Men’s fight to prolong their life has been and will be a constant in human existence. In a great number of cases transplants have allowed to get this target. This has been possible thanks to a life-cycle that starts with an act out of solidarity, DONATION, follows with the implementation of the necessary technology to make it suitable to other human beings and finishes with the TRANSPLANT. The yearly number of organs -kidney, heart, liver, pancreas, lung or intestine transplanted raise up to 4,000 in Spain and up to many thousands in the Western Countries. In terms of tissues, the amount of transplants of cornea, bone, cartilage, arteries, heart valves, skin or pancreatic islets goes far beyond that figure.
“Without a donor there is no transplant”. This coined phrase reveals that to initiate this life-cycle there is an absolute need of solidarity from other else. In the countries where transplants are allowed, the duty and the right of a donation are legally regulated and respect the wish of the defunct. When legal requirements occur and the donor’s will has to be fulfilled, everything must be organized in order to act under any circumstances, at any place, at any time.
Donation has increased throughout the world in the last years. The average in Europe raises up to 18 donors/million citizens, up to 22 donors/million citizens in the United States, up to 8-10 in Latin America and up to 2-4 in the Middle East. Spain occupies a preeminent position in the world with a ratio of 35.1 donors/million citizens in 2005, with small variations depending on the Autonomous Community. These figures are not sufficient to supply the growing organ demand considering that with the current waiting lists the need would be of 50 donors/million citizens.
The use of current technology permits the recuperation of only 2-5% of
the organs from people deceased in hospitals. Tissue donation can be carried
out in more places and under different circumstances, depending on the time
passed between death and extraction. Each single case of donation must be
carefully studied so as to ensure, among other things, the non transmission
of any diseases from donor to receptor. That means the elimination of those
donors presenting neoplasia, HIV-positive, non-controlled infections, etc.
To achieve the organ suitability for transplant, all the functional studies as well as the security and availability controls must be passed in order to guarantee that it is suitable for a transplant.
Organ transplant as replacement therapy has progressively consolidated in our country until becoming a current therapy for those cases presenting severe cardiac, pulmonary or hepatic insufficiency. In the case of major renal insufficiency, depending on the patients characteristics, this alternative is preferable to dialysis.
This fact has facilitated, on one hand, the possibility of offering a transplant to receptors that years ago were considered non suitable candidates and, on the other hand it has also helped to change the current characteristics of donors, being now older, deceased by cerebral vascular accident and with many pathologies associated. Both factors have conditioned the change in the criteria of acceptance for donors and receptors and obligate to a more accurate and safer evaluation of the organ in order to establish its viability and suitability according to the current waiting lists.
Since 1959, thanks to the advances in the mechanical ventilation systems and the expansion of the Intensive Care Units (ICU), which permit ventilation and hemodynamic assistance to patients with Traumatic Brain Injury (TBI) or severe brain vascular disease, the concept of Brain Death (BD) has emerged. After this concept was accepted by many legislations in Western Countries, it started to be considered that those people deceased by BD could become the main donors of organs and tissues for a transplant.
The Transplant Coordinator figure (CT) was created at the request of the transplant teams, who suspected the necessity of detecting and evaluating all the possible donors. In Europe, it came up out of the transplant teams themselves, who needed people able to organize every step between the donation in the ICU/resuscitation room, and the organs extraction in the operating room. His work was gradually growing until he became in charge of the follow up of the receptors too.
In the US the functions of a CT are similar, although instead of belonging to the transplant teams they work for the so-called OPO (Organ Procurement Organization) in parallel and independently from that ones.
The Law for Transplants was issued in Spain in 1979. It accepted Brain Death as the death of the individual. It reported that the State would work for obtaining as much organs for transplants as possible and also that donation would not be for economic purposes: neither economic compensation given to the donor nor payment required to the receptor. The Transplant Coordination was born in Catalonia but it was totally regulated and institutionalized just in 1985, once the first course of TC took place and the administrative regulations were settled, stating that to be officially authorized, every hospital practicing transplants or generating organs for transplants should have a TC. The fist ones were nephrologists that organized renal extractions. Afterwards, coinciding with the development of other transplant programs new teams came up composed by specialists and/or nurses with broader medical and organizational responsibilities and linked to other professionals inside and outside the hospital who should negotiate solutions and take decisions. This is one of the keys for Spain to occupy de first place in the ranking of donors/million population worldwide.
From an organizational point of view, both hospitals and authorities are used to render health services to their patients but not to generate their own grafts (organ, tissues), which are necessary for patients’ treatments. That is why the Transplant Coordination Units, in charge of facilitating the transplant procedure, were created. They have two main functions: