Organ Transplantation: Current Challenges and Solutions
Transplantation has become one of the miracles of modern medicine. The World Health Organization estimates that more than 120,000 patients benefit from organ transplantation annually across the world. Although the activity is impressive, it barely covers 10% of the global transplantation needs of patients. As a result of organ shortage, many patients die or endure a poor quality of life while waiting for an organ. Organ shortage is therefore the main limitation to the expansion of transplantation therapies.
Since the creation of the Spanish Organización Nacional de Trasplantes (ONT) back in 1989 and the implementation of the so-called Spanish Model on Organ Donation and Transplantation, Spain has been a worldwide leader in organ donation and transplantation activities. The key for success of the Spanish system is an appropriate management of the process of deceased donation — since the identification of donation opportunities to the successful transplantation of organs in patients in need. Donor coordinators with the most appropriate profile (intensive care physicians) are designated in every hospital with a potential for organ donation. National and regional health authorities guarantee adequate guidance and continuous training of the donor coordination network. There is also a constant evaluation of performance in deceased donation through a Quality Assurance Programme. A specific relationship with the mass media has replaced any public campaign in support for organ donation. Hospitals are reimbursed to cover all resources required for donation, procurement and transplantation activities. The Spanish model on Organ Donation and Transplantation has been partially or completely reproduced by other countries with successful results.
The Spanish system has also adapted to a scenario where mortality relevant to organ donation is decreasing, neurocritical care improves and important changes have occurred in the care of patients at the end of life. Novel strategies to increase donation opportunities include intensive care to enable organ donation, the use of organs from expanded and non-standard risk donors, and donation after circulatory death.
The progress towards self-sufficiency in transplantation does not only entail increasing the availability of organs, but also decreasing the needs through preventive strategies that reduce the occurrence of with chronic –or acute—diseases treatable through transplantation. A recent example of public health policies impacting upon the need of transplantation is that of Direct-Acting Antivirals for the treatment of hepatitis C virus infection. Action in terms of reducing the incidence of acute – and chronic rejection – or inducing tolerance in transplanted patients can also contribute to reduce the need for re-transplantation.
The creation of human organs by 3D printing or by chimerism whereby animals can “incubate” human organs is a current area of active research. Although the future in clinics of these initiatives is still to de delineated, not only they could help to confront the shortage of organs for transplantation, but also prevent the rejection of organs that are created with recipient`s own cells.
KEYWORDS & TOPICS
Organ donation and procurement; Transplantation; Intensive Care; Donation after Circulatory Death; Cell therapy
Speaker: Beatriz Domínguez-Gil González
Institution: Organización Nacional de Trasplantes