The Journey of Organ Transplantation: Waiting Lists and Medication Shortages in Colombia

At the age of 58, María Cristina Galeano received the diagnosis of cirrhosis –a disease of the liver– that his doctor gave him in July 2022. He remembered the moments when he did not refuse a pork rind or a drink.

From then on, Cris – as his family tells him – had days of forced rest in hospitals while they tried to make him stable. However, each time they released him, he worsened again, until the doctors determined that the best thing to do was give him a transplant.

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With that decision, she had to move from Cereté (Córdoba) to Rionegro (Antioquia) with her husband. There they had to wait for her “turn” to come. But for that, a medical committee of specialists had to determine if she was a suitable patient. The go-ahead came to Cristina last June and since then the regressive countdown began which, in all cases, is relative.

Waiting list, not waiting line

Getting on a waiting list as a potential organ recipient is not the same as being in a first-come-first-in line.

This is how the former director of the National Institute of Health –entity in charge of managing transplants–, Martha Lucia Ospina. “It is not a waiting line in which the procedures are done in turnsbut it is a list that is organized by compatibility between the donor and the possible recipient”.

The way in which that compatibility is defined seems to be done by Artificial Intelligence. It is a web application, created in 2016in which the information of possible recipients of an organ, donors and health providers for the donation and transplantation processes converges.

The algorithm does match –according to variants of blood type, age, location, organ, life expectancy– with the person on the list who will receive the call for the transplant. The only human interference is entering accurate patient data. In 2022, according to the executive report of the INS Donation and Transplantation Network, there were 3,663 people on the waiting list, of whom 110 died and 1,171 received transplants.

For this reason, Ospina adds that “There are people who can last months or years on the waiting list, like others who last a week”. As also explained by the president of the Colombian Association of Organ Transplantation, Paola García, who alludes to the fact that “the clinical conditions of the patient also influence: the more antibodies (immune system defense against a threat) you have, the less likely you will be to get a transplant.”

“Lliver and heart have a priority urgency because they are organs that do not have alternative treatment to live”, adds García.

In the case of Cristina Galeano, she only had to cross out the days of a month on the calendar until they called her. Her transplant took place at the San Vicente Fundación de Rionegro Hospital between 9 pm on July 23 and 4 am on the 24th. Until the night of that day, her husband, daughter, niece and other relatives were able to see her in the intensive care unit.

The lack of medicines appears

The shortage of some medicines, which has affected the country since October 2022, It also has an impact on organ transplantation. The Colombian Association of Pneumology and Thoracic Surgery (Asoneumocito) and the National Foundation for Transplant Patients alerted since March the shortage Tacrolimus, Mycophenolate (taken by transplant recipients) and Perfadex (which helps preserve the organ).

Asoneumocito alerted a month ago that five institutions were going to close lung transplant programs due to the lack of this drug, which directly affected 60 patients who, according to them, expected to receive a lung.

On the other hand, the director of the Transplanted Foundation, Gloria Cecilia Calle, indicates that this four-month shortage generated “great stress in the patients” that he joined the “lottery that is to get a donor, that the organ is compatible and that it adapts well to his body.”

EL COLOMBIANO was able to establish with medical sources that the Perfadex returned to the country on July 27at least at the Cardio VID Clinic in Medellín.

Meanwhile, el Tacrolimus appears as medicine “not in stock” in the latest update (June 7) of the Invima supply list; Mycophenolate, meanwhile, is “out of stock” in the EPS Suraaccording to a last june list; and another solution for organ preservation – such as dimethyl sulfoxide – is among the vital medicines not available from Invima (from July 1).

Cris Galeano’s life – which would have been reduced to 10% had it not been for the transplant – was saved and now he must follow a lifelong medication and diet for his new liver to function. This present from her shows the final link, and the best face, of the unpredictable chain of organ transplantation in Colombia: a process in which there may be about 7,585 potential donors per year.

Bottleneck in organ donation

According to INS data, per year there are 244,000 deaths in the country. Of these, the number of actual donors is reduced by factors such as 3% occur in departments that do not have night air access or short duration by landas well as just 26.7% of ICUs those who arrive have the capacity to preserve the organs.

In 2021, of that amount, 2,613 were possible donors; of these, 27% (710) were potential to donate; of this percentage, 73% (524) were eligible (by the conditions of the corpse); and of the latter, 51% (268) were donors. 10.2% of the total potential donors and 0.10% of the total annual deaths.

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