Organización Nacional de Trasplante de Venezuela: a new initiative to approach donation and transplantation in our country

Organizacio´n Nacional de Trasplante de Venezuela: A New Initiative to Approach Donation and Transplantation in Our Country C.L. Milane´s, E. Hernandez, P. Clesca, J. Becerra, L. Serrano, R. Mamblona, H. Sivira, L. Gonzalez, N. Calvanese, V. Sanna, S. Guipe, and P.A. Rivas-Vetencourt

T

HE PURPOSE of the present study was to evaluate the impact on transplant activity in our country following the creation of the “Organizacio ´n Nacional de Trasplante de Venezuela” (ONTV). ONTV was created in 1997, as a private, nonprofit organization whose main purpose is to facilitate and coordinate the transplant activity. The aim of ONTV is to establish a program to create a working interface between patients’ needs, scientific societies, and government authorities.

MATERIAL AND METHODS Program implementation has included the following: (1) Establishment of a common language and rules between the transplant teams of the different organs and tissue, workshops organization, as well as lectures and groups discussions. (2) Attitude and knowledge evaluation about donation and transplantation in Venezuelan society. (3) Cost-effectiveness analyses of kidney and liver transplantation in Venezuela. (4) Development of a pilot organ procurement network in the metropolitan area of Caracas with six transplant coordinators fully trained and with a 24-hour a day response capacity.

RESULTS Evaluation of Public Attitudes Toward Transplantation and Donation

To identify the factors that facilitate and obstruct the process of organ donation for transplantation in Venezuela, we carried out a field study in a random representative sample of the population of the metropolitan area of Caracas. The sample was constituted of 100 adults with a mean age 34 ⫾ 15 years (range, 18 to 65 years), equally distributed by gender. The perception of donation was explored using a questionnaire designed by the Autonomous University of Madrid, Spain, adapted and validated by the Institute of Psychology of the Universidad Central de Venezuela (UCV). The analysis and crossing of variables was performed using the Statistical Package for Social Sciences. The study revealed that 72% of the population was favorable to organ donation, 75% of them by feelings of solidarity and 20% to avoid organ waste. Seventy-four percent of persons manifested a positive intention toward © 2001 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010

organ donation from relatives. The main reasons to oppose donation were fear that the organs were taken prematurely (25%), lack of confidence in the public health system (16%), and limited information about organ donation (11%). Information about organ donation and transplantation was obtained mainly through television (28%), newspapers (20%), radio (8%), and health care professionals (20%). Insufficient knowledge of the legal aspects of the donation and transplantation were detected in 81% of those interviewed. The only predictive factors for a favorable attitude toward donation were the level of information (P ⬍ .05) and socioeconomic status (P ⬍ .05); gender and religion did not exert significant influence. Cost-Effectiveness Analysis of Kidney Transplantation and Dyalisis in Venezuela

Because of the limited economic resources available for health care in Venezuela, it is important to evaluate the economic impact of alternative treatment strategies for end-stage renal disease (ESRD). The present study was designed to compare relative cost of the renal transplantation (Tx) with hemodialysis (HD) and peritoneal dialysis (DP) as alternative methods of renal replacement therapy, as a means to provide an analytic framework useful for public policies making in the health ministry. For the cost-effectiveness analysis, we considered changes in the quantity and quality of patients’ lives using the following indicators: (1) cost per year of life saved adjusted by quality (QALYs) and (2) cost for saved life (CLS). The results are shown in Table 1. Development of a Pilot Organ Procurement Network

As a medical activity, the process of organ and tissue procurements requires a varied series of skills that, when From the Organizacio´n Nacional de Trasplante de Venezuela (ONTV), Caracas, Venezuela. Supported by the Organizacio´n Nacional de Trasplante de Venezuela (ONTV). Address reprint requests to Dr Pedro A. Rivas Vetencourt, Apartado Postal 66622, Plaza Las Ame´ricas, 1061-A Caracas, Venezuela. 0041-1345/01/$–see front matter PII S0041-1345(00)02784-6 2047

Transplantation Proceedings, 33, 2047–2048 (2001)

MILANE´S, HERNANDEZ, CLESCA ET AL

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Table 1. Cost-Effectiveness Analysis of Kidney Transplantation and Dyalisis in Venezuela Cost per Year of Life Saved Adjusted by Quality (QALYs) Age (y)

LD-Tx ($)

CD-Tx ($)

0 –19 20 – 44 45– 64

9877 10,081 10,497

9956 10,209 10,671

Cost for Life Saved (CLS)

DP ($)

HD ($)

LD-Tx ($)

DC-Tx ($)

DP ($)

HD ($)

24,270 24,279 24,296

29,327 29,327 29,327

62,129 68,528 92,561

76,445 83,689 114,496

160,350 287,572 580,884

193,760 347,362 701,147

LD, living donor; CD, cadaveric donor.

well coordinated, are fundamental for successful results such as a larger number and good quality of the organs and tissues for transplantation. The process includes detection and maintenance of the donor, diagnosis of brain death, obtaining family consent, organ removal, and selection of the recipients. ONTV designed an organ procurement system led by a trained transplant coordinator who is in charge of the entire process initiated by a referral to a 24-hour telephone information service (free phone call through) of the potential donor generated in any public or private hospital in the health care system. The transplant coordinator also has the task of making both society in general and health care professionals aware of organ donation and its development, requesting collaboration in organ generation of the media (press, radio, and television) and emergency medical teams. The information transmitted must reflect the existence of a structured system for obtaining and distributing organs which is well defined and submitted by official regulations. Since the inception of the ONTV Organ Procurement System (OPS) average detection, referral, and effective cadaveric donation has increased. However, there are still a number of potential donors that are lost in the detection, maintenance, brain death diagnosis, or family consent phase of the process.

CONCLUSION

A high level of public information about organ donation and the socioeconomic status of the population were the main factors that determine a favorable attitude toward organ donation in our study. Therefore, the achievement of effective organ procurement for transplantation in Venezuela must be based on careful designed educational programs to the community. The QALYs and CLS of transplant from both, LD or CD were better than that of HD and DP. In conclusion, (1) transplantation is the renal replacement therapy with better cost effectiveness for ESRD and (2) the economic analysis of clinical decisions may facilitate the assignment of resources from the public field to the transplant activities as the ideal therapy for ESRD. The results of each has shown a need for better guidelines for declaring brain death, an improved in-hospital coordination donation process, an educational protocol for nationwide knowledge of the legal aspects of organ and tissue donation and transplantation, and the awareness of organ donation in the medical society and general public with the development of an adequate legislative lobby for a more cost-effective utilization of monetary resources directed for transplantation activity. The present initiative should have a beneficial impact on organ and tissue procurement and transplantation in the near future.