The first successful case of adult living donor liver transplantation was performed in Costa Rica, marking a significant milestone in that field. Developed by a Korean surgeon three decades ago, this life-saving procedure has now reached Costa Rica, a Central American nation.

On April 11, a team at Hospital Doctor Rafael Ángel Calderón Guardia under the Costa Rican Social Security Fund (Caja Costarricense de Seguro Social) successfully conducted the country’s inaugural adult living donor liver transplant. The achievement was made possible through the transfer of liver transplantation skills and expertise from Asan Medical Center (AMC).

The technique behind this groundbreaking procedure was pioneered by Professor Sung-Gyu Lee from the Division of Liver Transplantation and Hepatobiliary Surgery at AMC in 1991. Known as the ‘modified right-lobe graft,’ it enhances the success rate of living donor liver transplantation by creating a new middle hepatic vein in the transplanted right lobe. This innovation ensures proper blood drainage throughout the right lobe and has since become the standard surgical procedure worldwide.

The recipient of the historic liver transplantation in Costa Rica was Ms. Jeannette Lorio, a 60-year-old woman suffering from liver cirrhosis. Her daughter, Ms. Bianca Oviedo, 32 years old, selflessly donated a healthy liver, enabling her mother to experience a remarkable recovery.



Living donor liver transplant is a complex procedure with higher risks of complications compared to deceased donor liver transplantation. However, due to Costa Rica’s low organ donation rate at 7 per million population and high waitlist mortality rate of 30 percent, living donor liver transplantation became an urgent necessity.

Hospital Doctor Rafael Ángel Calderón Guardia, a renowned medical institution in Costa Rica, played a vital role in performing liver, pancreas, small intestine, and lung transplantations in the country and across Central America. Recognizing the need to enhance their liver transplantation capabilities, the team at Hospital Doctor Rafael Ángel Calderón Guardia sought assistance from AMC, the world’s pioneer in modified right-lobe liver transplantation and 2-to-1 living donor liver transplantation. AMC had already completed 5,000 living donor liver transplantations by 2018.

In May 2019, AMC decided to share their expertise in living donor liver transplantation, initiating a comprehensive training program. The 24 members of Hospital Doctor Rafael Ángel Calderón Guardia’s liver transplantation team underwent rigorous training at AMC, spanning five sessions from December of that year.

The training encompassed specialists in surgery, anesthesiology and pain medicine, radiology, as well as nurses from the operating room and intensive care unit. They received six weeks of intensive training covering surgical techniques, post-operative care, and complications management. The Costa Rican team fully immersed themselves in all aspects of AMC’s liver transplantation procedures, actively participating in daily meetings, organ retrieval from deceased donors, and even emergency surgeries conducted during late-night hours.



Following the completion of their training, Hospital Doctor Rafael Ángel Calderón Guardia’s liver transplantation team returned to Costa Rica and established various systems within their local setting. These included implementing a living donor liver transplantation program, improving vascular reconstruction techniques, launching a laparoscopic surgery program, standardizing liver transplantation nursing techniques, refining intensive care unit nursing management, and enhancing infection control for liver transplantation recipients. Through these initiatives, they achieved the successful adult living donor liver transplantation in April of the following year.

Professor Vanessa Lopez, a specialist in liver, pancreatic, bile duct, and transplant surgery at Hospital Doctor Rafael Ángel Calderón Guardia, led the groundbreaking surgery. She expressed gratitude to AMC’s liver transplantation team for their wholehearted support and acknowledged the transformative impact on patients and their families in Costa Rica.

Professor Sung-Gyu Lee from AMC commended Hospital Doctor Rafael Ángel Calderón Guardia’s liver transplantation team for their skillful execution of this challenging surgery and extended congratulations and gratitude. He reaffirmed AMC’s commitment to sharing medical expertise globally, offering patients around the world second chance at life.

The knowledge transfer of liver transplantation has been an ongoing endeavor at AMC. Starting in 2011, the transplantation team has been visiting Mongolia and Vietnam, countries with a high incidence of liver cancer, multiple times a year to train local medical professionals. Additionally, over 250 local medical professionals have been invited to AMC for specialized training. These efforts have resulted in the ability of the First Central Hospital of Mongolia and Cho Ray Hospital and University Medical Center (UMC) of Ho Chi Minh City (HCMC) in Vietnam to independently perform liver transplantation.



Moreover, AMC’s liver transplantation team has expanded their knowledge transfer initiatives to other countries. They achieved several notable milestones, including Turkey’s first adult living donor liver transplantation in 2001, France’s first and the first in Europe, 2-to-1 living donor liver transplantation in 2004, Turkey’s first 2-to-1 living donor liver transplantation in 2006, Qatar’s first adult living donor liver transplantation in 2016, and Kazakhstan’s first 2-to-1 living donor liver transplantation in 2019.

AMC’s liver transplantation team continues to lead the global field of liver transplantation, boasting an impressive record of 8,000 liver transplantations, 6,658 living donor cases and 1,342 deceased donor cases, with a success rate of 98 percent as of September 2022.

By Minu Kim

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