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Objective: The objective of this study is to evaluate the results obtained by the Training Unit of the Regional Transplant Organization of Andalusia from 2015 to 2017., Methods: The following indicators were analyzed: number of activities carried out, number of students trained per year, students who do not complete the course, student and teacher satisfaction, learning assessment via postformation test, and transfer of training to the workplace., Results: Between the years 2015 to 2017, 86 courses were carried out, and 2600 students were trained (1325 doctors, 1064 nurses, and 211 students with other degrees). A total of 83 students (3.2%) withdrew from training after its initiation. The overall assessments from teachers and students were 95/100 and 92/100, respectively. Student scores from the postformation test to assess learning averaged 77 points., Conclusion: It is worth noting the elevated number of courses offered and students trained over this 3-year period. We believe this has had a strong impact on the donation rate in Andalusia, which rose from 37.5 donors per million inhabitants in 2014 to 52.5 donors in 2018. Although student and teacher satisfaction was very high, it is clear that the transfer of new skills to the workplace could benefit from improvements in teamwork, communication with the transplant coordinator, the overall work environment, and the resources at their disposal., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Efforts to expand the organ donor pool to meet growing transplant demands remains a top priority, as does maintaining the quality and safety standards of potential recipients. There is a short window of time from organ retrieval to decision making on organ acceptance, based on the available data. Furthermore, the limitations of intraoperative biopsy can often lead to donor or organ refusal due to a suspected tumor, which, if not confirmed in the final biopsy, results in the loss of a transplant opportunity., Methods: Donor characteristics and organs discarded on suspicion of neoplastic disease at the time of extraction were analyzed in Andalusia between January 2014 and July 2018. The variable analysis included sociodemographic data, type of donor, location of the potential malignancy, histopathologic examination, and discarded organs., Results: A total of 43 cases were identified. The organs of 33 donors (76.7%) were discarded. Kidneys were the most frequent location for a suspected tumor (44%), followed by the liver (21%). In 18 of the 43 cases (42%), the suspected malignancy was not confirmed, and of these, only 3 livers and 1 kidney were implanted. Sixty potentially transplantable organs were discarded, including those that would have been extracted and/or implanted in the absence of a suspected tumor., Conclusions: These results highlight the need not only to improve the accuracy of intraoperative biopsies but to seek new decision-making strategies for the short interval after organ retrieval. This involves avoiding both extremes of donation contraindications, while maintaining quality and safety standards., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: The objective is to study the geographic distribution of public awareness and acceptance of organ donation in Andalusian municipalities and determine its relationship with each population and the rate of aging., Methods: Data on organ donors from the Information System for Autonomous Regional Transplant Coordination in Andalusia were analyzed from 2006 to 2017. The geographic analysis was performed using free software from the Generalitat Valenciana Geographic Information System (gvGIS, Valencia, Spain). Data from the Spanish National Statistics Institute for the year 2017 were used as a reference for population estimates and calculating the rate of aging., Results: From 2006 to 2017, a total of 3698 donors were registered in Andalusia, 28 of whom were residing in another autonomous community and 120 who were not censored as residents of their municipality, leaving a final total of 3550 donors. The rate of aging in 2017 was 1.02. Choropleth mapping was used to identify donors in each municipality. Population and aging rate in 2017 for these areas were also analyzed., Conclusion: Georeferenced data on organ donation not only reveals spatial differences in the distribution of public acceptance; it also provides insight into the relationship between this distribution and the sociodemographic characteristics of each community. In this study, areas with the least number of donors seem to coincide with difficult accessibility, higher aging index, and low population rates. These maps can assist transplant coordinators in targeting areas for public education and information campaigns to heighten awareness of the positive results of organ donation and potentiate its acceptance., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The progressive increase in the number of liver transplantation candidates has brought with it a consequent increase in waiting list mortality, making it necessary to revise donor selection criteria and to analyze the factors that optimize outcomes. This retrospective observational study of 1802 liver transplantations performed in Andalusia between 2000 and 2010 analyzes the outcomes from donors aged 70 years or older (n = 211) in terms of survival rates of the graft and the recipient, the type of transplant, donor age, and DMELD (Donor-Model for End-Stage Liver Disease) score. The most frequent reasons for transplantation were alcoholic cirrhosis (45.5%), hepatitis C cirrhosis (20.4%), and liver cancer (11.8%). The overall survival rate at 5 years was 67%; with a significant decrease in survival rates for recipients with a DMELD greater than 1400 (44%). In the 70-year-old-plus donor group, the overall patient and graft survival rates were 57% and 52%, respectively. The re-transplantation rate increased proportionately with donor age: 5.9% between 70 and 74 years, 9.5% from 75 to 79 years, and 17.6% from 80 to 84 years. In the alcoholic cirrhosis recipient sub-group, the overall survival rate at 5 years was 69% (P < .05) compared to 34% in hepatitis C patients (P < .05). The widening of the donor age selection criteria is therefore a safe option, provided that a DMELD score less than 1400 is obtained. Although re-transplantation rates increase progressively with donor age, they remain less than 10%. It is necessary to carefully screen recipients of older organs, taking into account that the best results are obtained for patients who have alcoholic cirrhosis, are hepatitis C negative, and have a DMELD score that is less than 1,400., (Copyright © 2013 Elsevier Inc. All rights reserved.)