Kidney transplant in the next decade: Strategies, challenges and vision of the future.

Although the results of kidney transplantation (KT) have improved substantially in recent years, a chronic and inexorable loss of grafts mainly due to the death of the patient and chronic dysfunction of the KT, continues to be observed. The objectives, thus, to optimize this situation in the next decade are fundamentally focused on minimizing the rate of kidney graft loss, improving patient survival, increasing the rate of organ procurement and its distribution, promoting research and training in health professionals and the development of scientific registries providing clinical and reliable information that allow us to optimize our clinical practice in the field of KT. With this perspective, this review will deep into: (1) strategies to avoid chronic dysfunction and graft loss in the medium and long term; (2) to prolong patient survival; (3) strategies to increase the donation, maintenance and allocation of organs; (4) promote clinical and basic research and training activity in KT; and (5) the analysis of the results in KT by optimizing and merging scientific registries.

Trasplante renal en la próxima década: estrategias, retos y visión de futuro / Kidney transplant in the next decade: Strategies, challenges and vision of the future

Aunque los resultados del trasplante renal (TR) han mejorado sustancialmente en los últimos años, continúa observándose una pérdida crónica e inexorable de los injertos debido principalmente a la muerte del paciente y a la disfunción crónica del TR. Por tanto, los objetivos para optimizar esta situación en la próxima década se centran fundamentalmente en minimizar la tasa de pérdida de injertos renales, mejorar la supervivencia de los pacientes, incrementar la tasa de obtención de órganos y su distribución, fomentar la investigación y la formación de los profesionales sanitarios y la elaboración de registros científicos que proporcionen una información clínica y fiable que nos permita optimizar nuestra práctica clínica en el campo del TR. Con esta perspectiva, esta revisión profundizará en: 1) estrategias para evitar la disfunción crónica y la pérdida del injerto a medio y largo plazo; 2) prolongar la supervivencia del paciente; 3) estrategias para incrementar la donación, mantenimiento y distribución de órganos; 4) promocionar la investigación clínica y básica y la actividad formativa en TR; y 5) el análisis de los resultados en TR mediante la optimización y fusión de los registros. (AU)

Although the results of kidney transplantation (KT) have improved substantially in recent years, a chronic and inexorable loss of grafts mainly due to the death of the patient and chronic dysfunction of the KT, continues to be observed. The objectives, thus, to optimize this situation in the next decade are fundamentally focused on minimizing the rate of kidney graft loss, improving patient survival, increasing the rate of organ procurement and its distribution, promoting research and training in health professionals and the development of scientific registries providing clinical and reliable information that allow us to optimize our clinical practice in the field of KT. With this perspective, this review will deep into: (1) strategies to avoid chronic dysfunction and graft loss in the medium and long term; (2) to prolong patient survival; (3) strategies to increase the donation, maintenance and allocation of organs; (4) promote clinical and basic research and training activity in KT; and (5) the analysis of the results in KT by optimizing and merging scientific registries. (AU)

Bárbara, una posible donante de órganos / Barbara, a potential organ donnor

This article presents the case of a 47 year old woman, on encephalic death state, who had not expressed her willing or acceptance for organ donation. The case is described as a narrative, contextualized, and in an anonymous way. A bioethical analysis of the family decision making and of the role of transplant coordinator is proposed. This presentation, with the description of its whole context and of the factors that influenced decisions, has the purpose to contribute to the development of deliberation competencies and to increase the awareness of the ethics problems of family decisions, of the conditions of anonymous organ assignation and of the of the end of life's meanings.

Se presenta el caso de una mujer de 47 años, en muerte encefálica y sin expresiones previas sobre su voluntad de ser donante de órganos. El caso se expone como una narración contextualizada, anonimizada y seguida de un análisis bioético de las decisiones familiares y del rol del coordinador de trasplantes. La presentación, con una descripción del contexto y de los factores que condicionan las decisiones, tiene el propósito de contribuir al desarrollo de la capacidad deliberativa y a tomar mayor conciencia del problema ético de las decisiones familiares, del anonimato de la asignación de órganos y del sentido del final de la vida.