Non-heart-beating donation in Spain

Abstract

The aim of our study was to describe our protocol of non-heart-beating-donor (NHBD) lung transplantation and discuss data regarding the situation of NHBD and lung transplantation in Spain. Experimental work regarding NHBD led our National Organization of Transplants to develop several working groups with the objective of investigating the possibility of using uncontrolled NHBD in our country. This turned into a flexible and useful legal mechanism that allowed immediate judicial permission to preserve-and harvest-those organs. Several harvesting programs for mainly abdominal organs (kidney and liver) started in Spain during the late 1980s, with good mid-term results. The collaboration between two hospitals in Madrid-Hospital Clinico San Carlos and Hospital Puerta de Hierro as transplantation hospital-led to the development of a successful NHBD lung program for uncontrolled donors that is a pioneer in the world. In Spain, donation after cardiac arrest represents 6.7% of all transplants, mainly from types I (dead on arrival) and II (unsuccessful resuscitation) donors. NHBD for lung transplantation is concentrated in Madrid, with approximately 60 potential NHBDs per year. With this additional source of organs we have so far been able to perform 32 lung transplantations, which represents an increase of 13% of our annual transplantation rates. NHBD is no longer just a promising source of organs for lung transplantations, it is a real one. We hope that in the near future many other units will develop similar protocols to improve the use of these grafts and decrease the mortality rate among those on the waiting lists.