Sunday, January 5, 2014

Transplants: A very human chain

If your kidneys pack in or you need a new pair of lungs then Spain is an excellent place to be. Spain has the highest rate of donations of organs per million of population in the world. Last year 1,643 donors made possible 4,211 kidney, lung, heart, pancreas and intestine transplants. There were around ten times as many transplants of skin, bone and corneas.

The first organ transplant in Spain was in 1965. It was a kidney. Throughout the rest of the 60s,70s and 80s there was an organised chaos about Spanish transplants. The legal and social objections to the process were legion but in 1979 legislation was put into place to regulate transplants. The two guiding principles were altruism, no selling of organs, and anonymity. The big change though came in 1989 with the founding of the National Transplant Organisation or, with its Spanish initials the ONT.

The ONT co-ordinates donations with need. In each hospital there is a transplant co-ordinator usually someone in the Intensive Care Unit the place where life and death most often cross paths. The co-ordinators tell the ONT about people who need a transplant and about potential donors. The ONT maintains and matches the two lists based on a scale of need and suitability. Someone who will die within 24 hours, “Urgency 0” gets first dibs. Bearing in mind that the maximum window for a transplant is four hours from harvesting to transplant they have to be pretty well organised.

When transplants first began in Spain the typical donor was someone under the age of 50, often the victim of a road traffic accident. Older donors were rejected out of hand. Nowadays over half the donors are over 60 years old. Most of the donors are dead but healthy. Think of the footballer who drops dead on the pitch, the old boy having sex with a younger woman – people whose hearts give out – or someone who suffers a sudden cerebral haemorrhage or someone who dies in the mayhem of a traffic accident. Not all the donors are dead though. Live transplants, for instance organ donation within the same family, now account for 15% of all Spanish donations and the target is 25%. The hope for the future is from tissue grown from stem cells being used to replace damaged organs.

Transplants are now so commonplace, over 86,000 since transplants began, that they are a real possibility in the treatment of patients. 5,500 people are waiting for a transplant. Life expectancy after a transplant is excellent. People can basically live out their years on borrowed organs. The biggest problem remains the body's own defence mechanism which will try to reject the new organ though the use of immunosuppressant drugs to stop rejection has advanced considerably over the years.

There is a word in Spanish – solidario- which encapsulates the idea of looking out for your own, caring for people, pulling your weight, doing the decent thing. The Spanish are very “solid” about transplants. The default position is that you will donate. Families are always consulted but 85 out of every 100 say “yes” Those family members are just a part of the chain of nearly 200 people involved in making a single transplant work.

It seems like a very human chain to me.

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