hopes of them eventually doing the surgery on their own.

While doctors on the Caribbean island have done other surgeries, they have not tried a liver transplant because of the lack of resources and medicine, Rabb said.

Nemours first realized there was a need in Jamaica when patients practically "showed up on their doorstep," he said.

After the first Jamaican patient came to Nemours for the surgery six years ago, "word got out on the island," he said. In the past six years, six families have traveled from Jamaica to Delaware for a liver transplant, Raab said.

But because health care costs are expensive in the United States, it's not feasible for the Nemours doctors to be the "only place to do transplants for the Caribbean," he said.

Dunn, who has previously taught doctors how to do the operation in India and Bolivia, said liver transplant surgery is one of the few surgeries not performed by Jamaican doctors.

Unlike five years ago, doctors at Bustamante Hospital for Children, a public hospital in Kingston, now have the technology and medicine they need for a transplant. Nemours doctors will bring some supplies, such as microvascular instruments and an abdominal retractor, in their suitcases.

"It's not a huge list, but it’s an expensive list," he said.   

Dunn said transplant surgeries don't occur in developing countries because, unlike in the United States, there isn't a network or infrastructure to find organ transplants for patients.

Since both the babies were diagnosed with their condition at a late stage, surgery is the only option, the doctors said. 

Biliary atresia, a condition in which the liver cells produce a liquid that digests fat, is the most common reason babies need a transplant, the doctors said. Without surgery, 95 percent of babies who have the condition won't live past 18 months due to malnutrition and infections. 

Each Nemours doctor will have a Jamaican counterpart whom they will help teach. Most of the surgery consists of taking out the inflamed liver and preserving the attaching blood vessels, which can be a bloody procedure, Dunn said.

The doctors said they likely will stay in Jamaica one week after the surgery, in case of complications. After they return, they will follow up with patients via telemedicine.

Dunn estimates that the Nemours doctors will need to assist with 10 to 15 surgeries in a two-year period before the Jamaican doctors will feel comfortable doing them on their own.  

Both Dunn and Raab said the Jamaican doctors have something to teach them as well. 

"They have creative ways of solving problems there that we're not used to," Dunn said. "Sometimes we actually adopt them." 

Contact Meredith Newman at (302) 324-2386 or at mnewman@delawareonline.com. Follow her on Twitter at @merenewman.

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