What Is Excellence in Pediatric Liver Transplantation?
Clinical excellence is developed through experience. Our team includes clinicians, some of whom were involved with the earliest pediatric liver transplants, performed in the United States. From the beginning, we have been involved in developing best practices for surgical technique as well as determining which patients need and will do best with transplantation. In fact, one of our team members authored a landmark article on patient selection that is still relevant today, more than 30 years after it was published.
But there is more to the story.
At Nemours, true excellence means bringing our experience and skill to as many children as possible by increasing access to care. Today, we perform 2.5 times the number of transplants on African American children than other centers, yet barriers to care persist. Poverty, poor availability to health care facilities, discrimination and limitations in medical institutions, such as a lack of staff expertise and a hesitation to care for patients who are high risk, constitute obstacles. Fortunately, we have improved access to life-saving transplants through new techniques and outreach efforts.
Improving Access Through New Technique
There are not enough pediatric liver donors for all the children who need to be transplanted. One of our surgeons helped to pioneer a collaborative effort to develop techniques that allow adults to be living donors for small children. The method uses only a portion of the adult liver. This means parents or other matched relatives can donate a small portion of their liver to a child. Using this approach, we have nearly eliminated the number of children who died waiting for a liver in our program.
We also pioneered the use of liver transplantation to treat children with liver tumors that could not be treated with surgery or chemotherapy. Our efforts were initially met with skepticism. But our success, along with that of others, led to policy changes that allow more of these children to receive liver transplants. Today, we transplant a higher proportion of children with liver cancer compared with other centers and have one of the highest transplant success rates in the United States.
But we did not stop there.
Improving Access Through Outreach and Partnership
Twenty-five years ago, our team started a liver transplant program in Bolivia by training local surgeons. We started a similar program in India two years later. Today, we continue to initiate new programs in countries where clinicians are ready to begin the journey of providing this care to children.
What is excellence in pediatric liver transplantation?
It is excellent outcomes for all children who need liver transplantation anywhere in the world.
It is using the next available, high quality liver for a child even when it requires technically demanding surgery, while delivering excellent outcomes and reducing the risk of dying on the wait list.
That is what we believe. This is who we are. We would feel privileged to become a part of your child’s liver transplant journey.
References and Resources
Pediatric liver transplantation: Patient evaluation and selection, infectious complications, and life-style after transplantation; Transplantation Proceedings, September 1987, 19 (4):3309-16.
From the Desk of Stephen P. Dunn, MD
Nemours Pediatric Transplant Surgeon
Chair, Nemours Department of Surgery
Excellence in pediatric transplantation is commonly regarded as having a superior number of children who both survive surgery and live successfully with their transplanted organ for three years. This is the standard used by the United Network for Organ Sharing (UNOS)