The United States has clearly increased its organ transplant activity in recent years, so much so that it has placed itself in second place in the world for donors, only surpassed by Spain (48.9 donors per million inhabitants compared to 44. 5 per million inhabitants in the US). This is explained by the notable increase in young donors as a result of deaths from weapons, trafficking and, in recent years, fentanyl. While in Spain the donor profile is over 65 years old, in the United States they only represent 9%.
This was stated by the director of the National Transplant Organization (ONT), Beatriz Domínguez-Gil, during the XIX National Meeting of Transplant Coordinators and Communication Professionals, which was held in Toledo. Although Spain has “elderly donors”, its leadership continues for 32 consecutive years.
“Even with a more complex population we have a great capacity to transplant. Last year, 5,863 transplants were performed, 9% more than in 2022. And this year’s goal is to exceed 6,000,” he explained.
How is it possible if there are fewer and fewer brain deaths (traffic deaths, work accidents…), the main source of organs in the United States? “Things are getting difficult,” acknowledges the director of the ONT, but “there are options to improve what is already being done.”
For now, the search for possible donors beyond the ICUs has intensified (active detection by hospital transplant coordinators). The ONT has established an entire strategy to locate patients who want to donate in their last moments of life. These are admitted to the UCI to follow the entire process.
In addition, donation in asystole (deaths in cardiorespiratory arrest) continues to be promoted, which already represents 45% of donors. In this group, people who have exercised their right to die (euthanasia) stand out. 13% of them have donated their organs: 90 since the law was approved at the end of 2021 until December 31, 2023.
And they want to promote living donor donation (kidney and liver), which is not developed as it should be in all autonomous communities. At this moment they represent 12% of the total.
The director of the ONT believes that one of the impediments to the development of living donation is the lack of a law that protects them not so much at a health level, which is guaranteed, but at a labor level. This rule was written and prepared, but the call for elections caused it to be forgotten. The law protected the donor in the workplace to facilitate sick leave for both the preoperative period, the intervention and the following check-ups. “This rule is fundamental. We know of cases in which days are denied to do the reviews or to check compatibilities. And we know, for example, that a father was fired because he was going to donate his kidney to his daughter and that meant some casualties. Either your daughter or the company, they told him. And that cannot happen,” says Beatriz Domínguez-Gil,
But all this is insufficient to cover the needs. The waiting lists remain, despite the increase in transplant activity, because the criteria are becoming more flexible. At this moment there are almost 4,800 patients waiting for organs (almost 4,000 a kidney), of which 12% have “very difficult” getting them. They are hyperimmunized patients (pregnant women, people who have already had a transplant…), and who have been on dialysis for up to 7 years.
Despite the size of the waiting list, it has nothing to do with the American one, where, for example, there are 250 patients per million inhabitants who need a kidney, compared to 150 in Spain. Because? Because of the universal and free health system that Spain has, which allows us to better address the chronicity of citizens, something that does not happen in the United States. “In the United States they are looking for an immediate source of organs in animals,” explains the person in charge. of the ONT. (They have already performed three xenotransplants: two pig cardiac transplants modified in the laboratory, and the first made public on March 22, the first kidney transplant.
In Spain, work is not being done on xenotransplants, but to obtain new “sources” of organs, research and innovation have increased everywhere. At the Toledo meeting, Nuria Montserrat, group leader at the Institute of Bioengineering of Catalonia, explained what her team works on: how human tissues are generated to better understand why they stop functioning during the disease.
By generating small cultures that resemble human organs, called organoids, the Montserrat team has led work to decipher how the kidney and heart are formed in humans.
