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Los cuidados intensivos orientados a la donación (CIOD) se definen como el inicio o la continuación de medidas de soporte vital, incluyendo la ventilación mecánica, en pacientes con lesión cerebral catastrófica y alta probabilidad de evolucionar a muerte encefálica, en los que se ha descartado cualquier tipo de tratamiento.

Las lesiones de los músculos isquiotibiales ocurren más frecuentemente en actividades en las que se combinan la contracción excéntrica y velocidad. Su biomecánica es compleja debido a su condición biarticular que hace que participen en la estabilización de la pelvis, rodilla de forma individual y de ambas articulaciones durante la marcha. Su lesión puede ir de una simple distensión (que conlleva un buen pronóstico de recuperación a corto plazo) a una rotura total de la inserción proximal (asociada más frecuentemente a una recuperación más compleja). Presentamos el caso clínico de una rotura total de la inserción proximal de los isquiotibiales con recidiva a las dos semanas y realizamos una revisión de la literatura.

With 40 donors and more than 100 transplant procedures per million population in 2015, Spain holds a privileged position worldwide in providing transplant services to its patient population. The Spanish success derives from a specific organizational approach to ensure the systematic identification of opportunities for organ donation and their transition to actual donation and to promote public support for the donation of organs after death. The Spanish results are to be highlighted in the context of the dramatic decline in the incidence of brain death and the changes in end‐of‐life care practices in the country since the beginning of the century. This prompted the system to conceive the 40 donors per million population plan, with three specific objectives: (i) promoting the identification and early referral of possible organ donors from outside of the intensive care unit to consider elective non‐therapeutic intensive care and incorporate the option of organ donation into end‐of‐life care; (ii) facilitating the use of organs from expanded criteria and non–standard risk donors; and (iii) developing the framework for the practice of donation after circulatory death. This article describes the actions undertaken and their impact on donation and transplantation activities. The authors summarize the challenges that the Spanish donation and transplantation system has faced in further developing deceased organ donation, and describe the three strategies that allowed Spain to rise to the highest solid organ transplant activity in the world in 2015. For further discussion, see the letters from Sharif (page 1694) and Matesanz (page 1695).

With 40 donors and more than 100 transplant procedures per million population in 2015, Spain holds a privileged position worldwide in providing transplant services to its patient population. The Spanish success derives from a specific organizational approach to ensure the systematic identification of opportunities for organ donation and their transition to actual donation and to promote public support for the donation of organs after death. The Spanish results are to be highlighted in the context of the dramatic decline in the incidence of brain death and the changes in end-of-life care practices in the country since the beginning of the century. This prompted the system to conceive the 40 donors per million population plan, with three specific objectives: (i) promoting the identification and early referral of possible organ donors from outside of the intensive care unit to consider elective non-therapeutic intensive care and incorporate the option of organ donation into end-of-life care; (ii) facilitating the use of organs from expanded criteria and non–standard risk donors; and (iii) developing the framework for the practice of donation after circulatory death. This article describes the actions undertaken and their impact on donation and transplantation activities.

Describir las prácticas clínicas al final de la vida relevantes para la donación de órganos en pacientes con daño cerebral catastrófico en España.

A benchmarking approach was developed in Spain to identify and spread critical success factors in the process of donation after brain death. This paper describes the methodology to identify the best performer hospitals in the period 2003–2007 with 106 hospitals throughout the country participating in the project. The process of donation after brain death was structured into three phases: referral of possible donors after brain death (DBD) to critical care units (CCUs) from outside units, management of possible DBDs within the CCUs and obtaining consent for organ donation. Indicators to assess performance in each phase were constructed and the factors influencing these indicators were studied to ensure that comparable groups of hospitals could be established. Availability of neurosurgery and CCU resources had a positive impact on the referral of possible DBDs to CCUs and those hospitals with fewer annual potential DBDs more frequently achieved 100% consent rates. Hospitals were grouped into each subprocess according to influencing factors. Hospitals with the best results were identified for each phase and hospital group. The subsequent study of their practices will lead to the identification of critical factors for success, which implemented in an adapted way should fortunately lead to increasing organ availability.

A benchmarking approach was developed in Spain to identify and spread critical success factors in the process of donation after brain death. This paper describes the methodology to identify the best performer hospitals in the period 2003–2007 with 106 hospitals throughout the country participating in the project. The process of donation after brain death was structured into three phases: referral of possible donors after brain death (DBD) to critical care units (CCUs) from outside units, management of possible DBDs within the CCUs and obtaining consent for organ donation. Indicators to assess performance in each phase were constructed and the factors influencing these indicators were studied to ensure that comparable groups of hospitals could be established. Availability of neurosurgery and CCU resources had a positive impact on the referral of possible DBDs to CCUs and those hospitals with fewer annual potential DBDs more frequently achieved 100% consent rates. Hospitals were grouped into each subprocess according to influencing factors. Hospitals with the best results were identified for each phase and hospital group. The subsequent study of their practices will lead to the identification of critical factors for success, which implemented in an adapted way should fortunately lead to increasing organ availability.

Background: Tissue factor (TF)‐bearing microparticles (MP) from different origins are thought to be involved in the pathogenesis of cancer‐associated thrombosis. However, the role of circulating tumor cell‐derived TF is not well understood. Methods: TF antigen and activity were measured in MP generated in vitrofrom human TF‐expressing cancer cells by ELISA and clotting or thrombin generation assays, respectively. TF antigen and activity were also measured in vivoin cell‐free plasmas from mice previously injected with in vitro‐generated MP or in cell‐free plasmas from nude mice bearing orthotopically injected human cancer cells. Results: Tumor cell‐derived MP (TMP) exhibited strong TF‐dependent procoagulant activity (PCA) in vitroand in vivo. Injection of TMP into mice was associated with acute thrombocytopenia and signs of shock, which were prevented by prior heparinization. Human TF antigen and activity could be detected in mouse cell‐free plasmas up to 30 min after TMP injections. Human TF was detected in the spleen of injected mice and its clearance from circulation was delayed in splenectomized mice, suggesting the involvement of the spleen in the rapid clearance of circulating MP in vivo. Detectable levels of TF‐dependent PCA and thrombin‐antithrombin complex were found in cell‐free plasmas from mice growing pancreatic human tumors, suggesting that circulating tumor‐derived TF causes coagulation activation in vivo. Conclusions: MP derived from certain cancer cells exhibit TF‐dependent PCA both in vitroand in vivo. These results provide new information about the specific contribution of tumor‐derived MP to the hypercoagulable state observed in cancer.