Publication: Puesta en marcha de un Plan Nacional de Donación Cruzada y cadenas de trasplante en España. Expectativas de la donación altruista
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2017-09-14
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Universidad Complutense de Madrid
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Abstract
El trasplante renal es el tratamiento que ofrece una mejor calidad de vida y una mayor supervivencia a los pacientes con insuficiencia renal crónica terminal, independientemente de la edad y del grado de morbilidad asociada a la enfermedad renal terminal. Como consecuencia, se ha producido una ampliación en los criterios de inclusión en lista de espera renal y, a pesar de que en las últimas dos décadas la cifra de trasplantes renales no ha dejado de crecer, el desbalance entre la necesidad de trasplante renal y el número de donantes se mantiene año tras año. En los últimos veinte años se han puesto en marcha diferentes estrategias en España para incrementar la tasa de utilización de donantes fallecidos, como son: la instauración de programas de evaluación de la calidad y benchmarking en el proceso de donación de órganos, la expansión de los criterios de utilización de donantes fallecidos en muerte encefálica y la puesta en marcha de programas de trasplante de donantes fallecidos por parada cardiocirculatoria (asistolia). En su conjunto, estas estrategias han permitido incrementar el número de donantes, pasando de una tasa de 33,9 donantes por millón de población (pmp) en el año 2000 a 36 donante pmp en 2014. El número absoluto de trasplantes renales ha crecido de 2000 a 2552 en el mismo periodo. Sin embargo, las cifras alcanzadas siguen siendo insuficientes para hacer frente a la lista de espera en la que, al final de cada año, permanecen alrededor de 2000 pacientes. El trasplante renal de donante vivo es otra estrategia que además ofrece mejores resultados en cuanto a la supervivencia de injerto y paciente que el trasplante procedente de donante fallecido, con un riesgo bajo para el donante. Estos buenos resultados se mantienen aún entre aquellos receptores que no comparten antígenos de histocompatibilidad con su donante, lo que ha favorecido el trasplante entre individuos no genéticamente relacionados como pareja sentimental, familia política o amigos/as...
Kidney transplantation is the best treatment for patients with end stage renal disease in terms of recipient’s quality of life and survival, even for old patients or those with comorbidities. As a consequence, the number of patients on the waiting list continues to grow and demand of donors is ever increasing. In the last fifteen years, some strategies have been placed in Spain to face the donor shortage, such as the development of quality assurance programs and benchmarking projects in organ donation process, the expansion of the criteria for the use of brain death donors and the implementation of programs to use donors after circulatory death. These programs have contributed to increase donor’s rate, from 33.9 donors per million population (pmp) in 2000 to 36 donor pmp in 2014. In parallel, the number of kidney transplants has increased from 2000 to 2552 in the same period. However, the figures achieved are still insufficient to address the waiting list and around 2000 patients remain waiting for transplantation at the end of every year. Live donor transplantation is another option to increase the donor pool that provides even higher graft and patient survival than the transplantation from a deceased donor. Similar outcomes are found among those recipients with poor HLA match with his willing donor, which has strengthened the transplantation between non-genetically related individuals (i.e. couples or friends). All this encouraged by the low risk assumed for the live donor Unfortunately, approximately 30% of patients with willing live donors are excluded from conventional direct live donor renal transplantation due to blood type incompatibility or positive donor specific crossmatch...
Kidney transplantation is the best treatment for patients with end stage renal disease in terms of recipient’s quality of life and survival, even for old patients or those with comorbidities. As a consequence, the number of patients on the waiting list continues to grow and demand of donors is ever increasing. In the last fifteen years, some strategies have been placed in Spain to face the donor shortage, such as the development of quality assurance programs and benchmarking projects in organ donation process, the expansion of the criteria for the use of brain death donors and the implementation of programs to use donors after circulatory death. These programs have contributed to increase donor’s rate, from 33.9 donors per million population (pmp) in 2000 to 36 donor pmp in 2014. In parallel, the number of kidney transplants has increased from 2000 to 2552 in the same period. However, the figures achieved are still insufficient to address the waiting list and around 2000 patients remain waiting for transplantation at the end of every year. Live donor transplantation is another option to increase the donor pool that provides even higher graft and patient survival than the transplantation from a deceased donor. Similar outcomes are found among those recipients with poor HLA match with his willing donor, which has strengthened the transplantation between non-genetically related individuals (i.e. couples or friends). All this encouraged by the low risk assumed for the live donor Unfortunately, approximately 30% of patients with willing live donors are excluded from conventional direct live donor renal transplantation due to blood type incompatibility or positive donor specific crossmatch...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 18-01-2016