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Biomedical subjects

B Miranda

Publications and source records attributed to B Miranda.

At least 55 records · Page 3Linked to original sources
PubMed1995

Evolution of the characteristics of transplant donors in Spain.

During the last 4 years the organ donor rate increased in Spain, from 14.3 donors per million population per year in 1989 to 22.6 in 1994. This could have been even greater, since we observed 25% of family refusal rate during this period. The average age of organ donors increased by 4 years during the last 2 years. At the same time a change in the cause was mainly cranial trauma, during the last year 46% of organ donors died due to cerebrovascular problems, and 45% due to trauma, including road traffic and other causes. Road accidents causing death have decreased by more than 20% since 1992 explaining such a change in donors characteristics. While the percentage positive for hepatitis B virus in the donor population has remained stable during last years (1.7%), the percentage of (hepatitis C virus-positive donors) increased from 1.7% to 2.7%. Six per cent of kidneys grafted in Spain during 1993 were obtained from donors with previous hypertensive problems. Current donors are older, more have concomitant problems, and most of them died due to cerebrovascular problems; thus we have to be very careful about possible influences of these factors on graft outcome, paying great attention to donor and organ maintenance, ischaemia times, the use of nephrotoxic drugs, etc. Such caution should be increased when considering organs at the limit of acceptance for transplantation.

Adolescent↗
PubMed1995

[Heart donation and transplantation in Spain].

Organ donation rate has increased in Spain by 75% during last five years, from 14 donors per million population (p.m.p.) in 1989 to 25 in 1994. This improvement in the availability of solid organs for transplantation purposes occured at the same time we, fortunately, saw a decrease in the death rate on road traffic accidents. This lead to an important change in the profile of the organ donor in Spain, whi is now older and die due to cerebro vascular accident. This rise in the organ procurement rate lead to the consequent increase in the number of solid organ grafts. Hence, the heart transplant rate has doubled. The waiting list mortality is only 8% and 77% of patients are grafted before 2 months on waiting. This activity allowed near 1,200 patients to live in Spain with a functioning heart graft.

Adolescent↗
PubMed1995

The Spanish model of organ donation: the National Organization of Transplants (ONT) Registry report 1994.

The Spanish organ procurement rates have resulted mainly from efforts to overcome obstacles such as untrained or under-trained staff, unidentified donors and reluctance to approach grieving families. [This meant "professionalization" of organ donation and an organization to promote and facilitate all necessary actions.] The overall analysis of the organ donation process in the states or the circumstantial evaluations of problems in each region or hospital provided us the means to find the appropriate solutions. We are not sure that these could be applied to every country or health system, but we believe strongly that they should be tried before other more difficult or potentially dangerous strategies.

Adolescent↗
PubMed1994

Organ procurement and renal transplants in Spain: the impact of transplant coordination. Spanish National Transplant Organization (ONT)

The growing shortage of cadaveric organ donors remains the major obstacle to achieve satisfactory rates of transplantation. In Spain an integrated transplant organization programme, mainly focusing on organ procurement, has been established, based on a network of well-trained transplant coordinators. In every hospital that was a potential candidate for donor procurement, a transplant coordinating team was founded, including medical doctors and nurses (42% of whom belonged to renal units). The team was put in charge of all steps of transplant procurement, from locating potential donors to the organ grafting or tissue banking. The teams were integrated into a National Organization of Transplants (ONT), i.e. a coordinating structure without executive function. The annual rate of cadaveric organ donors increased from 14.3 per million population (p.m.p.) in 1989 to 21.7 donors p.m.p. in 1992. Total solid organ retrieval rate increased by 81% and renal transplants by 44% during the same period (from 1039 to 1492, i.e. from 26 to 38.8 renal transplants per million population, 99% of which were kidneys from cadaveric donors). This successful approach has overcome obstacles such as untrained or undertrained staff, failure to identify donors, or reluctance to approach grieving families.

Humans↗
PubMed1994

Organ procurement in Spain: impact of transplant coordination.

Organ transplantation is a well-established treatment for irreversible renal, liver, cardiac, and respiratory failure. However, there is a shortage of organs that remains a serious obstacle to the full development of these therapeutic procedures. Some solutions such as presumed consent laws, the use of organs from living unrelated donors, compensation or payment for organs or xenografting have been proposed. In Spain during the last 3 years a well-designed program of transplant organization including a network of well-trained transplant coordinators has been established. In each potential donor hospital there is a transplant coordination team that is responsible for the whole process of organ procurement, from the detection of the donor to the organ grafting or tissue banking. Annual rate of cadaveric donors rose from 14.3 per million population (pmp) in 1989 to 21.7 donors pmp in 1992. Organ retrieval rate increased by 81% during the same period. Renal, liver and cardiac transplants increased by 44%, 175% and 162% respectively. We conclude that this particular approach to the problem has been successful in Spain, overcoming obstacles such as untrained or undertrained requesting staff, unidentified donors, and reluctance to approach grieving families. This kind of approach should be considered initially before resorting to more controversial approaches to the problem of the organ donor shortage.

Government Agencies↗