The United States has increased its activity of organ transplants in recent years in a clear way, so clear that it has been placed in the 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 USA). This can be explained by the remarkable increase in young donors as a result of deaths from guns, traffic and, for some years now, from fentanyl. While in Spain the donor profile exceeds 65 years, in the United States they represent only 9%.
This was indicated by the director of the National Transplantation Organization (ONT), Beatriz Domínguez-Gil, during the XIX National Meeting of Transplantation and Professionals, which was held in Toledo. Despite the fact that Spain has “big 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 carried out, 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 (deaths from traffic, from 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”.
At the moment, the search for possible donors has been intensified beyond the UCIs (active detection of hospital transplant coordinators). The ONT has established a whole strategy to find patients who want to donate in their last moments of life. These patients are admitted to the emergency room to follow the whole process.
In addition, donation in asystole (deaths in cardiorespiratory arrest), which already represent 45% of donors, continues to be promoted. This group includes people who have exercised their right to die (euthanasia). 13% of which have donated their organs: 90 since the law was approved at the end of 2021 until December 31, 2023.
And we want to promote living donor donation (kidney and liver), which is not developed as it should be in all autonomous communities. At the 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 in the health field, which is guaranteed, as in the labor field. This rule was drafted and prepared, but the call for elections caused it to be forgotten. The law protected the donor in the labor field so that work leaves were facilitated both for the pre-operative period, the intervention and the subsequent reviews. “This rule is fundamental. We know of cases where they are denied days to do revisions or to check compatibilities. And we know, for example, that a father was fired because he wanted to donate a kidney to his daughter and that meant some casualties. Either your daughter or the company, they told him. And that can’t happen”, points out Beatriz Domínguez-Gil,
But all this is insufficient to be able to cover the needs. Waiting lists are maintained, despite the increase in transplant activity, because the criteria are becoming more flexible. At the moment there are almost 4,800 patients waiting for an organ (almost 4,000, a kidney), of which 12% have “very difficulty” in getting it. They are hyperimmunized patients (pregnant women, people who have already been transplanted…), and who have been on dialysis for up to 7 years.
Despite the volume of the waiting list, it has nothing to do with the American one, in which, for example, there are 250 patients per million inhabitants who need a kidney, compared to 150 in Spain. Because? For the universal and free health system that Spain has, which makes it possible to better attend to the chronicity of citizens, something that does not happen in the USA. “In the United States they are looking for an immediate source of organs in animals,” explains the head of the ONT. (They have already done three xenotransplantations: two cardiac, pig, modified in the laboratory, and the public event on March 22, the first kidney).
In Spain, no work is being done on xenotransplantation, but in order to obtain new “sources” of organs, research and innovation have increased everywhere. At the meeting in Toledo, Núria Montserrat, group leader at the Bioengineering Institute of Catalonia, explained what her team is working on: how human tissues are generated to better understand why they stop functioning during 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.
