Apoio
Latin America
Transplantation
Report 2009
American Tr ansplantation Report 2009Valter Duro Garcia
José Medina Pestana
President
José Toro Cornejo
Graphic and Visual Planning
Lado a Lado Comunicação e Marketing Phone/Fax [55 11] 3888 2222 www.ladoalado.com.br
ABTO - Associação Brasileira de Transplantes de Órgãos
Mail Adress Av. Paulista, 2001 17th floor conj. 1704/1707 ZIP Code 01311-300 São Paulo SP Brazil
Phone [55 11] 3283 1753 / 3262 3353 Fax [55 11] 3289 3169 abto@abto.org.br
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 Garcia
Editor – Latin America Transplantation Report
America and the Caribbean and the Pan American
Society for Dialysis and Transplantation
Latin America Transplantation Report
Board EditorsEditor Valter Duro Garcia
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
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
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.
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).
Editor Valter Duro Garcia
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
The 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.
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)
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 200Transplantation Societies
Kidney
20
Heart
14
Liver
13
Pancreas
11
Lung
8
Small bowel 5
The Transplantation Society of Latin
America and the Caribbean
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
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)
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)
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)
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 consultedAlmost 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
Renal transplantation in South America Transplant 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 America Nefrologia 1993, 13 (suppl 2): 12-17 Santiago Delpin EA, Duro Garcia V. Latin American Transplantation Register Pasteur-Merieux. November 1993
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
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.
Kidney Argentina June 11, 1957
Receptor: 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-FMUSP 1. 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 Aires
May 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 Janeiro May 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 Paulo
1968 – 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 2009 Successful liver, pancreas and small bowel transplantation
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
Restrospective 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
Problem: small identification of potential donors in most of countries.
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 Cuba
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. 100 90 80 70 60 50 40 30 20 10 0 2000 2001 2002 2003 2004 2005 2006 2007 2008
In last 6 years increased 3.8 pmp (0.5 pmp/y)
through 2.1 pmp to 5.9 pmp
Deceased donors pmp
7 6 5 4 3 2 1 0 2001 2002 2003 2004 2005 2006 2007 2008 2,1 3,8 4,2 3,2 5 5,4 5,8 5,9pmp – 2007
Latin America: 5.8 pmp (n = 3,195) 35 30 25 20 15 10 5 0 30,8 18,2 17,8 12,3 10,7 8,1 7,1 6,2 3,7 3,3 3,1 1,8 1,4 1,4 1,3 0,8 0,8 0,1Puerto Rico Uruguay
Cuba Argentina Colombia Chile Costa Rica Br azil
Venezuela Mexico Panama Ecuador El Salv
ador Guatemala Bolivia Par aguay Peru Dominican
Country Donors (n) Puerto Rico 113 Uruguay 65 Cuba 189 Argentina 528 Colombia 425 Brazil 1,317 Chile 115
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 0Puerto Rico Uruguay
Cuba
Argentina Colombia Costa Rica
Br
azil Chile
Venezuela Mexico Panama
Bolivia Ecuador Guatemala Dominican Republic Par aguay Peru El Salv ador 29 19,1 16,6 13,1 9,6 7,3 7,2 7,1 3,3 3,2 0,8 2,2 0,6 0,5 0,4 0,3
• Not yet employed in any country in Latin America
- Not covered by the law - Technical difficulties - High cost
Perspectives of deceased donors rate for the next 10 years
to increase 1 – 1.5 pmp/year (20 pmp)
• Brain death donors
- Low detection rate (potential donors): < 50% - Low effectivation rate: 20 – 30%
25 20 15 10 5 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Deceased donors pmp 5,8 7 8,2 9,5 11 12,5 14 15,5 17 18,5 20
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.
2007
Costa Rica Mexico Br azil Guatemala Dominican Republic Venezuela El Salv ador Bolivia Argentina Par aguayEcuador Chile Panama
Puerto Rico Uruguay
Cuba Colombia Peru Hondur as Nicar agua 25 20 15 10 5 0 19,3 15,2 9,2 7,7 7,7 5,8 5,4 5 3,9 3,3 3,1 3 2,6 2,3 1,8 1,5 1,3 0,6 0,5
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 5,3 4,2 3,6 3,3 2,5 2,2 2,1 1,5 0,7 4,9 Costa Rica Mexico Dominican Republic Br azil
Argentina Guatemala Puerto Rico Bolivia Venezuela Par
aguay
Ecuador Chile Uruguay Colombia Cuba Panama
Peru El Salv ador Hondur as Nicar agua 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 Panama Peru El Salvador Honduras Nicaragua Latin America 4,246
2007
n: 199 Rate: 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 0,1n: 133 * Rate: 0.3 pmp * partial data
2008
0,6 0,5 0,4 0,3 0,2 0,1 0 0,6 0,2 0,1Brazil 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
12.7% of the liver transplantation (1,921) were performed with living donors
Brazil
1,461 LDLT - 3 donors died
Mortality rate: 1 / 487
19 16,8 15,9 14,3 9,8 3,6 3,5 2,9 1,9 12,7Costa Rica Argentina Brazil Venezuela Mexico Uruguay Chile Peru Colombia Latin America 20
15
10
5
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)
126,965
54360 26897 12272 8321 5504 4311 3988 2340 1885 1502 1370 900 851 778 644 461 294 229 47 11 Brazil Mexico Argentina Colombia Chile Cuba Venezuela Peru Costa Rica Puerto Rico Uruguay Guatemala Bolivia Ecuador Dominican El Salvador Panama Paraguay Honduras Nicaragua 0 10000 20000 30000 40000 50000 60000Between 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 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
42%
45%
53%
Deceased Living 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 1980 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008DD: 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
32,2 30,9 24,4 22 19,5 18,4 17,9 15,8 14,8 13,3 10,4 9,7 7,3 6,5 3,9 3,8 2,8 0,5
Costa Rica Uruguay Puerto Rico Argentina
Mexico Br
azil
Chile
Colombia
Cuba
Venezuela Guatemala Panama
Bolivia
Dominican Ecuador Par aguay Peru Hondur as El Salv ador Nicar agua 35 30 25 20 15 10 5 0
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)
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)
16.1 pmp
Costa 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
Costa Rica Uruguay Argentina Puerto Rico
Br azil Mexico Chile Colombia Cuba Dominican Venezuela Bolivia
Guatemala Ecuador Par
aguay Panama Peru Hondur as 40 35 30 25 20 15 10 5 0
Living Donor Deceased Donor
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)
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
2000 1800 1600 1400 1200 1000 800 600 400 200 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2007 n pmp LD Brazil 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 LD Brazil 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 43 114 138 225 369 514 664 822 959 1038 1088 1316 1513 1688 1728 1891 1524
Annual number
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 Rica Cuba 1 Puerto Rico 1 Peru 2 20 (0.7) Bolivia 1 Paraguay 1 Total 122 560 (1.0)
Country Period Transplants 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 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 142007 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 stabilized In 2008 it increased again (15.5%) 151 147 194 203 195 184 222 285 288 287 299 344 372 381 352 367 433 500 450 400 350 300 250 200 150 100 50 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Annual number
Total
Country Period Transplants
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 906 466 267 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) Argentina 9 62 (1.6) 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)
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 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 13 10 26 24 31 29 13 16 44 51 55 51 68 78 81 96 88 111 2008
Small number of transplants In few countries
Centers n Waiting list n (pmp) Brazil 40 145 (0.9) Argentina 4 43 (1.1) Mexico 16 (0.2) Colombia 1 Chile 1 10 (0.6) Uruguay 1 5 (1.5) Cuba 1 Total 48 219 (0.3)
Country Period Transplants
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 1515
90%
250 56 38 30 28 18 2 5 2 1Total
2007 n pmp Brazil 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 pmp Brazil 166 0.9 Argentina 76 1.9 Mexico 1 0.01 Colombia 4 0.1 Puerto Rico Uruguay 6 1,8 Chile 0 0 Cuba 1 0.1 Total 254 0.5
Pancreas transplantation
300 250 200 150 100 50 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2 6 11 6 6 33 17 8 24 54 132 144 236 246 203 218 258 254 2008 Increased from 1998 to 2004 after it stabilizedAnnual number
10 9 8 7 6 5 4 3 2 1 0 1968 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)
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
Needed and performed transplants
Latin America – 2008
transplant country year n
Pancreas 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 1,891 3,312 254 111 1,656 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
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 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) Liver transplantation 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 Heart transplantation 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) Lung transplantation 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) Pancreas transplantation 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) Small bowel transplantation n 1 1 0 0 7 8 6 8 31
Map – General information
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 0 7 7 9 13 16 20 pmp 0 (0.8) (0.8) (1.0) (1.4) (1.8) (2.2) Kidney transplantation 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 Liver transplantation n 6 pmp 0 % living donor 0 Heart transplantation n 1 pmp 0 DKT = deceased kidney transplant
Brazil
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 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) Kidney transplantation 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 Liver transplantation 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 Heart transplantation 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) Lung transplantation 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 Pancreas transplantation 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) Small bowel transplantation n 3 0 0 1 1 1 0 0 6Chile
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) Kidney transplantation 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 Liver transplantation 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 Heart transplantation 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) Lung transplantation 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) Pancreas transplantation n 13 0 0 1 2 1 1 0 17 pmp 0 (0) (0) (0.1) (0.1) (0.1) (0.1) Small bowel transplantation n 0 0 0 1 0 0 0 0 1Colombia
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 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) Kidney transplantation 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 Liver transplantation 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 Heart transplantation 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) Lung transplantation 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) Pancreas transplantation 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) Small bowel transplantation n 0 0 0 2 2 0 4 2 10Costa Rica
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 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) Kidney transplantation 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 Liver transplantation 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 Heart transplantation n 13 0 0 0 0 0 1 14 pmp 0 0.2 Pancreas transplantation n 2 0 0 0 0 0 0 2 pmp 0Cuba
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) Kidney transplantation 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 Liver transplantation 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 Heart transplantation 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) Lung transplantation n 2 0 0 0 2 0 0 0 4 pmp 0 (0) (0) (0) (0.2) (0) (0) (0) Pancreas transplantation n 25 1 1 0 0 2 0 1 30 pmp 0 0.1 0.1 0 0 0.2 0 0.1Dominican Republic
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 0 0 0 0 0 0 1 4 5 pmp (0.1) (0.4) Kidney transplantation 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 Liver transplantation 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 0Ecuador
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 0 3 7 8 13 19 10 12 72 pmp 0 (0.3) (0.6) (0.6) (1.0) (1.4) (0.7) (0.9) Kidney transplantation 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 Liver transplantation n 2 0 0 0 0 0 0 2 4 pmp 0 % living donor 0 Heart transplantation n 7 0 0 0 1 1 1 0 10 pmp 0 (0.1) (0.1) (0.1) Pancreas transplantation n 1 0 0 0 0 0 0 0 1 pmp 0El 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) Kidney transplantation 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 78.3Guatemala
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) Kidney transplantation 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 88.6Honduras
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 0 0 0 0 pmp 0 Kidney transplantation 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 DD 1990:7 LD 1991:2 LD 1992:4 LD 1993:4 LD 1994:4 LDRenal Transplantation in Honduras
Experience with 22 cases
Dr. Pluraco E. Castellanos D.
Mexico
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 0 330 315 328 352 355 pmp 0 (3.3) (3.0) (3.0) (3.3) (3.3) Kidney transplantation 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 Liver transplantation 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 Heart transplantation 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) Lung transplantation n 19 0 5 0 2 2 2 1 31 pmp 0 (0) (<0.1) (0) (<0.1) (<0.1) (<0.1) (<0.1) Pancreas transplantation n 34 0 2 1 4 4 10 1 45 pmp (0) (<0.1) (<0.1) (<0.1) (<0.1) (0.1) (<0.1) Small bowel transplantation n 3 0 0 0 0 0 0 0 3 % living donor 33.3 33.3Nicaragua
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 0 pmp 0 Kidney transplantation n 11 pmp 0 % living donor 100Panama
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 0 15 16 19 10 pmp 0 (5.0) (5.3) (6.3) (3.3) Kidney transplantation 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 36.4Paraguay
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 0 0 1 1 2 2 2 3 11 pmp 0 0 (0.2) (0.2) (0,3) (0.3) (0.3) (0.4) Kidney transplantation 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 Heart transplantation n 9 0 1 1 2 1 14 pmp (0) (0) (0.2) (0.2) (0.4) (0.2)Peru
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 0 39 76 28 23 20 36 9 231 pmp 0 (1.4) (2.7) (1.0) (0.8) (0.7) (1.3) (0.3) Kidney transplantation 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 Heart transplantation n 20 3 0 2 1 2 4 32 pmp 0 (0,1) (0) (<0.1) (<0.1) (<0.1) (0.1) Lung transplantation 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 0Puerto 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) Kidney transplantation 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 Heart transplantation n 30 4 17 10 16 15 13 105 pmp 0 (1.1) (4.5) (2.6) (4.0) (3.8) (3.3) Pancreas transplantation n 0 0 0 0 0 0 5 pmp 0 0 0 0 0 0 1.3Uruguay
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 0 46 50 56 66 79 58 61 416 pmp 0 (14.8) (16.0) (18.1) (20.6) (24.7) (18.2) (19.1) Kidney transplantation 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 Liver transplantation 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 Heart transplantation 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) Lung transplantation n 1 0 0 1 0 0 2 2 6 pmp 0 (0) (0) (0.3) (0) (0) (0.6) (0.5) Pancreas transplantation 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)Venezuela
until 2001 2002 2003 2004 2005 2006 2007 2008 Total Effective donors n 0 68 50 53 45 62 99 89 466 pmp 0 (2.6) (1.9) (2.0) (1.7) (2.3) (3.6) (3.3) Kidney transplantation 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 Liver transplantation 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 Heart transplantation n 10 0 0 0 0 0 0 0 10 pmp 0 Pancreas transplantation n 2 0 0 0 0 0 0 0 2 pmp 0In 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 with coverage)(% Population
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
Paraguay
Since 2008, there is financial support for kidney transplantation given by the government, to all the population.
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.
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:
advertisements
Colombia
Law 1493 / 2004
Art. 40. To perform a transplant on aforeigner 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
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
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
Follow up of 9,441 patients with Glasgow < 7
October 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%
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%
Graft survival from deceased donor
Kidney
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 100 80 60 40 20 0 1988-1995 1996-1999 1981-1987 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 Surviv al probability
Uruguai
72% 68%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 20002004 1995-1999Brazil
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 20002004 1995-1999Brazil
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 donor Deceased donor YearsBrazilian 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%
• 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.
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.
President
José Toro Cornejo
Graphic and Visual Planning
Lado a Lado Comunicação e Marketing Phone/Fax [55 11] 3888 2222 www.ladoalado.com.br
ABTO - Associação Brasileira de Transplantes de Órgãos
Mail Adress Av. Paulista, 2001 17th floor conj. 1704/1707 ZIP Code 01311-300 São Paulo SP Brazil
Phone [55 11] 3283 1753 / 3262 3353 Fax [55 11] 3289 3169 abto@abto.org.br
Apoio
