Searching for organs self-sufficiency

For eight years Valter has lived with a kidney that used to be in the body of another person. On the day he was operated on by surgeon Rui Maio and received this kidney, leaving behind him two years of haemodialysis, another patient in the same hospital also received a kidney. They were hospitalised, almost side by side for nearly three weeks, recovering from the operation. By chance, a mere chance, they learned that the two kidneys had come from the same donor – a woman killed in a traffic accident on the 25 de Abril bridge in Lisbon.

«He got the right kidney, I got the left one. Since then we’ve thought of each other as brothers», says Valter. As if something stronger than a mere coincidence had linked them forever from that point on.

Of course, both of them suffered from renal insufficiency: Valter’s illness had shown up two years earlier, that of his ‘brother’ before that. «It was all very sudden», he recalls. «I went to do the routine exams with the family doctor because my blood pressure was very high, although I was only 25 years old.» And, from one day to the next, he was hospitalised, a catheter was put in and haemodialysis was begun immediately. «I was half out of it, it was all very strange and new to me. I couldn’t even really think about what was happening to me.»

For two years he was forced to slow down the pace of work, watch what he ate, and make a radical change in his life. «What really helped was that I was working in my father’s company…», he confesses. Now, he says, he has returned almost to the point where he was before all this happened. «I have to take medication several times a day and every three months I have tests made and go to the doctor», he explains. «But the rest is as if there was nothing wrong with me,» he affirms, obviously satisfied.

Organ transplants are, definitively, the life-saving therapy for diseases that cause organ failure. «It’s a well-defined therapy, well established, and there are no doubts about the corresponding benefits from it,» confirms Rui Maio, a surgeon specialised in transplants, and clinical director of Beatriz Ângelo Hospital (the public hospital managed by Espirito Santo Saúde under a public-private partnership). He is also the director of the symposium «Transplantation and Regenerative Medicine Slot», at Leaping Forward – Lisbon International Clinic Congress of Hospital da Luz.

Valter is one of the many examples of what these benefits represent: he has a better quality of life, his prospects for surviving his disease are practically one hundred percent and the costs associated with monitoring his health are incomparably lower than those that would be involved in treating his renal insufficiency.

But one could also say his was a case of luck. He received the transplant when, in our country, the number of organs harvested from donor cadavers and the pace of transplants in public hospitals were beginning to grow to the point that within a few years, Portugal came to occupy first place in Europe in the number of available organs and second in the number of transplants carried out.

Recently, however, this success has suffered a serious setback. From one year to the next, our country fell to 12th place in these rankings, aggravating the situation in the list of patients waiting for an organ, which many say is motivated by the crisis Portugal is going through. «The problem of a scarcity of organs, which has again become a significant issue for us, is the most important current debate around the world, when we talk about transplants. This is why it is the backdrop, the central thread of our symposium at Leaping Forward», says Rui Maio.

The question of a lack of organs has a very simple explanation. On the one hand, says the doctor, «the illnesses that cause organ failure are much more prevalent, as is the case of diabetes or hypertension. On the other hand, as transplantation is a therapeutic that is increasingly effective because of the advances in medicine, the criteria for accepting patients on the waiting list for a transplant are increasingly less restrictive. That means that there are more and more patients needing an organ, but the number of available organs remains unchanged. The gap between the supply and the demand grows exponentially every year. Just to give you an idea of the current situation, every day in Europe, 12 persons die because they didn’t receive a transplant in time», he concludes.

Measures on a planetary scale

Is it foreseeable that one day we will be able to reach a point of equilibrium?

The answer is everything except obvious. «It depends on the advances in medicine», replies the surgeon. «But there are measures that can be taken already that can make a tremendous contribution in our fight to close this gap». This is because it is no longer only a matter of preventing more patients from dying whilst waiting for an organ. «There are other related problems, such as the illegal trade in organs, transplant tourism—persons going from richer countries to poorer countries to get transplants and running a lot of risks—an exploitation of the poor by the rich, always through processes that are not really transparent and sometimes clandestine, in which the recipients run great risks, because the donors are not selected as carefully. Money is their only motivation, for example. The ethical and legal questions surrounding this problem are immense and call for measures that must probably be planetary in scale,» adds Rui Maio.

The question of a scarcity of organs has therefore been the central topic of debate on transplantation around the world. «In recent years, a new concept has begun to be talked about – the need for countries to be self-sufficient –, adding further that this is an objective that must be worked towards, pursuing different strategies.

«These are the alternatives that are being discussed around the world today, and which we want to debate at Leaping Forward, as well», says Rui Maio.

Strategies that, first of all, end up reinforcing the public health measures that prevent diseases that lead to organ failure.

But they are also intended to expand the criteria for donations, considering as donors those who have been rejected up until now because of their age, taking more and better advantage of donors, for example, whose heart has stopped and perfecting the local and regional networks for the allocation of organs. Another goal is to work more consistently with the living donor. And finally, to increase the survival rate of the transplanted organs, in order to extend the period for a patient with a transplanted organ to re-enter the waiting list.

«This is a debate that is absolutely essential in Portugal, also. We have therefore brought to the Hospital da Luz, in Lisbon, the specialists who have been in the forefront of these proposals, as is the case of Francis Delmonico, as well as others who lead innovative projects in this area, with very positive results», explains Rui Maio. One example: «We are going to learn about the work of Euro Transplant in the Netherlands and Germany, for example, which uses innovative criteria in the selection of donors.»

But as the doctor goes on to say, nothing of this is done unless the governments and the political decision makers make their contribution and commitment to health policies that enable the implementation of these strategies. For this reason, the symposium «Transplantation and Regenerative Medicine Slot» of this Leaping Forward will be attended by the Portuguese Secretary of State for Health, Fernando Leal da Costa. «The measures that were recently taken will produce some results» in the situation of organ transplants in Portugal, admits Rui Maio. The truth is that much more still remains to be done. G.R.


Special Report, Leaping Forward - Lisbon International Clinical Congress, Hospital da Luz, Lisbon, february, 13-19.