Dr. Gerard Sánchez and Dr. David Paredes: "We don't see death as a failure, but rather as a process in which new life can be generated"
Last year, 239 transplants were performed at the Hospital Clínic. The Donation and Transplantation Coordination Section managed 213 deceased organ donors and 40 living organ donors. This figure consolidates the hospital’s leadership in living donation, with 18% more donors than last year.
In 1985, the first Transplantation Coordination Team in Spain was created at the Hospital Clínic de Barcelona. This successful model was gradually implemented in other centres, regions and countries. Dr. Gerard Sánchez and Dr. David Paredes tell us what work is carried out in the section and how the donation process works. They also describe the coordination between the hospital’s different services in order to ensure the donation and transplantation process is successful.
Gerard Sánchez: The Section is responsible for finding donors in the hospital, assessing these potential donors and coordinating the whole process from the removal of the organ to the transplantation. At the Hospital Clínic we receive 80 visits each year from people who wish to become donors.
David Paredes: We also play a key role in coordinating with the Catalan Transplant Organization (OCATT) and the Spanish National Transplant Organization (ONT), especially in receiving offers of potential donors that arrive from other cities and other autonomous communities, which correspond to our centre.
"At the Hospital Clínic we receive 80 visits each year from people who wish to become donors".
DP: Apart from managing our own donors, as we mentioned before, when we receive the offer from a donor in another hospital, we are phoned by the OCATT and we liaise with the transplant teams in each service. They give us all the information on the donor and the assessment of the organ carried out by the other centre. We then evaluate the proposal using our acceptance criteria and we pass it on to the corresponding transplant team. If the team accepts it, we arranged for one of our teams to go to centre where the donor is located, in order to extract the organ and take it to the Hospital Clínic as quickly as possible.
GS: It is also our job to find potential donors and assess the organs that could be optimal for transplantation. However, it is the OCATT that manages the distribution of these organs, since it aware of all the centres' urgent needs. The entire process is very clear and transparent.
"We have to make very important decisions very quickly. When we’re offered a potential organ, we have to respond in less than 30 minutes. Otherwise, we lose it".
GS: Yes, that’s true. We have to make very important decisions very quickly. When we’re offered a potential organ, we have to respond in less than 30 minutes. Otherwise, we lose it.
DP: The law says that we are all donors provided that, during our lifetime, we do not state that we do not want to be one, or express this in writing. As long as the person meets the criteria to be a deceased donor, we review their medical records and try to find out whether or not there are any advance directives. This information can be used to inform the family whether or not this person declared that they wanted to be a donor. We do not discuss this with the family in order to obtain authorization, but rather to ask if they know if this person stated in life whether or not they wished to be a donor.
GS: Despite the fact that the law says we are all donors, we never go ahead with a donation without the family's consent.
GS: Well, we try to tell the family about the positive aspects of donation. We don’t try to convince the families, but rather to help them see donation as a positive process.
DP: Sometimes, it’s very hard. However, it is a multidisciplinary task, because things can be easier when there is proper communication with the family from the moment that the patient’s condition becomes critical in the Hospital. It is a process.
GS: It is teamwork. It is important to provide the families with all the information right from the start: in the A&E department, in the intensive care units, etc. All the hospital's professionals must be involved in the donation process.
GS: One of the keys to the success of our model is that the transplant coordinators are inside the hospitals and have a very close relationship with the units where the donors are generated (A&E, ICU, etc.) Another key to success has been the communication of the Spanish and Catalan transplant model. Society is very aware that we have an excellent model and it has great confidence in the system. I don’t believe our society is more generous that in other countries, but the model is very well organized and its success has had a positive impact on society.
"Si els professionals sanitaris no ens creiem aquest procés és molt difícil que la societat hi participi".
DP: I think families, and society in general, must understand this message. But it is also a phrase that we can apply to ourselves and that hospital professionals must make their own too. If we health professionals do not believe in this process, it is very hard for society to participate in it. Donation must be an integral part of the end-of-life process, and we can all do our bit...
DP: We have set up a project with patients who are on waiting lists, in order to prepare them and inform them of the whole process: about how donation works, what the treatment can be like, how the follow-up will be carried out, etc. But one thing we place great emphasis on is to explain where the donors may come from, how donors are generated, why there are donors, etc. In this way, we want patients to know which things have to happen and why they have to happen.
"Under no circumstances are we going to look for possible patients who might accept euthanasia to increase donations".
GS: The euthanasia law allows a person, in certain conditions, suffering from an irreversible and serious neurological or respiratory illness, to request a procedure to help them die. And, on the other hand, all citizens have the right to be a donor. These two wishes must be respected. However, we have to make these two rights compatible in some cases. We must make it clear, however, that they are two separate processes. But our obligation as health professionals is to try to guarantee this twofold request. We are still learning, but this situation has made us change some processes, because this is a new scenario. Under no circumstances are we going to look for possible patients who might accept euthanasia to increase donations.
