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
“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
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
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.
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
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”.