TRASPLANTE RENAL EN ECUADOR, PUNTOS CLAVE Y SITUACIÓN ACTUAL.

IntroductionKidney transplantation in Ecuador began in 1976, it was limited until 2011, when the Organic Law of Donation and Transplantation of Organs, Tissues and Cells became valid. This is indicated in end-stage renal failure, in adult and pediatric patients; and, compared to peritoneal and renal dialysis, it is less expensive for the health system. In 2015, in Ecuador, at least 30,000 people suffered from end-stage kidney disease; 45% of them could die without treatment. The objective of this study was to determine the current situation in Ecuador regarding kidney transplantation. MethodologyA descriptive, retrospective study. INDOT statistics were reviewed from 2007 to August 2019, to determine the total number of transplants and kidney transplants, type of transplant, effective donors, rate of donors per million population (pmp), transplanted organ rate (pmp), evolution of the national waiting list, survival rate, etc. Results From 2007 to 2019, 6134 transplants were performed: 25.4% renal. Most donors were male (68.1%). The donor rate (pmp) between 2009 and 2019 was 4.2 (SD: ± 2.1). The mean rate of transplanted organs was 8.1 (SD: ± 3.6) (pmp) from 2007 to 2019. In this period 1560 kidney transplants were performed: 83.1% with cadaveric donors (88.1% adults; 11.9% pediatric) and 16.9% with living donors (72.4% adults; 27.6% pediatric). The one-year survival rate after cadaveric and living donor kidney transplantation was 0.94 and 0.97 in adults; and 0.90 and 0.97 in pediatrics, respectively. Currently there are only 5 accredited centers for kidney transplantation in adults and one for pediatric kidney transplantation .ConclusionsKidney transplantation has made significant progress in Ecuador, however, it is still below the World Health Organization (WHO) goal established for the proper management of patients with chronic kidney failure.

A Case for an Opt-Out Organ Donation System in Canada

This commentary supports an ‘opt-out’ system for organ donation in Canada. To begin, it examines the state of organ donation in our country and presents both the ‘opt-in’ and ‘opt-out’ schemes. Then, it argues in favour of implementing ‘opt-out’ legislation in Canada, suggesting that this system makes donation easier for families and improves the donor rate. Opinions against ‘opt-out’ are considered and debated. Finally, other donation systems as well as potential methods to encourage organ donation are briefly discussed. RÉSUMÉ Ce commentaire appuie la mise en place d’un système avec option de retrait (‘opt-out’ system en anglais) pour le don d’organes au Canada. Tout d’abord, ce commentaire se penche sur l’état actuel du don d’organes dans notre pays et présente à la fois le modèle à option d’adhésion (‘opt in’) et celui à option de retrait (‘opt out’). Puis, il argumente en faveur de la mise en œuvre d’une législation qui permettrait un système avec option de retrait au Canada, suggérant que cela faciliterait le don d’organes pour les familles et amé- liorerait les taux de dons. Certains des arguments contre le système avec option de retrait sont examinés et démontés. Finalement, d’autres systèmes de dons, ainsi que des méthodes pouvant possiblement encourager le don d’organes, sont discutés brièvement.

Xenotransplantation: A Potential Solution to the Critical Organ Donor Shortage

The success of allotransplantation as a treatment for end-stage organ failure has resulted in the need for an increasing number of organ donors. Attempts to meet this need include the use of organs from living related and unrelated donors, financial or other incentives for the donor family, and even the reuse of transplanted organs. Despite these initiatives, the supply of organs for transplantation still falls far short of the demand, as evidenced by longer waiting times for transplantation and decreasing transplantation rates. Even if Canada were able to increase its organ donor rate to that of Spain (40 to 50/million), where organ donation is governed by ‘presumed consent’ legislation, this would not alleviate the problem of donor shortage. Interest in xenotransplantation stems from the need to overcome this increasingly severe shortage of human organs. Indeed, some argue that xenotransplantation is the only potential way of addressing this shortage. As immunological barriers to xenotransplantation are better understood, those hurdles are being addressed through genetic engineering of donor animals and the development of new drug therapies. However, before xenotransplantation can be fully implemented, both the scientific/medical communities and the general public must seriously consider and attempt to resolve the many complex ethical, social and economic issues that it presents.

Organ donation: comparison of nurses' participation in two states

BACKGROUND: The number of organs available for transplantation in the United States is insufficient, and the donor rate in New Jersey is particularly low. OBJECTIVES: To explore reasons nurses do or do not refer organ donors and to identify factors that contribute to differences in referral rates in New Jersey and Pennsylvania. METHODS: Registered nurses (N = 976) in 57 nongovernmental acute care hospitals, primarily in emergency departments and intensive care units, completed a questionnaire that focused on their knowledge and participation in the organ procurement process. RESULTS: Two-thirds of the subjects said they had participated in organ procurement. Pennsylvania nurses had a significantly higher involvement rate than New Jersey nurses. Pennsylvania nurses were also slightly more knowledgeable about the process. A higher proportion of nurses in both states who attended continuing education programs participated. CONCLUSIONS: Nurses need more inservice education regarding policies and procedures for organ donation.