Spain has successfully performed its first two kidney cross-transplants with a live donor

(My Original Blog Post: http://www.spanishvida.com/2009/07/spain-has-successfully-performed-its-first-two-kidney-cross-transplants-with-a-live-donor/)

• Two people from Andalusia and another two from Aragon were the central figures in this new form of transplant that is based on exchanging live kidney donors among two or more pairs.


• The four people (two donors and two recipients) have already been discharged from hospital. They were operated on at Barcelona’s Hospital Clínic and Hospital Virgen de las Nieves in Granada on the same day and at the same time.


• Kidney cross-transplant aims to offer patients with chronic kidney failure the possibility of receiving a live kidney transplant from their donor partner even though they may not be compatible.


• 8 Spanish hospitals are currently involved in this programme and it is hoped that more will join it in the coming months.


• The first assessment of an exchange of potentially compatible donors and recipients was carried out between 16 couples who fulfilled all the expected requirements of the programme.

The exchange of live kidney donors among two or more couples has now become reality in this country. Spain has successfully performed its first two kidney cross-transplants with a live donor. This involved two people from Andalusia and another two from Aragon who were operated on at Barcelona’s Hospital Clínic and Hospital Virgen de las Nieves in Granada on the same day, 21st July, and at the same time.

The four people (two donors and two recipients) have already been discharged from hospital.

This involves a complicated process that demands total collaboration between the ONT, the transplant co-ordinators for the Autonomous Regions, the hospitals and the medical teams involved. This first process involved ONT experts, the regional co-ordination of Catalonia, Aragon and Andalusia, as well as a large number of professionals at the hospitals in Barcelona and Granada.

The programme aims to carry out a new assessment of potentially compatible donor partners and recipients (these could be mother-son, husband-wife, etc.) before the end of the year with the couples still on the waiting list after this first double transplant, as well as with new ones from all over Spain that come to light before the assessment date. The compatible couples from this exchange will undergo analysis to finally decide whether both transplants can be performed.

Kidney Cross-Transplant Programme

A national programme to promote live kidney donation will thus take shape. It was started by the ONT in collaboration with the Autonomous Regions in June 2008 following the approval of the Transplant Commission that belongs to the national health system’s Interterritorial Council.

Kidney cross-transplant – which is what the programme is called – aims to offer patients with chronic kidney failure the chance to receive a kidney transplant from a live donor, thanks to their partners’ generosity, even though they may not be compatible. This programme is based on the exchange of live kidney donors among two or more couples.

This therapeutic model was developed in countries where post-mortem donation is non-existent or lower than in our country, as is the case in South Korea, Holland, the UK and the USA, where this kind of transplant has been performed for over a decade with excellent results.

In this country the changes in the profile of post-mortem donors, who are increasingly older, and the development of laparoscopic surgery, which is not very invasive for donors, have led the ONT to promote live donation.

There are currently 27 teams performing live donor kidney transplants throughout Spain. This kind of intervention represents 7% of all kidney transplants in this country, whereas a decade ago it was 1%. ONT aims to increase this figure to 15% over the next few years.

Ethical and Legal Aspects

In this country the 1979 transplant act and the subsequent 1999 Royal Decree regulate live donation among relatives or people with emotional ties, as our legislation states that organs coming from live donation should be transplanted to a specific person. Spanish law expressly forbids live organ donation if economic, social and psychological factors are involved.

The Spanish protocol for kidney cross-transplants has been created by an expert committee that comprises ONT representatives, co-ordinators from the Autonomous Regions and hospital staff involved in transplants, nephrologists, urologists, immunologists, judges and bioethical experts. It includes requirements for donors and recipients as well as the hospitals involved in this programme, and lays out the procedures to be followed throughout the process from a medical, ethical and legal point of view.

Requeriments

The donor must be of age, of sound mind and in good health, and the hospital staff should certify these conditions. Likewise, the ethical committee at the transplant unit should also approve the donation.

Finally, the donors must confirm, in front of a judge, their willingness to donate a kidney without any contributing factors. This must be done in the presence of the doctor who will remove the organ, the hospital transplant co-ordinator and the doctor who has certified the donor’s health.

The only requirements for patients are that they should have a renal illness that requires a transplant and they have an incompatible donor partner.

The hospitals must be authorised to perform the live kidney transplant, must have performed a minimum of 15 operations of this kind during the last 3 years, must regularly use laparoscopic surgery to remove kidneys, and must have a favourable report from the Autonomous Regions’ transplant co-ordination service.

There are currently 8 Spanish hospitals involved in this kidney cross-donor programme and it is hoped that more will join in the coming months. The hospitals already involved are:

• Hospital Clínic i Provincial, Barcelona.


• Hospital Doce de Octubre, Madrid.


• Hospital Fundació Puigvert, Barcelona.


• Complejo Hospitalario Universitario, Corunna.


• Hospital Universitario de Bellvitge, Barcelona.


• Hospital Universitario de La Paz, Madrid.


• Hospital Virgen de las Nieves, Granada.


• Hospital Virgen del Rocío, Seville.

The kidney cross-transplant programme is considering creating a National Register of donor-receiver partners that will be managed by the ONT. ONT has therefore developed a computer application that will facilitate the process of identifying possible exchanges among couples on the register. The possible exchanges between candidates will be analysed three times a year in order to identify new compatible pairs.

As in these first two operations, each kidney cross-transplant will be performed in the receiver’s hospital and the donor will have to travel.

Spain is the world leader in terms of transplants, with 34.2 donors per million of the population (p.m.p.).