Dr. Tomoaki Kato of New York's Columbia University Medical Center began performing the transplants in Venezuela a decade ago
Clutching a tiny Bible, Gilda Velasquez leans over her son as he falls asleep with the help of a powerful sedative and a catchy cartoon jingle playing on a hand-held TV.
"Remember, you're a Christian, you're a Christian," she repeats amid her tears to Yin Carlos as orderlies wheel the 6-year-old into the operating room where he will get a new liver.
For any family touched by liver disease, an organ transplant can be a second chance at life. But the procedure is practically a miracle in Venezuela, where an economic crisis makes even needles and acetaminophen scarce.
Yin is benefiting from the efforts of a U.S.-based surgeon and his counterpart in Caracas who have helped save dozens of Venezuelan children with failing livers.
The doctors now hope to replicate their success in such a challenging environment as Venezuela and assist hundreds of boys and girls from other parts of Latin America and the Caribbean where pediatric transplants are unavailable.
Dr. Tomoaki Kato of New York's Columbia University Medical Center began performing the transplants inVenezuela a decade ago after he was contacted by Dr. Pedro Rivas Vetencourt, a surgeon at Caracas' Policlinica Metropolitana.
The Japanese-born physician says that back then he couldn't even locate Venezuela on a map. But he and Rivas Vetencourt have now performed 50 pediatric transplants with living donors in the South American country, gradually building a large team of medical professionals.
With live-donor transplants, surgeons remove a recipient's diseased liver and replace it with part of the donor's healthy organ. Both the donor's liver and the donated section of organ subsequently grow to full size.
Kato and Rivas Vetencourt say they have a one-year survival rate of over 90 percent for the procedure they perform at Policlinica Metropolitana, which is similar to outcomes in the U.S. After that, the risk of infection or complications falls dramatically and most recipients go on to lead healthy, long lives.
The socialist government provides 30 percent of the funding for the transplant program that aims to help poor families like Yin's. Philanthropy, medical insurance and the patient's family pay for the rest of the procedure that costs roughly $20,000 at the weakest of Venezuela's three official exchange rates, including a steep discount by the surgeons.
Yin's family didn't have to pay a cent because the father's employer picked up the remainder of the bill.
Hours before checking into the hospital last month to donate part of his liver to his son, Jean Carlos Fernandez recounted the last two hellish years. Yin made multiple visits to the emergency room, frequently missed school and the family had to sell their home in the eastern city of Maturin to pay for overnight bus trips to the capital for exams to investigate why the boy's liver was scarring.
"The doctors told me that if we don't find a donor, the boy will never reach the age to have a girlfriend," Fernandez, a construction worker, said while resting at a relative's apartment on the outskirts of Caracas where a photo of the late President Hugo Chavez featured prominently on the wall.
Yin, his stomach bloated and skin jaundiced from liver disease, seemed oblivious to the pending 12-hour operation. The shy, soft-spoken boy practiced writing the alphabet in a notebook and said he wanted a pinata for his July birthday.
Once the surgery was underway, about a dozen medical professionals led by Rivas Vetencourt extracted the child's mottled liver while Kato, heading a similar team, spliced a 400-gram (almost 1 pound) portion of his father's healthy organ.
The World Health Organization says that only about 150 pediatric liver transplants are performed each year in Latin America and the Caribbean, mostly in Argentina and Brazil, compared with about 600 in the U.S.
"A lot of children die each year in Latin America because they do not have all treatment options locally for end-stage liver disease," said Dr. Juan Carlos Caicedo, a Colombian-born doctor who oversees a transplant program geared to Hispanic children and adults at Northwestern Memorial Hospital in Chicago. "A lot more pediatric transplant programs are needed in the region."
The payoff can be huge in terms of lives and money saved. An organ transplant in the U.S. costs upward of $500,000, but it's just a fraction of that in Latin America. Successful transplants can also save money by sparing years of costly dialysis and other palliative treatments.
With the backing of Venezuelan fashion designer Carolina Herrera, who met Kato when he performed a life-saving operation on her cousin, the two doctors have created a foundation, FundaHigado America, to raise funds to train medical teams in Latin America and the Caribbean. They hope to launch the project in the Dominican Republic later this year.
For hospitals across the region, recruiting and retaining talent is a major challenge. Many Latin Americans who study in the U.S. are easily enticed into staying, as Rivas Vetencourt says he almost did after completing his fellowship at the University of Illinois-Chicago. If they do return home, facilities and nursing staff aren't as advanced, making it more difficult to provide the same quality of care.
In Venezuela, currently known more for a health care crisis rather than state-of-the-art medicine, the difficulties are even more pronounced. Venezuela's Medical Federation says more than 10,000 doctors have left the country in recent years as salaries — especially at public hospitals — have tumbled with a currency that has lost more than half its value on the black market this year alone.
A few of the doctors who Kato and Rivas Vetencourt spent years training were among those doctors leaving.
As Venezuela's economic crisis has deepened, the government has been allocating fewer dollars to the private sector, leading to widespread shortages of medical supplies and equipment.
"This is like a storm and it's my job to make sure people don't get wet," Rivas Vetencourt said.
Some hospitals, including the once-prestigious public University Hospital in Caracas, have had to suspend all surgeries. Kato says on occasions he has had to ferry vascular clips and other hard-to-find supplies in his luggage.
But the two surgeons said the sacrifices are worth it.
Yin, who was discharged from the hospital this week, is expected to make a full recovery. He'll spend the next three months convalescing with his family in Caracas, wearing a surgical mask to guard against infection. While shy as ever — his family jokes he should've had a tongue transplant — he's smiling more and the whites of his eyes have returned to their natural color, a sign of a healthy liver.
Kato and Rivas Vetencourt are also thrilled, because with every life saved a legacy of knowledge is being left behind in a country long accustomed to losing its best doctors.
"If you go do surgery and go back (home), there's nothing left when the surgical team leaves," said Kato. "This is a different approach."
