Review of the allocation criteria for heart transplant in Spain in 2023. SEC-Heart Failure Association/ONT/SECCE consensus document.

Heart transplant (HT) remains the best therapeutic option for patients with advanced heart failure (HF). The allocation criteria aim to guarantee equitable access to HT and prioritize patients with a worse clinical status. To review the HT allocation criteria, the Heart Failure Association of the Spanish Society of Cardiology (HFA-SEC), the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) and the National Transplant Organization (ONT), organized a consensus conference involving adult and pediatric cardiologists, adult and pediatric cardiac surgeons, transplant coordinators from all over Spain, and physicians and nurses from the ONT. The aims of the consensus conference were as follows: a) to analyze the organization and management of patients with advanced HF and cardiogenic shock in Spain; b) to critically review heart allocation and priority criteria in other transplant organizations; c) to analyze the outcomes of patients listed and transplanted before and after the modification of the heart allocation criteria in 2017; and d) to propose new heart allocation criteria in Spain after an analysis of the available evidence and multidisciplinary discussion. In this article, by the HFA-SEC, SECCE and the ONT we present the results of the analysis performed in the consensus conference and the rationale for the new heart allocation criteria in Spain.

Transplantation of organs from SARS-CoV-2-positive donors: Preliminary experience from Spain.

BACKGROUND: The utilization of non-lung organs from deceased donors with a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of donation can be lifesaving, although the safety of this policy must be assessed. METHODS: This is a nationwide, prospective study, reporting the experience on the utilization of non-lung organs from SARS-CoV-2-positive donors between December 15, 2020 and May 31, 2022 in Spain. RESULTS: A total of 69 patients received a solid organ transplant (41 kidney, 18 liver, 8 heart, and 2 combined liver-kidney) obtained from 32 donors with a positive SARS-CoV-2 PCR at the time of donation (four of them with a cycle threshold value <30). All recipients tested negative for SARS-CoV-2 and were free of coronavirus disease 2019 (COVID-19) symptoms prior to transplantation. Nasopharyngeal swab turned positive for SARS-CoV-2 PCR in 4 (5.8%) recipients at 3, 8, 11, and 20 days after transplantation, though evidence did not support a donor-derived COVID-19. Four kidney recipients lost their grafts and two patients died: one heart recipient due to cardiogenic shock and one combined liver-kidney recipient due to lung hypertension and right heart failure. Graft losses and patient deaths were deemed unrelated to the donor SARS-CoV-2 status by the treating teams. No other adverse reactions were reported. CONCLUSIONS: This preliminary experience supports the safety of the use of organs other than lungs from SARS-CoV-2 PCR-positive donors, in alignment with previous series. However, the impact of SARS-CoV-2 infection upon organ quality should be established in future research.

Can We Improve the Effectiveness of the Spanish Nondirected Donation Program?

BACKGROUND: A nondirected altruistic living kidney donor is a person who wants to donate a kidney to anyone in need. In 2010, the Spanish National Transplant Organization developed a national protocol to make the assessment of every potential nondirected living kidney donor. The aim of this study was to describe the potential donor pool and its characteristics and the overall effect of the program. MATERIAL AND METHODS: A retrospective analysis was performed using data from the Spanish National Registry of Transplant Activity, and the Nondirected Donors National Database, between 2010 and 2017. Data related to sociodemographic characteristics, main motivations toward donation, and causes of dismissal were collected from all potential donors. The assessment of each candidate was carried out in a step-by-step process based on the national protocol. RESULTS: Two hundred seventy-two people contacted us, showing interest in the nondirected kidney donation, only 203 people underwent the early triage, and 16 of them successfully completed the assessment proces s, representing 8% of the total. The main motivation toward anonymous donation (n = 161) was: social awareness (22%) and to improve the quality of life of other people (9%). One hundred eighty-two candidates did not proceed, due to medical and psychological contraindications (42%) or donor refusal after specific information about the donation process (33%). The number of utilized nondirected altruistic living donors was 13 out of 203 (6%) of the candidates who began the early triage. Twelve transplant chains and a direct donation were performed, which made 38 kidney transplants possible (2.9 transplants per nondirected donor). CONCLUSIONS: We have to continue working to optimize our program. Our next steps will be to review the evaluation process, to detect areas for improvement, to understand why we lost many possible donors, and to ascertain if any of the reasons could be avoided.

El trasplante renal de donante vivo: una opción terapéutica en consulta de Enfermedad Renal Crónica Avanzada / Kidney transplantation from a living donor: a therapeutic option in consultation in Advanced Chronic Kindey Disease

En España se ha conseguido gestionar la donación de órganos a lo largo de los últimos 30 años, de manera más efectiva que en el resto de los países. Aun así, no hemos alcanzado la autosuficiencia. La prevalencia de enfermedad renal en nuestro país para el año 2017 fue de 685 p.m.p. teóricamente el 22% de estos pacientes serán candidatos a trasplante renal, lo que supone una necesidad de 150 trasplantes renales p.m.p. En 2017, la lista de espera para trasplante renal albergaba a 7.211 pacientes, 3.269 consiguieron trasplantarse (332 de donante vivo), lo que suponen 70 trasplantes p.m.p. El porcentaje aumenta cuando hablamos de receptores jóvenes, ya que, el número de donantes mayores de 60 años supera el 50% del total. Así mismo, se observan notables diferencias en la distribución de actividad de trasplante renal de donante vivo por CCAA. Con la donación renal de vivo, se pretende atender mejor las necesidades de la lista de espera para trasplante, reducir los tiempos de espera en general y aumentar la oferta de una excelente opción terapéutica, con mejores resultados en supervivencia y rehabilitación para el paciente, siendo actualmente una opción muy segura también para los donantes. El abordaje de los pacientes con enfermedad renal crónica debe plantearse desde el punto de vista multidisciplinar (enfermeras, nefrólogos, psicólogos y cirujanos), destacando el papel clave de la enfermera como gestora de cuidados, por la influencia que ejerce en su educación sanitaria y en la orientación terapéutica que se proporciona desde las consultas de enfermedad renal avanzada

In Spain, organ donation has been managed over the last 30 years, more effectively than in the rest of the countries. Even so, we have not reached self-sufficiency, specifically in the case of kidney transplantation, there is still a negative balance between patients who annually enter the waiting list and organs available for transplantation. The prevalence of kidney disease in our country in 2017 was 685 donors per million population (p.m.p) theoretically 22% of these patients will be candidates for kidney transplantation, which means a need for 150 kidney transplants p.m.p. In 2017, the waiting list for kidney transplantation had 7,211 patients, 3,269 were transplanted (332 from living donor), which means 70 transplants p.m.p. The percentage increases in young recipients, since, the number of donors older than 60 years exceeds 50% of the total. There are also notable differences in the distribution of renal transplant activity from living donors by Autonomous Community. Kidney donation from living donors, aims to better meet the needs of the waiting list for transplant, reduce waiting times in general and increase the supply of an excellent therapeutic option, with better results in survival and rehabilitation for the patient, being currently a very safe option also for donors. The approach to patients with chronic kidney disease must be multidisciplinary (nurses, nephrologists, psychologists and surgeons), highlighting the key role of the nurse as manager of care, by the influence on their health education and therapeutic guidance, which it is provided from the consultations in advanced chronic kidney disease