Beatriz Mahíllo

The 40 Donors Per Million Population Plan: An Action Plan for Improvement of Organ Donation and Transplantation in Spain

INTRODUCTION Spain has been showing the highest rate of deceased donor organ recovery in the world for a whole country, namely, 33-35 donors per million population (pmp) during the last years. This activity is attributed to the so-called Spanish Model of organ donation, an integrated approach to improve organ donation since the start of the Organización Nacional de Trasplantes (ONT) in 1989. However, in 2007 there were 7/17 regions with >40 donors pmp and a marked regional variability. Thus, ONT has set a large-scale, comprehensive strategy to achieve a substantial improvement in donation and transplantation in Spain in the coming years: The 40 Donors pmp Plan. PURPOSE AND SCOPE The overall objective is to increase the average rate of deceased donors to 40 pmp between 2008 and 2010. The areas of improvement, specific objectives, and actions have come from deep reflection on the data and the material generated from multidisciplinary discussions and open consultation with the donation and transplantation community. KEY AREAS SELECTED FOR ACTION Detection and management of brain-dead donors, with 4 specific subareas: access to intensive care units, new forms of hospital management, foreigners and ethnic minorities, and evaluation/maintenance of thoracic organ donors. Expanded criteria donors, with 3 subareas: aging, donors with positive tests to certain viral serologies, and donors with rare diseases. Special surgical techniques. Donation after cardiac death.

The global diffusion of organ transplantation: trends, drivers and policy implications

Abstract Rising incomes, the spread of personal insurance, lifestyle factors adding to the burden of illness, ageing populations, globalization and skills transfer within the medical community have increased worldwide demand for organ transplantation. The Global Observatory on Donation and Transplantation, which was built in response to World Health Assembly resolution WHA57.18, has conducted ongoing documentation of global transplantation activities since 2007. In this paper, we use the Global Observatory’s data to describe the current distribution of – and trends in – transplantation activities and to evaluate the role of health systems factors and macroeconomics in the diffusion of transplantation technology. We then consider the implications of our results for health policies relating to organ donation and transplantation. Of the World Health Organization’s Member States, most now engage in organ transplantation and more than a third performed deceased donor transplantation in 2011. In general, the Member States that engage in organ transplantation have greater access to physician services and greater total health spending per capita than the Member States where organ transplantation is not performed. The provision of deceased donor transplantation was closely associated with high levels of gross national income per capita. There are several ways in which governments can support the ethical development of organ donation and transplantation programmes. Specifically, they can ensure that appropriate legislation, regulation and oversight are in place, and monitor donation and transplantation activities, practices and outcomes. Moreover, they can allocate resources towards the training of specialist physicians, surgeons and transplant coordinators, and implement a professional donor-procurement network.

Donantes de órganos en España: evolución de las tasas de donación por comunidades autónomas y factores determinantes

Fundamento y objetivo El proposito del estudio ha sido analizar la evolucion de las tasas de donacion en las diferentes comunidades autonomas durante los ultimos anos y describir los factores con un mayor peso especifico en relacion con el numero de donantes. Material y metodo Se ha realizado un estudio descriptivo y retrospectivo, con datos de donacion y poblacion general, poblacion en individuos de 70 anos o mas, siniestralidad vial, numero de entrevistas para la donacion y porcentaje de respuestas negativas, en las diferentes comunidades autonomas entre 2001 y 2006. Tambien se analizo la correlacion entre los factores estudiados estratificando por ano. Para evaluar la evolucion temporal se realizo un analisis de regresion lineal para medidas repetidas. Resultados El numero de habitantes, la poblacion de 70 anos o mas y el numero de victimas mortales por accidente de trafico se correlacionaron con el numero de donantes general, de ese grupo de edad y fallecidos por esa causa, respectivamente. Estas relaciones no se cumplieron en todas las comunidades autonomas. El porcentaje de negativas no guardo relacion con el numero de entrevistas realizadas, si bien su disminucion se relaciono con un aumento de la tasa de donantes. Aunque de forma no tan constante, el aumento del porcentaje de donantes de 70 anos o mas y la disminucion del de fallecidos por accidentes de trafico se relacionaron con mayores tasas de donantes. Conclusiones La evolucion del numero de donantes sigue el crecimiento de la poblacion y el descenso del porcentaje de negativas, si bien se explica de forma diferente segun la comunidad autonoma.

2009 global data in organ donation and transplantation: activities, laws, and organization.

The Global Observatory on Donation and Transplantation represents the most comprehensive source of worldwide data concerning activities in organ donation and transplantation and information on legal and organizational aspects. Of the countries reporting information, 84.7% have a national structure supervising or coordinating donation and transplantation and 91% have specific legislation. Worldwide approximately 104,065 solid organ transplants are performed each year. There is a vast difference in rates of kidney and liver transplantation, especially from deceased donor depending on the level of development. This analysis provides an overview of existing organizational structures, related legislation, and activities.

Global Database on donation and transplantation: Goals, methods and critical issues (www.transplant-observatory.org)

The Global Database on Donation and Transplantation represents the most comprehensive source to date of worldwide data concerning activities in organ donation and transplantation derived from official sources, as well as information on legal and organizational aspects. The objectives are to collect, analyse and disseminate this kind of information of the WHO Member States and to facilitate a network of focal persons in the field of transplantation. They are responsible for providing the legislative and organizational aspects and the annual activity practices through a specific questionnaire. 104 out of the 194 WHO Member States that cover the 90% of the global population contribute to this project.Although we know the numerous limitations and biases as a result of the different interpretations of the questions, based on cultural factors and language, there is no other similar approach to collect information on donation and transplantation practices all over the world. The knowledge of demand for transplantation, availability of deceased and living donor organs and the access to transplantation is essential to monitor global trends in transplantation needs and donor organ availability. Information regarding the existence of regulatory oversight is fundamental to ensure the ethical practice of organ donation and transplantation.

Global Observatory and Database on Donation and Transplantation: World Overview on Transplantation Activities

INTRODUCTION The Global Database on Donation and Transplantation is one of the main areas of the Global Observatory on Donation and Transplantation (GODT), which is the information platform designed to implement some of the requirements of the World Health Assembly Resolution WHA57.18. OBJECTIVES OF THE GLOBAL DATABASE: The objectives are to collect, analyze, and disseminate information on legislative and organizational frameworks and annual aggregated data on donation and transplantation activities of the World Health Organization (WHO) Member States. Another objective is to establish the transplantation network with the national health authorities. The database should provide a working tool that helps to exchange information and be a reference for professionals involved, promoting international cooperation through the website. METHODS The data collection for the Global Database is done through a specific questionnaire, including questions on legislation, organizational systems, and updated data on organs, tissues and cells donation, and transplantation from each country. For the statistical analysis of activity data, descriptive statistics have been used. RESULTS The Global Database has organizational and legislative pieces of information of 94 countries. In 2007 activity data of 97 countries have been analyzed. Reported to the database were 21,489 deceased donors. Currently around 100,000 solid organ transplantations are performed per year worldwide: 68,250 kidney, 19,850 liver, 5179 heart, 3245 lung, and 2797 pancreas transplantations. CONCLUSIONS This kind of tool is necessary to improve knowledge about the donation and transplantation activities over the world. Close collaboration with countries is crucial to obtain reliable data.

How Spain Reached 40 Deceased Organ Donors per Million Population

With 40 donors and more than 100 transplant procedures per million population in 2015, Spain holds a privileged position worldwide in providing transplant services to its patient population. The Spanish success derives from a specific organizational approach to ensure the systematic identification of opportunities for organ donation and their transition to actual donation and to promote public support for the donation of organs after death. The Spanish results are to be highlighted in the context of the dramatic decline in the incidence of brain death and the changes in end‐of‐life care practices in the country since the beginning of the century. This prompted the system to conceive the 40 donors per million population plan, with three specific objectives: (i) promoting the identification and early referral of possible organ donors from outside of the intensive care unit to consider elective non‐therapeutic intensive care and incorporate the option of organ donation into end‐of‐life care; (ii) facilitating the use of organs from expanded criteria and non–standard risk donors; and (iii) developing the framework for the practice of donation after circulatory death. This article describes the actions undertaken and their impact on donation and transplantation activities.

A colloquium on the congress "A gift for life. Considerations on organ donation".

Alessandro Nanni Costa, J. M. Simon i Castellvi, Antonio G. Spagnolo, Nunziata Comoretto, Jean Laffitte, Hakan Gabel, Francis L. Delmonico, Ferdinand Muehlbacher, Walter Schaupp, Alexandra K. Glazier, Valter D. Garcia, Mario Abbud-Filho, Jose O. Medina-Pestana, Mariangela Gritta Grainer, Pier Paolo Donadio, Anna Guermani, Riccardo Bosco, Francesco Giordano, Blanca Martinez Lopez de Arroyabe, Marco Brunetti, Marti Manyalich, Gloria Paez, Ricardo Valero, Rafael Matesanz, Elisabeth Coll, Beatriz Dominguez-Gil, Beatriz Mahillo, Eduardo Martin Escobar, Gregorio Garrido, and Felix Cantarovich

Comparison of CHOP treatment with specific short-intensive chemotherapy in AIDS-related Burkitt's lymphoma or leukemia

BACKGROUND AND OBJECTIVE AIDS-related Burkitts lymphoma or leukemia (BLL) is increasingly treated with specific and intensive multiagent schedules. This retrospective study aimed to compare the results of CHOP with those from two protocols (PETHEMA-LAL3/97 and BURKIMAB) of specific therapy in Spain. PATIENTS AND METHODS Patients from Group A (n=31) received 6 standard CHOP cycles every 3 weeks. Patients from group B (n=44) received six multiagent cycles including high-dose methotrexate and high-dose cytarabine. The response to therapy, disease-free survival and overall survival (OS) were compared in the two groups. RESULTS Both groups were comparable for the main clinical and biological parameters at diagnosis except for risk activity, previous HAART, bone marrow involvement, bulky disease and extranodal involved sites. Complete remission (CR) was achieved in 10 out of 31 (32%) patients in group A and 28 out of 44 (67%) patients in group B (P=.005). After a median (range) follow-up of 70 (26-139) and 17 (1-134) months, the 5-year (95% CI) DFS probability was 87% (64%-100%) for group A and 70% (51%-89%) for group B (P=.374), and the 5-year (95% CI) OS was 27% (10%-43%) for Group A and 57% (40%-74%) for group B (P=.028). Multivariate analyses showed that specific therapy was associated with an improved CR and OS. CONCLUSIONS In AIDS-related BLL short intensive specific chemotherapy is feasible, with higher remission rate and improved survival than that obtained with CHOP-based regimens.

About the Opt‐Out System, Live Transplantation, and Information to the Public on Organ Donation in Spain … Y olé!

We agree that Spaniards consider insignificant the impact of the type of consent on the donation activity. To the contrary, infrastructure, organization around the process of deceased donation, and continuous innovation are deemed the keys for success (2). The opt-out system was stated in the Transplantation Law, issued in 1979. The terms of its application are specified and softened in the successive Decrees. The donor coordinator is legally obliged to rule out an expressed opposition to donate, in the patient0s documentation, clinical record, advanced directives register, and through a family interview. In practice, the relatives always give the final veto. Therefore, the Spanish approach is not substantially different from that in opt-in realities. Moreover, it was not until 10 years after the Law approval that donation took off.