Gregorio Garrido

The Latin American population in Spain and organ donation. Attitude toward deceased organ donation and organ donation rates

The Latin American (LA) population has similarities with the Spanish population which makes its integration into Spanish society easier. Objective: to analyze the attitude toward organ donation among Latin American citizens residing in Spain, to determine the psychosocial variables which affect this attitude, and to examine the correlation between donation rates of LA citizens in Spain and in their countries of origin. A random sample of LA residents in Spain was taken and stratified according to the respondents nationality (n = 1.314), in the year 2010. Attitude was assessed using a validated questionnaire (PCID‐DTO Dr Rios). The survey was self‐administered and completed anonymously. Statistical analysis: Students t‐test, the χ2 test, and logistic regression analysis. There was a 94% completion rate (n = 1.237). Attitude toward donation was favorable in 60% of cases (n = 745), 12% (n = 145) were against, and 28% (n = 347) were undecided. The following variables were associated with attitude toward donation: sex (P = 0.038), level of formal education (P < 0.001), country of origin (P = 0.002), attitude toward the donation of a family members organs (P < 0.001), having discussed donation with the family (P < 0.001), carrying out prosocial activities (P = 0.025), attitude toward cremation of the body (P < 0.001), attitude toward burial of the body (P < 0.001), attitude toward having an autopsy carried out (P < 0.001), previous experience of the organ donation and transplantation process (P < 0.001), fear of mutilation after donation (P < 0.001), knowledge that the Church has a positive attitude toward organ donation and transplantation (P < 0.001), knowledge of ones partners attitude toward organ donation (P < 0.001), and a belief that one might need a transplant in the future (P < 0.001). The donation rates in this population group in Spain are higher than those recorded in their countries of origin (55.76 vs. <10 pmp; P < 0.001). The attitude toward organ donation among LA citizens residing in Spain is slightly worse than that reported in the native Spanish population and is determined by many psychosocial factors. The donation rates of LA citizens in Spain are higher than those in their countries of origin.

The attitude of latin american immigrants in florida (USA) towards deceased organ donation

The Latin American (LA) population resident in the USA is a growing subgroup of the population. To find out the structure of attitude towards organ donation in the LA population resident in Florida (USA). A sample was taken of LA residents in Florida, randomized and stratified by nationality, age and sex (n = 1524). Attitude was assessed using a validated questionnaire (PCID–DTO Rios) that was self‐completed anonymously. The survey completion rate was 95% (n = 1450). Attitude was favourable in 33% of respondents (n = 485), against in 40% (n = 575) and undecided in 27% (n = 390). The following variables were associated with a favourable attitude: country of origin (Dominican Republic; P = 0.038); sex (female; P < 0.001); marital status (married; P < 0.001); level of education (university; P < 0.001); previous experience of the subject (P < 0.001); considering the need for a transplant in the future (P < 0.001); understanding the concept of brain death (P = 0.003); attitude towards donating a family members organs (P < 0.001); having discussed organ donation and transplantation with ones family (P < 0.001) or with ones partner (P < 0.001); participation in pro‐social type activities (P < 0.001); the respondents religion (atheist–agnostic; P < 0.001); a respondents knowledge of the attitude of his or her religion towards organ donation (P < 0.001); no concern about mutilation after donation (P < 0.001); acceptance of cremation (P < 0.001); burial (P < 0.001); and an autopsy if one were needed (P < 0.001). The attitude towards donation of LA in Florida is worse than that reported in the native population and is associated with certain psychosocial factors.

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.

The Spanish National Transplant Organization (ONT) tumor registry.

Background. It is important to know the actual risk of tumor transmission from donor to recipient and the serious consequences for the recipient. Tumor registries can help us to improve our knowledge about this problem. Methods. We have studied all the donors registered in the Spanish National Transplant Organization from January 1, 1990, to December 31, 2006, and especially the donors with a malignant tumor as well as the recipients who have received an organ from these donors. Results. We found 117 donors with a malignant tumor (5.8 per 1000 donors). One hundred fifty-five recipients were transplanted with an organ from these donors. The average age (SD) of donors with tumor was 53 (17) years. The most frequent cause of death was cerebral stroke in 81 donors. Donors with tumor are older than donors without tumor. The cause of death was cerebral stroke more frequently in donors with tumor than donors without tumor. Twenty-two of the recipients who received an organ from a donor with a tumor are dead. In 7 of these 22 recipients the death was cancer-related. Only 13 of the 100 recipients studied developed a malignant tumor, and only 10 of these tumors were donor-related. Conclusions. The profile of a donor who could have a tumor was most frequently an elderly person who had died of a cerebral stroke. In our experience, the risk of tumor transmission from donors to recipients is low and depends on the aggressiveness of the donor tumor.

Disparities in access to liver transplantation in Spain.

Background. The maintenance of an equitable system for access to transplantation is a matter of concern to all professionals involved in this field. Any national system must ensure equity. Methods. The rates of indication for liver transplantation have been reviewed for all Spanish regions. The time to transplantation was evaluated with respect to different recipient characteristics and donor rates. The indication rates for liver transplantation are similar in the different countries with liver transplant programs but are far from similar among different regions in Spain. This suggests that there is not equity in the access to liver transplantation. Results. A review of the factors affecting the waiting times to transplantation after being registered for the waiting list shows that some groups of patients are currently waiting less time than others. Shorter waiting times occur in patients of the AB group, children, patients with hepatocarcinoma, and patients living in the zone of Valencia, despite similar organ donation rates in all transplant zones. Conclusion. Neither the rate nor the probability of liver transplantation is affected exclusively by the organ donation rate in Spain but also depends on the number of patients admitted to the waiting list. Despite the existence of an organ allocation system that is center-oriented, liver patients are receiving grafts mainly based on the severity of the illness, because clearance rates from the waiting list of both dead patients and grafted patients are the same.

Poor compliance with antifungal drug use guidelines by transplant physicians: a framework for educational guidelines and an international consensus on patient safety

Muñoz P, Rojas L, Cervera C, Garrido G, Fariñas MCarmen, Valerio M, Giannella M, Bouza E. Poor compliance with antifungal drug use guidelines by transplant physicians: a framework for educational guidelines and an international consensus on patient safety. 
Clin Transplant 2012: 26: 87–96. 
© 2011 John Wiley & Sons A/S.

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

Incidence of tuberculosis in deceased-organ donors and transmission risk to recipients in Spain.

Background Globalization and migration patterns have increased the number of donors from countries with high incidence rates of tuberculosis (TB) in low incidence countries, with the subsequent increase in risk of TB transmission to the recipients. Methods Retrospective cohort study, including all actual deceased donors in Spanish hospitals between January 1998 and June 2011 and all the recipients who had received an organ from donors identified as TB cases. Results Six actual donors were identified as TB cases, representing an annual incidence of 30.6 cases/100,000 donors (95% CI, 4–58). Two cases did not become utilized donors, because TB was detected in the organ recovery and were therefore excluded. Annual incidence in utilized donors was 23 cases/100,000 donors (95% CI, 6–59). Annual incidence of the Spanish population in the same period was 17.5 cases/100,000 inhabitants (95% CI, 17–18). Annual incidence in actual donors belonging to the Romanian immigrant community was 2353 cases/100,000 donors (95% CI, 286–8242). Variations in the prophylactic strategy utilized in recipients were observed. TB was transmitted to three recipients (27.3% transmission), two of whom developed active TB. Conclusions Incidence of TB in actual donors is greater than that of the general population (P<0.001). The risk of immigrant communities should be grouped according to the real incidence in donors. Transmissibility of TB is high; therefore, transplant teams should be immediately informed when TB donor transmission is suspected to prevent TB in the recipient.

Resultados clínicos de la revascularización miocárdica con doble arteria mamaria frente a única: 15 años de seguimiento

Introduccion Mediante la revascularizacion de la descendente anterior con la arteria mamaria se consigue una mayor supervivencia y reduccion de acontecimientos cardiologicos. Existen, sin embargo, resultados discrepantes sobre los beneficios de ambas mamarias. Objetivos Comparar los resultados del empleo de ambas mamarias frente a una. Pacientes y metodo Estudio de cohortes retrospectivo, con un seguimiento medio de 9,0 ± 4,2 anos, en el que se han incluido 108 pacientes consecutivos en los que se emplearon ambas mamarias (II), y 108 elegidos aleatoriamente de aquellos en los que se empleo una mamaria (I). Resultados Ambos grupos fueron homogeneos. No hubo diferencias en la morbimortalidad operatoria. La supervivencia a los 10 anos fue similar (II: 84,61 ± 4%; I: 85,18 ± 3,8%), mientras que la recurrencia de angina (II: 29,63 ± 5,3; I: 47,55 ± 5,6%) (p = 0,012), la necesidad de angioplastia percutanea (II: 3,98 ± 2%; I: 12,99 ± 4,1%) (p = 0,009) y el acontecimiento cardiologico (II: 33,48 ± 5,5%; I: 48,48 ± 5,5%) (p = 0,022) fueron inferiores en el grupo de dos mamarias. En el analisis multivariante, el empleo de ambas mamarias resulto ser un factor protector independiente para la recurrencia de angina (RR = 0,54), angioplastia (RR = 0,18) y acontecimiento cardiologico (RR = 0,60). Conclusiones El empleo de ambas mamarias no incrementa la morbimortalidad operatoria y reduce la recurrencia de angina, la necesidad de angioplastia y los acontecimientos cardiologicos en el seguimiento, por lo que su uso parece justificado.

CHARACTERIZATION AND BIOCOMPATIBILITY OF PERFUSION-DECELLULARIZED HUMAN HEART MATRIX: TOWARD BIOENGINEERING PERFUSABLE HUMAN HEART GRAFTS

The current best treatment option for patients with end-stage heart failure is allograft heart transplantation, which is limited by donor source and immunorejection. Generating an autologous bioartificial heart could overcome these. Here we demonstrate perfusion decellularization of human whole