| • Steps for organs and tissues
obtaining for transplant. |
| • Allocation of organs and
tissues. |
| |
| Steps for organs and tissues obtaining
for transplant |
Corporacion del Trasplante has a
Medical Director, in charge of the management of
the procurement network (the different stages from
the detection from a donor to the delivery of the
organs and tissues for transplant). Two medical
coordinators who alternate themselves weekly next
to three central coordinators, who receive the warnings
of near 25 local coordinators who are distributed
in the different hospitals from Arica from Punta
Arenas, These last ones are nurses, in charge to
detect a potential donor in their hospitable center.
They give warning to the central coordinator, to
develop the different passages from the procurement
network.. While before warning on the existence
of a potential donor occurs, better the system works,
since time always works against the factor.
The objective is that the central coordinator can
begin, as rapidly as possible, to solve each detail
of the procurement network: warning to the ISP for
the preselection of the possible receivers of organs,
taking of blood samples, warning to the legal doctor
(if the death is by not known cause or the participation
is presumed of third), interview to the family and,
later request, to coordinate to the extraction equipment
(kidney, lungs, heart, liver and tissues: bones,
skin and valves cardiac), transfer of the extractors
equipment and later distribution of the organs (Fach,
LAN Chile, Police). Finally, the local and central
must send to the Corporacion del Trasplante, the
Protocols of all the activity done, in a way to
maintain a registry updated, that it includes the
data of the transplanted patients. These coordination
often include not only a donor, but who in more
than an opportunity, has been due to make all this
work with five donors in simultaneous. Thanks to
the efficiency and professionalism of the involved
ones, all the coordination have been successful. |
| |
| Organs allocation |
| This action is defined in Chile
by the Commissions Integrated of each organ, conformed
by the equipment of transplant of the organ and
tissue, representing of the ISP, the Corporation
del Trasplante and the Ministry of Health. This
multidisciplinary work allows to offer the same
conditions to all the Chileans who hope by an organ
without concerning their social condition, educational
or economic. On this way, only the medical criteria
prevail at the time of assigning a certain organ.
The Institute of Public Health, (ISP) administers
the National List in Delay for Transplant of Organs
(kidney, liver, pancreas, lung and heart). Each
Transplant Center proposes its patient as candidate
for transplant, that after fulfilling the studies
of histocompatibility in the ISP, enters the National
Listing. When one has procured organs for transplant
previously consider the established criteria, these
are annually reviewed of way to update this activity.
Unlike the heart, lung and liver, in addition to
the traditional criteria, identity of sanguineous
group, weight and carves of the donor), in the case
of the kidney, studies are due to do elaborated
more of histocompatibility to determine types and
amount of compatible antigens between donor and
possible receivers. This hard work near 12 hours.
Also it is possible to indicate that the time in
Waiting list and, of course, the specific situation
of the patient at the time of the transplant are
used as parameters. The criterion of Medical Urgencies
for Transplant exists. This must be asked for by
the head of the equipment, under strict medical
antecedents, determined specifically according to
the functionality of each organ. When speaking of
Medical Urgencies, a vital risk for the patient
in a very brief term of time is indicated (not more
than 15 days) and has been specified for heart and
liver. Habitually, the reasons of activating a Medical
Urgency usually are, because the patient in delay
has undergone an abrupt discommendation of the function
of the damaged organ or because somebody that were
healthy and that presented/displayed a sudden acute
disease took it to the necessity of transplant like
only alternative to continue living. To these cases
the priority for the transplant falls to the patient
in urgency. Nevertheless, always criteria of compatibility
with the donor must exist such who in the other
cases. In the case of the kidney, to each patient
in waiting list an score is assigned to him considering:
the disease of base, the age, the histocompatibility,
the time in dialysis and the existence of preformed
antibodies. As opposed to the existence of an effective
donor the kidneys are assigned of the following
form: one of them remains in the center (kidney
marries) where procured the donor, always when it
is a center where transplants of kidneys are made.
The second goes away to the National Listing. A
series of examinations to the donor is made (Laboratory
of the ISP) to identify the antigens of compatibility
with the receiver. This proceeding lasts of approximately
12 hours. Finalized this, the ISP gives a list with
the receiving potentials that previously have an
score assigned according to the mentioned aspects.
When the kidney marries is not in the place where
it detected the donor, (by lack of histocompatibility,
etc.) the kidney is given to the National Pool,
just as the other. |
| Tissues |
| Waiting list for tissues does not
exist (bones, skin, cardiac valves, corneous). Nevertheless,
each Center handles to its own Waiting list with
its patients in the different hospitals and private
clinics. In these centers equipment exists that
is in charge to extract weaves, besides to comprise
of the rotating one of extraction, that works to
the interior of Corporacion del Trasplante. The
allocation criteria also are governed by medical
factors that prohang to favor to all the patients
in equality of conditions. |
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