Car­ol Quash

When some­one dies, they leave every­thing be­hind, ex­cept their body. That's un­less they were an or­gan donor. Span­ish sur­geon Dr Jos&ea­cute; Manuel Gar­cia Buitr&oa­cute;n says or­gan do­na­tions, es­pe­cial­ly ca­dav­er do­na­tions (or­gans do­nat­ed by peo­ple who were pre­vi­ous­ly healthy but die due to an ac­ci­dent or brain bleed­ing, etc) al­low donors the op­por­tu­ni­ty to live on af­ter they have died. "Don't do­nate; every­thing goes. Do­nate; you leave some­thing be­hind. You live on in some­one." In No­vem­ber last year, Buitr&oa­cute;n led two lo­cal doc­tors, Dr Prisca Brad­shaw and Dr Brid­get El­cock, in a five-day ad­vanced in­ter­na­tion­al train­ing course in trans­plant co-or­di­na­tion, as part of a pi­lot project for the im­prove­ment of live and ca­dav­er or­gan do­na­tion and trans­plan­ta­tion in T&T. The doc­tors were trained in the le­gal, tech­ni­cal and so­cial as­pects of or­gan har­vest­ing, and how to keep body and or­gans in a con­di­tion that can be used for trans­plant. Brad­shaw and El­cock sub­se­quent­ly par­tic­i­pat­ed in a hos­pi­tal in­tern­ship at the Com­plexo Hos­pi­ta­lario Uni­ver­si­tario in Coruña, Spain. An­oth­er lo­cal sur­geon, Dr James Byam, is in Spain un­der­go­ing train­ing in trans­plant surgery. Spain is the lead­ing coun­try in the world in or­gan do­na­tion and trans­plan­ta­tion. It has been at the top of the trans­plant list at the in­ter­na­tion­al lev­el for 17 years, and dou­bling the Eu­ro­pean av­er­age rate of donors per mil­lion.

The project is be­ing spon­sored by the Rep­sol Foun­da­tion, with an aim to im­prove do­na­tion rates and equal­i­ty in ac­cess to trans­plants in T&T. The foun­da­tion is work­ing close­ly with the Min­istry of Health and the Na­tion­al Or­gan Trans­plant Unit (NO­TU). Buitr&oa­cute;n be­lieves T&T has great po­ten­tial for or­gan do­na­tion and trans­plan­ta­tion. "Trinidad and To­ba­go is a coun­try that has every­thing that can ac­com­mo­date this. All the con­di­tions are there to do it," he said, adding that the ex­is­tence of the func­tion­ing NO­TU and the will­ing­ness of the Min­istry of Health and com­pa­nies like Rep­sol to sup­port the project made it more promis­ing. "Peo­ple need donors. It will be more prob­a­ble that you will need an or­gan than you'll be a donor." Buitr&oa­cute;n said in Spain, 95 per cent of trans­plants came from ca­dav­er donors. "The dri­ve of the project is to get to that point in T&T," he stressed. Med­ical di­rec­tor of the NO­TU, Dr Les­ley Roberts, says the unit has done 83 kid­ney trans­plants since it was es­tab­lished in Jan­u­ary 2006. Three of the or­gans came from ca­dav­er donors and the re­main­ing or­gans from live donors. "That cer­tain­ly doesn't meet our de­mand," she lament­ed, as there are ap­prox­i­mate­ly 738 peo­ple cur­rent­ly on dial­y­sis, with one third be­ing po­ten­tial trans­plant can­di­dates. Donors are need­ed. "In Spain, trans­plant co-or­di­na­tors are based in all hos­pi­tals. We are try­ing to fol­low the mod­el of what Spain has de­vel­oped. Not that we are go­ing to im­port whole­sale, of course. It will be a mat­ter of ob­serv­ing and putting a lo­cal spin on it," Roberts said.

At some hos­pi­tals in Spain, Buitr&oa­cute;n said, 250 trans­plants, in­clud­ing heart, lungs, liv­er, kid­ney and pan­creas, were done every year. Roberts ex­plained that in T&T, on­ly kid­ney trans­plants were done be­cause of the high de­mand for them at the time the unit was es­tab­lished. Even­tu­al­ly, the pro­gramme will be ex­tend­ed to in­clude hearts, pan­creas, lungs and liv­ers. But kid­ney trans­plants was a good place to start, Buitr&oa­cute;n opined. "Kid­neys can be har­vest­ed from both live and ca­dav­er donors, be­cause you have two. "In ad­di­tion, trans­plants are less ex­pen­sive than dial­y­sis. For some peo­ple it is fi­nan­cial­ly im­pos­si­ble to sus­tain dial­y­sis as their on­ly means of treat­ment for re­nal fail­ure."