DTI: The Future of Donation and Transplantation

In our first two articles in this three-part series about the Donation and Transplant Institute, we first spoke to Isabel Rosselló, who handles much of the community relations of the DTI, and then to Dr. María Paula Gómez, who directs the day-to-day activities of the complex international non-profit. They both mentioned that they were brought into the organization by a visionary medical doctor who has been at the head of the DTI since its inception, and who is the principal driving force behind the Foundation’s vision for the future. That doctor is Martí Manyalich.

Dr. Manyalich has 35 years of experience in the field of organ, tissue and cell donation and transplantation. He is the advisor on transplantation at the Hospital Clínic de Barcelona, as well as associate professor at the University of Barcelona’s Medical School. He is also a member of several international societies and was awarded the Josep Trueta Prize for scientific research in 2018 by the Academy of Medical Sciences and Health of Catalonia and the Balearic Islands Foundation. As the president of the DTI Foundation and Board of Trustees, Dr. Manyalich represents the foundation worldwide at forums and congresses and directs training and collaborative programs around the world.

“I would say that my fundamental role at the DTI is as an international ‘donation ambassador’,” Dr. Manyalich says. “After all these years, I know people everywhere: in Spain, Europe, Latin America, Asia, Australia and Oceania. My job is to facilitate connections within this network between those interested in improving their transplantation system, and those with more experience. That’s how we continue to improve our training, cooperation, research and innovation.”

Spreading the Word

Before we delve into innovation, flashback to 1991: as we mentioned in our previous articles, the Transplant Procurement Management (TPM), or the education arm of the DTI, came first. The organization had five years of organ donation training under its belt, and its reputation was growing. The National Transplant Organization in Madrid requested that the TPM take on the task of training health professionals in order to improve donation and transplantation all around Spain. The first program at the Parador Nacional de Vic, organized in conjunction with the University of Barcelona and the Bosch i Gimpera Foundation, received such overwhelmingly positive feedback from the attendees that what started out as a single event eventually grew into a network of educational programs around the world.

As the first edition had been in Spanish, the next several countries to be incorporated into the program were Portugal and Latin American countries. “And then,” says Dr. Manyalich, “We ran into a great challenge for professionals in our country, which was to start performing the training sessions in English in order to accommodate the influx of international students. The language barrier was a real issue 25 years ago. So we started offering training in English, and then our neighbors in France said, ‘why not in French?’ So we adapted our best teachers to teach in French. Next came Italian. And so on.”

Other countries began to request additional services—such as collaborations, consulting services, help for research programs in need of biological material, on-site advisory visits—which were difficult to include under the umbrella of the University of Barcelona. As a result, in 2008 Dr. Manyalich and his team came up with the idea of creating a non-profit organization dedicated to helping the world learn the importance of developing transplantation for donation programs in their hospitals. The DTI was born.

Going Global

Later, around the year 2000, they took some of their training online and continued to expand their net of collaboration throughout Europe, America and eventually Asia. “The ‘home base’ here in Barcelona had to adapt its way of operating and utilize modern technology in order to maintain the highest possible educational and academic quality as we grew,” says the doctor. 

The DTI also had to adapt in other ways as it made its first forays into Asia. “We found ourselves facing cultural and regulatory barriers, as well as infrastructure problems,” he says. “Transplants have been around for 70 years, but they are not ‘traditional’ medicine, so it can be a challenge to gain societal acceptance of the process. It is not a question of a lack of understanding, it is a question of these various barriers to its implementation.”

“So we studied their cultures, their politics, their health systems, and—thanks largely to generous funding from the European Union—we began to collaborate with countries such as Thailand, the Philippines, Hong Kong, Singapore, Malaysia and in 2012, with China. We spent two years there, until programs by Chinese entities were finalized and which have helped that country to make the leap from having no brain death donors to having between 5,000 and 10,000 each year,” says Dr. Manyalich. 

Thanks to the DTI and its partner organizations, the global medical community has made great strides in the search for effective treatments for some of humanity’s most debilitating diseases. These in turn have further increased demand for expanded training and educational programs in order ultimately deliver better health care for future generations. 

The Here and Now 

Now it’s 2020, and in spite of the unprecedented challenges brought on by the global pandemic, Dr. Manyalich and his team are leading the DTI into the future. In the modern age of biotechnology and genetic engineering, advances in human tissue allografts—the transplantation of cells, tissues, or organs from a genetically non-identical donor—cell therapy and regenerative medicine represent new horizons in medicine with endless possibilities for the human race. 

Acquiring samples of living human tissue is a critical step for a wide range of research activities, but the legal and ethical issues involved as well as the practical challenges that come with the process of sourcing high quality, fully-formed specimens that are fit for use in a range of analyses can be daunting. The elaboration of standards of quality and safety for the donation, procurement, testing, processing, preservation and storage of human tissues and cells is a controversial issue, and tissue banking procedures—like transplantation—require specific knowledge and skills. Everything must be performed in accordance with the Spanish and European legal requirements.*

Entering a New Phase

The DTI’s Tissue Banking and Advanced Therapies Training Program is based on the EQSTB (European Quality System for Tissue Banking), which sets the standard for transparency, quality and safety throughout the donation and transplant process. The Tissue for Research Unit of the DTI Foundation has also created a platform designed to coordinate and facilitate the donation of human tissues and cells for biomedical research purposes, including collaborations with national and international procurement centers. The Unit supports researchers by providing high quality samples according to the project needs, facilitating access to key data ranging from early stage research to drug safety evaluation, as well as preclinical and clinical research.

“We have entered a new phase of bioengineering, tissue engineering, cell therapy, regenerative medicine, stem cells. Technology allows us to advance in the transmission of this knowledge,” says Dr. Manyalich. “It allows us to make techniques easier and more affordable. In certain parts of the world we try to assist with the design, development, implementation, training and management of these tissue banking and regenerative medicine establishments. We believe that in the future there will be more and more of these very specific techniques. What DTI does and will continue to do is the same thing that it did in the year 1991: put a territory with specific needs in contact with the best world experts of that time.”

Looking Ahead

What is the DTI focusing on when looking towards the future? “We are looking at Africa,” Dr. Manyalich says. “We are looking at Ghana, South Africa, Ethiopia. In North Africa we have already been visiting and learning for years—in Morocco, Algeria, Tunisia, Egypt—also in many parts of the Middle East, where thanks to DTI collaborations it has been possible to initiate, develop and increase donation and transplantation significantly.”

In this moment of global pandemic and of widespread social change, the DTI has also had to reinvent itself in order to adapt to the world’s changing needs. “Our knowledge of organs, tissues and cells is the same, but the transmission and development of this knowledge must come from new technologies and innovative programs,” he says. “For example, in order to compensate for the current travel and social distancing limitations, we are developing robotics programs that will later become a permanent function of the TPM. We are also developing artificial intelligence decision-making programs for organ donation processes.” The robot or the system will be able help doctors make certain decisions, especially in circumstances where the health professional has less expertise.

According to the DTI, the global demand for organ transplant currently adds up to approximately one million transplants per year. In spite of the Foundation’s great strides over the years, that threshold is far from being met. “The future of transplantation is related to the future of the social and health development of our society,” says Dr. Manyalich. “The world is composed of 10% wealthy people and 90% poverty. If health systems and access to them do not improve, it will be almost impossible to meet global transplant needs. But the DTI is constantly evolving, like any organization in the world today. Our group is excited about its work. It is a group of the best professionals in the field in the world, all united by the same desire: to improve the quality of life of as many people as possible through transplantation.”

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.