2024-03-23 09:47:35
“The ideal would be to have perfect donors, but we do not have organs on demand. And that is why new possibilities arise,” says the director of the National Transplant Organization (ONT), Beatriz Domnguez-Gil. There is no magic formula, but The objective of the ONT is to provide an individual solution to each patient requiring a vital organ transplant. With this “the pool of donors and recipients could be increased. In many cases these are techniques that would not have been thought of,” explains Domnguez-Gil.
Here, we go beyond xenotransplantation. The review of the present and future of transplants that took place during the XIX National Meeting of Transplant Coordinators and Communication Professionals coincided in time with the announcement of one of the latest milestones in the field: a group of surgeons from the United States For the first time, a genetically modified pig kidney is transplanted into a living patient.
Regarding this possibility, the director of the ONT showed criticism and reticence about when and to whom this option should be offered. “The main question is related to What criteria must be met to opt for a xenotransplant versus a consolidated therapy? and with very good results such as the conventional transplant, the human transplant.” And he added, during his speech at the meeting, that there are still “many doubts about the effectiveness and safety in the short, medium and long term” of these procedures. .
In these sessions, how to innovate in a matter in which Spain is a leader and pioneer in many aspects was addressed from different angles. The revolution will come from the possibilities that open up with artificial intelligence and their role in the allocation of organs for transplantation, the roles of organoides and its regenerative potential or genetically modified cells to treat spinal cord injuries. “But we have to choose carefully who we subject to each new technique,” says Domnguez-Gil.
Spain is a world leader in transplants
Spain has started 2024 with a new maximum number of transplants carried out, a total of 1,043. This is 13% more than the first two months of 2023, when they already set their thirty-second world record. For this reason, the director of the ONT is optimistic, believing that in 2024 the figure of 6,000 could be exceeded.
Figures that allow us to look without envy at the US, where only 9% of donors are 65 years old or older, compared to 44% of Spaniards. In our country, new strategies are sought and designed – “many of them pioneering worldwide” – to increase the number of donors, because “things are becoming more complicated,” explained Domnguez-Gil, due to the decrease in accidents.
Meanwhile, in the US there is “more mortality from traffic, from firearms, which does not exist in our country, and from the socio-health crisis of opioids, which has become the main cause of death in people under 50 years of age.” 17% of North American donors died from overdose.
New areas with potential in the present
Getting to it goes through bet on donation programs that seek solutions beyond the current ones, such as donors from asystole, living, from patients who have suffered a tumor disease or neurological deterioration, such as ALS.
Mario Royo-Villanova, transplant coordinator at the Virgen de la Arrixaca University Hospital, Murcia, told how this experience was born. “It was due to the case of the father of an oncologist, Juan Antonio Encarnacinwho developed a tumor, but wanted to donate his organs.” This marked the beginning of a thesis and a protocol in the Murcian community that they will try to take to the national level.
Consider the patients with brain tumors as potential donors It is a new way in donation. To do this, the situation of these patients must be “well studied beforehand, although there is no zero risk, in tumors of the central nervous system the benefits are greater,” explained Royo-Villanova.
Another way to Searching for the best donors on a list comes from artificial intelligence. Javier Briceo, director of the Clinical Management Unit of General Surgery and the Digestive System at the Reina Sofá University Hospital in Córdoba, in his speech pointed out the need for it “not only to serve to select the best donor for a recipient,” but also to “How to collect the future AI law being worked on in Europe will provide an explanation.”
For Briceo this tool must have the trait of explainability. “Doctors need to know the why of things. In the case of choosing one patient over another due to diabetes or another critical factor.”
Los organoides and its future role was addressed by Nuria Montserrat, group leader at the Bioengineering Institute of Catalonia. “We are still at the beginning,” he says. “But we are taking important steps to learn more about the biology of organ development in order to be able to generate substitutes.”
The director of the ONT also put the spotlight on how to offer organs to hyperimmunized patients. They are up to 10% of the people on the waiting list and “they are one of the objectives that we have set for ourselves at the ONT,” Domnguez-Gil stressed.
Those people who have a large amount of antibodies, sometimes 100%, which causes rejection of any transplant. Ignacio Revuelta, from the Nephrology Service of the Hospital Clnic of Barcelona, listed a series of options whose purpose is “to trick the body into eliminating the antibodies and being able to perform the transplant.”
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