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Jefferson Surgical Solutions

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More than 20 years ago, Stephen P. Dunn, MD, FACS, Professor of Pediatric Surgery at Jefferson, encountered a young liver transplant patient who had traveled from his home in Santa Cruz, Bolivia, to St. Christopher’s Hospital for Children. After inquiring why the boy hadn’t been transplanted in his home country, Dr. Dunn learned that while surgeons in Santa Cruz had a fair amount of experience with kidney transplants, they were not able to perform liver transplants. In order to have these life-saving surgeries, patients in Santa Cruz needed the funds not only to pay for the operation but also to travel outside the country.

Dr. Dunn reached out to the surgeons in Santa Cruz and invited them to Philadelphia for training on liver transplantation. He also began making trips to Bolivia. In 1996, Dr. Dunn performed the first-ever liver transplant in Bolivia at Santa Cruz’s Clinica Incor. That patient, a young girl, is now a thriving adult—and part of a community of patients who have benefitted from Dr. Dunn’svolunteer work.

In 2012, Dr. Dunn approached Warren R. Maley, MD, Professor of Surgery and Director of Jefferson’s Live Donor Liver Transplant Program. Until then, Dr. Dunn had been handling all of the transplantation surgeries, operating on live donors as well as pediatric recipients. He asked Dr. Maley if he would be willing to assist with operating on the live donors in Santa Cruz. That first year, Dr. Maley made the trip four times. Since then, Dr. Maley has begun assisting with adult liver transplants, as well, but only using deceased donors. Unlike pediatric cases, which can be planned in advance, there’s no advance notice for adult transplants.

When a liver becomes available, Dr. Maley gets a call and starts the long trip—arriving the following morning to perform the transplant. “When we do the pediatric transplants, we usually stay three or four days to make sure things are headed in the right direction,” Dr. Maley explains. “Every time Dr. Dunn and I go back to Bolivia, we have the chance to see the adults and kids we’ve transplanted. They all come back to the clinic.”

Since pediatric transplants are often performed while the patients are babies, he doesn’t really “recognize” them when they come back to visit years later. However, he and Dr. Dunn thoroughly enjoy seeing them active and vibrant—running, playing and even flexing their muscles. Adult patients are equally grateful, with one serenading the surgeons with his accordion at a reunion dinner.

Dr. Maley notes that while Santa Cruz is home to some very wealthy families, most of its two million residents are very poor. “There’s a large population of people who, if they get sick, can’t afford to go anywhere else,” he said. In fact, even with Dr. Dunn and Dr. Maley donating their services, transplant patients’ families must raise a significant amount of money to cover other costs. Many sell the family car or take on additional jobs to raise the funds. Dr. Dunn is actively working to find ways to help bring down those costs. And both surgeons are focused on increasing the self-sufficiency of the local surgeons.

“With each visit, we impart more expertise to the surgeons there,” he says. “I think before too long, they really can be self-sufficient. That would be tremendously rewarding— a great accomplishment for everyone on the team.”

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