Selección del donante y criterios de viabilidad de los órganos: Expansión de los criterios de donación

Abstract

Donation criteria have become more flexible over the years, hence at present the only criteria for absolute exclusion are infection with the human immunodeficiency virus (HIV), tumoral disease and uncontrolled bacterial or viral infections. Organ viability criteria are conditions of a clinical, biochemical, morphological and functional nature that donors and their organs must meet in order to guide the decision as to what organs of a donor may be used. These criteria seek to ensure, as far as possible, that the transplanted organs function after the process of extraction, conservation, implantation and reperfusion without transmitting any infectious or tumoral disease. In recent years, both the macro and microscopic aspect has become one of the fundamental criteria for the selection of potentially viable organs. At present, there is no age limit for liver and kidney donation, and chronic damage to the organ is the main counter-indication for donation. To accept the heart, on the other hand, criteria such as the donor's age, and the doses of vasoactive drugs received and history of prior cardiac arrest are still very much taken into account. However, performing echocardiograms can relativize some of these conditions. In the lung, anatomical integrity, oxygenation capacity and the absence of infection in the airway are the basic criteria for viability. For the pancreas, having no history of diabetes or alcoholism and a donor age of less than 45 are the only notable differences with respect to the criteria for acceptance of kidney donors. However, the use of each organ should be decided individually after a profound analysis of all viability criteria, weighing up the advantages and disadvantages that the implantation of a certain organ may represent for the recipient.