Juan Vicente del Río Martín: the man behind the transplants

This interview is not intended for colorless or fragile souls. They are then listed.

Let's talk about the most mean of our internal organs. To the right of the belly I say that they do not feel unnecessary. It is not convenient. It is a surly animal, a small friend of the pats and hugs. Dr. Juan Vicente del Río Martín knows them as nobody. To the liver, I mean. It is aimed at extracting them if they no longer want to work, and then it ends up in a healthy place. A whole liver, or half, depends on it. Technically, you can cut a liver into three parts, for as many sick as people who need it. The general thing is that it becomes whole, or divided in two. After the liver is reconnected to your new host, the liver gradually grows to a normal size. It is the only organ that regenerates, like the tails of the lizards.

"No," he told Del Rio enthusiastically. The tail of the lizard comes out in the same way as before. The liver, no. Hypertrophy, never returns to the original liver form.

Better, I mean, it does not matter. It is not worn on the outside.

In Puerto Rico, thanks to the tenacity of this Spanish physician, the 55-year-old Toledo, who runs the transplant center of the Auxilio Mutuo hospital, between 40 and 45 liver transplantations are performed each year, for a total of more than 240 transplanted livers. In just over six years, since the first was made, a man of 57, in February 2012.

– And is that first transplant still alive?

-What if he lives! The liver worked perfectly.

On my question if his hands were ever shaken before he started working – a liver, after all it is a liver: an ugly and slippery thing – Dr Del Río admits that, before he did that first operation in Puerto Empire, historically in many respects, he felt a slight quake. It was the only time and he had his reasons. Two years earlier, in 2010, he left the management of the liver transplant center at the Mount Sinai Medical Center in New York, where he carried out more than 400 transplants, to come to Puerto Rico to arrange the design and organization of the facilities. in which he would later save the lives of hundreds of people. He had not been active for a while, supervised even the smallest details of the new operating rooms and was dedicated to recruiting the cream from the professionals who would accompany him. Everything went well that first time. And it went well in general, even after the passage of hurricane Maria. Within 48 hours, after the last storm, they were ready to continue with operations.

-We never stopped receiving organs and were also not thrown away because of logistical problems.

I told him that in Asian countries, especially India, where it is difficult to get organs from dead donors, for religious reasons and the funeral ritual, almost all transplants come from living donors.

– It is not necessary here. We do not run that risk. The liver comes from brain-dead donors. In contrast to the donation of the kidney or bone marrow, where the risk is reduced, the person who donates part of his liver may have major complications.

"Part of your liver" is an unstoppable sentence. Dr. Del Rio says that they had discovered in ancient times that this viscera is regenerating, and from there the Greek myth of Prometheus and the eagle would have arisen, the bird sent by Zeus to devour the liver of the chained hero; liver that has grown at night, however. That rock where Prometheus cried was the first transplant center.

The liver transplant brings out the best in everyone, says Del Rio, and the people around the patient. The candidate must have a family environment that supports him when we dismiss him, and that he is on top of him to take his medicine and diet … It is very sad that he eventually passed two or three days and he forgot to take the pills, that liver that has been transplanted with so much difficulty, is ruined, with great emotional and economic costs. We are talking about an operation that costs about $ 300,000 on average.

The next question I meditated. I do it with my heart in my hand (this is scattered), and a little whispering, because I know that many patients listen to us. The question is: when time passes, when that liver works like any other – and is happier than the tail of a lizard – can the transplant take a drink for the health of the surgeon?

-No, I do not recommend it. Alcohol causes an effect that we see later in laboratories. We quickly find out if the patient has drunk. But almost nobody does it. After the operation, when the transplant used to drink, it did not even feel like it. In Puerto Rico the main cause of liver failure is not alcohol, but hepatitis, or autoimmune problems, and especially obesity, there are too many fat livers.

Married to Raquel, the driving force behind his fast career, and the mother of his three children, is Dr. Del Río Catholic of the daily mass and communion, so it is inevitable to ask him about the cause of God. The hours that the transplantation takes, the process of removal and placement in the privacy of the operating room, the same moment when it withdraws the useless organ and it resembles the hollowness in the abdomen of the other, there is not a shock, an existential something , a seduction of atheism like that of Saint Therese of Lisieux, who said at the end: "Even if you do not exist, I love you"?

-no. I confirm my trust in every operation I do. I see the perfection of God.

But what perfection, if it removes a substance made by the liver …

– And I put another one that has been given by the family in the realization that it will save one or two lives. Is not that perfect? I did not come to Puerto Rico for economic reasons. I wanted, yes, to leave New York to another place in the United States where these procedures were not carried out, and thus be able to develop them from scratch, in my own way. I arrived at the Auxilio Mutuo, the San Vicente building, the old part. I saw that checkered floor, the statue of La Milagrosa next to the stairs, the crucifixes, the community of the nuns …

– They have a cock.

-Who? The doctor asks.

– The nuns. A rooster I saw it there. They recently interviewed him for the hospital magazine.

– Rooster? … The fact is that I called my youth in Toledo. It was the language. The smell of those things that I believe in. I would not find that in any hospital in the United States. At that moment I felt that God had brought me and I decided to stay.

With everything and the impressive number of transplants that are carried out in the Center that he leads, and that currently has a survival rate of 85 percent, which is one of the best in the United States, is of the opinion that only half of the people who need it are transplanted, a figure that is calculated in relation to the number of inhabitants.

– Sometimes patients arrive too late or do not even arrive at the transplant center. They go from doctor to doctor and until it is certain that he is a candidate to get a liver, he spends a lot of time. One of the biggest challenges we have in the health system of Puerto Rico is to improve the communication lines between primary doctors and specialists.

As far as he is concerned, he informs me that he is ready to perform a larger number of liver operations or pancreatic, another transplant in which the Center specializes. These operations, which last about six hours in the best hospitals in the world – depending on the method used – consume barely three, with the help of a technique he has perfected and which has earned him worldwide recognition. Thanks to this technique you usually do not have to transfuse blood during the intervention.

-The procedure of transplantation of the organs in general, and the liver in particular, has evolved a great deal in recent years. The drugs to prevent rejection are becoming more accurate and less toxic.

It brings with it a book that has become the bible of anaesthesiology and critical care in liver transplants. Dr. Juan del Río is one of his employees – the only one who is based in a Caribbean hospital – and although he does not say so, he is overflowing with pride for the chapter he has written. It is a chapter for specialists, explaining the different technical options of transplantation. The photo's and drawings that illustrate it are from Del Río himself.

– Look at the gate triad … Those three conduits are the ones that I reconnect in a transplant.

I have restored myself Go as I mark it. A hepatic artery, a vein, a bile duct. Striemen. Surgical forceps that capture the ends of a gland that has an undeniable reptilian shape. We are nothing. I would urgently need the cup that is closed for the transplanted.

Dr. Del Rio scans the article so that he can read it later. In El Antiguo Bilbao, the bakery that formed the framework for this meeting, there is a slate with the menu of the day. I ask the doctor if he does not mind to display himself there, just before the "liver onions".

– No why?

He stands up for the photographer. The viscus that regulates the sense of humor is unique and adjustable.

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