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Cozzi E, Álvarez M, Carmona M, Mahíllo B, Forsythe J, Lomero M, López-Fraga M, Sapir-Pichhadze R, Cardillo M, Domínguez-Gil B. An Analysis by the European Committee on Organ Transplantation of the Council of Europe Outlining the International Landscape of Donors and Recipients Sex in Solid Organ Transplantation. Transpl Int 2022; 35:10322. [PMID: 35928348 PMCID: PMC9343585 DOI: 10.3389/ti.2022.10322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/06/2022] [Indexed: 11/23/2022]
Abstract
Discrepancies in donation and transplantation by sex and gender have previously been reported. However, whether such differences are invariably the inevitable, unintended outcome of a legitimate process has yet to be determined. The European Committee on Organ Transplantation of the Council of Europe (CD-P-TO) is the committee that actively promotes the development of ethical, quality and safety standards in the field of transplantation in Europe. Whilst the ultimate objective is to shed light on the processes underlying potential gender inequities in transplantation, our initial goal was to represent the distribution by sex among organ donors and recipients in the CD-P-TO Member States and observer countries. Our survey confirms previous evidence that, in most countries, men represent the prevalent source of deceased donors (63.3% in 64 countries: 60.7% and 71.9% for donation after brain and circulatory death, respectively). In contrast, women represent the leading source of organs recovered from living kidney and liver donors (61.1% and 51.2% in 55 and 32 countries, respectively). Across countries, most recovered organs are transplanted into men (65% in 57 countries). These observations may be explained, at least in part, by the higher burden of certain diseases in men, childbearing related immune sensitization in women, and donor-recipient size mismatch. Future research should establish whether gender-related socially-constructed roles and socioeconomic status may play a detrimental role reducing the access of women to transplantation.
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Affiliation(s)
- Emanuele Cozzi
- Centro Nazionale Trapianti-Istituto Superiore di Sanità (CNT-ISS), Rome, Italy
- Department of Cardiac, Thoracic and Vascular Sciences, Transplant Immunology Unit, Padua University Hospital, University of Padua, Padua, Italy
- *Correspondence: Emanuele Cozzi,
| | - Marina Álvarez
- Organizacion Nacional de Trasplantes (ONT), Madrid, Spain
| | - Mar Carmona
- Organizacion Nacional de Trasplantes (ONT), Madrid, Spain
| | | | - John Forsythe
- NHS Blood and Transplant (NHSBT), Bristol, United Kingdom
| | - Mar Lomero
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | - Marta López-Fraga
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | - Ruth Sapir-Pichhadze
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Massimo Cardillo
- Centro Nazionale Trapianti-Istituto Superiore di Sanità (CNT-ISS), Rome, Italy
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Mahíllo B, Martín S, Molano E, Navarro A, Castro P, Pont T, Andrés A, Galán J, López M, Oliver E, Martínez A, Mosteiro F, Roque R, Pérez-Redondo M, Cid-Cumplido M, Ballesteros MA, Daga D, Quindós B, Sancho M, Royo-Villanova M, Bernabé E, Muñoz R, Chacón JI, Coll E, Domínguez-Gil B. Malignancies in Deceased Organ Donors: The Spanish Experience. Transplantation 2022; 106:1814-1823. [DOI: 10.1097/tp.0000000000004117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Matesanz R, Domínguez-Gil B, Coll E, Mahíllo B, Marazuela R. How Spain Reached 40 Deceased Organ Donors per Million Population. Am J Transplant 2017; 17:1447-1454. [PMID: 28066980 DOI: 10.1111/ajt.14104] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/17/2016] [Accepted: 10/28/2016] [Indexed: 01/25/2023]
Abstract
With 40 donors and more than 100 transplant procedures per million population in 2015, Spain holds a privileged position worldwide in providing transplant services to its patient population. The Spanish success derives from a specific organizational approach to ensure the systematic identification of opportunities for organ donation and their transition to actual donation and to promote public support for the donation of organs after death. The Spanish results are to be highlighted in the context of the dramatic decline in the incidence of brain death and the changes in end-of-life care practices in the country since the beginning of the century. This prompted the system to conceive the 40 donors per million population plan, with three specific objectives: (i) promoting the identification and early referral of possible organ donors from outside of the intensive care unit to consider elective non-therapeutic intensive care and incorporate the option of organ donation into end-of-life care; (ii) facilitating the use of organs from expanded criteria and non-standard risk donors; and (iii) developing the framework for the practice of donation after circulatory death. This article describes the actions undertaken and their impact on donation and transplantation activities.
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Affiliation(s)
- R Matesanz
- Organización Nacional de Trasplantes, Madrid, Spain
| | | | - E Coll
- Organización Nacional de Trasplantes, Madrid, Spain
| | - B Mahíllo
- Organización Nacional de Trasplantes, Madrid, Spain
| | - R Marazuela
- Organización Nacional de Trasplantes, Madrid, Spain
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Matesanz R, Marazuela R, Coll E, Mahíllo B, Domínguez-Gil B. About the Opt-Out System, Live Transplantation, and Information to the Public on Organ Donation in Spain … Y olé! Am J Transplant 2017; 17:1695-1696. [PMID: 28382792 DOI: 10.1111/ajt.14296] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- R Matesanz
- Organización Nacional de Trasplantes, Madrid, Spain
| | - R Marazuela
- Organización Nacional de Trasplantes, Madrid, Spain
| | - E Coll
- Organización Nacional de Trasplantes, Madrid, Spain
| | - B Mahíllo
- Organización Nacional de Trasplantes, Madrid, Spain
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Mahíllo B, Alvarez M, Carmona M, López-Fraga M, Domínguez-Gil B, Matesanz R. SP647PROGRESS OF KIDNEY TRANSPLANTATION ACTIVITIES IN THE EUROPEAN UNION (2005- 2014): DATA FROM THE NEWSLETTER TRANSPLANT OF THE COUNCIL OF EUROPE. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw178.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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White SL, Hirth R, Mahíllo B, Domínguez-Gil B, Delmonico FL, Noel L, Chapman J, Matesanz R, Carmona M, Alvarez M, Núñez JR, Leichtman A. The global diffusion of organ transplantation: trends, drivers and policy implications. Bull World Health Organ 2014; 92:826-35. [PMID: 25378744 PMCID: PMC4221768 DOI: 10.2471/blt.14.137653] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/18/2014] [Accepted: 06/20/2014] [Indexed: 11/27/2022] Open
Abstract
Rising incomes, the spread of personal insurance, lifestyle factors adding to the burden of illness, ageing populations, globalization and skills transfer within the medical community have increased worldwide demand for organ transplantation. The Global Observatory on Donation and Transplantation, which was built in response to World Health Assembly resolution WHA57.18, has conducted ongoing documentation of global transplantation activities since 2007. In this paper, we use the Global Observatory’s data to describe the current distribution of – and trends in – transplantation activities and to evaluate the role of health systems factors and macroeconomics in the diffusion of transplantation technology. We then consider the implications of our results for health policies relating to organ donation and transplantation. Of the World Health Organization’s Member States, most now engage in organ transplantation and more than a third performed deceased donor transplantation in 2011. In general, the Member States that engage in organ transplantation have greater access to physician services and greater total health spending per capita than the Member States where organ transplantation is not performed. The provision of deceased donor transplantation was closely associated with high levels of gross national income per capita. There are several ways in which governments can support the ethical development of organ donation and transplantation programmes. Specifically, they can ensure that appropriate legislation, regulation and oversight are in place, and monitor donation and transplantation activities, practices and outcomes. Moreover, they can allocate resources towards the training of specialist physicians, surgeons and transplant coordinators, and implement a professional donor-procurement network.
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Affiliation(s)
- Sarah L White
- Sydney Medical School, Charles Perkins Centre, The University of Sydney, New South Wales 2006, Australia
| | - Richard Hirth
- Department of Health Management and Policy, University of Michigan, Ann Arbor, United States of America (USA)
| | | | | | | | - Luc Noel
- Service Delivery and Safety, World Health Organization, Geneva, Switzerland
| | - Jeremy Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
| | | | - Mar Carmona
- Organización Nacional de Trasplantes, Madrid, Spain
| | | | - Jose R Núñez
- Service Delivery and Safety, World Health Organization, Geneva, Switzerland
| | - Alan Leichtman
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
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Coll E, Miranda B, Domínguez-Gil B, Martín E, Valentín M, Garrido G, Mahíllo B, de la Rosa G, Matesanz R. Donantes de órganos en España: evolución de las tasas de donación por comunidades autónomas y factores determinantes. Med Clin (Barc) 2008; 131:52-9. [DOI: 10.1157/13123486] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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