The worldwide success of transplant medicine in Puerto Rico is thanks to the foundation of the first official program that gave life to hundreds of Puerto Rican patients.
Within the framework of the 10 years since the celebration of the first transplanted liver in Puerto Rico, we remember through this story the foundation of the first transplant program in the country. Relive in the voice of the protagonists the clinical advances that today are the life expectancy for hundreds of Puerto Ricans.
Dr. Juan del Río Martin recalled in the midst of the celebration of 10 years of transplantation at Hospital Auxilio Mutuo how Dr. Santiago Delpín inspired him to live in Puerto Rico and be part of the history of this type of surgery. An inspiration that today has become the dozens of doctors who are part of the multidisciplinary teams that make these procedures possible.
Experimental surgery, transplantation and immunology. Mentor of physicians and surgeons, co-editor of the first book in Spanish on transplantation with nearly 2,000 transplanted kidneys during his career among adult and pediatric patients.
From the mentorship and advice of Dr. Francisco Raffucci –pioneer in heart surgery-, who became one of the figures that took the surgical and administrative baton for the founding of the Transplant Programs of the Veterans Hospital, Auxilio Mutuo together with the School of Medicine of the Medical Sciences Campus (RCM) since the early 1970s. This was achieved when he returned from his training in immunology, kidney transplants, and liver and pancreas basics at the University of Minnesota.
“They performed the first 20 kidney transplants and were the true pioneers, but at a time when the necessary drugs and immunological knowledge did not exist, long-term results were not to be achieved,” he said.
“When I returned to Puerto Rico in the 1970s, there were no laws that could govern transplants, infrastructures, there was no hospital for transplants, no trained personnel, no data; there was a fearful attitude of doctors and nurses, especially with donation There were no alliances with other countries, transplant anesthesiologists, and quantities huge blood in liver“, he recalled.
When the Puerto Rico Transplant Program was founded after creating the infrastructure and necessary scaffoldingthe donor service was directed by Dr. Ernesto Rivé Mora, who guided it for 35 years.
As the service was having a high demand in the population non-veteran, after the 135 successful transplants -including the first in 1977 officially under a transplant program-, the mobilization of the program was considered, and the Auxilio Mutuo Hospital accepted said assignment.
On September 21, 1983, the first kidney transplant from a living donor was carried out at Hospital Auxilio Mutuo as the beginning of the new program in that institution.
The transplant team demonstrated the success of these interventions on the island, where these patients, a year after their operation, 98% were alive and over 96% of the transplanted kidneys continued to function.
More than 100 children and even babies weighing between 12 and 20 kilos were transplanted (kidneys to) and many of them are alive with their transplant. Elderly people or people with diabetes were also transplanted, all with good results. We transplanted over 40 patients who were 70 years old or older and five who were over 80 years old. “Age cannot be a factor in excluding a patient from the benefit of this surgery if they were in good health and functional,” she said.
Another achievement that the team can highlight is its authorship of over 200 scientific publications and various positions at the University of Puerto Rico (UPR) and other institutions.
Santiago Delpín served as Associate Dean of Biomedical Sciences from 1988 to 1990 and as director of the Department of Surgery between 1990 and 1993, both at the UPR. He was director and participated in the founding of organizations such as the Puerto Rican Kidney Foundation, the Renal Council, the Puerto Rico Organ, Body, and Tissue Disposal Board, the Allergy and Immunology Society, the Raffucci Forum, the Latin American Registry of Transplantation, the Pan-American Society of Dialysis and Transplantation, the Transplantation Society of Latin America and the Caribbean, among dozens of other medical associations of which he has been a member.
Despite the fact that during the first 20 years organ donation in Puerto Rico was scarce, surgeons such as Dr. Luis Morales Otero, LifeLink’s medical director, helped establish the alliance with LifeLink Florida and the foundation of LifeLink Puerto Rico, which resulted in a dramatic increase in donations and has positioned Puerto Rico at number 26 in the world and number one in Latin America when measuring the number of transplants per million inhabitants.
Previously, donation here had been very limited. Dr. Morales with his team has continued with donation and transplant education programs, and has participated in initiatives in the United States.
The advent of Lifelink then allowed the start and development of heart, pancreas, liver and combined transplant programs.
“Before, liver transplants could not be performed because we did not have a dedicated intensive care unit, intensivists and large amounts of blood. We started working with this in 1993, but the three of us could not handle everything. We established the infrastructure, we drafted the necessary laws , financing, education for all sectors, from the laboratory to nutritionists, nurses, among others,” she said, referring to her other work colleagues, Dr. Zulma González, the first female transplantologist, and Dr. Luis Morales.
It should be noted that Dr. González was one of the first transplant surgeons in the hemisphere and the first specialist to be partially trained in pancreas surgery in 1982. Then Dr. Diego Solís entered, who was a pioneer in pancreas transplantation and began surgery. hepatobiliary as a service from 2005.
Later, Dr. Carlos del Coro and then Dr. Pedro Hernández continued with the pancreas. González was also a developer and promoter of programs and education in critical medicine and in nutrition and immunology in Puerto Rico and Latin America, as well as innovative educational programs,
“Our main precept is: the patient first and a transplant program belongs to the whole country. Success is due to the work of an entire team at all levels, and with continuous communication among all. There would have been no achievements if the Hospital of Veterans had not opened the doors to establish the program, like the Auxilio Mutuo Hospital, with a concept that was seen as experimental at that time. The government also supported it all the time,” said Santiago Delpín.
Nor without the coordinators, social workers, nurses, secretaries, nutritionists, psychiatrists, support staff, administrators, consultants, hospital services and others who always functioned as an integrated team. “Continuous education and communication were key. Nephrologists, including pediatrics, were central to this joint success. Success has been shared by all,” she concluded.
Today the Hospital Auxilio Mutuo Transplant Center is directed by the Spanish surgeon, Dr. Juan del Río Martin.