Satellite Strategy: A Simple Approach Which Solved Access to Lung Transplant in Uruguay

Abstract

Purpose To show an organizational approach which solved access to lung transplantation. Methods In 2003 and through the ministries of health and national organ procurement organizations, Uruguay and Argentina, countries with geographical and cultural proximity, initiated a framework agreement in lung transplantation, a growing activity in Argentina not developed in Uruguay. In this agreement, the lung implant would be carried out in Argentina and the pre and post-transplant management and assistance on the waiting list in Uruguay. In order to provide quality care, a training program was started in world reference centers. The groundwork for the establishment of an Uruguayan procurement team was also started. This approach was simple but clever. In Uruguay, with 3.3 million inhabitants and no experience in the area of ​​lung transplantation, the organizational aspects and the training of human resources would have required a lot of time and financial resources. The number of transplants/year (Tx/y) would have been limited, which is strongly correlated with morbidity and mortality. Currently, with the incorporation of Uruguayan transplants, Fundacion Favaloro exceeds 30 Tx/y with improved results. Results Since 2003, more than 250 patients were evaluated and 93 listed. 42 transplants were performed, more than a half of them in the last 4 years. The underlying pulmonary diseases is similar to international registries, 3 were retransplantations. Nowadays, Uruguay has the higgest lung transplant rate of the region with 1,8 transplant/pmp each year, more than Argentina (0,98), Brasil (0,62) or Chile (0,83). Unfortunately waiting time remains excessively long (19.4 ± 17,6 months) and mortality on the waiting list is still high (30%). Taking into account the entire cohort of patients, adult and pediatric, uni- or bipulmonary, the median post-transplant conditional survival observed in Uruguay is 7.5 ± 2.5 years. 95% of transplant patients achieved total reintegration to work and/or educational tasks with a great positive impact on the quality of life measured using Likert scale. Conclusion This “satellite strategy” allowed the development of a lung transplantation program helping Uruguayan population to access this complex procedure, improving results for both countries. This organizational approach, based on solidarity and teamwork, could be transferred to other situations.