Renal transplant

A country, a region or a hospital can have a large health infrastructure and be equipped with cutting edge technology and trained professionals to conduct all types of transplants, but if they do not have an adequate system for detecting donors, they may not have organs to transplant to their patients.
The shortage of organs and tissues of the body remains the main obstacle to the full development of transplants. This shortage of organs can be addressed through various strategies, but undoubtedly the most important thing is to optimize the detection of potential donors, thus creating the service for the Coordination of organ and tissue donation for transplants.

The Coordination of organ and tissue donation at Galenia Hospital is a service where they manage the administrative processes, promote, disseminate and process the donation in conjunction with the National Transplant Center.

For more information we listed some of the most frequently asked questions.

WHAT IS THE PURPOSE OF ORGAN AND TISSUE DONATION FOR TRANSPLANTATION?
It is the act of giving something of yourself to another person who requires it. It is an altruistic act, generous and supportive, which means giving without receiving anything in return. During this process medical, psychological, social, ethical and legal aspects are involved.
By saying "yes to organ donation" you allow up to 8 people to continue living, or improve their quality of life.
Transplants can be done only through the solidarity of those who donate their organs altruistically and voluntarily either in life or at death. Unfortunately if there is no donor, there is no transplant.

WHY IS ORGAN DONATION SO IMPORTANT?
In our country, hundreds of people die every day due to chronic degenerative diseases (such as heart disease, diabetes, hypertension, liver cirrhosis, end-stage renal disease, and chronic obstructive pulmonary disease) whose ideal therapeutic treatment is organ transplantation. Even when they have the possibility of being cured through the transplant, unfortunately this procedure is not carried out due to lack of donors. Because of that, it is necessary to create a culture of donation, which will lead to an increased decision to donate organs at time of death and thus save many people, whose only hope of life lies in a transplant.

WHAT IS A TRANSPLANT?
It is an exchange of an organ or tissue that no longer works for a healthy one, thereby restoring lost functions. In many cases a transplant is the only way in which the person’s life can be saved or be improved.

WHO IS A DONOR?
It is the person who makes the decision to donate their organs or tissues either in life or after death, so that someone else might be saved or have an improvement in their quality of life.
WHO IS A RECEIVER?
It is the person who requires transplantation of an organ or tissue, to save their lives or improve their quality of life. It is the person who receives the benefit of the transplant.
WHAT CAN I DONATE WHILE ALIVE?
YOU CAN DONATE:
 
• A kidney.
• A segment of the liver.
• Some renewable tissue (blood, bone marrow, skin) or tissues considered as waste (from stem cells in the umbilical cord).
• In life minors can only donate bone marrow with the express consent of their parents or legal guardians.

WHAT CAN BE DONATED AFTER DEATH?
• If the person loses their life because of being brain dead, they may donate organs such as hearts, lungs, kidneys, liver, pancreas and intestine and
Tissues such as: corneas, bone, skin, tendons, cartilage and blood vessels.
• If the person passed away from unrecoverable cardiac arrest, they can only donate tissue such as corneas, bone, skin, tendons, cartilage and blood vessels.
• If the person dying from cardiac arrest is "witnessed" (where within a short period of time cardiopulmonary resuscitation is started to try and reverse the arrest.  If this is ineffective, once the diagnosis of death is made, they use cooling and special preservation techniques in order to allow removal of organs suitable for transplants).
 
Such donors can donate organs and tissues listed above.
WHO CAN DONATE WHILE LIVING?

• Men and women.
• Legal Adults, with plain use of mental faculties.
• Those found it good health.
• Those who are an acceptable match to the receiver.
•  Blood relative (children, parents, siblings, grandparents, cousins, etc.), adoptive parent or child, or civil (spouse, common law partner).
• And that they give their written consent for the donation.

   Under age children can only donate bone marrow with the authorization of their parents or legal guardians because this is tissue that will regenerate on its own in a short time without causing negative consequences to the donor.
WHO CAN BE DONORS AFTER DEATH?

• There is no age limit and the donation will depend on the medical evaluation and the cause of death.
• Under age children can donate, if the legal representatives give their express consent for the donation.

WHO CAN NOT DONATE?
In accordance with Article 326 and 332 of the General Health Law, the following cannot donate:

• Living under age children, cannot donate organs nor tissues (except when it is a transplant of bone marrow), which requires express consent from the parents.
• Concerning minors who have lost their lives, their organs and tissues can only be taken for transplant with the consent of their legal representatives.
• Those with mental incapacities and other people subject to a power of attorney (incarcerated) cannot donate their organs, in life nor after death.
• Living pregnant women can donate only if the receiver is in danger of dying and only if there are no implications of risk for the mother or the product of conception

Currently there are few absolute contraindications for donation:

• People infected with human immunodeficiency virus (HIV) or some other active virus.
• Or with severe deterioration of health conditions, systemic viral or bacterial infection, malignancy and among others.

How can I donate in life?
Article 333 of the General Health Code states:

1. You must be an adult and be in full possession of mental faculties.
2. Donating an organ or part of one, at the moment of extraction, it’s function can be compensated for by the organism of the donor in a safe and adequate form.
3. You must have acceptable compatibility with the receiver.
4. You must receive complete information about the risks and consequences of the surgical removal of the organ or tissue, other than by a physician who will be performing the transplant.
5. Having given explicit consent.
6. Transplants are preferred to be conducted on blood relatives, civil or adopted family.  When there is no donor linked by some kind of kinship, it is possible to make the donation if the following requirements are met :

• Receive favorable resolution from the Committee for transplants after medical, clinical and psychological assessments.
• The donor must give their explicit consent before a Notary Public, saying they have received complete information on the procedure by authorized sources, specify that the consent is altruistic, free, conscious and without any remuneration.  The donor consent for transplants between living persons may be revoked at any time prior to transplantation and
• Having fulfilled all legal requirements to verify the donor is not profiting from this practice.

How can I donate my organs?

• Receive information and get all of your questions clarified.     
• Be convinced that donating is an act of solidarity and generosity  that can give continuity of life to others.
• You must speak with your closest relatives (parents, wife, children, siblings or guardians) and tell them your decision, because in the event of your death, these are the main people who will make the final decision.

• Have a living will-manifest your desire to donate in writing (in documents or a notarized letter, sign the donation card, among other things)

Where can I donate?
In all hospitals in the country that have been authorized by the Ministry of Health through the Federal Commission for Protection against Sanitary Risk (COFEPRIS) and the National Center of Transplants (CENATRA) and having a sanitary license to carry out health activities, extraction from the body, and transplants.
In Cancun, there is a Coordination of Donation with after the transplant in "Galenia Hospital" which follows these requirements set by COFEPRIS and CENATRA.

If I am a Donor, at the time of my death, what should my family do?
 
• If you die in a hospital where there is a program of organ and tissue donation (Galenia Hospital), the Coordinator of donation will approach your family to offer them the option to donate. Your family will have to analyze the options and make the important decision to give continuity of life to someone else.
• If you die in a hospital that has no program of organ and tissue donation and your family knows your wish to donate, they should discuss it with the doctor treating you, so that they can communication with the Coordinator of donation at Galenia Hospital.  Through this Coordination the donation process can begin.

If I die, who receives my organs?
 
There are Institutional, State and National waiting lists for those people who need an organ donor and do not have one. These lists are coordinated and supervised by the National Centre for Coordination and the Hospitals Coordinator where the donation will take place.
Once a donor is found, the identification of potential recipients for each organ and tissue begins, taking into account the seriousness of the receiver, the blood and immunological compatibilities, and other corporal measures according to the established waiting list.

 WHAT IS the waiting list?
This is an electronic record where all the patients register that have met the protocol (medical and psychological) and who are awaiting an organ or tissue. All of the data needed to detect that the organ available is appropriate for the receiver is found in this record.

How can express my wish to be a donor?
• Show your desire to donate through the Voluntary Donation of Organs or Tissues Card, which can be found at the website for the National Center of Transplants: www.centra.gob.mx , or by calling Toll Free 01 800 201 78 61 and 01 800 201 78 62.
• You can also obtain one through the Coordination of Organ and Tissue donation at Galenia Hospital here in Cancun. Another way to express your decision to donate is through an official document which is a private document, created by you and with your signature, or through a public document, before an official authority, it may be noted for whom the donation is made or the conditions under which such donation will be made, this document may not be revoked by others but the donor may revoke their desire to donate at any time without liability.

 

 
How are donation processes done on corpses?
• A potential donor is detected in a critical care area (intensive care, emergency neurosurgery).
• The physician provides the clinical diagnosis of brain death.
• Studies are conducted to confirm brain death (2 electroencephalograms).
• The Doctors certify the loss of life.
• Notice is given to the National Transplant Center of a potential donor.
• Transplant doctors perform a comprehensive assessment and maintenance to the donor cadaver.
• The Hospital Coordinator of Donation gives the family the option of
       donation, in case of acceptance,
•CENATRA in notified for allocation of organs and tissues (for donations multi-organic) and contact the soliciting groups.
• Official documents are filled out, established by the National Transplant Center (CENATRA).
• If the cause of death involves an act of violence, the Public Prosecutor's Office is informed so that the documents are attached to donation at the preliminary investigation.
• When the process concludes, is the procurement of organs and tissues in done at authorized hospitals established by the CENATRA:
-Once the procurement of organs is finished , the body is made available to the family or agent of the Prosecutor’s Office, as appropriate.
 
What are the most frequent myths about DONATION AND
TRASPALNTES?
Myth: If doctors know you’re an organ donor, they will not do everything possible to save your life.
Reality: The doctors were trained by a major priority: saving lives. Organ donation can only be considered at the time of death and confirmation of the loss of life, with the consent of your closest relatives.
 
Myth: Someone can put something in my drink to make me fall asleep and when I wake up I am missing organs and in a bathtub of ice?
Fact: It is not impossible
The completion of a removal of organs for transplant is a complex surgical procedure that warrants an area with high-technology and special surgical material. In addition a multidisciplinary medical team who are highly trained to extract the organs appropriately is needed.
 
Myth: If someone learns that I am organ donor, can they kidnap me to take my organs?
Reality: NO. Even though you have the donation card, the determination to donate your organs depends on your family and not strangers. Your family will determine the organ (s) and tissues that they wish to donate. To grant permission, numerous official documents are required and legally warn the CENATRA and in medical cases, the law intervenes on the procurement of justice, and the Prosecutor’s Office of the state who will give trust and legal process to the procurement of organs.
It is important to remember that to do a multi-organ extraction, there is a need for specialized medical equipment and a hospital that has the permission and the necessary infrastructure for this type of surgical event which are complex and require special hygienic measures to ensure that the transplant is successful.

Myth: Just by signing the donation card, I am guaranteed that my organs will be donated?
Reality: NO. The donation card has no legal value, only moral, it is a means by which you can express your desire to donate, but the most important thing is communicating with your family and relatives to make more people know your will, and when the time comes they will be spokesmen for your decision, because ultimately it is they who will have the last word.

Myth: Can wealthy people buy organs for transplant?
Reality: It is a crime to buy or sell organs and it has a penalty of imprisonment from 4 to 10 years. There is no way to advance in this process or buy a place on the waiting list because the waiting lists are guarded and supervised by the National Transplant Center to ensure legality and transparency.
 
Myth: Organ donation disfigures the body.
Reality: Organ donation does not affect the physical appearance of the donor. The body is treated in the most dignified way and left in the most aesthetically pleasing way possible.
 
Myth: The transplants only benefit the upper class. Could this lead to corruption?
Reality: It is not true! 78% of the transplants that are performed in Mexico are through public institutions which shows that people with fewer resources are the most benefited from such procedures.
 
Myth: Is the donation is Mandatory?
Reality: False! At all times freedom of choice for the person is respected, the person is even given power to deny his donation after his death through those closest to him. The law is very clear, because everyone is the representative of their body and can donate it, in whole or in part for these purposes. Even the donor who expresses their consent to donate their organs, after his death, retains the right to revoke that decision.
 
Myth: Is part of the loved one lost at donation?
Reality: Inaccurate! At the time death occurs the individual is no longer the person they once were and, since that person ceases to exist, the body becomes a corpse, is a simple matter, which of course must be treated with as much dignity they ever were.
What the person was, will not change by donating their organs, to say this would reduce the person to a mere object. The soul, spirit, the person themselves, do not vary with the destination being of a corpse.
 
Myth: If they extract my organs when I have experienced brain death, am I giving up the hope of “returning?”                            Reality: Never! In cases that are of encephalic death, there is NO
possibility that the person will "return.” The cells that make up the brain are not renewable, so any damage is irreversible and this is proved through totally reliable methods.
 
How can I get more information?

Through the coordinator of donations Claudia PEREZ HERNANDEZ at GALENIA Hospital her number is:
(52) 998 891-5200
donar.organos@hospitalgalenia.com

We must not forget that the best way to achieve your desire to be a donor at death is to communicate this to your family, since they are the ones who will have the final say consent to the donation or not.
Renal Transplant

Kidney Transplant is the hope for life in Quintana Roo
HOSPITAL GALENIA
TRANSPLANT COORDINATION
Responsible for the program of transplant
DR EDGAR Rodolfo Benitez Cejudo
Transplant Surgeon

Kidney.

The human body has two kidneys that filter blood substances expelling waste and excess salt, regulating the balance of fluids in the body, this filtering produces urine, which is carried from the kidneys to the bladder by a pair tubes called ureters. Then, the urine is ejected by a tube called the urethra.

Terminal Chronic Kidney Disease (TCKD) is diagnosed when it presents a malfunctioning kidney which accumulates harmful substances and loses useful substances for the body.
 
Among the symptoms are presented in the TCKD are: urinate less times and less amounts, swollen eyelids early in the morning, fatigue, feeling sick and loss of appetite.

TCKD is diagnosed when the residual kidney function reaches 60 ml x minute. But when this function is reduced to 5 to 10 ml per minute the patient needs any of the alternative treatments to survive:

These three treatments for this disease are:

• PERITONEAL DIALYSIS: In the belly of the patient, the doctors place a plastic tube, to allow liquid to pass to the interior, they leave the liquid inside the body for a few moments and then later remove the liquid. That way the debris that the kidneys no longer can remove is eliminated.
• HEMODIALYSIS: It filters the blood through a machine, the procedure lasts between two and five hours and is performed three times a week or so.

Transplant: It consists of placing the kidney of another person (donor) in the lower right or left quadrant of the abdomen of the patient (host) with the result being that this new kidney filters the blood and eliminates the toxic substances in the body.

One of the realities facing Mexico is undoubtedly the hundreds of people dying daily, because of diseases whose only therapeutic treatment is organ transplantation.

It is estimated that in our country the growth rate of TCKD, discounting the deaths, has been approximately 11% per year.

If this increase continues, by 2010 the number of cases will have doubled affecting 70 thousand Mexicans.

In our state of Quintana Roo the most common causes of the TCKD is mellitus diabetes (51.23%), hypertension (8.42%), kidney stones (5.6%), and Unknown (9.47%)

In our country in 2007 kidney transplants were performed 1978 times of which 504 (25.4%) were cadaverous donors. In 2008 so far there have been kidney transplants preformed 1039 times with the same percentage of cadaverous donors.

The National Transplant Center (CENATRA) has estimated that 5000 kidney transplants should be carried out annually.

What is a transplant?

It is the replacement of an organ or tissue that is no longer working, with one that is, in order to restore lost functions. In many cases, transplant is the only way that someone else’s life can be saved or quality of life regained.

Transplant Protocol

At Galenia Hospital in the City of Cancun Quintana Roo there are 2 protocols kidney transplant:
 
• Protocol for renal transplant from live related donor (PRTLRD)
This is the protocol in which patients admitted with TCKD wanting a transplant have various possible kidney donors. According to the  health legislation in Mexico, these potential donors may be the patient's relatives (siblings, parents, children, cousins, etc.) or they can be emotionally related (spouse, friends).

• Protocol for kidney transplant from donor cadavers (PKTDC)
It's the protocol in which all patients admitted with TCKD wanting to receive a transplant and do not have a possible kidney donor.
The first contact with the Renal Transplant Service may be because the nephrologist (specialist in the functionality of the kidneys) refers the patient. Another way is direct consultation with specialists from Renal Transplant.

Study prior to transplantation.

• Medical studies.

Phase I: Laboratory studies (blood, urine and cultures). To help detect infections, kidney problems, liver, glucose, etc.
 
Phase II: complete studies (X-ray studies or ultrasounds that make it easier for doctors to see internal structures of your body in order to see if there is any anomaly, for this phase it will be necessary for you to stay in the hospital for a few days).

Phase III: This is the evaluations that are preformed by various specialties in the hospital: ENT (ear, nose and throat) Urology (urinary system), Gynecology (female reproductive system), Cardiology (heart), Anesthesia (avoid the pain), Nephrology (kidneys) and a Psychologist in transplantation.

• procedure for carrying out a transplant from a live related donor
 
Once all the medical and psychological studies have been preformed, an appointment is made with a kidney transplant Subcommittee, which is made up of medical specialists who will discuss the results of the studies, this allows necessary clarifications. When everything is ready the case is presented to an internal committee formed by experts in various medical and non-medical specialties where the case is discussed, approving and scheduling the date of transplant.
 
   
 
Procedure for carrying out a transplant from donor cadavers
 
The procedure for being placed on the waiting list for a transplant donation from a cadaver is as follows: once all of the medical and psychological studies have been completed, the Coordination Services of Renal Transplant approves the enrollement of the patient to the Institutions waiting list (Galenia Hospital) and therefore is also added to the federal list (National Center of Transplants CENATRA).
 
It is important to know that you can only be enrolled in ONE local list.
 
The time a patient remains on the waiting list varies. It can be influenced by multiple variables such as blood type, age, body size, a change in illness and position on the waiting list. Both receiving candidates as well as the donor are studied carefully and because of that everything is decided a few hours before transplantation.
 
While you're on the waiting list you must attend your monthly checkup in which you will be receive medical and psychological evaluation with the aim of assessing whether you're apt to stay on the waiting list for the month, however, if you are not apt, remember that you can rejoin the waiting list the next month.

The Cadaverous Donor is subjected to multiple laboratory testings and committee tests with the aim of ensuring the right characteristics of tissues and organs and to ensure that they are free from infection or tumors, for which complex protocol and tests are preformed and crossed with the different potential receivers in order to decide the most suitable and compatible patient.

In the Multi-organic Extraction Surgery, organs and tissues can be taken, which are used in the different programs that the hospital has.  If there is not an appropriate match or the organs or tissues can not be taken advantage of, these are then made available to CENTRA.  They along with the Coordination of the Donation of Organs at Galenia Hospital with do the pertinent medical and legal formalities for the assignment of these organs to other states in the States of the Republic. 
The admission of a patient to the waiting list requires a great effort from both the transplant team and the patient himself so that once he’s entered the list is important that he is reachable, as the transplantation of a cadaverous donor there is no surgery planned and that in an emergency can be done any day, at any time.
 
THE kidney transplant.
In the case of living related donor transplantation, one or two days before the transplant you will be admitted to the hospital for the preoperative studies, sometimes, during these days dialysis or hemodialysis sessions are administered in order to prepare for surgery. Because each body is different, the duration of each surgery is variable.

The success rate of having a related living donor transplant is 95% while the success rate of a cadaverous donor transplant is 85%. The transplant team will contact your family once the surgery is completed.
 
After surgery will be located an isolated area located in the Intensive Care Unit.  Your time in that area will depend on your progress, you could be hospitalized anywhere from four days up to a month; remember that the important thing is that you come out of this in good condition and not the amount of time you remain hospitalized.                  
 
LAPAROSCOPIC NEFRECTOMY
The Program of Renal Transplant at Galenia Hospital has the technology and the specialists trained in transplantation to offer a more modern surgical technique and an international stature as is the laparoscopic NEFRECTOMY.

Previous studies have demonstrated the benefits of laparoscopic surgery in nephrectomy when comparing it with the open technique, the conclusions show a lower morbidity, less need of analgesics, less intraoperative bleeding, an early oral tolerance, shorter stay in the hospital and that they are able to resume daily activities faster. 

Immunosuppression. The immune system attacks the foreign agents (viruses, bacteria, fungi) that invade our bodies. But what happens when our body needs "a strange agent" to recover lost health? We refer to a kidney transplant. The immune system attacks with identical force for viruses as for a kidney transplant, making it necessary to reduce or abolish this system and this is achieved by immunosuppressive drugs which, dropping defenses prevent rejection of the kidney, while it increases susceptibility to infectious diseases for which you should follow the self-care behaviors that you are listed below. The rejection is the attempt of your immune system to attack and destroy the kidney. To prevent rejection, you must take immunosuppressive drugs as prescribed, for the lifetime of the kidney.

Care POST TRANSPLANT
• Closely monitor your temperature, blood pressure, weight and amount of urine.
• Stay in an isolated room at home for two months.
• Take medicines as the doctor has prescribed, because otherwise the rejection would begin immediately.
• Attend medical consultations and if feeling some discomfort (temperature, pain in the area of graft, changes in the urine) visit the medical team, do not self medicate.
• Drink from two to three liters of pure water a day, remember that water should always be boiled or chlorinated.
• Follow the food guidelines and avoid eating out! Your diet should include fruits, vegetables, grains, dairy products and lean meats.
• Wash your hands before and after using the toilet and cooking or eating.
• Bathe daily with warm water.
• Use face mask when you go out.
• Avoid contact with people carrying contagious diseases.
• When the doctor tells you exercise (walking three times a week). If you experience any of the following symptoms, stop exercising and consult your doctor: chest pain, a lot of fatigue, shortness of breath or dizziness.
• You should avoid activities that your kidney at risk: contact sports, motorcycle, horseback riding, etc..
• Avoid contact with animals.
• Avoid vaccines with live viruses.
• Avoid alcoholic beverages because they can damage your liver.
• Do not smoke, if you do, join a support group for quitting.
• Use a sun protective lotion of at least SPF 15.
• You should use condoms to reduce the risk of sexual infections.

More Information contact Hospital Galenia’s Renal Transplant Service

transplants.coordination@hospitalgalenia.com
Please call us: (52) 998 8915200 Ext. 432