Keeping Kidneys: Most Countries Struggle to Meet the Demand for Transplant Kidneys, but a Few Are Reaping the Benefits of Systems Dedicated to Increasing the Number of Organ Donations after Death
2012; World Health Organization; Volume: 90; Issue: 10 Linguagem: Inglês
ISSN
1564-0604
Autores Tópico(s)Renal Transplantation Outcomes and Treatments
ResumoOn a shelf in Maria Jesus Gonzalez's home in Toledo, Spain, there is a small frame with a remarkable image. It is an echogram of a freshly-transplanted kidney. Her transplanted kidney. The case of Gonzalez, who had a transplant in 1992 after being diagnosed with renal failure in November 1988, is not uncommon, even if her way of reminding herself of it may seem unusual to some. Gonzalez is candid when she talks about her post-transplant People who have received a transplant can teach a lot to others regarding how to live well: in general, we have a more positive attitude towards life, because we get a new reason for living. You can't be sad or get worried about everyday problems because the important thing is that you have a better quality of life, and that you are living thanks to the work of many she says, referring to the time and effort not just on the part of the donor but also the surgeons, nurses and doctors, who are responsible for the success of a kidney transplant and the follow-up care. [ILLUSTRATION OMITTED] Gonzalez is one of the lucky ones. Figures released in 2010--the latest available by the Global Observatory on Donation and Transplantation, a collaboration between the Spanish national transplant organization (Organizacion Nacional de Trasplantes) and the World Health Organization (WHO), show that the number of organs--including kidneys--transplanted that year was less than 10% of what is actually needed worldwide. 2010, that 10% represented 73 179 transplanted kidneys, well short of the estimated 800 000 actually needed. Dr Luc Noel, an expert on transplantation issues at WHO, says that kidney donation is hampered by several factors. Many people, including health professionals, do not appreciate the value of organ donation after death or how it works, and few countries have a system to allow for it, Noel says. With regard to live kidney donation, he says that many people do not realize that the risks of health complications or death for donors is low. He cites a study published in JAMA in 2010 that found that there are 3.1 such deaths as a result of surgery for every 10 000 live donors in the United States of America, and that live donors' long-term life expectancy does not change, when proper donor selection, care and follow-up is applied. In many countries end-stage renal failure still leads to death, even though some patients are on dialysis for a while, Noel says, referring to patients with less than 10% kidney function, like Gonzalez. But we know that a transplanted kidney can give the recipient several decades of high quality life. Although kidney transplantation is routine clinical practice, it needs inter-disciplinary work and follow-up, including medication, lab work and expertise in rejection treatment, Noel says, adding that even with follow up, transplantation is cheaper than renal dialysis after the first year. A 2011 costing report by the United Kingdom's National Institute for Health and Clinical Excellence found that by increasing the number of kidney transplantations and, thereby, reducing the number of patients on renal dialysis, significant cost savings can be made after the first year and that these savings increase until the eighth year, when they remain steady. One country that has tapped the potential of renal transplantation to excellent effect is Spain. The western European country is now working with WHO to improve renal transplantation worldwide via initiatives such as the Global Observatory on Donation and Transplantation. The Spanish system deploys transplant coordinators who work in hospitals across the country to increase organ harvesting from persons--often known as deceased donors--by identifying possible donors, mainly people who die in accidents or from stroke or heart attack, and by talking to the donors' next of kin to gain their consent. …
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