Challenges

In recent years, the transplantation of human cells, tissues and organs has been one of the most cost-effective therapies for the treatment of a large number of chronic diseases and has led to continuous improvement in patient survival rates and quality of life. In the Americas region, the capacity to perform transplants varies from country to country. Barriers to making transplant therapy increasingly available in many countries include a lack of institutionally integrated and consolidated national programmes, adequate infrastructure and human resources with relevant skills and training. Transplantation needs to be developed equitably in the region. Some countries in the Americas need to prioritize and promote procurement activity as part of national health agendas. Many countries have been requesting support to help put the issue on their agendas and move forward with local initiatives.

Toward a Solution

The Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI) in Argentina, in partnership with the Pan American Health Organization/World Health Organization (PAHO/WHO) and the Ministry of Foreign Affairs, International Trade and Worship of Argentina, is working with counterparts in Ecuador, Paraguay and Peru on a transplantation cooperation project, called the Strengthening National Systems for Organ, Tissue and Cell Donation and Transplantation in Ecuador, Paraguay and Peru. INCUCAI is a decentralized agency of Argentina’s Ministry of Health and the country’s national coordinator of ablation and transplant activity. INCUCAI has an outstanding track record of international cooperation, in addition to working to strengthen the countries’ donation and transplant systems and has worked with PAHO/WHO as a Collaborating Center since 2017.

The project launched in 2019, following PAHO/WHO’s approval of Resolution CD57/R11, drafted with the participation of countries in the region. Its Strategy and Plan of Action serve as a roadmap for development of this project. The initiative for the strengthening of the donation and transplantation system, takes into account the realities of the hospital networks and the need to develop information systems that provide the bases for communication and outreach activities.

At the start of the project, virtual meetings were held among senior authorities of the agencies involved. The project’s objectives and work methodology were consensually agreed upon and formulated, which was fundamental to ensure ownership at the country level and provide the necessary political support to make structural changes in the donation and transplantation systems of the countries. Three technical working groups were organized, with activities to be carried out and a schedule for completing them.

As a result of this exchange, the countries have been able to prioritize at the national level the strengthening of their donation and transplant institutions, starting from a mapping of the health care facilities with the capacity to perform complex interventions, which is a pillar to develop a sustainable network, particularly in the context of a pandemic. Because the current health emergency prevents in-person activity, the hope is to be able to organize missions to the countries to define the rest of the activities to be carried out.

The strengthening of donation and transplant agencies has been successfully included among these countries’ national priorities. Mapping has been completed of hospitals with the capacity to generate donors to establish the network, and measures have been taken to maintain these services in the pandemic context.

INCUCAI has a track record in the field and seeks to share what it has learned with its counterparts, taking advantage of the similarity of the health systems in the three countries involved. Because of its federal organization, Argentina has extensive experience with subnational work in diverse contexts. INCUCAI has been working with its jurisdictions to develop local capacities – experiences that can be shared with the three countries in the project, and in turn with other countries in the region.

Already, this partnership has achieved the following:

• improvements in communication and public awareness of donation and transplants;
• baselines built on health care networks available in the countries, as well as national capacities, providers and types of financing for these services; and
• strengthening the stewardship and governance of donation and transplantation systems in the countries.

One of the advantages of having three counterpart countries is that the process will transfer capacities among them, in addition to those contributed by INCUCAI. This project will facilitate achievement of at least three of the progress indicators of the Strategy and Plan of Action on Donation and Equitable Access to Organ, Tissue, and Cell Transplants 2019-2030. Achievement of the objectives will have an impact on SDG 3.4 by improving access to therapies for chronic noncommunicable diseases and on SDG 3.8 by improving access to essential quality health care services, in addition to contributing to meeting SDG 17.