“¡Barcelona¡¡¡ And the expected day arrived, the beginning of the Course. I can only praise the Organizer Committee, to Carmen Blanco, the Secretary TPM- Project, whom I met at my arrival to Barcelona.

         The time of arrival was 5 o’clock afternoon, of Monday, 19th, February, 2007, and people were arriving, specially spaniadards from the different communities, medical doctors, nephrologists, ICU professionals, a few nurses also doctors from other countries such as Cuba, Argentina, Paraguay, Guatemala, El Salvador, Peru, Brazil and Chile.

         A bigger surprise for me was to recognize Lina Valdés, a nurse from my country, Emergency Hospital Center, at Santiago, she was here at Spain with me¡¡¡ really a twin soul to share, we spend a great time together and suffer with the practices.

The participants of the Course were 54 and the Professors 22, also with 4 persons in charge of administrative and technical  items.

The organization of the Course, it is really in a superior level, since your arrival to the last detail was covered. The rooms were previously defined by every participant, so there were no delays for check inn, every one has their own room and had, identification card,  numbers and letters to where was your seat in theories classes , which group you belong to practical classes, etc.

Everything anticipated from already, the phone rang automatically at 6:30 am, to wake you up, breakfast was exactly at 7:30am, where you received one or another instruction to tasks of the day and classes began at, without delay, 8:30 am.

And so, morning passed , of course, with the special spanish bread (hojaldre) and warm coffee and a lot of fruit at 10hrs. am, and also the necessary cigarette ( you must go outside to smoke). Lunch was fixed at 13:30hrs., always buffet so there was no space for laziness and noon schedule began at 3 o’clock pm, until 7o’clock with practices and group works ( which were evaluated and then communicated to all). Supper was at 9 o’clock in the night and after a time for relax at the bar with music and talks at midnight you were send to bed same as living at boarding school. Even, at that time I only wanted to sleep.

An so on, I could named all and every one of them, with an special memories, can not forget our morning editor, Alberto Villamar, who every single morning at breakfast appears with the day edition with weather news, photos of the past day, also some gadgets, and the most important, between lines, very values issues to the development of the diary work ( population by city, number of hospitals, beds in ICU’s, etc.)

José Luis Escalante from Madrid and José Ignacio Sánchez Miret from Zaragoza:

Practices Program, where every one of us were designed, trimmed in this subjects:

Detection and donor identification
Brain Death
Donor Maintenance
Family Interview
Organization, distribution and organs Interchange
Non - Heart Beating Donors
Tissues Donor
Clinical cases and organs viability
Organization TPM office
Action Learning

Now, what is the formula?
It had been 25 years since Spanish parliament   approved law 30/79 for transplantation and extraction. Over 50.000 Spaniards had received an organ in this time, well done kidney in the early days or heart, lung, liver, intestine later. Even a quarter of million of patients if we count people who received tissue or cells. Spain leader with extraordinary advantage over the rest of the world, rates for organ donation for any organ, doing three times the job done in German, England or Sweden, for instance.

And How?? Because it had develop an organizative model adapted to the state of the autonomies and leader by ONT (National Transplant Organization), which performance works perfectly fine and is also an international reference to this paradigm of the modern medicine when you talk about organ donation in any international summit. “Spanish patient is the best situated all over the world to receive a transplant, in a public and universal system, without economics or social position differences” said Rafael Matesanz, National Transplant Coordinator .

Matesanz also says: “the best way to describe this model after 15 years of performance and uninterrupted increase is because of its legal and technicians  foundations, a link of Transplants Coordinators in three levels: national, autonomic, and hospitable with an special profile of three levels of coordinators, with the coordinators inside hospitals, a quality program in donation process, a Central Office as a support of the system, a big effort in personal training, an hospitable reimbursement and a continue attention to the media”.

According this model  “the organizative model of transplants “, let the responsibility of transplant and tissue and organs donation to the Hospitals,
and not only the detectors  , extractors and transplanted ones but also to those hospitals with a few capability of generation ( 1 or 3 donors by year). In this centers, authorized as a captained ones, it is done all the process of donation and brain death diagnosis to later transfer corpse to  an extraction center obtaining organs and tissues.

To achieve this goals, they have favored the professional of  donation activity and  allocation of responsibilities . That is the reason TPM it is situated into Hospitals Transplants Organization, as an independent member of transplants teams, with a labor contract and dependency from medical direction. TPM specialist necessary to organize donation activity vary between 1- 5pmp, depending potential generating capacity (60 brain deaths/pmp reported) and the real one, 1 TPM for every real 12 donors.

Where are we?

         I agree our conceptual bases are the same and even legal ones, if not equals, we also use family signed agreement; there is no difference with management, detection or death diagnosis, as neither in a way to approach family and conditions in general coordination, but the differences are transplant and donation it is a part of hospital policy, hospitals had settled a system of quality management, through norms ISO 9001-2000, allowing a cycle of continuous improve, where the customer is the generating unit, having donors, family donors. So, with the measure, analysis and improve of all the satisfaction and requirements of these costumer, you would take actions in order to improve all the generation, process and preservation of organs and tissues with other activities, such as of investigation and formation.

         By other hand, the difference is with the number of people working in coordination; according to Spanish model, after the creation of ONT
( 1989), which it constituted in a real services agency to all the National System of Health, the coordination was articulated through a functional, non hierarchies system with 3 levels of coordination: national, autonomic and hospitable.
         In this way, all the efforts and hospitable resources are focused in ICU’s, where donors are generated. According Spanish model philosophy: ” the main cause for losing donors all over the world and the one to point the difference among countries and hospitals, is the NON potential donors detection”. Any later percentage of losses by legal, medical or family refusal causes or any other are compensated with an appropriate detection.

         So, the main agent capable of acting over this process is the Intensives MD, in charge of manage potential donors and, for those all the hospitals  might have professionals available and trained in consecution to harness donation.

         That’s the reason because hospitals with ICU’s, had established coordination teams to obtain an effective cover 365 days by year, where coordination is in charge    of a medical doctor at part- time, who faced detection and consecution donors tasks, specially for the fact to talk in a equal way to the responsible of the medical attention to the donor and the need to establish a proactive system for brain deaths detection , a matter so hard to establish by a nurse.

Also, the dependence of the coordination, is a freak factor to consider, the transplant coordinator is a direct collaborator of the medical manager, in matter of transplants, to a similar one in coordination of Emergencies, Quality or Teaching.

In this way, every hospital has organ donation programs to promote and training courses to the new ones, where medical professionals, nurses and students of high schools, as  a part of their electives activities .

         The combination of a positive  social environment, the relevance in
Training, knowledge and education in donation and transplant play a determinant role in the participation of the citizen in donation and transplant process.

Suitable treatment of mass media.

Appropriate reimbursement of the hospitals for extraction and transplant activity.

Immunology Laboratory for Histocompatibility, with results in 2 hours, settled in generators and transplant hospitals makes a difference.

What else?

         I would write a lot of things but I think the essential is here, the rest is the own value you would give at this rewarding experience, now we only must work and deeply thanked the trust you had put on me, given me the opportunity to know another ways to look the binomial phenomenon of donation / transplantation and thanked at Isapres de Chile, for make it come true.

Barcelona, a beautiful city, … with its culture, history and education. Gaudí, Picasso, Dalí. Gothic Neighborhood, Sacred Family, La Rambla Ride and… so many things.