Number of transplants in Catalonia bounces back over 1,000
However, family members' refusals to donate are on the rise, a fact that is attributed to communication difficulties between families and hospitals
The first year in which Catalonia reached the thousand-transplant benchmark was 2016, a figure that was maintained, and even surpassed – 2019 holds the record with 1,296 – until the pandemic arrived. During 2020, activity was temporarily halted for a few months, and only pediatric and life-saving emergency transplants were maintained, and the year closed with 999 transplants. The activity, however, is beginning to recover and during 2021 the thousand-transplant benchmark was attained again. There were 1,063, 6.4% more than in 2020. "We recovered a little from the drop of about 25% in 2020, the first year of covid, and we reached the thousand-transplant benchmark, which few regions can attain. This is the fourth best year," emphasises Jaume Tort, director of the Catalan Transplant Organization (OCATT). This volume of activity in the Catalan hospitals, with an average of almost three transplants per day (2.9), has made it possible to increase the rate again: 137 transplants per million population, one of the highest in the world. "These are extraordinary numbers and it is the forecast we had because in the covid scenario we work with an excess of caution, given that these are fragile patients," Tort adds. For this year, the forecasts are for continued growth. "If we do 5% or 6% more transplants it will already be a success for the system, we do not expect to recover 2019 figures," admits the director of OCATT.
By type of organ, there have been 743 kidney, 156 liver, 54 heart, 85 lung and 25 pancreas transplants. The increase has been widespread, although cardiac transplants have recorded a greater increase (50%) – they suffered a significant drop during 2020 – and liver transplants are down 17%. "But we consider it normal and we are not overly concerned because the waiting list is in a good situation," says Tort. These results place Catalonia in the fourth best year in number of organ transplants and fifth in number of real cadaver donors.
More refusals from relatives
As for the waiting list, 1,218 people are waiting for an organ, a figure similar to the pre-pandemic years, and the list of lung transplants has risen especially, which professionals dissociate from the effects of covid and attribute it to other pathologies such as emphysema, genetic diseases or smoking. By type of donor, encephalic (brain) death donors increased by 14.9%, while those who died in asystole (cardiac) remained the same as last year. The cadaver donor profile is that of a 59-year-old male, brain-dead, blood group A, who dies due to a stroke.
However, the percentage of family refusals to donate is the highest in recent decades (23.6%) and the reason given by the relatives is, in most cases, the previous refusal of the potential donor or the family. Those responsible for transplantation in the Department of Health attribute this, in part, to the difficulty of communication in hospitals in the midst of the pandemic at a time as complicated as the death of a loved one. "It has not been possible to conduct interviews calmly and communication with families has been difficult and we believe this explains the increase in refusals," says Tort. In 2021, living donation increased by 28.3% over 2020, with 145 living kidney donors. Renal living donors managed in Catalan hospitals represent between 40% and 45% of the state total.
In 2021, 40 paediatric transplants were also performed and the heads of OCATT and the Department of Health wanted to highlight several further milestones. Ten crossed renal transplants were completed and one of them included an international exchange. The first lung transplant for a post-covid patient was also carried out. Recipient Jordi Soriano, 51 years old, was the first person in Spain to have a lung transplant after covid, which he contracted during the third wave, leaving his lungs useless. "The Vall d'Hebron Hospital has evaluated three other cases of post-covid patients, but none of them met the criteria for a lung transplant," explained Tort. To be eligible for a transplant, certain requirements must be met, such as the fact that other organs must be functioning properly, there can be no active covid infection, and the patient must be conscious and give informed consent to the transplant.
By centres, the Hospital Valle d'Hebron led the way with 277 interventions, followed by the Hospital de Bellvitge (259) and the Hospital Clínic (239). In addition, 14,088 patients have benefited, in 2021, from tissues distributed by Catalonia's Blood and Tissues Bank, previously obtained through donations.