Pontificia Universidad Católica de Chile: Team UC leads figures for liver transplants with living donors in Latin America

In May, the Hospital Clínico performed the 33rd liver transplant surgery among adults, a procedure that has reduced the waiting lists of patients who need an organ in Chile. Without a living donor, almost 40 percent of them die before reaching the ward.

Raúl Morales was twelve when he told his mother, Rosa Pino, diagnosed with autoimmune hepatitis, that he would donate her liver. But no one paid much attention to him at the time because, he says, “you couldn’t either.” Rosa was part of the list of patients in Chile who wait for years for an organ from a deceased donor.

Donation rates in the country are low. They fluctuate between six and 10 per million inhabitants, while in countries like Spain, they exceed 40.

One of the alternatives to combat this deficit is transplants from living donors. But Rosa had no choice ten years ago. The first liver transplant of this type to an adult at UC was performed in 2016, which is currently the center with the most experience and the highest annual number of these procedures in Latin America.

“The advantage of living donor transplants is that you can prepare the patient and schedule the surgery before their condition worsens” – Pilar Domínguez, coordinating nurse of the UC Transplant Program.


After successive crises and cirrhosis, in December of last year Rosa’s condition worsened and Raúl, who is 23 years old today, volunteered as a donor. The San Juan de Dios Hospital , where she was treated, referred her to the UC team, which began the examinations. In these cases, the donor is subjected to a complete health study, which includes physical and psychological aspects.

“His transplant had to be done imminently because he was very serious. He had practically no liver reserve left. We had begun to study his son as a donor and when he was hospitalized, the tests were quite advanced. We waited three days for a deceased donor to appear and he did not appear, ”says Pilar Domínguez, nurse coordinator of the Transplant Program .

The 54-year-old Rosa’s transplant is the 33rd adult-to-adult living donor performed by the UC team since 2016. Living donor liver transplants for pediatric patients are simpler and have been done for years. 20 years, explains Dr. Martín Dib, head of the program. “From adult to adult, almost 70 percent is removed, just over half of the liver. On the other hand, from adult to pediatric, we only get 20 percent ”, he details.


The transplant for Rosa, 54, is the 33rd living donor from adult to adult, carried out by the UC team since 2016. Her son Raúl, who is now 23 years old, gave her his organ.
Living donor procedures have decreased mortality on the waiting list and improved patient survival expectations .

“The ISP’s waiting list is around 160 patients. They depend on the appearance of a liver from a deceased donor. Almost 40 percent die waiting for a transplant. The advantage of living donor transplants is that one can prepare the patient and schedule the surgery before their condition worsens, ”explains Pilar Domínguez.

“We have patients from Santiago and regions. We have patients from Isapre and Fonasa. We have donors who have been children, cousins, nephews, siblings, even some who have requested special authorization from the Ministry of Health to be able to donate to a brother-in-law or a non-blood relative ”- Martín Dib, head of the UC Transplant Program.


51 transplants in 2020
For more than seven consecutive years, the UC Clinical Hospital has performed the largest number of liver transplants in the country. Last year there were 51 transplants. 20 percent of these interventions are with a living donor. The hospital compound that follows him on the list – the Calvo Mackenna Hospital – performed 22 transplants. It is a very complex surgery, which requires a team with a lot of experience.

“We have specialists in each of the disciplines -arsenalera, nurses, anesthetists, radiologists, hepatopathologists and endoscopists who are experts in transplantation-, which allows us to have a rescue capacity in the face of possible complexities of the patients, which is key,” explains the doctor. Fig.

But beyond the figures, the head of the program highlights their role as facilitators of a human process. “Donors are true heroes who undergo surgery that they do not need to save the life of their family member. And the entire medical team and the health team treat them in a way that they feel very protected during the period they are here, ”he says.

And he adds: “We have patients from Santiago and other regions. We have patients from Isapre and Fonasa. We have donors who have been children, cousins, nephews, siblings, even some who have requested special authorization from the Ministry of Health to be able to donate to a brother-in-law or a non-blood relative ”.


Martín Dib, head of the UC Transplant Program: “Donors are true heroes who undergo surgery that they do not need to save the life of their family member.”

Update Chilean legislation
The director of the UC Hospital, Dr. José Ignacio Rodríguez, who must meet with each of the donors to formalize the procedure, relates his experience: “There is a very formal act in which he declares that there is no pressure, that there is no incentive economic. I interview them and I know their stories and I can’t help but get emotional every time. It is an extraordinary thing that inspires us all ”. Pilar Domínguez corroborates this: “You create a bond. It is a very intense and beautiful experience. To work on this you have to be highly enrolled ”.

“You imagine doctors as cold, but they are the opposite. They behaved very well, always attentive and available to our consultations ”, highlights Raúl Morales.

Rosa Pino is already back at home. “My mom is another. It’s incredible what happened because they told us that she was going to react on the third or fourth day of the operation because she was intubated, but an hour passed and she opened her eyes. And the liver started working immediately. He has even been in less pain than me, ”he says.

In countries such as Canada, the US and some in Europe, non-consanguineous donors are allowed for these cases, but in Chile until January 2021 the law did not authorize it. The new amendment to the law accepts affinity related donors up to the second degree. Martín Dib argues that the next step is to further update local legislation to allow non-consanguineous donors.

“For example, the lifelong friend or neighbor, who has an equal or greater affection than a relative. The correctly evaluated non-consanguineous donor is an alternative to expand the possibilities of these patients, who are on the waiting list, and to reduce mortality. We must trust the experts we have in the country to evaluate them and increase transplant rates ”, he says.

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