María O. Valentín

Analysis of the attitudes and motivations of the Spanish population towards organ donation after death

Starting with the relevance of the Spanish experience, this study analyses the population’s disposition towards organ donation after death by means of a representative survey of the adult Spanish population (N = 1206, estimated error ±2.87%, P < 0.05). Of the participants, 8.1% were declared donors, 59.3% were likely to donate, 14.5% were against donating and 18.1% did not know or did not respond; 87.3% would donate relative’s organs if the deceased favoured donation, 50.2% if the deceased’s wishes were unknown and 13.1% even if the deceased opposed donation. Among people who were favourable towards donation, the main motives expressed were the will to save other people’s lives, solidarity and knowing they might someday need a donation. The most important motives for not donating among participants who were against it were the fear of premature organ extraction, of premature pronouncement of death and of mutilation. Reticence to donate is associated with low socio‐economic and cultural level, advanced age and high religious commitment; it is also associated with a low perception of transplant efficacy, not directly knowing any transplanted people and the lack of qualified information. The results support diverse potentially effective strategies for promoting donation in the general population.

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.

Factors related to attitudes toward organ donation after death in the immigrant population in Spain.

López JS, Valentín MO, Scandroglio B, Coll E, Martín MJ, Sagredo E, Martínez JM, Serna E, Matesanz R. Factors related to attitudes toward organ donation after death in the immigrant population in Spain. 
Clin Transplant 2012 DOI: 10.1111/j.1399‐0012.2011.01586.x. 
© 2012 John Wiley & Sons A/S.

Cardiac Transplantation in Spain: Have We Reached Our Peak?

193Have we reached our limits in the field of hearttransplantation? Can we satisfy our needs at the presentrate? Are we doing our utmost to make the best possibleuse of our resources in this respect? Can we do more?The answers to these questions probably vary widelydepending on who voices them. The views of thetransplant teams, program coordinators or the SpanishNational Transplant Organization (ONT) itself do nothave to be identical, mainly because the position fromwhich each observes the process and the information towhich we have access differ widely. In fact, it is morethan likely that, even among cardiologists, thoseinvolved in a transplant team have a different view of theproblem than those who occasionally have to evaluate adonor heart to assess its viability.For these reasons, the report by Chamorro et al

The Spanish Prioritization System for Highly Sensitized Patients: A Successful Tool

PATHI. A prioritization kidney allocation system, based on virtual crossmatch, was implemented in Spain in June 2015 to broaden access to transplantation for patients with cPRA ≥98%. Participating centers must offer to the program one of the kidneys of every brain-death donor between 18–70 years old. The algorithm for recipient’s selection was based on blood type compatibility and negative crossmatch by using Human leukocyte Antigens class I (A, B, C) and class II (DRB1, DQB1, DQA1). Aim To evaluate the results of a National prioritization system based on virtual crossmatch in very high sensitized patients waiting for a kidney transplant after 18 months. Methods Demographic and clinical characteristics were collected from every patient included in the program between June 2015 and December 2016. The number of brain death donors assigned to the program, and patients transplanted were analyzed as well as number of kidney offered and reasons for either rejecting an offer or non-proceeding with the transplant once the kidney is accepted. Outcomes of patients transplanted between June 2015 and September 2016 were also studied. Results 786 patients with cPRA ≥98% were registered in the program. 408 (51.9%) were men and the mean age was 52.6 (12.3), median time on dialysis was 75.5 (45.7-114) months. 86.2% of patients had been previously transplanted. 879 brain death donors were assigned to the program. Virtual crossmatch was negative for 308 (35%) donors. From them, 243 kidneys were accepted and 159 transplanted (20.2% over patients included. The mean time from the registration to transplant was 158 (76–277) days. The reasons for refusal (N=163) were reasons related to the recipient (non-immunological) in 34 (36%), unacceptable antigen in 12(13%), donor pathology in 23 (24%) cases, ischemia time in 8 (9%) and age difference in 17 (18%) cases (median age difference 26 (21–35) years). After accepting the kidney, the transplant didn’t proceed in 84 cases (37% due to positive real crossmatch). Outcomes were analyzed in 125 patients. Median cold ischemia time was 19 (16–22) hours. Delayed graft function was detected in 12 (9.6%). The median follow-up time was 7.4 (4–10) months. Patient and graft survival were 93.6% and 89.7% respectively. Median Creatinine level (N=109) was1.48 (1.13-1.97) mg/dl. Conclusion The Spanish prioritization system increases transplant options for hypersensitized patients with excellent outcomes in the short term after transplantation. Non-heart beating donors or living altruistic donors could be offered to the priority allocation system to increase donor pool and transplant options.

Living Kidney Donation in Spain, A Global Strategy to Increase this Modality of Transplantation

Objective To describe the impact of a strategy implemented to broaden living kidney donation over the last eleven years. Methods Between January 2005 and December 2016, the Spanish National Transplant Organization together with the Network of kidney transplants teams undertook the following measures: Training (living kidney donation courses targeted to health-care professionals); promotion through public campaigns, in collaboration with patient’s associations, and a specific website developed and maintained to inform general population on living donation; Clinical guidelines were developed by the ONT in cooperation with the Spanish Society of Nephrology; the implementation of the Spanish living kidney donation registry (in 2010); strategies to overcome donor-recipient incompatibility as the National Kidney Exchange program (in 2009); a protocol for the work up of altruistic donors (in 2010). Living donor activity has been analysed. Results Living kidney donation activity has increased from 87 to 343 (294% increment), the last accounting for 7.4 pmp. 142 kidney paired transplants have been performed. For the same period, 10 altruistic donors have triggered 32 transplants. However, 4321 patients still remained on the waiting list at the end of 2016. Living donation was different among regions. Thus, in 2016 Cataluña, Galicia and País Vasco reached 18.35, 10.33 and 9.63 living donor kidney transplants pmp respectively. Conclusion The strategy to increase living donation has been successful in some regions with low increase in others. Benchmarking procedures should be implemented to search for specific measures that have contributed to success.

The Spanish Kidney Exchange Model: Study of Computation-Based Alternatives to the Current Procedure

The problem of incompatible pairs in living-donor kidney transplant can be solved using paired kidney exchange, i.e., two incompatible patient-donor pairs interchange donors, creating a cycle, which can be extended to three or even more pairs. Finding a set of cycles that maximizes the number of successful transplants is a complex task.

Transplant Programs Worldwide and the Spanish Miracle

With close to 40 donors and over 100 transplant procedures per million population in 2015, Spain holds a worldwide privileged position in providing transplant services to its patient population. The Spanish miracle derives from a very specific organizational approach to ensure the systematic identification of opportunities for organ donation, and their transition to actual donation. The way the system is conceived has facilitated the implementation in practice of the principle that donation should be considered a routine component of end-of-life care. The Spanish results are of particular merit taking into account the dramatic decline in the incidence of brain death in the country since the beginning of the century. This has prompted the system to develop new strategies to increase organ availability: (1) promoting the identification of possible organ donors outside of the ICU to consider elective nontherapeutic intensive care; (2) facilitating the use of organs from expanded criteria and nonstandard risk donors; (3) developing the framework for the practice of donation after circulatory death; (4) expanding the living kidney transplantation activity, while ensuring comprehensive donor protection and care.