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Biomedical subjects

B Miranda

Publications and source records attributed to B Miranda.

At least 19 recordsLinked to original sources
PubMed2005

[Opinion survey on renal donation from living donor].

Spain is the leader country in cadaver kidney transplantation. However the percentage of those transplants coming from living donors represents only a 2% of the total activity. To analyze the cause of this situation the Spanish Society of Nephrology and the National Transplant Organization carried out an opinion pole between patients and health professionals including nephrologists, surgeons/urologists and nurses implicated in kidney transplantation. 60% out the patients consider that the time into the waiting list is to long and 59% don't have any information about living donor kidney transplantation. All the health professionals believe that living donor share better results than get cadaver donors and that the number of the procedure are not enough. Considering that scarcely motivation of professionals and the family of the patients are the main cause. Parents, brothers and sister were considered the best match between donor and recipients and non genetically/emotionally-related donors were accepted by only 2.5%. A 55.7% out of the health professionals considered that the nephrologists are the people that must inform the patients and family about living kidney donation.

Adult↗
PubMed2003

Disparities in access to liver transplantation in Spain.

BACKGROUND: The maintenance of an equitable system for access to transplantation is a matter of concern to all professionals involved in this field. Any national system must ensure equity. METHODS: The rates of indication for liver transplantation have been reviewed for all Spanish regions. The time to transplantation was evaluated with respect to different recipient characteristics and donor rates. The indication rates for liver transplantation are similar in the different countries with liver transplant programs but are far from similar among different regions in Spain. This suggests that there is not equity in the access to liver transplantation. RESULTS: A review of the factors affecting the waiting times to transplantation after being registered for the waiting list shows that some groups of patients are currently waiting less time than others. Shorter waiting times occur in patients of the AB group, children, patients with hepatocarcinoma, and patients living in the zone of Valencia, despite similar organ donation rates in all transplant zones. CONCLUSION: Neither the rate nor the probability of liver transplantation is affected exclusively by the organ donation rate in Spain but also depends on the number of patients admitted to the waiting list. Despite the existence of an organ allocation system that is center-oriented, liver patients are receiving grafts mainly based on the severity of the illness, because clearance rates from the waiting list of both dead patients and grafted patients are the same.

Geography↗
PubMed2003

Functions, responsibilities, dedication, payment, organization, and profile of the hospital transplant coordination in Spain in 2002.

In Spain, the number of donors per million of population and the activity of transplantation is a direct consequence of the continued work of the hospital transplant coordinators. There are 146 procurement hospitals with approximately 534 transplant coordinators (13.6 coordinators per hospital and 12.7 per million of population). A voluntary survey of 74 Spanish transplant coordinators revealed 67.6% to be men and 32.4% women of average age 43 years with specialization of 75.7%, Intensive Care Medicine; 8.1%, Anesthesiology; 6.7%, Nephrologists; and the rest, General Surgery or without any specialization. Among the group who responded to the injury, 86.5% were doctors and 13.5%, nurses. The overall team is composed of 52% doctors, 27.7% nurses and others with 70.3% working part-time and 27%, full-time. Previous experience was noted to be less than 5 years among 51.4%, and more in the rest of the cases. The 85% work under medical direction by management. Their payment includes salary plus activity in 48.7% of the cases; 21.6%, only salary, and 18.9%, only activity. Each coordinator generates between 3 and 7 organ as well as 3 and 11 of tissue donors. In conclusion, comparing this data with the practice in the United States demonstrates the unique aspects of the Spanish system.

Adult↗
PubMed2003

Optimizing cadaveric organ procurement: the catalan and Spanish experience.

The need to face the increasing gap between the supply and the demand of transplants has led to the development of a permanent network of trained medical staff responsible for the organ donation and removal process in all centers accredited for that process. In Spain, this activity received a specific budget, like any other medical activity in hospitals, and the responsible staff became accountable for performance. This system dramatically increased the number of potential donors referred, not only young donors with trauma, but also elderly donors dying from stroke. The effect was that the donation rate increased by more than 100% in 10 years (from 14 to 34 donors per million population). Consequently, so did all the transplant figures. In some areas, such as Catalonia, it has been demonstrated that sustained kidney transplant activity of over 60 procedures per million population can maintain or slightly decrease the waiting list, despite increasing incidence and prevalence of end-stage renal failure. Quality monitoring of the donation and retrieval process shows that there are still opportunities for improvement if all potential donors are referred and all technical problems are overcome. Living donation and nonheart beating organ retrieval should also be promoted.

Adolescent↗
PubMed2003

Kidney donor profile in Spain: risks factors and characteristics of the organs rejected for transplantation.

During recent years organ donation in Spain has increased by 100%, with important changes seen in the donor profile. Mean age has increased by more than 10 years, being nowadays more than 33% of our donors over 60 years. Ten years ago road traffic trauma was the main cause of death, while now most of our donors die due to stroke and only 21% die in a traffic accident. This changes lead to an increase in the number of kidneys discarded for transplantation every year. Among the 2517 kidneys retrieved during 2001, 567 were discarded, mainly due to different glomerular, interstitial or vascular pathologic damage. The older is the donor the higher is the percentage of kidneys discarded. It has to be underlined that an increased number of livers from donors, whose kidneys could not be used, are being grafted (141 in 2001 over 281 donors from whom no kidney could be grafted and over a total number of 1335 donors). Only 5% of kidneys were discarded due to technical problems. An important number of kidneys were discarded due to malignancy suspicion or diagnosis (12.3%). Organ donation has improved but kidney transplantation did not in parallel, due to the increasing number of kidneys discarded for transplantation in close relation with the evolution of donor's characteristics. Organ donation rate is around 33 donors per million population while efficient organ donation rate is around 30 donors per million. Only from 67% of donors both kidneys can be grafted and from 20% of donors no kidney can be used. These data will not change our policy, at least by the moment, we will continue to evaluate every potential brain death donor with the aim of studying if organs can be used. It is true that in 50% of cases over 70 years no organ can be used after retrieval and microscopic exam, but in the other 50% we can proceed.

Age Factors↗