Successful Example of How to Implement and Develop a Deceased Organ Donation System in the Caribbean Region: Five-Year Experience of the SEUSA Program in Trinidad and Tobago.

BACKGROUND: The SEUSA program, the Donation and Transplantation Institute foundation consultancy program, was implemented in Trinidad and Tobago (T&T) in 2010 with the support of the National Organ Transplant Unit (NOTU) and the Ministry of Health of T&T. METHODS: The SEUSA program included (1) diagnosis of the current situation using the ODDS (Organ Donation Diagnostic Surveys); (2) creation of a human resources structure through Transplant Procurement Management (TPM); (3) detection of all brain and cardiac deaths in the hospitals implementing the DAS (Decease Alert System); (4) in-hospital awareness based on the EODS (Essentials in Organ Donation); and (5) external hospital audits. Additionally continued monitoring is performed. RESULTS: Thus far, thanks to implementation of the SEUSA program in Trinidad and Tobago 175, healthcare professionals have been exposed to training programs in the organ donation field. The Living Kidney Program was reinforced and the structure of the Deceased Donation (DD) network was defined. Since 2010, 485 potential organ donors have been detected, and 9 have become actual organ donors; 74 patients have received a kidney transplant (59 from living and 15 from deceased donors). CONCLUSIONS: This project results demonstrate that the application of the SEUSA program is an efficient methodology to develop DD programs that increase and consolidate transplant programs in the Caribbean region.

Response from Dilip Dan to Commentary from Inge on CaseReport OBSU-D-09-00159

We would like to thank Professor Inge for his commentary and agree with most of the comments. It has been said that the first step of a journey is usually the most important and often the most difficult. This case was the first in our collective experience and provided an extraordinarily difficult therapeutic challenge. The risk/benefit ratio of bariatric surgery is well established in the morbidly obese adult and is under current investigation in teenagers. The decision to undertake a sleeve gastrectomy in one so young and with such debility as in the current case was the Aristotelian mean of cost, benefit, availability, feasibility, and accessibility of therapeutic options. We agree that our work with this child has just begun!