In Mexico's medical infrastructure and human resources for organ donation and transplantation is poor and also most concentrated in three states in the country: D
In Mexico there are states that are devoid of staff and infrastructure to perform organ transplants. The only option for many Mexicans who require this surgery is to travel outside their place of residence to another state that has the resources to make an operation of this nature.
The scarcest resource are surgeons. There currently are 778 doctors registered with the National Transplant Registry, which are mainly concentrated in Mexico City, Nuevo León and Jalisco.
The result is obvious. These entities half of the 17 000 325 kidney transplants performed, 85% of 725 liver, 91% of the 12 pancreatic and 94% of 179 cardiac performed between 2007 and 2013, according to figures from the National Transplant Center (CENATRA).
In Jalisco was conducted solely done small bowel transplantation in the country, while in Nuevo León were made six of seven lung transplants.
In contrast, in the same period only seven surgeries in Guerrero, Oaxaca six, three in Nayarit and in Campeche, all kidney were performed.
Without accurate registry of staff
A transplant is not easy. In fact, it is the process that there is multidisciplinary, requiring a variety of specialists.
First are the surgeons: a national level there are 778 that perform transplants. One in four working in a hospital in Mexico City, while no records of specialists in Campeche, Guerrero, Morelos, Nayarit and Quintana Roo.
In this regard, Enrique Martinez, director of the National Transplant Registry, the report notes that surgeons who have "is still not mature enough because hospitals are not used to record this type of information."
Although registration has today CENATRA not sufficiently clear the exact number of surgeons, Martínez Gutiérrez agree that "there are things we do know: we do not have enough surgeons. Many of them come to the wrong place despite being trained and finished devoting to something else. "
Even more rare are the doctors who made the donation coordinator functions. This figure is the one that is responsible for detecting potential donors, talk to their families, evaluate and coordinate the donor removal and relocation of the organ to the patient who will receive.
"We do have a few surgeons, but we have even less donation coordinators ... The efficiency in transplantation in European countries speak of seven donation coordinators for each surgeon. Our flag still can not even match one to one ", said Martínez Gutiérrez.
But surgeons and donor coordinators are not the only personnel required to do a transplant. Negligible resources and infrastructure are also required.
As pointed Martínez Gutiérrez, "not enough to train surgeons, transplant goes beyond sewing a body, is a multi-step process that requires the participation of many people ... I can take you to a surgeon to a small state with little infrastructure, but I gain nothing there for a surgeon who is very capable if you do not have everything you need around. "
complex process
Transplantation is a process that goes from the detection of the person who will receive their study, acceptance for operation, organ procurement, surgery and patient follow-up. For it is not enough just to have a surgeon.
As an example, Dr. Guillermo Careaga, director of the General Hospital, National Medical Center La Raza, this means the detailed type of staff needed for a heart transplant.
First, there is a group of cardiologists evaluate whether a patient needs a heart transplant because there is no other option to offer.
"There are some patients who are very ill, with a damaged heart, but corrective surgery to improve their conditions and need not reach the transplant; the important thing is that they be evaluated in a timely manner so that these treatment options and apply a complex surgery is not necessary.
"If the patient unfortunately not on time or even deteriorates despite these measures then it is evaluated by the transplant clinic. They participate the heart team, specialists for hemodynamic catheterization, echocardiography and nuclear medicine for the evaluation to be as complete as possible and well justified indication, "said Careaga Reyna.
Already involved in the operation, in addition to cardiothoracic technicians in charge of managing infusion equipment that meet the patient's heart functions at the time that the diseased organ is replaced by donated surgeons, anesthesiologists, surgical nurses. There is also a medical team to collect the donated organ and another group of specialists in intensive care patients.
"We are talking about the surgical process trans least 30 people and participate in the pre and the post would add another 20 or 30 people who are involved in the transplant," he said.
Although the staff varies according to the organ in question, the fact is that it is a complex process that requires a very broad and diverse group of experts that are not in all states.
Hospitals at the forefront
Between 2007 and 2013 the number of transplants in the IMSS spent thousand 428-2000 181. Currently the institute takes one in two that are made in Mexico.
In kidney transplants, also highlight IMSS institutions such as NMC Specialty Hospital West, 708 thousand surgeries, Hospital La Raza, 865, and the Specialty Hospital No. 71, with 775 interventions.
Hospitals of La Raza and Cardiology CMN Siglo XXI concentrated almost three quarters of heart operations.
The private sector is particularly noticeable in liver transplants, pancreas, lung and small intestine.
According to Enrique Martínez, liver transplants "actually began to grow in a private group. Now the phenomenon is reversed and the hospital ... Today this most transplanted organ is the National Institute of Nutrition. "
About bowel surgery states that "no longer be one of the least transplants performed worldwide and more meager results ... when there is a large intestinal transplant experience the best you can do for them [patients] is to use another treatment.
"The case of Jalisco is an exception. It is a case that really any other options did not work and then had to leave for a heroic attempt. "
Also, Dr. Martinez said the IMSS and the National Institute of Respiratory Diseases (INER) are already developing a lung transplant program, and he notes that the hospital José E. González, who made six lung operations, is an institution with nonprofit.
"A private hospital hardly invest funds in lung transplant program, because it is not a business."
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