Uruguay will enable cross-organ donation between non-relatives

RIO DE JANEIRO, BRAZIL – Uruguay’s waiting list of patients for organ or tissue transplants currently stands at almost 480 people. In 2018, 158 kidney, 14 heart, 5 lung and 24 liver transplants were performed, according to Uruguay’s National Institute of Cell, Tissue and Organ Donation and Transplantation.

Regarding kidney transplants, children have an average waiting time of 1 and a half year, if designated as priority cases. While the transplant does not take place, patients must undergo dialysis. In fact, the National Resources Fund invests US$60 million to finance this type of treatment. Many of these patients for whom dialysis is funded are on a transplant waiting list.

This dialysis expense represents 30% of the Fund’s annual expenditure, exceeding its spending on organ transplants. The 152 kidney transplants in 2019 cost approximately US$8 million.

In this context, the case of an 8-year-old girl inspired the bill, promoted by National Party senator Carmen Asiaín (President Luis Lacalle Pou’s party). Lourdes Ubillos was born with kidney failure that worsened over the years and is currently undergoing dialysis to survive, while waiting on the kidney transplant list.

Her father, who was willing to donate a kidney, cannot do so due to incompatibility, and her mother, who is compatible, cannot due to medical reasons, stated senator Asiaín in her explanatory memorandum for the amendment of the law. In addition, her sister is a minor, so she would not be able to donate either.

There is no other person who can donate her a kidney, as guaranteed by law, so her health is slowly deteriorating while she waits on the kidney transplant list.

According to Uruguayan law, organ donations are restricted to relatives by consanguinity or affinity up to the fourth degree, or spouse or partner.

But cross-donation is an option. This is defined as “the exchange of organs that takes place when a living donor is incompatible with its recipient pair, but compatible with the recipient of another donor/recipient pair that is incompatible with each other, and/or results in immunological, infectological and age-related benefits equally,” as stated in the Buenos Aires Nephrology Association journal.

The substitute bill proposes that cross-donation be enabled in these cases. “It is as if I donated to my recipient, but the organ goes to the recipient of another pair, and vice versa,” Asiaián said. She added that “we propose to broaden the donation options.”

Now passed by the senate committee, the bill will proceed to the Senate plenary. “I really wanted it to be much broader, not to be limited to just two pairs, to be much more of a chain, but the National Donation Institute opposed it, and we were not going to legislate without their agreement,” the sponsoring senator said.

Countries such as the Netherlands, Turkey, Norway, South Korea, the United States, Great Britain and recently Argentina have implemented the cross-donation option as a solution to this type of cases.