Health Transplants: this is how the liver that saved Juan Antonio's life was rescued
New techniques manage to 'resurrect' dead organs to save time for transplants
Àlex Sánchez Camargo
underwent his first check-up yesterday at the Vall d'Hebron Maternal-Children's Hospital in Barcelona, where just a week ago (September 28) he was
discharged with a new heart working perfectly
.
He is not yet 100% recovered, but that does not prevent him from sharing with the multidisciplinary team that has treated him for the last three months the joy of a
historic milestone to which he has contributed as a patient: the first thousand pediatric transplants at the Vall d 'Hebron.
This acute care center, the largest in Catalonia, has
received exactly 1,007 infant solid organ transplants
since it launched its program in 1981: 442 kidneys, 412 livers, 85 lungs and 68 heart;
many of them are multiple transplants.
For more than 40 years, Vall d'Hebron, which
is on the heels of Hospital La Paz in Madrid
in terms of the number of child transplants, has been overcoming obstacles and accumulating improvements and advances.
He was
a pioneer in Spain in performing a triple transplant on a pediatric patient
and in extracting and
transplanting the lungs of a baby given in controlled cardiac arrest
.
It was also the first hospital to transplant a patient who had overcome covid-19;
a teenager who, due to mitral stenosis, received a heart.
She broke the national record, in 2015, by performing six pediatric transplants in just 24 hours
.
And he was also the first to perform a liver transplant on an adolescent for the treatment of the rare disease gastrointestinal mitochondrial encephalopathy.
To know more
Special.
Story of a transplant of five hearts
Writing: PEDRO SIMÓN
Drafting: CARLOS GARCÍA POZO (PHOTOS)
Story of a transplant of five hearts
In 1994, this center, the flagship of the Catalan Institute of Health, performed the first national pediatric hepatorenal transplant, and much earlier,
in 1985, it performed the first liver transplant on a child in Spain
.
And it sports another great brand: it is
a national leader in pediatric lung transplantation.
Behind each of these more than a thousand interventions of all kinds and more or less innovative there is a child or an adolescent, a family and a large multidisciplinary team of which, over the decades, many professionals have been part.
A month on hold connected to a machine waiting for a new heart
The case of
Àlex, a 13-year-old minor with no health problems until then,
began like many of these cases: one night he woke up with chest pain and choking, after spending several days vomiting.
His parents, Paco and Mari Angeles,
took him to the primary care center where, from the outset, they diagnosed
him as "something viral."
The child was getting worse and returned to the primary school weeks later with 198 pulses, when normal at that age is 90;
but, again, they sent him home.
The family, not satisfied, took him to Cardiology at the Parc Taulí Hospital in Sabadell, where
they were unable to control the tachycardia with medication.
From there, he was referred to the Sant Joan de Déu Maternal-Child Hospital, in Esplugues de Llobregat, in Barcelona, where he was admitted to the ICU and
underwent two operations to try to solve the arrhythmia.
Àlex with his cardiologist, Paola Dolader. ARABA PRESS
The child was already entering multi-organ failure (kidney and lung involvement...), so
on July 17 he was admitted to the Vall d'Hebron, directly in the ICU and with ECMO
(extracorporeal membrane oxygenation, an extracorporeal technique that provides prolonged cardiac and respiratory support to patients whose lungs and heart are unable to function normally).
He entered the transplant waiting list on August 12
and was very lucky because in less than a month, on September 10, the bell rang: there was a compatible heart for him.
He explains the happiness that this news caused his parents, his brother and his other family, and the entire hospital team.
But he, he assures, he remained calm because, except for one occasion (at the beginning of the ECMO, when he vomited a lot and was very, very tired), he always trusted that he would make it out of the hospital alive.
That same day (September 10), the new organ arrived
at the center, at 7:00 p.m. sharp, and at 1:00 a.m. the next day (September 11), Àlex was already wearing his new heart.
"
With the ECMO I felt normal and after the transplant, too, only without tubes
", he explains to this newspaper.
His
cardiologist, Paola Dolader,
highlights from this young
patient how positive and emotionally strong he has been
throughout the process;
something that, without a doubt, has contributed to everything going smoothly.
Raúl Abella, head of Pediatric Cardiac Surgery,
highlights the importance of ECMO to keep minors alive and in good physical condition until they manage to find a compatible donor, which can take up to three months.
At the moment there are 4 children in that situation in the center.
He reports that
Àlex suffered an arrhythmia that deteriorated his cardiac cells
and affected myocardial function.
The patient did not respond to drugs and, even with ECMO, it took days to do so.
Abella is a surgeon, but she especially highlights the work of her colleagues in the
ICU, "who were able to keep Àlex alive" until the moment of the transplant
.
"This is a specialist hospital for ECMO and post-transplant ventricular assistance," he adds.
The results of pre-transplant care and surgery are among the best in Europe, says Abella.
For something
they serve minors from all over Spain and also from Portugal (lung transplant).
In a pediatric transplant, more than a hundred professionals can intervene directly.
According to this hospital, when there is an organ available for a child, a multidisciplinary team prepares to carry out the extraction, in the Vall d'Hebron itself or by going to another center.
Before that, a surgeon or specialist in the organ confirms its validity to be implanted.
In parallel, the recipient's family is informed, with whom communication is maintained throughout the entire process, and the operating room is prepared, where the surgical procedure will be carried out, in which anesthesia, surgery, and nurse professionals participate. surgeons, anesthesia nurses, perfusion nurses, auxiliaries and caretakers, as well as other service professionals such as Clinical Laboratories, Radiology, Infectious Diseases, Immunology, Pathological Anatomy, Emergencies and Pharmacy.
Before starting the surgical procedure, the ICU and the Blood Bank are alerted so that they are prepared.
Carme Vallès,
supervisory nurse for transplant coordination at Vall d'Hebron Hospital, points out the greater difficulty they currently have in finding donors.
The profile, as she indicates, has changed: now
the majority are people who have died from neuromuscular pathologies and traffic accidents
(not motorcyclists, thanks to the mandatory use of helmets).
Fortunately, the inclusion criteria have also changed, in such a way that before a 35-year-old donor was allowed to transplant only a minor and now, for example, the liver of an adult can be used for two children or for an adult and a little boy.
Vallès underlines the role of the Catalan Transplant Organization (OCATT) and the National Transplant Organization (ONT) because
"if there are no donors, there are no transplants"
.
And he praises the level of altruism in Spain, even among parents who have just lost their children.
Despite his experience, he is still amazed that these people are able, in such dire circumstances, to help children and families they know nothing about.
He also states that in transplants a hospital is not worth it just because it is something that depends on many centers working in a network: "it is very peculiar."
Carme Vallès (supervisory nurse), Paco (the father), Raúl Abella (head of Pediatric Cardiac Surgery), Àlex, Mari Ángeles (the mother) and Paola Dolader (cardiologist). ARABA PRESS
Àlex and his family walk around the hospital greeting everyone.
The professionals who have attended them are many and from different disciplines and shifts, but
the young patient knows everyone's name.
Gone are many days of waiting, tension and anguish, and also of laughter:
Àlex even danced while connected to the ECMO, he reveals.
The stay in the hospital, despite the magnificent human and technical level that Àlex and his parents insist on highlighting, has not been easy;
and outside of him, neither: his brother, 16 years old, has been alone at home for several months and only pending the evolution of Àlex;
and the rest of the family has thrown itself into helping Paco and Mariángeles, who have spent 5 months without being able to go to work.
They are all home now;
the worst is over, but Àlex still has about six months of recovery ahead of him.
María José Muñoz, the advanced practice nurse who accompanies him inside and outside the hospital, says that the most important thing now will be to empower him so that, without depending on anyone, he takes his medication well and takes care of himself (diet, physical exercise...) .
"From the age of 12, self-care is very important,"
she says.
Their contribution is not minor: the success of the pre-transplantation, the donation and the surgery must be followed by a good rehabilitation process and a return to normal life, including being welcomed into the school;
"It is an invisible job but it guarantees the final success," says Muñoz.
When he realizes it, Àlex, he will have already got used to taking the immunosuppressant medication that he will have to take throughout his life;
he will have regained weight, muscle and strength, and will go back to class and play football and basketball with his friends.
The bad times will be long gone, but the gratitude and pride for the model of organ donation and transplants and the public health that he has at his disposal will accompany him forever.
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