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Groundbreaking Liver Transplant Surgeries at Bustamante Hospital for Children


The Bustamante Hospital for Children (BHC) continues to give Jamaican children a

fighting chance with groundbreaking liver transplant surgeries. Two surgeries have so far

been done in 2023, and a further six patients are awaiting transplants.


Dr. Colin Abel, Chief and Consultant Paediatric Surgeon at the BHC, explains that over

the past ten years, an increasing number of children have been experiencing problems

where their liver starts failing. He says that while there are surgeries that can be done to

allow them to live a little longer, it is likely that without a transplant the liver will fail.

He explained that the programme began in 2013 when a patient at the BHC required a

liver transplant. “We searched to see who would be able to help us, but it is prohibitively

costly - over US$500,000. We were fortunate enough to make links with the Children’s

Hospital of Delaware (CHD), which took the child and transplanted for free.”

A relationship between the two hospitals led to him taking other children for transplants.

It was eventually determined that a plan should be put in place to do the surgeries in

Jamaica.


“It meant looking at what we had in terms of hospital facility, the structure, the available

resources and what we would need. We realised that we did not need much because we

had good nurses, good doctors, and a good Intensive Care Unit,” Dr. Abel informs.

The next step was to ensure that the requisite testing facilities were in place as well as

medication that would be required for transplant patients. This process took

approximately two years of work, following which the first two liver transplants were

performed in 2018. Since then, the BHC has done nine liver transplants.

Dr. Abel, who is also a Consultant Paediatric Urologist, says the BHC has also been able

to assist our Caribbean neighbours, with a recent transplant for a child from Antigua,

whom he notes is doing well.

The programme involves what is called Live Related Liver Transplants. This means that

a parent of the child will donate a part of their liver which will then be transplanted into

the child. The bad liver of the child is removed and replaced with the good liver from the

parent.


The Chief Surgeon explains the condition which has necessitated the liver transplants.

“There is a condition known as Biliary Atresia and that is a condition where, for reasons

unknown, the child might be born normal and then by about two weeks of age, starts to

become jaundiced, and the liver starts failing. By about six to eight weeks, we will do

tests on that liver and that is when we make the diagnosis of biliary atresia. Biliary

Atresia is a blockage in the tubes (ducts) that carry bile from the liver to the gallbladder.

This congenital condition occurs when the bile ducts inside or outside the liver do not

develop normally.”


Dr. Abel says that if nothing is done about that condition, the survival rate of the affected

children will be very low. He further explains that between three and four children are

diagnosed with Biliary Atresia each year and the children who will receive transplants

need to be strong enough to get to a size and weight that would make transplant feasible.

“You are putting a piece of the parent’s liver into them; they have to be big enough for it

to fit. We have found that the age that works well for us is about one year, and the child

would be about eight kilograms in size. So, we try to get the child up to that point,” Dr.

Abel explains.


When the parent’s liver is cut, it grows back and as the child grows, the liver grows. The

adult liver has two parts, a right and a left lobe. During the surgery half of the left lobe is

taken and the parent is left with at least three quarters of their liver, which is just more

than enough for them to have a normal life. The child is then given medication to reduce

the risk of rejection of the organ.


Dr. Abel explains that the reason more surgeries cannot be done per year is because of

the three-month recovery period for the children. “This takes up a lot of our human

resources, so we must be able to properly care for them, hence we don’t do more than we

can cope with. We must ensure that we have all the resources to support that one rather

than be doing more than we should and end up with bad results, the Chief Surgeon

contends.


He notes that the training and information sharing between BHC and CHD has benefitted

the programme, and that the facility has developed a good working relationship with the

University Hospital of the West Indies (UHWI), the Kingston Public Hospital (KPH) and

CHD. While the procedure is done at the BHC, the care of the adult is facilitated between

KPH and UHWI.


“We use two operating theatres beside each other, so the adult is in one and the team

from KPH and UHWI are working to get the piece of liver out, and in the adjoining

theatre we have the baby. Professor Dunn from Delaware and I are working in that

theatre so as soon as the liver comes out, we then put it,” he says.


“After the surgery for the adult, they will stay with us for about six to eight hours of

recovery, then they will move up to either KPH or UHWI to continue their post-operative

care for about a week” the Chief Surgeon adds.

He has expressed gratitude for the support from the other hospitals, from the Ministry of

Health and Wellness and from the Southeast Regional Health Authority as well as from

private individuals “who have given tremendous support over the years”.




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