San José, Costa Rica, since 1956

Potential Live Kidney Donors Back Out

THE generosity of a young womanwho donated one of her kidneys to astranger in need late last year and askedothers to follow her example triggered anoutpouring of copycat donors who notifieddoctors of their intention to donate anorgan, then backed out.Dr. Francisco José Mora, a kidney specialistat the public Hospital CalderónGuardia in San José, said 28 peopleoffered themselves for surgeries that couldhave helped some of the more than 100patients waiting for kidney transplants innational hospitals, but then “fled.”MORA was part of the surgical teamthat performed a kidney transplant inNovember 2004 between the donor, KatiaBrenes, 22, and the recipient Carlos Sánchez,21, whose body rejected the organ twodays later. Brenes did not know Sánchez;she said she had heard of his need for a kidneythrough a mutual friend and decided tohelp (TT, Nov. 26, 2004).Their story made headlines nationwide,and shortly after, potential donorscontacted medical authorities – but laterapparently lost interest.More recently, two others have offeredto donate, and haven’t backed out so far,Mora told The Tico Times.Meanwhile, Sánchez received dialysistreatments three times a week until Jan. 5,when he went under the knife again toreceive a transplant from a cadaver. Sofar, the operation has been successful,Mora said.DOCTORS have been transplantingkidneys in Costa Rica since 1974. In recentyears, Costa Rican doctors have successfullytransplanted livers, heart valves forbypass surgeries, skin for burn victims andbone for cancer patients, according to Dr.María Amalia Matamoros, liver specialistat the National Children’s Hospital.The nascent national liver transplantprogram has made gains this year, its fifth,nearly doubling the number of donors overlast year.Forty people received liver transplantslast year. The increase is the result of educationcampaigns and knowledge gleanedfrom a workshop with Spanish organdonor experts, Matamoros said.The program began with transplantsexclusively from live donors, but in itssecond year it advanced to organ harvestingfrom the recently deceased, which ispreferred.A live donor gives part of his or herliver to the recipient, a procedure that wasfirst carried out in the United States in1989. It is a more complicated surgicaloperation and is used in Costa Rica only inemergencies, Matamoros said.“We want to maximize the number oftransplants from cadavers through publicand internal education campaigns, andtransparency” in their operation,Matamoros said.Donating an organ “is not somethingthat will help people economically, (thefamilies of the donors) will just receive thegratitude of the recipients and their families.”In fact, economic remuneration isshunned among transplant specialists forfear of a black market trade or exploitationof the impoverished. Costa Rican doctorswill perform liver transplants from livedonors only if they are members of therecipient’s immediate family.“WE don’t accept Good Samaritandonors because you never know if they werepaid for the service,” Matamoros said.In 1994, lawmakers made it possible forCosta Ricans to indicate on their identificationcards whether they want to donateorgans in the event of a fatal accident, but,according to Matamoros, the law is ignored.Instead, the families of victims are consultedbefore any organs are harvested.Those interested in donating organsafter death can leave their desires in writingat national hospitals, but the informationremains within the hospital where it issubmitted because there is no shared networkbetween hospitals.Even if a person leaves their will inwriting, the wishes of the family arealways followed first, Matamoros said.FINDING donors, however, is not thebiggest problem.“Costa Ricans donate,” Matamorossaid. The problem is often with the doctorswho attend accident victims. They are notin the habit of asking families if they willallow organ harvesting, she said.“When we call, the cadaver is oftendeteriorated and beyond use,” Matamorossaid. “It’s an internal problem among us(in the medical field), as well.”To expand the organ donating programsin the country, members of theCosta Rican Transplant Foundation plan tomeet with Public Health Ministry authoritiesto discuss the issue.The focus of the talks will be to plannew donor recruiting and public educationefforts, according to Catalina Calderón, theExecutive Branch’s representative to thefoundation.

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