Transplants recover the pre-pandemic level and minimize the "collateral victims" of the coronavirus

It is explained in an interview with Efe by the director of the National Transplant Organization (ONT), Beatriz Domínguez-Gil, who, however, underlines that recovery started soon, in June 2020, with a rate of activity "above expectations" taking into account that they lived with the virus, and that it is evidenced by a 6% increase in donations and 7% in transplants in the first ten months of 2021.

Domínguez-Gil specifies that there was no increase in mortality in patients on the waiting list In 2020, what happened was that the transplant was less indicated and hence those thousand people, compared to 2019, who did not get to join the lists or did so belatedly due to the saturation of the system.

Waiting lists

Today the waiting lists have practically recovered their times, which in Spain they are very small compared to other countries in Europe: twelve to eighteen months for the kidney, but less than four months for all types of organs. And to emphasize the waiting times in Spain, Domínguez-Gil recalls that in Germany a patient must wait on average seven years for a kidney transplant.

The director of the ONT emphasizes that the Spanish transplant program "It works very well", which he attributes to the fact that it is built on a universal and public National Health System with technical capacity and a very supportive society.

Domínguez-Gil explains that the foundations of the Spanish transplant model were set in motion when the ONT was created (1989) in collaboration with the autonomous communities, and it focuses on transplant coordination units within hospitals with professionals who come from the intensive care units.

But also, Spain, he says, is distinguished by continuous training, action protocols and evaluation of results, such as the XVII annual meeting of transplant coordinators held this week in Zaragoza. It is an organizational and management model that justifies success together with the avenues for improvement that are being implemented.

New ways

And to increase the available organs, the ONT has been launched. With the entry into force of the euthanasia lawIn June 2021, requests began to arrive from people requesting assistance to die and, therefore, the donation of their organs. At the moment eight have arrived: two have already donated organs that have allowed six transplants and the other six requests are being evaluated.

The ONT is finalizing an action protocol with the transplant coordinators, since this type of death is compatible with donation, although death must occur in the hospital setting. It is, says Domínguez-Gil, that the cardiorespiratory arrest occurs in a controlled environment to be able to act quickly and that the organs are valid for transplantation.

Domínguez-Gil explains that, in general, donations from the deceased are produced from brain death with catastrophic brain damage and the transplant coordinator's relationship is with a grieving family.

In the case of people with neurodegenerative diseases, such as Amyotrophic Lateral Sclerosis (ALS), it is the patients themselves who, given the imminence of their death, are interested in donation and have such conversations in the first person with the coordinators. This year 29 people who died with ALS have donated their organs, 35 in 2020 and 124 since 2013. In total, these donations have made it possible to perform 310 transplants.

As for the deceased with covid, Domínguez-Gil specifies that on the one hand there are the donors who at the time of death present Positive PCR, that is, they have been diagnosed with covid, they have been clinically cured but the positivity persists and they die for another reason. In this case, the instruction is clear and if the symptoms have been mild and the viral load is low, it is safe to go ahead with the donation. In fact they have already been made six transplants from three PCR-positive donors.

And then there is the patient who dies from covid. This situation is being explored, but with a view to becoming a reality in the coming months for all organs, except the lungs.

In addition to these novelties, Domínguez-Gil recalls that in recent years other avenues of work have already been launched, such as collaboration with intensive care aimed at donation, transplantation of the elderly, pediatric donation and non-heart beating (absence of heartbeat for more than 5 minutes), which has revolutionized the model.

Objective: normalize

Domínguez-Gil acknowledges that the transplant program has suffered as a result of the covid, but has also shown signs of "recovery, adaptation to a complex environment and reconstruction." "And we have been able to reach some extraordinary levels of activity compared to any country in the world and, in addition, we have continued to innovate, "he adds.

The director of the ONT maintains that, taking into account the vividness, we should have a "very high level of satisfaction with what has been achieved" and as a legacy she says that she would like, rather than improve figures that can be altered by factors beyond our control, "normalize donation". It would be, he says, that "as a country and hospital policy, donation becomes normal in any end-of-life process, "and that the patient can be a donor whenever he wishes."