cystic fibrosis of Xavi Knight are fattened with your lungs. Diagnosed with two months, the hereditary disease, which is characterized by a problem of the mucous glands that damages the lungs, the pancreas and the gastrointestinal tract, among other organs, has conditioned its 37 years of life. Until August 5, 2018. A call from the hospital Vall d’hebron of Barcelona at noon interrupted him food and changed his life: he had a body for him. “Since I have use of reason, I was suffocating. At the age of 11, playing football and I was suffocating. It was a life of choking. The transplant has changed my life,” he explains. Since its intervention, Xavi has now joined the counter of success of the national system of transplants. Spain has validated, by the twenty-eighth consecutive year, its global leadership in transplantation (5.449 interventions) and in donations, with 48.9 per donor per million inhabitants.
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An opportunity for the health care system In the bowels of a transplant
Xavi had 15 months on the waiting list. They called two times prior to the vanquished, but the body, finally, was not supported. He was still waiting, tied to an oxygen machine. “When you see that they do not call you, you get used to and what you’re getting back to normal. You have to get on with your life,” he admits. This 7 of August, after the call, he left the food to be done and was rushing to the hospital from his home in Sant Pere de Ribes, a town 40 kilometres south of Barcelona —patients on the waiting list have to be less than two hours from the hospital that coordinates your transplant—. “I had the hunch that that day would be for me. When I put the slippers, the hat and the pajamas I knew that the transplant was going ahead,” he explains. Doctors do not confirm the operation until the last moments, when they have the evidence, after the extraction, that the organ is compatible.
The intervention was a success and, three days later, in the ICU, because we removed the oxygen. Since then, his life changed. “The system is perfect and the co-ordination, impressive. The donor and his family will be forever grateful because I have experienced a life that he never had imagined. I had not met 37 years if that family had not decided to donate”, values now Xavi, who has returned to make hiking trips to Cantabria or to the Teide and even a stretch of the Camino de Santiago.
The donation of organs has grown nearly 40% in the last six years. Although they have fallen by donors for road traffic accidents (just 4.4%), continues to rise the donation in non-heart-beating (for cardiac arrest) and is already a third of the total. Donors for brain death continue to remain the majority. “We continue to grow in the donor despite being in an environment that is not favorable to the donation because, by luck, have dropped the traffic and strokes”, says Beatriz Domínguez-Gil, director of the National Organization of Transplants (ONT).
The profile of donors has changed: young people died in a traffic accident in elderly people who die by natural causes, usually strokes. In fact, 30% of the donors had more than 70 years.
To further improve donation rates, the ONT has launched the Plan 50×22, in order to achieve the 50 donors per million people in 2022. “Almost what we get with two years in advance”, stresses Domínguez-Gil. Among the measures to achieve this challenge, the ONT is committed to promote the cooperation between the services of the ICU and the Emergency department to detect more donors and enhance the donation in non-heart-beating. “We started in 2009 with the asystole, but it is a technique more complex, because, with the cardiac arrest, the organs are left without blood flow and, until they are extracted, they may lose their viability. We want to encourage the donation in non-heart-beating [now 121 of the 185 centres that are authorised to coordinate donations] and transform it into a donation-organ. We are now developing techniques of preservation of organs, with machines of extracorporeal circulation, that we are copying other countries”, points out Domínguez-Gil.
The challenge of making a sustainable model of success
The director of the ONT, Beatriz Domínguez-Gil, ensures that, despite the good results for 28 years, “there is always room for improvement”. The big challenge, he admits, is the sustainability of this successful system. “The system has grown a lot, but the workers and units of donation and transplantation have not grown. If we want to continue increasing the rates, it is important to adapt the human resources and equipment to the reality that we have. The burden of care is brutal,” he admits.
Dominguez-Gil calls “more personal” dedicated to the transplants, and a plan of retention of talent. “This increase in activity keeps the system in tension and it is important to reinforce it. We need to attract and retain more professionals,” he adds.
The other great asset of the Plan 50×22 is to incorporate the private health system in the circuit of the donation —not the transplantation— under the supervision of the National Health System. “The interest is evident. We have signed an agreement with the employers of the private to develop a protocol and an implementation strategy. We believe that in four or five years could incorporate all centres with potential of donation and our forecasts suggest that, with them, you could grow the donation a 10 per cent”, adds the director of the ONT.
The result of the 2.301 registered donors in the past year has resulted in 5.449 transplants (a rate of 116 per million people, the highest in the world). Kidney transplants (3.423) and the lung (419), like Xavi, have returned to record highs. They have also made 1.227 liver, 300 heart, 76 pancreatic and four bowel.
all in all, the waiting list is located on the 4.889 patients, 93 of them children. People waiting for a liver is reduced, in 2018, a 15% the effect of novel therapies against hepatitis C, which began to be administered five years ago. To cure the disease, reduced the need for transplants by carcinomas and cirrhosis, two common ailments that causes the virus of hepatitis C.
Jesus Escudero, was one of the liver transplant before the arrival of the revolutionary antiviral. Was operated in the Hospital 12 of October of Madrid in October 2008, at the age of 53, after a year on the waiting list. Various tumors colapsaban your liver. “The situation of waiting was agonizing. My family and I notice how I turned off slowly, like a candle”, remember now this chemical dedicated to the audit of systems of power.
The night of the 7th of October, while I watched tv with sor woman, received a call from the hospital. He had a body that could be supported. After the intervention, that candle was extinguished, “began to recover each time with more force”.
The virus of the hepatitis returned to his new liver, but there had already been a few years, ran the 2014 and Jesus was one of the first candidates for new antiviral drugs. With a month of treatment, there were no signs of the virus. With 65 years, Jesus maintains his medical checks, but is clean of the virus and no problems with your new liver. “We are fortunate to live in a country that is the head the world in this. I have known my grandson thanks to a transplant,” he concludes.
