Pilar Pérez Toledo
Toledo
Updated Saturday, March 23, 2024-10:47
Health Spain has been the world leader in transplants for 32 years with a record of 5,861 in 2023
Advances 70 years of the machine that revolutionized cardiac surgery: from the heart being an unexplored territory, to entering the organ and performing transplants
"The ideal would be to have perfect donors, but we do not have organs on demand. And that is why new possibilities arise," says the director of the National Transplant Organization (ONT), Beatriz Domínguez-Gil. There is no magic formula, but
the goal of the ONT is to provide an individual solution to each patient
who requires a vital organ transplant. With this "the pool of donors and recipients could be increased. In many cases these are techniques that would not have been thought of," explains Domínguez-Gil.
Here, we go beyond xenotransplantation. The review of the present and future of transplants that took place during the
XIX National Meeting of Transplant Coordinators and Communication Professionals
coincided in time with the announcement of one of the latest milestones in the field: a group of surgeons from the United States They transplant a genetically modified pig kidney into a living patient for the first time.
Regarding this possibility, the director of the ONT was
critical and reticent
about when and to whom this option should be offered. "The main question is regarding
what criteria must be met to opt for a xenotransplantation compared to a consolidated therapy
with very good results such as conventional transplantation, human transplantation." And she added, during her speech at the meeting, that there are still "many doubts about the effectiveness and safety in the short, medium and long term" of these procedures.
To know more
Health.
Madrid, new reference center for future transplant coordinators: "We train problem solvers"
Editor: NURIA MONSÓ Madrid
Madrid, new reference center for future transplant coordinators: "We train problem solvers"
Health.
US surgeons transplant a genetically modified pig kidney into a living patient for the first time
Editorial: EFE New York
US surgeons transplant a genetically modified pig kidney into a living patient for the first time
In these sessions, how to innovate in a matter in which Spain is a leader and pioneer in many aspects was addressed from different angles. The revolution will come from the possibilities that open up with
artificial intelligence
and its role in the allocation of organs for transplant, the roles of
organoids
and their regenerative potential or genetically modified cells to treat spinal cord injuries. "But we have to choose carefully who we subject to each new technique," says Domínguez-Gil.
Spain is a world reference in transplants
Spain has started 2024 with a new maximum number of transplants performed, a total of 1,043. This is 13% more than the first two months of 2023, when he already set his thirty-second world record. For this reason, the director of the ONT is optimistic, believing that in 2024 the figure of 6,000 can be exceeded.
Figures that allow us to look without envy at the US, where only 9% of donors are 65 years old or older, compared to 44% of Spaniards. In our country, new strategies are sought and designed - "many of them pioneering worldwide" - to increase the number of donors, because "things are becoming more complicated," explained Domínguez-Gil, due to the decrease in accidents.
Meanwhile, in the US there is "more mortality from traffic, from firearms, which does not exist in our country, and from the socio-health crisis of opiates, which has become the main cause of death in people under 50 years of age." 17% of North American donors died from overdose.
New areas with potential in the present
Reaching it involves
betting on donation programs that seek solutions
beyond the current ones, such as donors from asystole, living donors, from patients who have suffered a tumor disease or neurological deterioration, such as ALS.
Mario Royo-Villanova, transplant coordinator at the Virgen de la Arrixaca University Hospital, Murcia, told how this experience was born. "It was following the case of the father of an oncologist,
Juan Antonio Encarnación
, who developed a tumor, but wanted to donate his organs." This marked the beginning of a thesis and a protocol in the Murcian community that will be attempted at the national level.
Considering
patients with brain tumors as potential donors
is a new avenue in donation. To do this, the situation of these patients must be "well studied beforehand, although there is no zero risk, in tumors of the central nervous system the benefits are greater," explained Royo-Villanova.
Another way to
find the best donors on a list comes from artificial intelligence
. Javier Briceño, director of the Clinical Management Unit of General Surgery and the Digestive System at the Reina Sofía University Hospital in Córdoba, in his speech pointed out the need for it to "not only serve to select the best donor for a recipient", but also to "how the future AI law being worked on in Europe will include, provide an explanation."
For Briceño, this tool must have
the trait of explainability
. "Doctors need to know the why of things. In the case of choosing one patient over another that is due to diabetes or another critical factor."
Organoids and their future role were addressed
by
Nuria Montserrat, group leader at the Bioengineering Institute of Catalonia. "We are still at the beginning," she said. "But we are taking important steps to learn more about the biology of organ development in order to be able to generate substitutes."
The director of the ONT also focused on
how to offer organs to hyperimmunized patients
. They are up to 10% of the people on the waiting list and "they are one of the objectives that we have set for ourselves at the ONT," stressed Domínguez-Gil.
Those people who have a large amount of antibodies, sometimes 100%, which causes rejection of any transplant. Ignacio Revuelta, from the Nephrology Service of the Hospital Clínic of Barcelona, listed a series of options whose purpose is "to trick the body into eliminating the antibodies and being able to perform the transplant."