CPMC Surgeon Performs Iraq's First Liver Transplant

Iraqi Family Grateful as 23-Year-Old Receives Liver from Brother

By Patrice Chamberlain and Laura Miyashita

Last November, surgeon Assad Hassoun, M.D. led a special medical mission to Iraq. What he could not have known then was that one surgery would not only change the lives of a family—it would ignite the spark of hope for many. It would also bring with it possibilities for an entire medical system. Hassoun, surgical director of CPMC’s Pancreas Transplant Program, went to the country in which he was born and raised to perform Iraq’s first liver transplant.

For Dr. Hassoun, a native of Babylon, Iraq, the successful transplant represented a way to give back to his country. “While our surgery represented Iraq’s first liver transplant, I am hopeful that it will ultimately be one of hundreds performed in the next decade,” he says.

A Vision to Provide Liver Transplant

During a 2004 visit to Iraq, Dr. Hassoun began recognizing that many young Iraqis were suffering from liver failure. Because Iraq’s medical system had been stymied for decades under Saddam Hussein’s rule,
economic sanctions and war, there were no options within the country for transplant surgery.

“Traveling to India or Pakistan for a liver transplant is a luxury few Iraqis can afford, not to mention the bureaucratic hurdle of obtaining governmental financial support,” explains Dr. Hassoun. The message was clear:Iraq needed to develop its capacity to perform liver transplants so that citizens with advanced liver disease would have a viable treatment option.

In subsequent visits, Dr. Hassoun met with Ministry of Health leaders and surgeons in an effort to provide Iraqis with advanced liver disease care. Eventually, he identified Zheen International Hospital, in the Kurdistan region of northern Iraq, as the best partner for his vision. The hospital
manager was unfamiliar with liver transplants but open to the prospect.

Transcontinental Connection

Liver transplantation using a living donor requires a great deal more expertise, preparation and management than a transplant from a deceased donor. In the U.S., only about 200 living donor liver transplants are performed annually by 40 transplant centers. Preparing to do this procedure 7,500 miles away is an entirely different story.

“I worked with Iraqi doctors in Baghdad and Kurdistan to identify potential candidates, ultimately selecting a 23-year-old man and his 27-year-old brother to be the recipient and donor,” explains Dr. Hassoun. Meanwhile, in San Francisco, he and his colleagues carefully reviewed preoperative tests and data, sharing CPMC’s liver transplant protocol with the Iraqi doctors. They also solicited donations of medical supplies, knowing there would be minimal access to equipment in Iraq.

In addition to medical preparations, Dr. Hassoun educated his colleagues about Iraqi customs. “In Iraq, it’s typical for men to hug, kiss and hold hands in public, but atypical for men and women to do this,” he says. Nurse Shannon Yrigoyen, R.N., of CPMC read Lonely Planet guidebooks to better understand the cultural landscape of Iraq. After studying up on security and cultural differences, she and her colleagues were reassured and encouraged to proceed with the trip.

Overcoming Transplant Obstacles

Following a 16-hour flight to Kurdistan, Dr. Hassoun and his team got to work immediately, their excitement overpowering tremendous jet lag. Surprises that could have led to disaster were instead met with creative solutions. “The local blood bank had a plasma and platelet shortage, so the patients’ dad eagerly recruited 20 people [all with the correct blood type] to donate in advance of the surgery,” explains Dr. Hassoun. Likewise, the absence of an ice machine on which to keep the donor
liver was solved by freezing sterile water and grinding it to slush.

The first day, the team worked 20+ hours performing the donor’s surgery to remove the right lobe of his liver and then transplant it into the recipient. Ultimately, the exhaustive efforts and months of careful planning were met with success: Both the donor and recipient surgeries went smoothly.

“The brothers were aware this was a very risky surgery, and they were willing to take that risk to save a life,” says Jonathan Judy, M.S., R.N., ACNP, a CPMC ICU nurse practitioner. Now, both brothers are healthy and educate others about liver transplant.

This May, many of the same team members returned to Iraq, performing three additional split liver transplants. “All of these patients were very sick before their transplant, but were discharged home within 10 days, and are now being followed by a local hepatologist,” says Dr. Hassoun.

Yrigoyen, who has now traveled to Iraq twice to assist with transplants, marvels, “Dr. Hassoun has such a big heart for his country.” But her biggest takeaway is: “We all believe the same — whether in Iraq or the U.S. We hurt the same pain. Bleed the same blood. And we need the same care.”

For more information on our liver disease and transplant services, visit www.cpmc.org/advanced/liver/.