For the first time in the history of Latin America, the 29th International Congress on Organ Transplants will be held in Buenos Aires from 10 to 14 September, which It will feature the participation of over 3,000 transplant specialists from around the world.
(Keep reading: these are some myths and truths about organ donation in Colombia)
Within a broad and varied scientific agenda, multiple topics will be addressed, such as cutting-edge technologies, robotic surgery and artificial organ transplants, as well as new practices such as xenograft (organ transplants between different species such as the famous case of a pig heart transplant on a human in the United States).
In this regard, EL TIEMPO spoke with Dr. Alejandro Niño Murcia, surgeon, transplant specialist, co-director of the World Transplant Congress and former president of the Colombian Organ Transplant Association, who describes the current perspectives of this situation in Colombia. and the world.
How advanced is transplant medicine in the world?
Transplant science is advancing rapidly and in late 2020 and early 2021 we saw reports of the first xenograft (transplantation with organs from other species) of both the heart and kidney. YesWhile it is true that research has been conducted on this subject in the last fifty years, only a few cases have so far been conducted clinically. These cases have allowed us to clarify that we are still far from being a daily clinical reality.
Organ transplants require donors. What is the world landscape in this regard?
Currently, the pandemic has had a very large impact on the decline in organ and tissue donations and transplants, with an average of 40 percent compared to activity prior to this biological phenomenon. All countries, including Colombia, are looking to bring their transplantation business back to at least previous levels to start growth.
(Of interest to you: shortage of organs to be transplanted, a public health problem in the country)
And in the countryside?
In Colombia, the number of donors per million (DPM) of the population dropped to 4.4, when we had 8.7 DPM before the pandemic. We are trying to reach at least that number so that more Colombians can benefit from organ transplants. To place this indicator in a global context, we must take into account that Spain has 50 DPM, the United States 26 DPM, Portugal 23 DPM and in Latin American countries Uruguay has 32 DPM and Argentina 14 DPM. .
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Better indicators of organ and patient survival are expected every day.
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Regarding survival, the evolution of kidney, liver and bone marrow transplant patients is known. What other bodies today offer this perspective?
Better indicators of organ and patient survival are predicted each day and are measured separately because one organ can lose its function and the patient can continue to live and receive a second, third or fourth transplant. It is universally accepted to measure these two indicators at 1 year, 5 years and 10 years. In kidney transplantation, survival of more than 94% of the transplant and more than 97% of the patient is expected for the first year. At five years these indicators will be higher than 80% for the graft and 90% for the patient. At ten years, graft survival should be greater than 70% and 80% for patients. The best indicators are obtained with living donor transplants compared to the results from cadaveric donors.
What are the positions of the main religions of the world on this issue?
There is a common denominator in all religions which is love for others and organ donation, both in living donors and in the authorization of their use in cadaveric donors, is the superlative act of generosity and solidarity. In this sense, the vast majority of religions favor the donation and transplantation of organs and tissues. Pope John Paul II attended only one medical congress and went to the world transplant congress in Rome in June 1991 and his speech is one of the events that most struck me in my life because it exalted genuine and effective love. for others. . That day it became clear to me, to paraphrase the well-known advertising phrase, that “I was working in the right place”. At the World Transplant Congress we will have a meeting dedicated to this theme and there will be representatives of the Evangelical Church, Judaism, Islam, Hinduism, Buddhism, the Sikh faith and the Catholic religion. discuss how each of these beliefs can and should encourage organ and tissue donation, leading more people to benefit from a transplant.
What do you think of the potential health reform, in particular with reference to organ transplants?
After the enactment of Law 100, high-cost pathologies that include organ transplants have had better coverage and with the decrees and subsequent reforms all organ transplants have been included in the pension plan. The living expenditure of these patients is practically zero, which is not what we see in other healthcare systems in Latin America or around the world. When I was president of the Transplant Society of Latin America and the Caribbean (STALYC), I had the opportunity to visit virtually every country in the region and learn about their health systems, and there is no doubt that ours is probably the improve. Obviously there is room for improvement in many things but you cannot destroy what works well. I believe that patients will have to play a fundamental role in this reform and defend what has been achieved. The implementation of the Statutory Health Law is the commitment we all have, but we must have “financial realism” and understand that in no political system the health resources are infinite.
(Read also: This is the process to be an organ donor in Colombia)
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Dr. Alejandro Niño Murcia, surgeon, transplant specialist, co-director of the World Transplant Congress and former president of the Colombian Organ Transplant Association.
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What is the behavior of the health system in the face of transplants?
In Colombia, all organ transplants are included in the benefit plan and patients are not treated just for the transplant, Furthermore, a follow-up is guaranteed as long as the organ maintains its functionality. Few healthcare systems in the world offer such a comprehensive advantage
What is the most donated organ in the world?
The most performed organ transplant in the world is the kidney. Both with living donor and with cadaver donor.
What are the main obstacles to organ donation?
There are still doctors and health professionals who do not refer patients to the evaluation of transplant groups and have them remain on dialysis in case of kidney disease, or sentence them to death in case of failure of other organs. Audit mechanisms need to be strengthened so that this does not continue to occur. In Colombia, there are more than 32,000 dialysis patients and only 3,200 patients on the waiting list for a kidney transplant. This number should be at least four times higher.
There are people who still talk about international organ trafficking. It’s true?
Fortunately for Colombia, this problem was solved after 2004, when transplantation of foreign recipients was regulated. It is currently practically impossible to transplant a foreign recipient with a cadaver donor. For example, five liver transplants and three kidney transplants on foreign patients were performed in Colombia in 2021, all with a living donor and subject to review and authorization by the National Institute of Health. Unfortunately, there are still some countries where organ trafficking and transplant tourism occur. Cases have been reported in the past year in Egypt, Turkey, India, Pakistan, Azerbaijan, among others. But it has been many years since new cases have been reported in Latin America.
What is the youngest and oldest age when a transplant was performed?
The transplants were performed on newborns who have, for example, very complex congenital heart disease, which if not transplanted could not survive. As for the older age at which a transplant was performed, it has changed a lot over time. For example, in Spain patients over the age of 90 are being transplanted and in Colombia the kidney transplant of an older patient I know is 80 years old. This upper limit is very likely to allow for transplantation of older patients. We must remember that age is only a number and it is the individual clinical condition of each patient that will determine the feasibility of receiving a transplanted organ.
Today we talk about autotransplants such as bone marrow. Is it possible with other organs?
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The experiments began a long time ago by transplanting the donor organ and bone marrow at the same time.
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For a long time, experiments began by transplanting the donor’s organ and bone marrow at the same time, trying to achieve tolerance, and therefore the recipient would not have to take immunosuppressive drugs to avoid organ rejection.
(It might interest you: What policy covers you if you don’t want to donate your organs when you die?)
How long after someone’s death can an organ be donated?
The brain dead patient has very important metabolic changes, so it is recommended to carry out the rescue of organs and tissues as soon as possible. Once the organs have been saved, a period called ‘cold ischemia’ begins, which is the time when an organ lasts in a refrigerator or storage machine without receiving blood and which, depending on the organ to be transplanted , may vary slightly. To give some very simple examples, in the case of a lung it is recommended to transplant within four hours, it is recommended to transplant a heart within six hours, a liver within twelve hours, a kidney within 24 hours. These times are sometimes prolonged because it is not easy to coordinate the logistics between donor and recipient.
More health news
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-Is there organ trafficking in Colombia? This and other myths and truths
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