Spain leads organ donation. What challenges await you?

On March 30, the National Transplant Day will be celebrated in Spain, an event promoted by the National Federation of Liver Patients and Transplanted Patients and whose main objective is thank the people who donate organs for this act of solidarity and encourage it so that lives can continue to be saved.

Despite the effects of the health crisis, which has caused a decrease in activity throughout the planet, Spain remained in 2020 – and it is now 29 years in a row – as the world leader in donation, with a rate of 38 donors per million population (pmp), as pointed out by the Council of Europe in the annual balance that it includes in its ‘Newsletter Transplant’ and which it released last August. The National Transplant Organization (ONT) then pointed out that, despite the drop in activity due to the coronavirus that year, the country’s figures exceeded those of any other in the world during the exercises prior to the pandemic. An achievement that highlights the remarkable potential of the Spanish health system in this area.

Likewise, in January last month the figures at the national level for 2021 were released, which reflected that Spain had grown by 8% to reach 40.2 donors pmp Altogether, 4,781 organ transplants were performed in the country: 2,950 kidney, 1,078 liver, 362 lung, 302 heart, 82 pancreas and 7 intestinal transplants.

Focusing on Aragón, in 2021 a total of 94 organ transplants were carried out. An activity that was made possible thanks to the 39 people who donated their organs after death and three who donated a kidney while they were alive. These figures have meant an increase in transplant activity compared to 2020 of 31%; reaching 34% in the area of ​​donation.

As reflected in January by the Aragon Transplant Coordination in its activity report for last year, the donation made in 2021 has generated more than 1,142.1 years of life for transplant patients, being 941.5 years of life gained by patients from Aragon and 200.6 years of survival for recipients of these organs in other autonomous communities, “which shows the high degree of collaboration and exchange of organs during the year” .

On the other hand, the average age of Aragonese donors was 65 years and the most frequent cause of death in these continues to be hemorrhagic cerebral vascular disease, which accounted for 46% of cases.

Low negativity rate

“For there to be a transplant, there must be a donation. And Aragón, year after year, has a refusal rate that is below the national average, standing at 13% in the last year. That means that 87% of the families that have been asked to donate have agreed, which shows the enormous solidarity of the Aragonese population and that they are aware of the importance of this”, explains Raquel Montoiro, autonomous coordinator of transplants of Aragon.

Awareness of this issue is a key point. In this sense, the initiatives developed in this regard stand out, such as the last National Meeting of Transplant Coordinators and Communication Professionals, which was held in Zaragoza last November and in which the main advances registered in the field were presented. One of the signs that this awareness is growing can be seen in the number of donor cards, which in the Community have increased significantly in recent years, going from 506 in 2018 to 1,894 in 2021.

“The media has a very significant role in raising awareness and it is important that we work hand in hand with them from the regional coordination”, Montoiro points out in this regard, who also underlines the work of the associations of affected people when it comes to getting the message across that donation saves lives.

XVII National Meeting of Transplant Coordinators and Communication Professionals, held in Zaragoza last November.

XVII National Meeting of Transplant Coordinators and Communication Professionals, held in Zaragoza last November.
Transplant Coordination of Aragon.

Regarding the decrease in activity caused by the pandemic, the head of the regional executive unit points out that every time a wave of covid occurs, there is an increase in the overload of the ucis, which is where the correct maintenance of the potential donor, so that when this happens, the donation and transplant units suffer. “Even so, at no time has activity stopped, which highlights the strength of our transplant programs.”

Regarding the process followed in these cases, the professional reports that when the patient dies, authorization is requested from the family. “The Spanish law establishes that we are all considered donors and forces us to ask family members about the patient’s will. That is why we emphasize the importance of communicating to loved ones the position in this regard. If authorized, complex intra- and extra-hospital logistics are set in motion that can involve up to 100 professionals, including health workers, police officers or airport personnel,” says Montoiro, who adds that his main objective is to reach pre-pandemic levels. , since the decrease has been around 15% compared to 2019, when the figures were “excellent”.

The reasons for success

The solidarity of citizens, the public and universal nature of the national health system and the effectiveness of a management model capable of identifying potential donors are the keys that explain Spain’s success in this area, as pointed out by the director General of the ONT, Beatriz Domínguez-Gil. “Person he has to die in the ICU, with mechanical ventilation and without contraindications, something that only occurs between 1% and 2% of cases of deaths in hospitals. Thus, the model is designed to identify these people so that the donation becomes a reality and that a highly complex process can be carried out flawlessly”, he points out.

Regarding the waiting lists –4,762 patients–, Domínguez-Gil indicates that, no matter how much transplantation is done, they will not be significantly reduced or disappear. “They always have a paradoxical behavior. Liver transplant rates recently dropped for direct-acting antivirals to treat hepatitis virus infection. And in 2020 it did go down in general because there were fewer inclusions, but the only effective way to reduce it is to develop prevention strategies that reduce the number of patients with diseases,” says the professional.

Regarding the initiatives developed from the ONT, it is worth highlighting the promotion of split liver transplantation, which allows the partition of the liver in two and that it is favoring the improvement of children’s access to these, and the ‘AB Cero Incompatible’ program, aimed above all at those under two years of age who are waiting for a heart transplant.

The most important objective set by the organization is clearly reflected in its ‘Plan 50×22’, with which they intend to reach 50 donors per million population. “We would have achieved it if it had not been for the covid, which was an obstacle for which we had to reinvent ourselves and adapt our entire program to these difficulties. Learning to coexist with the virus is the priority and that is why we are reactivating the work plans that were part of the plansuch as the pediatric line or the expansion of donation in asystole, in which we are transforming it into a multi-organ donation,” says the person in charge of the organization, belonging to the Ministry of Health.

A challenge that, however, will be difficult to achieve without the necessary resources. “Strengthening the coordination and transplant teams is an urgent need. The program urgently needs an adequate supply of human resources if the levels are to continue to be increased with security guarantees. It should be remembered that, in addition, it represents savings for the health system, since, for example, patients who have a kidney transplant stop dialysis. Likewise, it is very important to add support in relation to R+D+i”, concludes Domínguez-Gil.

This content has been produced by BLUEMEDIA STUDIO, Henneo’s Branded Content unit.

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