A baby receives the world’s first intestine transplant after donation in asystole

Pride, illusion and a lot of emotion lived this Tuesday at the La Paz University Hospital from Madrid who has successfully carried out, for the first time in the world, an intestine transplant that comes from a donation in controlled pediatric asystole. The recipient is Enma, a 13 month old baby that, since her first month of life, she had been diagnosed with intestinal failure and, worst of all, with very poor health. The little girl has already been discharged and he is at home with his parents, Ana and Daniel . Some happy and excited parents who, during the presentation ceremony of this milestone, held at the hospital, before a packed assembly hall and with enormous expectation, have shown gratitude and great emotion. Because the little girl’s life has taken a 180 degree turn. “It was a second chance” Emma’s father, also there, in his little chair, said, his voice cracking.

Non-heart beating donation is organ donation and tissues from a person diagnosed as dead after confirmation of irreversible cessation of cardiorespiratory function (absence of heartbeat and spontaneous breathing for more than five minutes). Emma’s case is a pioneer in the world . The words barely came out for Daniel to thank his professionals for the feat that has taken place during these months in La Paz, one of the most active pediatric transplant centers in Europe.

Also, to give infinite thanks to the families of the donors and to the Spanish Association for Helping Children, Adults and Families Affected by Intestinal Failure, Multivisceral Transplantation and Parental Nutrition (NUPA). Applause and more applause to acknowledge that, thank you to that pioneering transplant , the little baby is already crawling, that she is at home (the family comes from Segovia) and that, unthinkable, she hardly does anything, everything is moving forward. “There have been hard times, a path of pebbles that have helped us callus, but here we are, with a beautiful girl,” said Emma’s father.

History of a transplant

The story of the baby, the doctors will tell – a huge team participated in the operation – starts when she is barely a month old. She was very ill. Her intestine is not able to absorb. They had to operate on her in those first few months. I needed parenteral nutrition . In case of intestinal failure, one option was transplantation, but not in all cases. Despite the fact that 30% of the candidates die on the waiting list, the intestine from an asystolic donation had never been used, preferring that it would not be valid given the special characteristics of this organ. The scientific evidence also did not show that it could not be done .

For this reason, in this story of improvement, the professionals from La Paz -from the Congenital Malformations and Transplant Group of IdiPAZ- a three-year research project underway -thanks to funding from the Mutua Madrileña Foundation. Once the team was able to show, in various experimental models, that the intestine was valid, it could be moved to the clinic. It was a success. A work of a multidisciplinary team made up of professionals from Pediatric Gastroenterology, Pediatric Surgery, Pediatric Cardiac Surgery, Pediatric Intensive Care, Anesthesiology and Resuscitation…

A milestone in healthcare

The presentation was attended by the health workers who made it possible, the Madrid Minister of Health, Enrique Ruiz-Escudero and the director of the National Transplant Organization (ONT), Beatriz Dominguez-Gil. Ruiz Escudero spoke of a “milestone in Madrid’s health” and Domínguez-Gil of a pioneering transplant that opens a door to boys and girls who are in the same situation as Emma, ​​from all over the world. The great Madrid public health center It is the only one in Spain accredited to perform all types of pediatric transplants and the only one, at a national level, accredited to perform intestinal and multivisceral transplants in children.

The director of the ONT He recalled that the history of non-heart beating donation begins precisely in Madrid, in the early 1990s. A program that this community exported to other regions and countries. In recent years, the number of patients who require a solid organ transplant to stay alive and donation in asystole is becoming in an increasingly important source since in adult. It already represents a third of the donations made in our country. The technique allows considering the possibility of donation within end-of-life care in those patients in whom the adequacy of life support measures has been decided.

Also, that, after certification of death, organs can be preserved with perfusion of oxygenated blood through the Extracorporeal Membrane Oxygenation (ECMO) system. In this way, the organ to be transplanted does not deteriorate. Controlled asystolic donation has been shown to have similar results to classical donation in brain death and its use is also increasing. in other countries around us . In La Paz, it occurred for the first time in 2014 in adults and in September 2021 in children, although previously the pediatric transplant team had performed it with the itinerant ECMO team in three centers ( Madrid, Basque Country and Andalusia ), the first of them in 2018.

pioneering techniques

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Since the beginning, in La Paz there have been 147 ( 12 pediatric ) with organs from 64 donors, of which 57 were adults and 7 were pediatric. The first cardiac procedures derived from a donation of this type have also recently been performed, to date, one in an adult patient and two pediatric patients, all with serious illnesses. In fact, the center is consolidated as one of the best transplant hospitals for children in both Spain and Europe. In addition to hematopoietic precursor and cornea transplants, La Paz has performed 3,149 organs, of which 1,754 have been in children .

The majority of patients with intestinal failure who arrive in La Paz from all over Spain achieve digestive autonomy thanks to intestinal rehabilitation, which includes the administration of parenteral and enteral nutrition, medical treatment and surgery. Among the techniques used, transplantation is the last resort, but the only one that can save the lives of some patients. This month marks the 23rd anniversary of the first intestine test carried out in Spain by this team. It was in October 1999 and the recipient was a two-year-old boy who suffered from a congenital disease that he had no treatment and made it impossible for him to be fed through the digestive tract, so that from the age of 15 days he had to receive parenteral nutrition. Since then, 120 intestinal tests have been performed in La Paz, 72 of them multivisceral.