Publication: Calidad y seguridad del donante de riesgo no estándar
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2021-07-12
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Universidad Complutense de Madrid
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Abstract
A pesar del incremento de los trasplantes de órganos durante las últimas décadas, sigue existiendo un desequilibrio entre la demanda de los pacientes en lista de espera para trasplante y la oferta de órganos. Este problema conlleva que los pacientes afronten largos periodos hasta el trasplante y que muchos se deterioren o incluso fallezcan en ese tiempo. El proceso de caracterización y evaluación de los donantes y la valoración del riesgo-beneficio son complejos; la información se consigue a través de la historia clínica o de terceras personas que pueden no conocer determinados antecedentes o conductas de riesgo o no recordarlos en ese momento emocionalmente delicado. La contraindicación absoluta sólo debería ser utilizada si un donante no se puede ofertar para ningún receptor y el riesgo supera a los posibles beneficios; un donante inaceptable o inapropiado para un receptor concreto puede salvar la vida de otro. La falta de evidencia y el escaso conocimiento ante determinados antecedentes limitan las recomendaciones nacionales e internacionales y generan que la toma de decisiones de coordinadores y equipos de trasplante se basen frecuentemente en un supuesto riesgo en lugar de un riesgo basado en la evidencia. El proyecto de Donante de riesgo no estándar (DRNE) se encuentra entre las iniciativas puestas en marcha por la ONT y la red de coordinación con la finalidad de aumentar o mantener las tasas de donación y trasplante y optimizar la utilización de este tipo de donantes, pero asegurando la seguridad del proceso de donación y trasplante. Su principal objetivo es conocer las características, eficacia y utilización de órganos procedentes de DRNE así como estudiar los resultados de los trasplantes obtenidos de ellos, para constatar que son similares en términos de calidad y seguridad a los resultados de los trasplantes realizados de donantes sin estas condiciones...
Despite the increase of human organ transplantation during the last decades there is a chronic inability to satisfy the transplant needs and the main obstacle to further development is the shortage of organs. Additionally the epidemiological changes of donors profile make progressively more difficult the assessment of donor suitability. Medical contraindications represent an important reason why possible deceased organ donors do not transition to utilized deceased organ donors. On occasions, medical unsuitability is inappropriately established by the physician in charge of referring the possible organ donors. Sometimes however there is simply insufficient information to determine the safety of using organs from donors with specific diseases or conditions. National and international recommendations are also flawed by the poor knowledge and limited evidence that currently exist with regards to such safety. As a result, donor coordinators and transplant teams frequently take decisions based on a supposed rather than on an evidence-based risk. To reduce potential donor losses due to medical unsuitability and safely expand the donor pool, several measures have been adopted in Spain. The non-standard risk donor (NSRD) project is one of these strategies to adapt to this changing scenario, but also ensuring the safety of solid organ transplantation. The aim of this project is to know the characteristics, efficacy and utilization of organs from NSRD and to study the results of transplants performed with organs from these donors...
Despite the increase of human organ transplantation during the last decades there is a chronic inability to satisfy the transplant needs and the main obstacle to further development is the shortage of organs. Additionally the epidemiological changes of donors profile make progressively more difficult the assessment of donor suitability. Medical contraindications represent an important reason why possible deceased organ donors do not transition to utilized deceased organ donors. On occasions, medical unsuitability is inappropriately established by the physician in charge of referring the possible organ donors. Sometimes however there is simply insufficient information to determine the safety of using organs from donors with specific diseases or conditions. National and international recommendations are also flawed by the poor knowledge and limited evidence that currently exist with regards to such safety. As a result, donor coordinators and transplant teams frequently take decisions based on a supposed rather than on an evidence-based risk. To reduce potential donor losses due to medical unsuitability and safely expand the donor pool, several measures have been adopted in Spain. The non-standard risk donor (NSRD) project is one of these strategies to adapt to this changing scenario, but also ensuring the safety of solid organ transplantation. The aim of this project is to know the characteristics, efficacy and utilization of organs from NSRD and to study the results of transplants performed with organs from these donors...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 16/12/2020