Expanding Lifesaving Pediatric Liver Transplant Care from New York to Santo Domingo

Last July, Dr. Mercedes Martinez wrapped up a long week treating pediatric liver disease patients at her Washington Heights office. While she was finished with her cases at NewYork-Presbyterian/Morgan Stanley Children’s Hospital, her work was not done as she headed for the airport. She had another patient to care for — in the Dominican Republic. Dr. Martinez, along with a group of physicians, surgeons, radiologists, and clinicians, boarded a flight to help perform a lifesaving transplant on a young teen. It was the team’s fourth transplant in the country, which otherwise had limited access to pediatric liver transplant care.

“The option to receive life-saving treatment is not there. I think there are many countries in Latin America that can benefit from a program like this. We want to give back, and to do it pro bono, it’s really because we want to help kids and save lives,” she says.

As medical director of the Intestinal Transplant Program at the Center for Liver Disease and Abdominal Organ Transplantation at NewYork-Presbyterian, Dr. Martinez strives to improve the health outcomes of children at one of the largest transplant programs in the nation.

And when not working at her day job, she helps provide free educational and clinical support to liver transplant programs in underserved areas in Latin America and the Caribbean, fielding calls and reading labs results afterhours, and travelling to other countries on the weekend for the transplant surgeries. “I feel extremely fortunate to live in this country and at the same time, feel very attached to my people and want to give back to the Hispanic population,” Dr. Martinez says. “As a healthcare worker, it’s about helping wherever you can. A little bit of effort can save a lot of lives.”

Dr. Martinez grew up in a rural area of Cuba and was inspired to pursue a career in medicine. In her native country, she studied to be a general surgeon, but when she arrived in the United States in 1997, her path pivoted to pediatrics, where she specialized in hepatology.

“I was drawn to the miracles that happen when you see young patients go from extremely sick to thriving after transplant,” she says. “I couldn’t ask for a better opportunity than the reward of seeing them grow up and do fantastic things.”

When she joined NewYork-Presbyterian/Columbia University Irving Medical Center in 2003, Dr. Martinez felt an immediate connection to the community in northern Manhattan, especially the Dominican population. After visiting the Dominican Republic to give medical lectures and seeing young children with end-stage liver disease, she felt compelled to bring high-quality hepatobiliary care to the country.

“I was motivated by the human connection,” she says. “In Cuba, I grew up extremely poor, and if I was one of these kids with liver disease, there would be no option for me to survive. When I returned to the Dominican Republic six months after a trip, four of the kids I previously saw had died. After ten months, they all had passed. This work has come out of the needs that unfortunately, when unmet, come at the cost of children’s lives.”

Dr. Martinez found a partner in Dr. Tomoaki Kato, who in 2011 co-founded an organization called Fundahígado America, a group created to increase access to pediatric liver transplants in Latin America and the Caribbean by supporting improvements in hospital infrastructure and offering training and education to local medical staff.

Dr. Kato, chief of transplant surgery at NewYork-Presbyterian/Columbia University Irving Medical Center, was already working to expand pediatric liver transplant care in Venezuela with Venezuelan surgeon Dr. Pedro A. Rivas Vetencourt, founder of Fundahígado, a non-profit dedicated to treating patients with liver disease.

Dr. Martinez flew to Venezuela on several trips to oversee medical management for young patients. Over the years, the Fundahígado America team sought to replicate the success they found in Venezuela by offering training programs in Costa Rica, Guatemala, and El Salvador.

While healthcare access in Latin America is varied, some areas are limited in infrastructure and resources to provide surgical treatment such as liver transplant and the close follow-up care that comes with it. In the Dominican Republic, there is only one active liver transplant center, compared to 78 in Brazil, or 27 centers in Argentina, according to a 2023 study.

After nearly nine years of involvement with healthcare institutions, government officials, and local stakeholders in the Dominican Republic, Dr. Martinez was part of the organization’s first living donor pediatric liver transplant in the country in 2021.

Since then, she and her colleagues – some from NewYork-Presbyterian/Columbia University Irving Medical Center’s pediatric liver transplant program, and many others from Fundahígado’s Venezuelan and Dominican teams – have performed four pediatric living donor liver transplants. Through philanthropic funding, the surgeries and post-transplant support are without cost for the patients and families.

“Going back to see the kids doing beautifully and being able to spend time with them, it’s amazing,” she says.

During her visits she provides guidance by rounding with their clinical teams. When she returns to New York, she remains involved in the patients’ post-op care, often speaking to the international teams multiple times a day.

“It’s a big investment, but the goal is to train and support the local medical teams in their environment until they can perform cases on their own,” Dr. Martinez says.

In addition to patient care, she continues to speak at educational events to share her expertise in hepatology.

“I give lectures in many different places, but I appreciate the opportunity when I can give them in Spanish because I can connect with people in their native language,” she says. “I’m proud to be part of a culture of giving back, and to work with doctors across the world who are looking to improve and get to the next level.”

She credits the Plaza de la Salud partner hospital in the Dominican Republic’s capital, Santo Domingo, which has been able to expand services for their wider patient population due to the additional educational and technological advancements the program provides.

“Children continue to be at risk, and I hope to raise awareness for more people in the world that would be willing to invest in missions like this,” Dr. Martinez says. “I feel honored knowing I can give my time and knowledge to come together with others to help people more than a thousand miles away. Things can change, one child at a time.”