Emma, just 13 months old, has been the first person in the world to receive an intestine transplant from an organ from a donor with cardiorespiratory arrest. And this has been carried out in a Spanish center, the La Paz Hospital in Madrid.
This pioneering intervention in the world opens the door to the use of transplants in asystole or with cardiorespiratory arrest for many people who are waiting for an organ.
Donation in asystole, which is done in very few countries in the world, including Spain, consists of the use of organs and tissues that come from a person who is diagnosed with death after confirmation of the irreversible cessation of cardiorespiratory functions (absence of heartbeat and spontaneous breathing for more than five minutes).
The patient, as explained by the head of the Rehabilitation and Intestinal Transplant Unit, Esther Ramossuffered from short bowel syndrome that caused intestinal failure and that, after several interventions, had to undergo a transplant, since the treatment of choice, in which food is received intravenously, causes complications such as liver problems .
«When Emma arrived at the unit, barely 1 month old, from Valladolid, with an ultra-short intestine, the little she ate expelled it. She was in a situation of intestinal failure and depended on parenteral nutrition 24 hours a day », recalls Alida Alcolea, from the Intestinal Rehabilitation Unit of the Madrid hospital. The team first set out to improve his clinical situation. “During 4 or 5 months she underwent three surgeries.”
Pilar Serrano, also from the Intestinal Rehabilitation Unit, adds that the parents did not see the end. “By the third surgery we got her to stop throwing up and start eating a little more and she was able to go home with her parents.” But despite all these efforts, Emma did not improve. So she decided that she would get on the transplant list.
However, 30% of transplant candidates die on the waiting list. Until now, there had been no experience with this type of transplant; intestine from an asystolic donation had never been used, as it was considered that it would not be valid given the special characteristics of this organ.
As the scientific evidence did not show that it could not be done either, the professionals from La Paz belonging to the IdiPAZ Congenital Malformations and Transplant Group launched a three-year research project that has been possible thanks to the support of the Mutua Madrileña Foundation.
Thus, once the team was able to demonstrate, in several experimental models, that the intestine was valid, it could be transferred to the clinic, being a success. All this has been possible thanks to the collaboration of a multidisciplinary team made up of professionals from various hospital services, especially those of GPediatric Astroenterology, Pediatric Surgery, Pediatric Cardiac Surgery, Pediatric Intensive Care, Anesthesiology and Resuscitationas well as the Coordination of Transplants, Experimental Surgery and IdiPAZ.
And in the spring the possibility of transplantation in asystole arose.
This is where life changes Daniel and AnnaEmma’s parents. Before entering the operating room our life was very complex, says Daniel. «Although it was not very hard, because Emma was very careful, there came a point when we were going less and we were not advancing. The moment she entered the operating room was our salvation».
“We warn parents that during the post-transplant period, two months in the hospital, it is normal for complications to arise. But Emma didn’t give us any trouble. She was quite a surprise », remember doctors Alcolea and Serrano. Her parents say that she always behaved like “a fighter, a champion.” She was the girl who showed them her desire to live, overcoming “every adversity, trying to gain weight to move and evolve to be able to live and she gives you enough energy”-
The life of Daniel Lafora and Ana Ayuso It has taken another 180º turn. “Emma’s evolution has been impressive. She begins to crawl, she is evolving very quickly, she runs, dances, plays and begins to do many things and at a family level because she has given us complete happiness. She has quality of life, which is what mattered to us as parents”, Ana said yesterday. “She has given life to the three of us”, Daniel thanked the family of the deceased donor.
Now, warns the doctor Ramos“This is not a transplant for everyone, but for very selected cases that have to meet certain criteria.”
of the candidates for this transplant
die on the waiting list
Increases donation in asystole
Non-heart beating donation is becoming an increasingly important source of organs, acknowledges Francis Hernandez, pediatric surgeon from La Paz. However, on this occasion “we are facing a major problem with children who are on the waiting list for intestinal transplants, children who are months old, they have to spend many months, some of them even years, waiting for an organ. . And in this case, furthermore, it was a multivisceral graft consisting of the liver, stomach, pancreas and the entire small intestine, so that we have not only managed to demonstrate the validity of this type of graft, but we have also shown that it is compatible with the removal of other organs for transplantation.
“They were between eight and nine months on the multivisceral transplant waiting list,” confirmed the parents. “We reached the limit.”
Asystolic donation has been shown to have similar results to the classic donation in brain death
For Hernández, “it represents a great milestone that we hope will change the practice of intestinal transplantation in the rest of the world from now on.”
Beatriz Domínguez-Gil, director of the National Transplant Organization, an entity that has lent its support, recalls that there are very few countries that transplant non-heart beating donors. «Spain becomes the only country in the world that transplants all types of organs from non-heart beating donors».
In recent years, the number of patients who require a solid organ transplant to stay alive has increased and non-heart beating donation is becoming an increasingly important source since in adults it already represents a third of the donations made. do in our country. This technique makes it possible to contemplate the possibility of donation within end-of-life care in those patients in whom the adequacy of life support measures has been decided.
It also allows, after death certification, organs to be preserved with oxygenated blood perfusion through the Extracorporeal Membrane Oxygenation (ECMO) system. In this way, the organ to be transplanted does not deteriorate. Controlled asystole donation has been shown to have similar results to classic brain death donation and its use is also increasing in other countries around us.
And all of this is possible, reminds Belén Estébanez Montiel, transplant medical coordinator, of many professionals who participate, contributing a great deal of experience and professionalism, but above all, “this is possible thanks to the generosity of families who, in one of the worst moments of their lives decide to say yes to organ donation, they decide to help other families, other children, so that other parents don’t go through what they are going through.
Donation in asystole
In La Paz it was used for the first time in 2014 in adults and in September 2021 in children, although previously the pediatric transplant team had performed it with the itinerant ECMO team in three centers (Madrid, the Basque Country and Andalusia), the first of them in 2018. Since the beginning, in this public hospital in the Community of Madrid, 147 (12 pediatric) have been performed with organs from 64 donors, of which, 57 were adults and 7 pediatric.
Recently, the first cardiac tests derived from a donation of this type have also been carried out in La Paz, so far, one in an adult patient and two pediatric patients, all with serious heart disease.
More than 1,700 child transplants
Hospital La Paz is consolidated as one of the best transplant centers for children in both Spain and Europe. It is the only one accredited in our country to carry out all existing children’s programs and the only one that carries out the intestinal and multivisceral. In addition to transplants of hematopoietic precursors and cornea, La Paz has performed 3,149 organs, of which 1,754 have been in children.