DTI: Donation, Transplantation and the COVID-19 Pandemic

Thousands of people around the world are waiting for an organ transplant; many will die waiting. This is often due to a lack of transplantation infrastructure and/or donation culture in their home country, not due to a lack of suitable organs. Providing appropriate educational programs on organ donation for health-care professionals is key to solving this widespread organ scarcity. 

As we outlined in our first article in this three-piece series, the Barcelona-based Transplant Procurement Management (TPM) program was started in 1991 at Hospital Clínic, and is an international reference in professional education in the field of organ donation and transplantation. Its aim is to increase the quantity, quality and effectiveness of organ and tissue donation for transplantation. To date, it has trained over 17,000 health-care professionals from 101 countries. In 2010, the TPM merged with the Donation & Transplantation Institute Foundation, or DTI.

Making Things Happen

The coordination of all the DTI’s moving parts is a massive amount of work. Lucky for the organization, and for patients in need of a transplant, the woman in charge of this coordination is a powerhouse who is incredibly devoted to her work.

“Things do not happen; they are made to happen.” This is the quote that appears underneath the photo of Dr. Maria Paula Gómez on the DTI’s website. As executive director of the foundation, her job is essentially to make things happen. Her role includes coordinating the work of its various departments, making sure the day-to-day decisions at the organization follow the strategic direction set by the board of directors and leading the implementation of new projects within the institute. She is also a coordinator for several TPM educational courses worldwide. It is a more than full-time job, but Dr. Gómez is passionate about what she does.

As a medical doctor, her specialties are organ donation and health-care management. Her 17 years of experience supporting countries and territories in the implementation and development of organ donation systems began in 2008 when Dr. Marti Manyalich, the founder of the DTI, invited Dr. Gómez to join the project. He knew that her experience would prove extremely valuable to the foundation, as she had previously been the national transplant director in her native Colombia, working closely with the minister of health of that country. 

Dr. Gómez’s professional experience is global: she had also acted as the director of the Royal Prince Alfred Hospital Organ Donation Unit in Sidney, Australia, and was a member of the Implementation Advisory Committee in Organ Donation in New South Wales, Australia. The paradox in Australia at that time was that a well-developed country with no lack of resources had an extremely low rate of organ donation by global standards (less than 20 donors per million people). The consequence was that many people were dying while on the transplant waiting list. After working with the government, hospitals and private advocacy groups to help implement best practices in organ donation, she witnessed first-hand how a well-organized and concerted effort could result in dramatic changes that save lives.

Spain: World Leader in Donation and Transplantation

Spain is the number one country in the world in organ donation and transplantation. In 2019, Spain reached 49 donors per million population (PMP). In hard numbers, this means that 5,449 persons were given a second chance thanks to a life-saving transplant.

What do Spain’s numbers look like when compared to other European countries and the rest of the world? Portugal, Croatia and France have rates of 33 to 34 donors PMP. Outside of Europe, the United States has 36.8 donors PMP, the UK has 24.88 donors PMP, Australia is at 22.17 and Canada at 20.6 donors PMP. Although approximately 139,024 organ transplants are performed every year worldwide, this number covers less than 10% of the total global demand. 

The reason for this is not due to a lack of healthy organs available for transplant, but to the lack of organ donation and transplantation framework implemented within the countries’ hospitals, as well as the lack of clear governmental policies, infrastructure and resources dedicated to it.

“Society is ready to donate,” says Dr. Gómez, “but society needs to be well informed and have the mechanisms available in order to do so.”

Learning by Doing

According to the foundation’s experience, the most effective model in organ donation consists of a decentralized system where hospital-based organ donation units are empowered to manage the donation and transplantation process, with the support of regional and national offices. Working with a network of well-trained health-care professionals that understand the system is key to its success. 

The TPM has helped hospitals around the world implement these systems and prepare the professionals working within them. Using “learning by doing” methodology, TPM offers a wide range of online, face-to-face and blended courses, helping health-care professionals learn how to identify a potential donor and how to manage the donation and transplantation process. The end goal is to maximize donor potentiality and conversion rates while maintaining high ethical and quality standards. TPM offers intermediate and advanced courses for health professionals in Barcelona as well as on-site training in other countries. 

“We customized the training courses to be performed within each country so they would best suit each unique situation,” says Dr. Gómez. “Additionally, we have developed online postgraduate diploma courses and masters degrees in organ, tissues and cell donation for transplantation with the support of Barcelona University. We are very proud of the results so far, but there is still work to do.”

Coronavirus and Organ Transplantation

Some of that work includes facing the challenges presented by the COVID-19 global pandemic. In March of this year, Dr. Gómez and the DTI team created an independent international database called IDOTCOVID to evaluate the impact of coronavirus infection on organ donation and solid organ transplantation. The database functions as a support for health professionals worldwide, using artificial intelligence solutions to help doctors in their decision-making process. Now more than ever, the DTI’s goal is saving lives and optimizing the use of resources within the healthcare system. 

“We are trying to make the best out of a terrible situation by using the data collected during the pandemic to continue to help patients,” says Dr. Gómez. “The global pandemic has been a challenge for the entire human race, and no one—not governments, nor healthcare systems, nor public or private institutions—was prepared to respond to the situation, which is one reason why controlling the spread of the virus as well as its health and economic impacts has been difficult. Hopefully this data will help us to be more prepared in the future.”

IDOTCOVID is an offshoot of the DTI-TPM’s IRODaT registry, an open international registry which collects and makes available organ donation and transplantation data dating back to 1998. Every year over 90 countries worldwide report their activity in the field to IRODaT. Their statistics all come from official reporters, most of whom are members of National Transplant Organizations and Ministries of Health from countries around the world.

Transparency Is Key

The information that IRODaT provides is valuable for scientists, governments, PhD students conducting their own research, doctors and hospitals. Moreover, the IRODaT team is able to offer personalized reports on demand, with up-to-date information specific to any of their participating territories.

“Thanks to these statistics,” says Dr. Gómez, “we are able to offer current information to both the health-care community and the general public. Transparency in organ donation and transplantation is one of the guiding principles in the field as mandated by the World Health Organization.”

This emphasis on transparency stems from the worldwide problem of organ trafficking and transplant commercialism, which usually occurs in countries where the infrastructure doesn’t support the population’s need for transplants. 

COVID-19 has had the effect of pushing these organizations out of their comfort zones, and changes and improvements in their systems and services that could otherwise take years are now happening in a few short months. “COVID has forced us to achieve greater velocity in the implementation of innovation,” she says. “At the end of the day, those changes will benefit the society and show us new ways to better achieve our goals.” 

Going Digital

In planning for the future, the DTI is enhancing its online training, so that all TPM training programs will be available remotely. It is also developing a free telemedicine platform, i-DTI, which assists health-care professionals 24/7 by answering their questions during clinical practices. The technology continues to evolve, but the DTI’s goal remains the same: to offer a second chance at life to as many people as possible all over the world thanks to organ donation and transplantation. 

According to Dr. Gómez, the main challenge for the DTI is the lack of commitment by some governments to develop organ transplantation and donation in their regions. This reluctance often stems from a lack of understanding that long term benefits to patient health can positively impact both society and the country’s economy. Those same countries use public resources to offer expensive treatments, such as dialysis, that ultimately cost more and are less effective in the long term. In the case of chronic kidney disease, for example, the DTI’s and other international organizations’ statistics show that organ transplantation offers the possibility of a better quality of life in the long term—at a lower cost to the healthcare system—when compared to dialysis. 

“Spreading the knowledge of how to implement best practices in organ donation across the world, and finding the resources to do so, is our greatest challenge,” says Dr. Gómez. “Therefore, we invite anyone interested in learning more to visit our international online DTI Community, as well as our online fundraising campaign called Save 1 Million Lives. You can read about our mission, and all donations received through the platform will go to assist underdeveloped countries in creating a sustainable model for organ donation and transplant. Everyone is welcome.”

Dr. Gómez encourages people to talk with family and friends about organ donation, to consider donation and to make those wishes clear to their loved ones. “Organ donation saves lives, and when we die, we can’t take the organs with us,” Dr. Gómez says bluntly. It’s that simple.

If you’d like to learn more about the DTI and support its initiatives, take a look at its website, or consider making a donation to the foundation via its crowdfunding campaign on the Global Giving platform. Apart from donations, the DTI has a volunteer program through which anyone interested in collaborating with its mission can lend a hand. 

You can follow the DTI on Facebook: @transplantprocurementmanagement, Twitter: @DTI_Foundation and connect on LinkedIn.