The Transplantation Society of Latin America€¦ · Editor Valter Duro Garcia President José Toro...

Apoio

The Transplantation Society of Latin America

and the Caribbean

Latin America Transplantation

Report 2009

Lati

n A

mer

ican

Tra

nspl

anta

tion

Repo

rt 2

009

Valter Duro Garcia

José Medina Pestana

Eduardo Santiago-Delpin

Latin America Transplantation Report

ExpedientThe Transplantation Society of Latin America and the Caribbeanwww.stalyc.org

Editor Valter Duro Garcia

PresidentJosé Toro Cornejo

Graphic and Visual Planning Lado a Lado Comunicação e MarketingPhone/Fax [55 11] 3888 2222 www.ladoalado.com.br

ABTO - Associação Brasileira de Transplantes de ÓrgãosMail Adress Av. Paulista, 2001 17th floor conj. 1704/1707ZIP Code 01311-300 São Paulo SP BrazilPhone [55 11] 3283 1753 / 3262 3353 Fax [55 11] 3289 [email protected]

Introduction

Every two years we are honored to publish this important document for the global medical

community, specifically for those who are connected to the practice of transplantation in Latin

America and the Caribbean. In 2009, the Latin American Transplantation Registry celebrates

17 years of contribution to the experts from countries of The Transplantation Society of Latin

American and the Caribbean and the Pan American Society for Dialysis and Transplantation.

This is a joint effort of all these societies.

The vast majority of countries advanced in the number of transplants performed, which

proves that professionals are better prepared, hospitals equipped, and the population more

aware regarding the donation of organs and tissues.

To better understand the dynamics of each of the countries that are part of this record, we

establish the objectives of The Transplantation Society of Latin America and the Caribbean

and more. We show the performing countries transplants, the beginning of transplantation

activities, which are the transplantation organizations, donation national societies and

organizations, and explain the transplantation law, the donation and transplantation activities

by country, advances and difficulties.

We hope that you enjoy this material, and we are glad to be able to help you in your work.

Good reading.

Valter Duro GarciaEditor – Latin America Transplantation Report

Results of the Transplantation Society of Latin America and the Caribbean and the Pan American

Society for Dialysis and Transplantation

Latin America Transplantation Report 2009


Board Editors


Assistant Editors Eduardo A Santiago-Delpin

José Osmar Medina Pestana

Advisory Board Carmen Milanes Venezuela

Maria del Carmen Bacqué Argentina

Mário Abbud Filho Brazil

Sérgio Orihuela Uruguay

Suzana Elgueta Chile

José Salvador Aburto Mexico

Paulina Chiluiza Ecuador


General Index

Objectives of The Transplantation Society of Latin America and the Caribbean ............ 6

The Transplantation Society of Latin America and the Caribbean ................................ 7

Latin America Transplantation Report ........................................................................8

Data Obtained ......................................................................................................... 9

Latin America Overview ..........................................................................................10

Countries Performing Transplants ............................................................................12

Transplantation Societies ........................................................................................ 12

Beginning of Transplantation Activities ....................................................................13

National Transplant Societies ..................................................................................14

Transplantation Organizations ................................................................................14

Donation Societies..................................................................................................14

National Organizations ........................................................................................... 15

Transplantation Laws .............................................................................................. 16

First Latin America Registries ..................................................................................18

First Transplantation Activities .................................................................................19

Donation Activities ................................................................................................ 21

Transplantation Activities .......................................................................................33

Transplantation Activities by Country .......................................................................54

Difficulties .............................................................................................................. 74

Advances ............................................................................................................... 78

Conclusions .......................................................................................................... 84

Future steps .......................................................................................................... 85


Objectives of The Transplantation Society of Latin America and the Caribbean

To unify the Latin America and the Caribbean region with

educative, practical and investigational objectives in all about

organ transplantation.

To contribute for diffusion and improvement of the knowledge

about organ transplantation by means of congresses, meetings,

publications, etc.

Democratic representation of all Latin America countries.

To help the development of new transplant programs in all countries.

To help to optimize the transplant results in all region, identifying

success factors in some countries.

To promote ethical rules in all countries.

6


The Transplantation Society of Latin America and the Caribbean

2008 – 2009

President José Toro Cornejo

Vice-President Roberto Tanús

Vice-President Alejandro Nuño Murcia

Secretary David Arana

Treasurer Paul Clesca

General Secretary Domingo Casadei

President Elected Ashley Baquero

Past President José Osmar Medina Pestana

www.stalyc.org

Latin America Transplantation Society (1981) and Pan American Dialysis and Transplantation Society (1987)

were unified to found The Transplantation Society of Latin America and the Caribbean (1999).

7



Board Editors


Assistant Editors Eduardo A. Santiago-Delpin

José Osmar Medina Pestana

Advisory Board Carmen Milanes Venezuela

Maria del Carmen Bacqué Argentina

Mario Abbud Filho Brazil

Sergio Orihuela Uruguay

Suzana Elgueta Chile

Alejandro Nuno Murcia Colombia

Paulina Chiluiza Ecuador

8


Data Obtained

International registriesThe Transplantation Society of Latin America and the Caribbean

www.stalyc.org

The Punta Cana Group of Ibero-American Transplant Coordinators

www.gpuntacana.net

Red / Consejo Iberoamericano de Donación y Trasplante

National registries

Argentina www.incucai.gov.ar

Brazil www.abto.org.br

Chile www.trasplante.cl

Cuba www.sld.cu

Mexico www.cenatra.gob.mx

Uruguay www.bnot.hc.edu.uy

Publications, presentations and interviews of some countries in Latin America.

9


Latin America OverviewLatin America is a conglomerate of adjacent countries which have in common languages of Latin extraction, either Spanish or Portuguese. It includes Mexico from North America, countries of Central and South America and Spanish speaking Islands of the Caribbean.

North America Mexico

Central America Costa Rica

El Salvador

Guatemala

Honduras

Nicaragua

Panama

South America Colombia

Venezuela

Ecuador

Bolivia

Brazil

Peru

Paraguay

Uruguay

Argentina

Chile

Caribbean Islands Cuba

Dominican Republic

Puerto Rico

Population: 552 millions

Income per capita: 8,630 U$D

• Nicaragua 2,515 U$D

• Chile 13,083 U$D

Human Development Index:

0.797

• Guatemala 0.689

• Argentina 0.869

Incidence:

• dialysis: 105 pmp (58,000)

Prevalence:

• dialysis: 305 pmp (168,000)

• transplant: 110 pmp (60,000)

10


Population (million)

World Bank, 2008

3,2

3,4

3,9

4,1

5,6

6,7

6,9

7,5

9,1

9,4

11,4

12,7

13,7

16,2

26

28,6

40,3

44,3

108,7

190

Panama

Uruguay

Puerto Rico

Costa Rica

Nicaragua

Paraguay

El Salvador

Honduras

Bolivia

Dominican Republic

Cuba

Guatemala

Ecuador

Chile

Venezuela

Peru

Argentina

Colombia

Mexico

Brazil

0 50 100 150 200

Latin America Overview

11


Countries Performing Transplants

Transplantation Societies

Kidney 20

Heart 14

Liver 13

Pancreas 11

Lung 8

Small bowel 5

The Transplantation Society of Latin America and the Caribbean

National Transplantation Society: 17

12


Beginning of Transplantation Activities

Kidney Pancreas Liver Heart Lung Bowel

Argentina 1957 1993 1988 1968 1967 1999

Bolivia 1979 0 1999 2000 0 0

Brazil 1964 1968 1968 1968 1989 1968

Chile 1966 1994 1969 1968 1999 2004

Colombia 1965 1988 1979 1985 1998 2004

Costa Rica 1969 1993 1993 1991 0 0

Cuba 1969 1986 1986 1985 1989 0

Dominican Republic 1972 0 2008 0 0 0

Ecuador 1976 1991 2000 1988 0 0

Guatemala 1982 0 0 0 0 0

Honduras 1986 0 0 0 0 0

Mexico 1963 1987 1985 1987 1989 1991

Nicaragua 2000 0 0 0 0 0

Panama 1990 0 0 0 0 0

Paraguay 1978 0 0 1999 0 0

Peru 1965 0 1973 1970 2007 0

Puerto Rico 1968 2007 0 1999 0 0

El Salvador 1985 0 0 0 0 0

Uruguay 1969 2002 1998 1996 2001 0

Venezuela 1967 1990 1990 1968 0 0

13


National Transplant Societies

Transplantation Organizations

Donation Societies

Red / Consejo Iberoamericano de Donación y Trasplante (RCIDT)

National Transplant Organization: 17 from state: 15 private foundation: 2 (Chile and Venezuela)

Argentina 1985

Bolivia 1989

Brazil 1986

Chile 1981

Colombia 2002

Cuba

Dominican Republic

Ecuador

Guatemala

Honduras

Mexico 1996

Panama

Paraguay 1997

Peru

Puerto Rico

Uruguay 1984

Venezuela

Punta Cana Group of Latin America Coordinators

National Transplant Coordinators Society: 1 (Argentina)14


National Organizations

Uruguay 1978 Instituto Nacional de Donación y Transplante

Argentina 1979 Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI)

Cuba 1982 Centro Coordinador Nacional de Transplante

Mexico 1984 Centro Nacional de Trasplante

El Salvador 1988 Consejo Nacional de Transplantes

Chile 1990 Corporación del Transplante - Chile (CTCH)

Puerto Rico 1993 Agencia de Recuperación de Órganos y Tejidos

Venezuela 1997 Organización Nacional de Transplante de Venezuela (ONTV)

Brazil 1997 Sistema Nacional de Transplante (SNT)

Guatemala 1997 Unidad Nacional de Atención al Enfermo Renal Crónico (UNAERC)

Bolivia 1997 Comision Coordinadora Nacional de Transplante de Órganos y Tejidos (CCNTO)

Ecuador 1999 Organización Nacional de Transplante de Órganos y Tejidos (ONTOT)

Dominican Republic

2000 Instituto Nacional de Coordinación de Transplante (INCORT)

Paraguay 2001 Instituto Nacional de Ablación y Transplante (INAT)

Panama 2001 Programa Nacional de Transplantes

Colombia 2004 Rede Nacional de Donación y Transplante (DAVIDA)

Peru 2006 Organización Nacional de Donación y Transplante (ONDT)

15


Transplantation Laws

All countries – the law contemplates

brain death diagnosis

type of consent for retrieval

altruistic living related donation

restriction or not for living unrelated donation

medical criteria for allocation

prohibition of commercialization

penalties

Type of consent for retrieval

Presumed consent

Argentina (1993, 2005)

Colombia (1974, 1998, 2004)

Costa Rica (1974, 1994)

Dominican Republic (1998, 2004)

Ecuador (1994, 2001)

Mexico (1984, 2000)

Panama (1983, 1998)

Paraguay (1998)

Uruguay (1971)

Informed consent

Bolivia (1996)

Brazil (1963,1968, 1992, 1997, 2001)

Chile (1983, 1996)

Cuba (1983, 1995)

El Salvador (1994, 2001)

Guatemala (1996)

Honduras (1983)

Nicaragua (2003)

Peru (1974, 1982, 1998, 2005)

Puerto Rico (1974, 2000)

Venezuela (1972, 1992)In all countries the family is consulted

16


Transplantation Laws

a. Legislation against organ commerce Almost all countries have

b. Legislation for unrelated living donation (URLD) • In some countries it is forbidden

Argentina and Uruguay

• In other countries there are restrictions

Brazil: previous judicial authorization (new law, 2010):

requires previous approval of hospital ethical committee,

health state secretary and, finally, legal official consent

• In other countries there are no restrictions

Chile, Puerto Rico, Bolivia and Peru

Chile: no URLD kidney transplants (except spouse)

c. Legislation for transplant for nonresident patients from other countries

• In some countries it is prohibited

Uruguay

• In other countries there are restrictions

Chile: needs to live at least five years in the country

Colombia: allows if there are no nationals waiting for this organ

• In most of countries there are no specifications

Brazil (proposal from ABTO for a new law: to prohibit transplants to non residents aliens)

17


Martinez L, Pereira J. Renal transplantation in South AmericaTransplant Proc 1987, 19:3642-3644

Santiago Delpin, EA. Transplantation on Latin America.Transplant Proc 1991, 23:1855-1860

Duro Garcia V.Kidney donors in Latin AmericaNefrologia 1993, 13 (suppl 2): 12-17

Santiago Delpin EA, Duro Garcia V.Latin American Transplantation RegisterPasteur-Merieux. November 1993

First Latin American Registries

Historical series

Kidney 1957 Argentina

Lung 1967 Argentina

Heart 1968 Brazil / Chile / Argentina / Venezuela

Liver 1968 Brazil

Pancreas 1968 Brazil

Small bowel 1968 Brazil

Transplant programs

Kidney 1961 Argentina

Heart 1984 Brazil / Argentina

Liver 1985 Brazil

Pancreas 1986 Cuba

Lung 1989 Mexico / Brazil

Small bowel 2005 Argentina

The last Latin America Transplantation Report

18


First Transplantation Activities

Worldwide after the first four pancreas transplants at the University of Minnesota, the next four transplants (May to September 1968), were performed in South America, three in Brazil and one in Argentina. Gruessner RWG, Sutherland DER. Transplantation of the pancreas. New York. Springer.

2002. P 50.

The first hand transplantation in world. Ecuador, 1964. Hakin NS. The history of arm transplantation. In: Hakin NS, Owen E, Dubernard JM.

London. Imperial College Press. 2006. P1-9.

The first living donor liver transplantation in world. Brazil, 1989.Raia S, Nery JR, Mies S. Liver transplantation from live donors. Lancet 1989; 2:497.

The first laryngeal transplantation in Latin America. Colombia, 2002.XVII Congreso Latinoamericano de Transplante. Cuzco 2003.

19


First Transplantation Activities

Kidney Argentina June 11, 1957Receptor: 16 years old with ESRD (uremic coma).Donor: Anencephalic new-born.Technique: kidneys en-bloc placed in inguinal region (femoral vessels), ureters in skin.The graft never functioned and the patient died some days after.

Liver Brazil Hospital das Clínicas – Universidade de São Paulo 1. August 5,1968. Survival 8 days.2. May 31, 1969. Survival 18 days.Between 1970 and 1972: more three transplants.

Heart Brazil Prof. Euriclides Zerbini, HC-FMUSP1. May 26, 1968. Survival for 28 days 2. September 3, 1968. Survival for 411 days 3. January 6,1969. Survival for 83 days

Lung Argentina Molins, Instituto M. Ferrer – Buenos AiresMay 1, 1967 – 1st lung transplantation in humans, followed by other few days after. Both patients died because of surgical complications. 1992 – lung transplants restarted.

Pancreas Brazil Prof. Edson Teixeira, Hospital Silvestre – Rio de JaneiroMay 25, 1968 – First isolated pancreas transplantation of the world.Without immunosuppression – patient without insulin therapy for few days.

Small bowel Brazil Masayuki Okumura, Hospital das Clínicas – Universidade de São Paulo1968 – First small bowel transplantation in Latin America (survival: 12 days).1969 – Second small bowel transplantation (survival: 5 days).

Multivisceral Argentina Hospital Italiano de Buenos Aires – February 2009Successful liver, pancreas and small bowel transplantation

20


Donation Activities

More brain death cases than observed in developed countries:

associated to violence and traffic accidents (81-105 pmp) however

Potential donors notified (2008): 33 pmp

Brain Death EpidemiologyRestrospective studies in Brazil

Abreu Santos ALG. J Bras Nefrol 2006, 28:25-30

Pestana JOM. Transplant Proc 2001

Pestana JOM. Lancet 1993, 341:118

Registro Brasileiro de Transplante 2008, 13 (2):28-30

São Luís, 2003

São Paulo, 2001

São Paulo, 1991

Brasília, 2008

105

100

100

81

0 50 100 150

Found: 81-105 pmp

21


Donation Activities

Problem: small identification of potential donors in most of countries.

Evolution of potential donors notified

Potential donors rate (pmp)

2000 2001 2002 2003 2004 2005 2006 2007 2008

3. Less than 20 pmp

2. Between 20-50 pmp

1. Higher than 50 pmp

70

60

50

40

30

20

10

0

Mexico Uruguay Dominican Republic

Chile CubaVenezuela Peru Puerto RicoBrazil Argentina Colombia

22


Family refusal to donate

The family refusal rate is not different from that observed in developed countries. We can observe that it decreased in Colombia and Brazil; did not present modification in Argentina, Uruguay, Chile and Cuba; and increased in Peru.

Method for analysis of family refusal is not uniform in Latin America.

Donation Activities

100

90

80

70

60

50

40

30

20

10

02000 2001 2002 2003 2004 2005 2006 2007 2008

Uruguay Colombia Argentina Brazil Chile Cuba Peru

23


In last 6 years increased 3.8 pmp (0.5 pmp/y)

through 2.1 pmp to 5.9 pmp

Donation Activities

Deceased donors rate

Deceased donors pmp7

6

5

4

3

2

1

02001 2002 2003 2004 2005 2006 2007 2008

2,1

3,8

4,2

3,2

5

5,4

5,8 5,9

24


Donation Activities

Deceased donors rate per country

pmp – 2007

Latin America: 5.8 pmp (n = 3,195)

35

30

25

20

15

10

5

0

30,8

18,2 17,8

12,310,7

8,17,1

6,2

3,7 3,3 3,11,8 1,4 1,4 1,3 0,8 0,8

0,1

Puer

to R

ico

Urug

uay

Cuba

Arge

ntin

a

Colo

mbi

a

Chile

Cost

a Ri

ca

Braz

il

Vene

zuel

a

Mex

ico

Pana

ma

Ecua

dor

El S

alva

dor

Gua

tem

ala

Boliv

ia

Para

guay

Peru

Dom

inica

n

25


Country Donors (n)

Puerto Rico 113

Uruguay 65

Cuba 189

Argentina 528

Colombia 425

Brazil 1,317

Chile 115

Donation Activities

Deceased donors rate

pmp – 2008

Country Donors (n)

Costa Rica 30

Panama

Venezuela 86

Ecuador 11

Mexico 348

Bolivia 20

Guatemala 8

Country Donors (n)

Dominican R 4

Peru 9

El Salvador

Paraguay 3

Honduras

Nicaragua

Latin America 3,271

Latin America: 5.9 pmp (n = 3,271) ** partial data

35

30

25

20

15

10

5

0

Puer

to R

ico

Urug

uay

Cuba

Arge

ntin

a

Colo

mbi

a

Cost

a Ri

ca

Braz

il

Chile

Vene

zuel

a

Mex

ico

Pana

ma

Boliv

ia

Ecua

dor

Gua

tem

ala

Dom

inica

n Re

publ

ic

Para

guay

Peru

El S

alva

dor

29

19,1

16,6

13,1

9,6

7,3 7,2 7,1

3,3 3,2

0,82,2

0,6 0,5 0,4 0,3

26


Donation Activities

Donations from asystolic donors

• NotyetemployedinanycountryinLatinAmerica

- Not covered by the law

- Technical difficulties

- High cost

Perspectives of deceased donors rate for the next 10 yearsto increase 1 – 1.5 pmp/year (20 pmp)

• Braindeathdonors

- Low detection rate (potential donors): < 50%

- Low effectivation rate: 20 – 30%

25

20

15

10

5

02007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Deceased donors pmp

5,87

8,29,5

1112,5

1415,5

1718,5

20

Discussion:Must be initiated soon or

after improvement of the brain death donor rate

27


Rate: 8.5 pmp

URLD (except spouse): < 5%

The aim with living donors is to obtain 15 transplants pmp, using only LRD and emotionally related (spouses).To increase 0.5 – 1.0 pmp/y This restriction is necessary because of the great social inequalities.

Donation Activities

Living donor kidney transplantation

2007

Cost

a Ri

ca

Mex

ico

Braz

il

Gua

tem

ala

Dom

inica

n Re

publ

ic

Vene

zuel

a

El S

alva

dor

Boliv

ia

Arge

ntin

a

Para

guay

Ecua

dor

Chile

Pana

ma

Puer

to R

ico

Urug

uay

Cuba

Colo

mbi

a

Peru

Hond

uras

Nica

ragu

a

25

20

15

10

5

0

19,3

15,2

9,2

7,7 7,7

5,8 5,4 53,9

3,3 3,1 3 2,6 2,3 1,8 1,5 1,30,6 0,5

28


Donation Activities

Living donor kidney transplantation

2008

Rate: 7.7 pmp *

URLD (except spouse): < 5%

* partial data

The aim with living donors is to obtain 15 transplants pmp, using only LRD and emotionally related (spouses).To increase 0.5 – 1.0 pmp/y This restriction is necessary because of the great social inequalities.

25

20

15

10

5

0

20,5

15,5

10 9,6

5,4 5,34,2

3,6 3,32,5 2,2 2,1

1,50,7

4,9

Cost

a Ri

ca

Mex

ico

Dom

inica

n Re

publ

ic

Braz

il

Arge

ntin

a

Gua

tem

ala

Puer

to R

ico

Boliv

ia

Vene

zuel

a

Para

guay

Ecua

dor

Chile

Urug

uay

Colo

mbi

a

Cuba

Pana

ma

Peru

El S

alva

dor

Hond

uras

Nica

ragu

a

Country LDKT (n)Brazil 1,768

Mexico 1,687

Argentina 181

Venezuela 100

Dominican Rep 94

Costa Rica 84

Guatemala 71

Colombia 65

Chile 64

Bolivia 41

Ecuador 35

Paraguay 22

Puerto Rico 19

Cuba 8

Uruguay 7

PanamaPeru El Salvador Honduras NicaraguaLatin America 4,246

29


Donation Activities

Living donor liver transplantation

2007

n: 199Rate: 0.4 pmp

0,8

0,7

0,6

0,5

0,4

0,3

0,2

0,1

0

0,8

0,5

0,3 0,3

0,2

0,1 0,1

Brazil Argentina Uruguay Chile Venezuela Colombia Mexico Cuba Dominican

30


n: 133 *Rate: 0.3 pmp* partial data

Donation Activities


2008

0,6

0,5

0,4

0,3

0,2

0,1

0

0,6

0,2

0,1

Brazil Venezuela Mexico Argentina Chile Colombia Costa Rica Peru Cuba Uruguay Dominican

Country LDLT (n)

Brazil 121

Argentina

Mexico 8

Venezuela 4

Colombia

Chile

Uruguay 0

Cuba 0

Peru

Costa Rica

Dominican Rep 0

Latin America 133

31


12.7% of the liver transplantation (1,921)were performed with living donors

Brazil1,461 LDLT - 3 donors died

Mortality rate: 1 / 487

Donation Activities


19

16,815,9

14,3

9,8

3,6 3,52,9

1,9

12,7

Costa Rica Argentina Brazil Venezuela Mexico Uruguay Chile Peru Colombia Latin America

20

15

10

5

0

32


The number of kidney transplantation centers is

increasing.

181 in 1990

314 in 1999

450 in 2005

Most performs < 20 kidney Tx / year

The waiting list for kidney transplantation:

33,000 in 1995 (75 pmp)

50,000 in 2008 (90 pmp)

Transplant centers

Waiting list

n pmp

Brazil 167 32,155 (175)

Mexico 133 5,683 (53)

Argentina 54 4,667 (123)

Colombia 14 949 (22)

Chile 22 1,384 (87)

Cuba 9 900 (82)

Venezuela 11 830 (32)

Peru 7 800 (28)

Uruguay 4 488 (144)

Puerto Rico 2 454 (116)

Panama 1 192 (60)

Paraguay 5 96 (16)

Bolivia 11

Ecuador 10

Costa Rica 5

Guatemala 3 250 (20)

El Salvador

Dominican Rep 6

Honduras

Nicaragua

Latin America

456 48,848 (88)

Transplantation Activities

Kidney transplantation centers and waiting list

33


Total kidney transplants number by country


126,965

5436026897

122728321

55044311

39882340

188515021370

9008517786444612942294711

BrazilMexico

ArgentinaColombia

ChileCuba

VenezuelaPeru

Costa RicaPuerto Rico

UruguayGuatemala

BoliviaEcuador

DominicanEl Salvador

PanamaParaguayHondurasNicaragua

0 10000 20000 30000 40000 50000 60000

34


Kidney transplantation number per year


Between 1991 and 2008, it grew 206%, it corresponds to a mean annual growth of 7.0%.Population annual growth of 1.4%

2%

14% 9%

2% 9%

1%

8%

17%

22%

2% 5%

23%

42%

51%

44%

52%

5% 5%

4% 4%

9,105

6,450

3,910

2,976

5% 4%

10000

9000

8000

7000

6000

5000

4000

3000

2000

1000

01991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

35


Kidney transplantation % living and deceased donor


42%

45%

53%

Deceased Living

10000

9000

8000

7000

6000

5000

4000

3000

2000

1000

01980 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

36


Kidney transplantation by country – 2007

DD: 4,539 (52%)LD: 4,214 (48%)total: 8,753 (15,7 pmp)

Costa Rica, Uruguay, Puerto Rico and Argentina 20 renal transplants pmp

15.7 pmp

Uruguay, Puerto Rico, Cuba and Colombia> 85% with deceased donor

Living Donor Deceased Donor


32,230,9

24,4

22

19,518,4 17,9

15,814,8

13,3

10,4 9,7

7,36,5

3,9 3,82,8

0,5

Cost

a Ri

ca

Urug

uay

Puer

to R

ico

Arge

ntin

a

Mex

ico

Braz

il

Chile

Colo

mbi

a

Cuba

Vene

zuel

a

Gua

tem

ala

Pana

ma

Boliv

ia

Dom

inica

n

Ecua

dor

Para

guay

Peru

Hond

uras

El S

alva

dor

Nica

ragu

a

35

30

25

20

15

10

5

0

37


Country Kidney DD Rim LD Kidney total

Argentina 717 (18.2) 150 (3.8) 867 (22.0)

Bolivia 23 (2.3) 49 (5.0) 72 (7.3)

Brazil 1,751 (9.0) 1,709 (9.2) 3,460 (18.2)

Chile 217 (13.7) 66 (4.2) 283 (17.9)

Colombia 634 (14.3) 64 (1.5) 698 (15.8)

Costa Rica 55 (13.4) 77 (18.8) 132 (32.2)

Cuba 149 (13.3) 17 (1.5) 166 (14.8)

Dominican R 1 (0.1) 58 (6.4) 59 (6.5)

Ecuador 11 (0.8) 40 (3.1) 51 (3.9)

El Salvador 38 (5.7) 38 (5.7)

Guatemala 36 (2.7) 102 (7.7) 138 (10.4)

Honduras 0 (0) 4 (0.5) 4 (0.5)

Mexico 537 (5.0) 1,570 (14.5) 2,107 (19.5)

Nicaragua

Panama 20 (6.3) 11 (3.4) 31 (9.7)

Paraguay 3 (0.5) 22 (3.3) 25 (3.8)

Peru 17 (0.6) 63 (2.2) 80 (2.8)

Puerto Rico 86 (22.1) 9 (2.3) 95 (24.4)

Uruguay 96 (29.1) 6 (1.8) 102 (30.9)

Venezuela 186 (7.2) 159 (6.1) 345 (13.3)

Latin America 4,539 (8.2) 4,214 (7.6) 8,753 (15.8)

Kidney transplantation by country 2007


38


Kidney transplantation by country 2008

Country Kidney DD Kidney LD Kidney total

Argentina 769 (19,3) 181 (4,6) 950 (23,9)

Bolivia 38 (4,2) 41 (4,2) 79 (8,4)

Brazil 2,041 (10.7) 1,768 (9,3) 3,809 (20,0)

Chile 206 (12,7) 64 (4.0) 270 (16.7)

Colombia 650 (14,6) 65 (1,5) 715 (16,1)

Costa Rica 56 (13.6) 84 (20.5) 140 (34.1)

Cuba 136 (12,1) 8 (0,7) 144 (12,8)

Dominican R 7 (0,7) 94 (10) 101 (10,7)

Ecuador 22 (1.6) 35 (2.5) 57 (4.1)

El Salvador

Guatemala 14 (1,1) 71 (5,3) 85 (6,4)

Honduras

Mexico 555 (5,1) 1,687 (15.5) 2,242 (20,6)

Nicaragua

Panama

Paraguay 5 (0.7) 22 (3.3) 27 (4.0)

Peru

Puerto Rico 68 (17,4) 19 (4,9) 87 (22,3)

Uruguay 114 (34,5) 7 (2,1) 121 (36,6)

Venezuela 178 (6,4) 100 (3,6) 278 (10,0)

Latin America 4,859 (8.8) 4,246 (7.7) 9,073 (16.5)


39


16.1 pmpCosta Rica, Uruguay, Puerto Rico, Argentina Brazil and Mexico > 20 renal transplants pmp

Uruguay, Puerto Rico, Cuba and Colombia> 85% with deceased donor

DD: 4,859 (53%)LD: 4,246 (47%)Total: 9,105

Kidney transplants by country – 2008

Transplantation Activities Co

sta

Rica

Urug

uay

Arge

ntin

a

Puer

to R

ico

Braz

il

Mex

ico

Chile

Colo

mbi

a

Cuba

Dom

inica

n

Vene

zuel

a

Boliv

ia

Gua

tem

ala

Ecua

dor

Para

guay

Pana

ma

Peru

Hond

uras

40

35

30

25

20

15

10

5

0

Living Donor Deceased Donor

34,1 34,1

40


Transplant centers Waiting list

n pmp

Brazil 42 4,850 (25.5)

Mexico 14 330 (3.2)

Argentina 12 414 (10.9)

Chile 6 224 (14.0)

Colombia 8 144 (3.3)

Cuba 3

Venezuela 2 12 (0.5)

Peru 1 80 (2.9)

Uruguay 1

Puerto Rico 2

Panama 1

Costa Rica 2

Bolivia 1

Latin America 95 6,054 (11.0)

Liver transplantation


41




0 4000300020001000 8000700060005000 100009000

Brazil

Argentina

Colombia

Mexico

Chile

Cuba

Costa Rica

Peru

Venezuela

Uruguay

Bolivia

Ecuador

Dominican

9134

2892

1224

842

731

254

99

58

52

31

6

3

3

Country Period Transplants

Brazil 1968 – 2008 9,134

Argentina 1990 – 2008 2,892

Colombia 1991 – 2008 1,224

Mexico 1991 – 2008 842

Chile 1991 – 2008 731

Cuba 1991 – 2008 254

Costa Rica 1994 – 2008 99

Venezuela 1991 – 2008 52

Peru 1997 – 2005 58

Uruguay 1998 – 2008 31

Bolivia 1999 – 2001 6

Ecuador 3

Dominican 2007–2008 3

Total 15,329

Total

42



2000

1800

1600

1400

1200

1000

800

600

400

200

01991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

2007 n pmp LDBrazil 1,014 5.4 14.7%

Argentina 268 6.9 7.8%

Colombia 199 4.5 2.2%

Mexico 103 0.9 11.8%

Chile 79 4.9 3.5%

Cuba 39 3.4 0

Costa Rica 10 2.4 0

Venezuela 10 0.4 60%

Uruguay 5 1.3 20%

Dominican 1 0.1 0

Total 1,728 3.1 13.9%

2008 n pmp LDBrazil 1,175 6.2 10.3%

Argentina 291 + 7.3

Colombia 199 4.5

Mexico 96 0.9 8.3%

Chile 74 4.6

Cuba 28 2,5 0

Costa Rica 12 2.9

Venezuela 10 0,4 40%

Uruguay 2 0,6 0

Dominican 2 0.2 0

Ecuador 2 0.1

Total 1,891 3.4 7.1


Between 1999 and 2008, it grew 182%, It corresponds to a mean annual growth of 11%.

34 43114 138

225

369

514

664

822

9591038

1088

1316

1513

1688 1728

1891

1524

Annual number

43


Centers n Waiting list n (pmp)

Brazil 65 344 (1.9)

Argentina 28 104 (1.0)

Mexico 7 54 (1.4)

Colombia 7 7 (0.2)

Chile 5 11 (0.7)

Uruguay 4 20 (6.7)

Costa RicaCuba 1

Puerto Rico 1

Peru 2 20 (0.7)

Bolivia 1

Paraguay 1

Total 122 560 (1.0)

Heart transplantation


44





Brazil 1968 – 2008 2,477

Argentina 1968 – 2008 1,316

Colombia 1991 – 2008 532

Mexico 1991 – 2008 238

Chile 1968 – 2008 207

Cuba 1985 – 2008 133

Uruguay 1996 – 2008 110

Puerto Rico 1999 – 2007 105

Peru 1988 – 2007 30

Costa Rica 1991 –2007 14

Paraguay 1999 – 2007 14

Ecuador 1987 – 2005 11

Bolivia 1999 – 2001 1

Total 5,188

0 1000500 20001500 2500

Brazil

Argentina

Colombia

Mexico

Chile

Cuba

Uruguay

Puerto Rico

Peru

Costa Rica

Paraguay

Ecuador

Bolivia

Total

2,477

1,316

532

238

207

133

110

105

30

14

11

1

14

45




2007 n pmp

Brazil 159 0.9

Argentina 83 2.1

Colombia 60 1.3

Mexico 17 0.2

Chile 16 1.0

P Rico 13 3.3

Cuba 7 0.6

Uruguay 4 1.2

Peru 4 0.1

Paraguay 2 0.3

Costa Rica 1 0.2

Ecuador 1 0.1

Total 367 0.7

2008 n pmp

Brazil 200 1.1

Argentina 108 2.7

Colombia 83 1.7

Mexico 8 0.1

Chile 19 1.2

P Rico

Cuba 3 0.3

Uruguay 11 3.3

Peru

Paraguay 1 0.1

Costa Rica

Total 433 0.8

142

Between 1991 and 2007, it grew 130%, It corresponds to a mean annual growth of 5.8%.From 2003 to 2007 it stabilizedIn 2008 it increased again (15.5%)

151 147

194 203 195 184

222

285 288 287 299

344372

381

352367

433

500

450

400

350

300

250

200

150

100

50

01991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Annual number

46


Lung transplantation

Total



Brazil 1989 – 2008 466

Argentina 1967 – 2008 267

Chile 1999 – 2008 80

Colombia 1989 – 2008 51

Mexico 1999 – 2008 31

Uruguay 1989 – 2008 6

Cuba 2000 – 2008 4

Peru 2006 – 2008 1

Total 906

0 10050 200150 300250 400350 500450

466

267

80

51

31

6

4

1

Brazil

Argentina

Chile

Colombia

Mexico

Uruguay

Cuba

Peru

Centers n Waiting list

n (pmp)

Brazil 11 104 (0.6)


Mexico 1 4 (<0.4)

Colombia 1 10 (0.2)

Chile 2 5 (0.3)

Uruguay 1

Cuba 1

Peru 1

Total 27 175 (0.3)

47




2007 n pmp

Brazil 46 0.2

Argentina 24 0.6

Colombia 7 0.2

Chile 7 0.4

Uruguay 2 0,6

Mexico 2 <0.1

Total 88 0.2

2008 n pmp

Brazil 53 0.3

Argentina 32 0.8

Colombia 14 0.3

Chile 9 0.5

Uruguay 2 0.5

Mexico 1 <0.1

Total 111 0.2

120

100

80

60

40

20

01991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

1310

26 24

31 29

1316

4451

5551

68

7881

96

88

111

2008

Small number of transplantsIn few countries

Annual number

48


Pancreas transplantation


Centers n Waiting list

n (pmp)

Brazil 40 145 (0.9)


Mexico 16 (0.2)

Colombia 1

Chile 1 10 (0.6)

Uruguay 1 5 (1.5)

Cuba 1

Total 48 219 (0.3)


Brazil 1968 – 2008 1,515

Argentina 1990 – 2008 250

Mexico 1987 – 2008 56

Colombia 1987 – 2008 38

Cuba 1985 – 2008 30

Uruguay 2001 – 2008 28

Chile 1994 – 2008 18

Puerto Rico 2007 – 2008 5

Venezuela 1990 – 2006 2

Costa Rica 1994 – 2000 2

Ecuador 1991 – 2007 1

Total 1,945

Brazil

Argentina

Mexico

Colombia

Cuba

Uruguay

Chile

Puerto Rico

Venezuela

Costa Rica

Ecuador

0 200 400 600 800 12001000 1400 1600

1515

90%

250

56

38

30

28

18

2

5

2

1

Total

49




2007 n pmpBrazil 162 0.9

Argentina 70 1.7

Mexico 10 0.1

Colombia 8 0.2

Puerto Rico 5 1.3

Uruguay 2 0.6

Chile 1 0.1

Total 258 0.5

2008 n pmpBrazil 166 0.9

Argentina 76 1.9

Mexico 1 0.01

Colombia 4 0.1

Puerto RicoUruguay 6 1,8

Chile 0 0

Cuba 1 0.1

Total 254 0.5


300

250

200

150

100

50

01991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

2 6 11 6 6

3317

824

54

132144

236246

203218

258254

2008

Increased from 1998 to 2004 after it stabilized

Annual number

50


Small bowel transplantation


10

9

8

7

6

5

4

3

2

1

01968 1991 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

2

1 1

0

1

0

4

0

4

10

9

10 10

Brazil 6 1968 (2)

2002 (1)

2004 (1)

2005 (1)

2006 (1)

Mexico 3 1991 (1)

LD 1998 (1)

2000 (1)

Argentina 30 2002 (1)

2005 (7)

2006 (8)

2007 (6)

2008 (8)

Chile 1 2004 (1)

Colombia 10 2004 (2)

2005 (2)

2007 (4)

2008 (2)

51


Corneal transplantation

Transplants n pmp

Brazil 13,341 72.4

Mexico 2,639 24.4

Argentina 1,035 25.7

Cuba 578 50.7

Uruguay 196 57.6

Venezuela 108 4.2

Panama 32 10.0

Total 17,929 32.5

Waiting list n pmp

Brazil 24,450 129

Mexico 5,637 52

Argentina

Cuba

Uruguay

Venezuela

Panama

Total 30,087 55


52


Needed and performed transplantsLatinAmerica–2008

Other transplants

transplant country year nPancreas islets Argentina 1995 24

Brazil 2003 1

Chile 2004 1

Trachea Colombia 2002 3

Larynx Colombia 2003 2

Larynx – Esophagus Colombia 2002 5

Larynx – Trachea Brazil 2004 2

Urethra Brazil 2004 2

Multivisceral Argentina 2009 1


kidney liver heart lung pancreas

33,120

9,103

WL: 48,848

27.4%

WL: 6,054

13.6%

WL: 560

13.1%

WL: 175

3.4%

WL: 219

15.3%

13,800

1,8913,312

2541111,656

3,312

433

35,000

30,000

25,000

20,000

15,000

10,000

5,000

0

Needed

Performed

Needed pmp

Kidney: 60

Liver: 25

Heart: 6

Lung: 6

Pancreas: 3

53


Transplantation Activities by Country

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donorsn 0 249 301 403 407 445 471 498 2,744

pmp 0 (6.6) (8.0) (10.7) (10.7) (11.7) (12.2) (13.1)

Kidney transplantation

n 6,924 462 628 766 827 848 867 950 12,272

pmp 0 (12.3) (16.7) (20.4) (21.8) (22.3) (22.0) (23.9)

% living donor

38.7 17.3 29.8 24.5 25.9 25 17.3 19.3 (32.5)


n 1,170 180 244 251 252 236 268 291 2,892

pmp 0 (4.8) (6.5) (6.7) (6.6) (6.2) (6.9) (7.3)

% living donor

34.4 26.2 19.9 15.9 15.3 7.8


n 776 47 62 69 81 83 90 108 1,316

pmp (1.3) (1.7) (1.8) (2.1) (2.2) (2.2) (2.7)


n 116 11 12 26 20 26 24 32 267

pmp (0.3) (0.3) (0.7) (0.5) (0.7) (0.6) (0.8)


n 42 6 11 9 7 29 70 76 250

pmp 0 (0.1) (0.3) (0.2) (0.2) (0.8) (1.7) (1.9)


n 1 1 0 0 7 8 6 8 31

Map – General information

Argentina

54



until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donorsn 0 7 7 9 13 16 20

pmp 0 (0.8) (0.8) (1.0) (1.4) (1.8) (2.2)


n 521 23 26 33 41 56 72 79 851

pmp 0 (2.6) (2.9) (3.7) (4.6) (6.2) (7.3) (8.7)

% living donor

83.0 60.9 65.4 63.6 61.0 62.5 68.5 53.2 73.4


n 6

pmp 0

% living donor

0


n 1

pmp 0

DKT = deceased kidney transplant

Bolivia

55


Brazil

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donorsn 0 827 1,014 1,232 1,078 1,109 1,150 1,317 7,727

pmp 0 (4.6) (5.6) (6.8) (6.0) (6.0) (6.2) (6.9)


n 30,719 3,042 3,185 3,486 3,373 3,286 3,460 3,809 54,360

pmp 0 (16.9) (17.7) (19.2) (18.5) (17.9) (18.4) (20,0)

% living donor

61.8 60.9 57.3 48.6 52.0 53.6 49.4 46.4 57.7


n 2,474 676 816 966 977 1,036 1,014 1,175 9,134

pmp 0 (3.9) (4.6) (5.3) (5.3) (5.6) (5.4) (6.2)

% living donor

8.4 22.0 21.8 19.2 19.7 18.5 14.7 10.3 16.0


n 1,261 150 175 202 180 149 160 200 2,477

pmp 0 (0.9) (1.0) (1.1) (1.0) (0.8) (0.9) (1.1)


n 151 34 42 46 45 49 46 53 466

pmp 0 (0.2) (0.2) (0.3) (0.2) (0.3) (0.2) (0.3)

% living donor

2.0 9.1 7.9 9.5 6.7 8.2 5.6


n 200 193 217 251 181 181 162 166 1,551

pmp 0 (1.1) (1.2) (1.4) (1.0) (1.0) (0.9) (0.9)


n 3 0 0 1 1 1 0 0 6


56


Chile

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donors n 0 117 136 134 129 152 131 115 914

pmp 0 (7.7) (9.0) (8.9) (8.3) (9.8) (8.1) (7,1)


n 3,505 265 319 271 293 298 283 270 5,504

pmp 0 (17.1) (20.6) (17.5) (18.3) (18.6) (17.9) (16.7)

% living donor

37.8 18.1 17.2 15.5 19.1 22.5 23.5 23.7 31.2


n 233 54 65 68 69 89 79 74 + 731

pmp 0 (3.5) (4.2) (4.3) (4.3) (5.6) (4.9) (4.6)

% living donor

7.4 4.6 4.4 5.8 5.6 5.1 3.5


n 84 17 13 20 17 21 16 19 207

pmp 0 (1.1) (0.9) (1.3) (1.1) (1.3) (1.0) (1.2)


n 28 6 11 6 6 7 7 9 80

pmp 0 (0.4) (0.7) (0.4) (0.4) (0.5) (0.4) (0.6)


n 13 0 0 1 2 1 1 0 17

pmp 0 (0) (0) (0.1) (0.1) (0.1) (0.1)


n 0 0 0 1 0 0 0 0 1


57


Colombia

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donorsn 0 241 215 258 292 426 449 426 2,307

pmp 0 (5.6) (5.0) (6.0) (6.8) (9.9) (10.7) (9.6)


n 4,232 483 430 547 598 618 698 715 8,321

pmp 0 (11.2) (10.0) (12.7) (13.7) (14.1) (15.8) (16.1)

% living donor

8.9 10.0 15.0 20.8 11.5 9.2 9.1


n 227 86 86 131 115 181 199 199 1,224

pmp 0 (2.0) (2.0) (3.0) (2.6) (4.1) (4.5) (4.5)

% living donor

3.1 2.2


n 223 22 21 27 37 59 60 83 532

pmp 0 (0.5) (0.5) (0.6) (0.9) (1.4) (1.4) (1.9)


n 7 1 2 3 6 11 7 14 51

pmp 0 (<0.1) (<0.1) (<0.1) (0.1) (0.3) (0.2) (0.3)


n 21 4 5 0 2 3 8 4 47

pmp 0 (0.1) (0.1) (0) (< 0.1) (0.1) (0.2) (0,1)


n 0 0 0 2 2 0 4 2 10


58


Costa Rica

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donorsn 0 23 24 27 46 27 29 30 206

pmp 0 (5.8) (5.9) (6.6) (10.0) (6.6) (7.1) (7.3)


n 1,057 97 95 96 140 128 132 140 1,885

pmp 0 (24.3) (23.8) (24.0) (32.6) (31.2) (32.2) (34.1)

% living donor

80.0 60.0 45.7 59.4 58.8 60.0


n 20 9 13 12 11 12 10 12 99

pmp 0 2.3 3.3 3.0 2.8 2.9 2.4 2.9

% living donor

35.0


n 13 0 0 0 0 0 1 14

pmp 0 0.2


n 2 0 0 0 0 0 0 2

pmp 0


59


Cuba

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donors

n 0 190 191 182 126 168 196 184 1,237

pmp 0 (17.3) (17.3) (16.4) (11.5) (15.3) (17,8) (16,6)


n 3,044 252 213 185 178 129 166 144 4,311

pmp 0 (22.9) (19.4) (16.8) (16.2) (11.7) (14.8) (12.8)

% living donor

7.0 11.1 12.1 8.6 5.6 6.2 10.1 5.6 7.5


n 59 24 29 26 20 29 39 28 254

pmp 0 (2.2) (2.6) (2.4) (1.8) (2.6) (3.4) (2.5)

% living donor

0


n 105 7 3 3 2 3 7 3 133

pmp (0.6) (0.3) (0.3) (0.2) (0.3) (0.6) (0.3)


n 2 0 0 0 2 0 0 0 4

pmp 0 (0) (0) (0) (0.2) (0) (0) (0)


n 25 1 1 0 0 2 0 1 30

pmp 0 0.1 0.1 0 0 0.2 0 0.1


60


Dominican Republic

until 2001

2002 2003 2004 2005 2006 2007 2008 Total


pmp (0.1) (0.4)


n 232 62 53 30 58 49 59 101 644

pmp 0 (6.9) (5.9) (3.3) (6.0) (5.4) (6.5) (10.7)

% living donor

100 100 100 100 100 100 98.4 93.1 98.8


n 0 0 0 0 0 0 1 2 3

pmp (0) (0) (0) (0) (0) (0) (0.1) (0.2)

% living donor

0 0 0 0 0 0 0 0


61


Ecuador

until 2001

2002 2003 2004 2005 2006 2007 2008 Total


pmp 0 (0.3) (0.6) (0.6) (1.0) (1.4) (0.7) (0.9)


n 410 26 40 75 52 60 58 57 778

pmp 0 (2.2) (3.2) (5.7) (3.9) (4.4) (4.2) (4.2)

% living donor

77.8 80.8 65.0 81.3 59.6 45.0 69.0 61.4 72.0


n 2 0 0 0 0 0 0 2 4

pmp 0

% living donor

0


n 7 0 0 0 1 1 1 0 10

pmp 0 (0.1) (0.1) (0.1)


n 1 0 0 0 0 0 0 0 1

pmp 0


62


El Salvador

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donors

n 0 2 1 3 10 10

pmp 0 (0.3) (0.2) (0.5) (1.4) (1.4)


n 234 29 20 12 45 83 38 461

pmp 0 (4.5 (3.1) (1.8) (6.9) (12.9) (5.4)

% living donor

100 86.2 90.0 86.7 78.3


63


Guatemala

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donors

n 0 6 3 1 3 20 8

pmp 0 (0.5) (0.2) (0.1) (0.2) (1.6) (0.6)


n 304 70 73 75 74 81 138 85 900

pmp 0 (5.8) (6.1) (6.3) (6.2) (6.8) (10.4) (6.4)

% living donor

91.5 85.6 83.6 91.7 97.3 92.6 74.0 83.5 88.6


64


Honduras

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donorsn 0 0 0 0

pmp 0


n 38 2 3 4 47

pmp 0 (0.3) (0.4) (0.5)

% living donor

97.4 100 100 100 97.9

1986:1 DD1990:7 LD1991:2 LD

1992:4 LD1993:4 LD1994:4 LD


Renal Transplantation in HondurasExperience with 22 casesDr. Pluraco E. Castellanos D.

REVISTA MEDICA HONDUREÑA - VOL.62 - N˚4 - 1994

65


Mexico

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donorsn 0 330 315 328 352 355

pmp 0 (3.3) (3.0) (3.0) (3.3) (3.3)


n 13,472 1,614 1,738 1,752 2,041 1,931 2,107 2,242 26,897

pmp 12,339 (15.7) (16.9) (17.2) (19.8) (18.6) (19.9) (20.8)

% living donor

81.4 74.8 72.4 71.0 73.9 74.5 75.2


n 170 75 91 104 100 103 103 96 842

pmp 0 (0.7) (0.9) (1.0) (1.0) (1.0) (1.0) (0.9)

% living donor

12.4 9.3 9.9 5.8 7.0 10.7 11.8 8.3 9.7


n 114 19 23 23 21 13 17 8 238

pmp 0 (0.2) (0.2) (0.2) (0.2) (0.1) (0.2) (<0.1)


n 19 0 5 0 2 2 2 1 31

pmp 0 (0) (<0.1) (0) (<0.1) (<0.1) (<0.1) (<0.1)


n 34 0 2 1 4 4 10 1 45

pmp (0) (<0.1) (<0.1) (<0.1) (<0.1) (0.1) (<0.1)


n 3 0 0 0 0 0 0 0 3

% living donor

33.3 33.3


66


Nicaragua

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donorsn 0

pmp 0


n 11

pmp 0

% living donor

100

June 2002 – June 2006: 11 pediatric kidney transplants


67


Panama

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donorsn 0 15 16 19 10

pmp 0 (5.0) (5.3) (6.3) (3.3)


n 128 37 32 38 28 31 31 294

pmp 0 (12.3) (10.7) (12.7) (9.3) (9.7) (9.7)

% living donor

78.9 43.2 12.5 10.5 28.6 25.8 36.4


68


Paraguay

until 2001

2002 2003 2004 2005 2006 2007 2008 Total


pmp 0 0 (0.2) (0.2) (0,3) (0.3) (0.3) (0.4)


n 138 7 8 9 3 12 25 27 229

pmp 0 (1.2) (1.3) (1.5) (0.5) (2.1) (3.9) (4.0)

% living donor

80.0 100 75.0 77.8 33.3 83.3 88.0 81.5


n 9 0 1 1 2 1 14

pmp (0) (0) (0.2) (0.2) (0.4) (0.2)


69


Peru

until 2001

2002 2003 2004 2005 2006 2007 2008 Total


pmp 0 (1.4) (2.7) (1.0) (0.8) (0.7) (1.3) (0.3)


n 1,911 80 65 75 52 77 80 2,340

pmp 0 (3.0) (2.4) (2.8) (1.9) (2.7) (2.8)

% living donor

15.4 37.3 11.5 10.5 78.6

Liver transplantation n

n 15 3 6 8 3 58

pmp 0 (0.1) (0.2) (0.3) (0.1)

% living donor

7.7 0 0 0 0


n 20 3 0 2 1 2 4 32

pmp 0 (0,1) (0) (<0.1) (<0.1) (<0.1) (0.1)


n 0 0 0 0 0 0 0 1 1

pmp 0 0 0 0 0 0 0 (<0.1)

% living donor

0 0 0 0 0 0 0


70


Puerto Rico

until 2001

2002 2003 2004 2005 2006 2007 2008 Total

Effective donors n 0 62 68 85 120 113

pmp 0 (16.3) (17.9) (22.4) (30.8) (29.0)


n 898 68 84 86 109 75 95 87 1,502

pmp 0 (17.9) (22.1) (22.6) (28.7) (19.2) (24.4) (22.3)

% living donor

58.0 38.2 27.9 20.2 18.7 9.5 21.8 44.1


n 30 4 17 10 16 15 13 105

pmp 0 (1.1) (4.5) (2.6) (4.0) (3.8) (3.3)


n 0 0 0 0 0 0 5

pmp 0 0 0 0 0 0 1.3


71


Uruguay

until 2001

2002 2003 2004 2005 2006 2007 2008 Total


pmp 0 (14.8) (16.0) (18.1) (20.6) (24.7) (18.2) (19.1)


n 629 83 79 93 120 143 102 121 1,370

pmp 0 (26.0) (25.8) (29.1) (37.2) (45.9) (30.9) (36.6)

% living donor

17.0 3.6 3.8 6.5 3.3 5.6 5.8 5.8 11.3


n 12 0 0 1 1 10 5 2 31

pmp 0 (0) (0) (0.3) (0.3) (3.1) (1.3) (0.6)

% living donor

0 0 0 0 0 0 20 0 3.2


n 43 17 7 13 7 8 4 11 110

pmp 0 (5.3) (2.2) (4.1) (2.2) (2.5) (1.2) (3.4)


n 1 0 0 1 0 0 2 2 6

pmp 0 (0) (0) (0.3) (0) (0) (0.6) (0.5)


n 0 3 4 5 2 6 2 6 20

pmp 0 (0.9) (1.3) (1.9) (0.6) (1.9) (0.6) (1.8)


72


Venezuela

until 2001

2002 2003 2004 2005 2006 2007 2008 Total


pmp 0 (2.6) (1.9) (2.0) (1.7) (2.3) (3.6) (3.3)


n 2,308 208 145 202 231 271 345 278 3,988

pmp 0 (8.2) (5.6) (8.1) (8.7) (10.7) (13.2) (10.7)

% living donor

43.3 38.0 41.4 53.5 61.5 57.2 46.1 36.0


n 16 3 3 2 2 6 10 10 52

pmp 0 (0.1) (0.1) (0.1) (0.1) (0.2) (0.4) 0.4

% living donor

60.0


n 10 0 0 0 0 0 0 0 10

pmp 0


n 2 0 0 0 0 0 0 0 2

pmp 0


73


Difficulties

In some countries there is financial support for medical treatment given by the government, to all the population.

Also, for immunosuppressive drugs.

In other countries, there is restricted coverage of medical treatment,

including dialysis and transplantation.

Public universal coverage

Argentina

Brazil

Chile

Costa Rica

Cuba

Panama

Puerto Rico

Uruguay

Venezuela

Restricted coverage

(% Population with coverage)

Ecuador 20%

Bolivia 20%

Paraguay 30%

Peru 30%

Colombia 40%

Dominican Rep 40%

Guatemala 50%

Mexico 60%

The most important problem for transplant development in these countries

Government support

Paraguay

Since 2008, there is financial support for kidney transplantation given by the government, to all the population.

74


Difficulties

Brazil – 2001 to 2003

Most recipients from Israel, also USA

2001 – 2003: 14 poor Brazilian young men from Recife, travelled to South Africa (Durban) to sell their kidney.

Recife’s intermediaries: An ex-Israeli officer contacted an ex-officer from Recife to sell poor young people’s kidneys in Durban.

Transplant tourism

March 2003: Investigation of Federal Police began: denouncement of kidney selling by one person that gave up.

December 2, 2003: 11 people were arrested suspected of organ trafficking.

June 2005:12 persons convicted, 2 Israelis: they tried to convince poor people in Recife sell their kidneys.

Head of the gang: Retired Israeli major Gedálya Tauber convicted to 12 years imprisonment in Brazil.

75


Difficulties

Transplant tourism

advertisementsColombia

Law 1493 / 2004

Art. 40. To perform a transplant on a

foreigner not living in Colombia: only in

the case of there being no receptor on

the national waiting list for this organ

or absence of logistic conditions to

send the organ to the patient.

Transplant tourism

2007 2008

Liver 33 25

Kidney 4

Heart 4

Lung 2

76


Colombia

Difficulties

What are the roles of • World Health Organization

• The Transplantation Society

• Sociedad de Transplante de Latinoamérica y el Caribe

• Red Consejo Iberoamericano de Transplante

Surveillance

Denouncement

To banish transplant tourism

Declaration of the RCIDT about transplant tourism: it strongly disapproves transplant tourism, and will denounce it to the relevant authorities.

Document of the STALYC about transplant tourism: endorses the Istanbul Declaration and strongly rejects transplant tourism.

ACTO asks for the National Transplant Network to investigate transplants performed this year in Colombia due to rumors of patients with false Colombian citizenship. Ask for severe punishment if cases were confirmed.

ACTO invites TTS and STALYC to make an official visit to Colombia to visit the Health Minister and the Transplantation Director of the National Health Institute.

Declaration from the National Adviser Committee of the National Institute of Health of Colombia, regarding the Istanbul Declaration: it disapproves transplant tourism.

Information obtained on September 28, 2008 - Cartagena de las Indias, from Members of the ACTO to STALYC Board of Directors about transplant tourism in Colombia: it is decreasing because of the international pressure against it.

77


Advances

Influence of the “Spanish model”

Courses

Organizations

• Master en Organización y Gestión de Trasplantes

“Proyecto Siembra” – 1994 – 1995 – six months – 30 coordinators

• TPM – Courses

• Master Alianza en Donación y Trasplante

“Programa Alianza” – since 2005 – two months – 134 coordinators

Punta Cana Group – Latin America Transplant Coordinators (2001)

Founded by a group of transplant coordinators from Latina America and Spain in June 18, 2001 during the XVIII STALYC Congress, performed in Punta Cana, Dominican Republic

Red / Consejo Iberoamericano de Donación y Trasplante (RCIDT)

Cooperation: OPAS and national governments to improve donation and transplantation activities.

• donation registry

• courses in Latin America

• national activities

78


Brain death diagnosis

Follow up of 9,441 patients with Glasgow < 7October 2005 – July 2008

Follow up of 1,666 patients with Glasgow < 8

alive 2629 28%

cardiac arrest 3082 33%

brain death 3730 39%

organ donor 3125 90%

alive 733 44%

cardiac arrest 716 43%

brain death 217 13%

organ donor 82 38%

medical contra indication 70 32%

family non authorization 65 30%

Advances

79


Advances

Kidney transplantation by era

Puerto Rico – Kidney transplant (July, 2004 to December 31, 2006)

Registry with results in some countries

1980 1985 1990 1995 2000 2005 2008

Population (millions) 350 390 440 480 518 536 552

Transplants (n) 780 1,280 2,300 3,910 6,450 8,256 9,105

(pmp) (2.2) (3.3) (5.3) (8.1) (12.5) (15.4) (16.5)

Total of transplants

(n) 3,200 8,000 20,058 38,405 63,618 100,460 126,965

Deceased donors (%) 23 27 42 51 47 48 53

Unrelated donor (%) 6.8 3.3 7.0

There was an increase rate of 1 kidney transplant pmp each two years (increased 14 pmp in 28 years)

Adult patient survival 97%

Adult graft survival 94%

Pediatric patient survival 100%

Pediatric graft survival `92%

80



Advances

Graft survival from deceased donorKidney

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

100

80

60

40

20

0

1988-1995 1996-19991981-1987 20002004Years post transplant

Chile

Kidney Graft survival from living and deceased donors 2000-2007

0 1 2 3 4 5 6 7 8 9 10

1

0,9

0,8

0,7

0,6

0,5

0,4

0,3

0,2

0,1

0

Surv

ival

pro

babi

lity

Living donorDeceased donorYears

Uruguai

72%

68%

81


Advances


Liver Patient survival for transplantation time 2000-2007

0 1 2 3 4 5 6 7 8 9 10

1

0,8

0,6

0,4

0,2

0

200020041995-1999

Brazil

Heart Patient survival for transplantation time 2000-2007

0 1 2 3 4 5 6 7 8 9 10

1

0,8

0,6

0,4

0,2

0

200020041995-1999

Brazil

Kidney Graft survival from living and deceased donors 2000-2007

0 1 2 3 4 5 6 7 8 9 10

1,0

0,8

0,6

0,4

0,2

0 Brazil

60%

40%

Living donorDeceased donorYears

82


Safety for the donorBrazilian Registry of Living Liver Donor

Safety for the donor:

• Registry of living donors

• Outpatient clinic for all life

• If uremic: priority on waiting list

• Life insurance for one year (not yet obtained)

Incidence of re-operation

No 170

Yes 1

Incidence of death

There was no death

Biliary Complications

• Fistula (8 cases)

• Stenosis (1 case)

• Biloma (5 cases)

Incidence of re-hospitalization

No 162

Yes 9

Incidence of bleeding

There was no bleeding

Other complications

• There was no pulmonary complication

• There was no infection

• Deep Vein Thrombosis (2 cases)

• INR > of 3 (2 cases)

• Light hepatic dysfunction (2 cases)

Segments resection II and III

Segments resection II, III and IV

Segments resection V, VI, VII and VIII

Segments resection V, VI, VII e VIII + middle vein

Segments resection IV, V, VI, VII and VIII

4%22%

8%

47%

19%

Grafts types (Segments)

Advances

83


• All countries have transplantation laws.

• The donor deceased rate is still very low: 5.8 pmp, but it is increasing.

• The potential donor rate notified is low (less than 40 pmp in most of countries).

• All countries perform renal transplantation.

• The number of kidney transplants is increasing (7.5% to the year).

• The number of other organ transplants is small and performed in only a few countries.

• There is an increasing number of countries performing other organ transplants.

• Limited health coverage for the population in many countries.

• Some local problems: transplant tourism.

Conclusions

84


Future Steps

1. To obtain financial coverage for all the population.

2. To prevent or banish any form of transplant tourism or organ commerce:

• To improve the deceased donors rate (>10 pmp).

• To increase the living related donation rate for kidney transplants (15 pmp).

• To create National Registers, with transplantation results.

• To create Registry of living donors (kidney, liver, lung).

• To develop all transplant programmes.

for all Latin America countries

85



ExpedientThe Transplantation Society of Latin America and the Caribbeanwww.stalyc.org


PresidentJosé Toro Cornejo

Graphic and Visual Planning Lado a Lado Comunicação e MarketingPhone/Fax [55 11] 3888 2222 www.ladoalado.com.br

ABTO - Associação Brasileira de Transplantes de ÓrgãosMail Adress Av. Paulista, 2001 17th floor conj. 1704/1707ZIP Code 01311-300 São Paulo SP BrazilPhone [55 11] 3283 1753 / 3262 3353 Fax [55 11] 3289 [email protected]

Apoio

The Transplantation Society of Latin America

and the Caribbean

Latin America Transplantation

Report 2009

Lati

n A

mer

ican

Tra

nspl

anta

tion

Repo

rt 2

009

Valter Duro Garcia

José Medina Pestana

Eduardo Santiago-Delpin

Date post:	18-Oct-2020
Category:	Documents
Upload:	others
View:	0 times
Download:	0 times

The Transplantation Society of Latin America€¦ · Editor Valter Duro Garcia President José Toro...

Documents