Baby Emma in her mother´s arms. / EFE

Medical history made as a Spanish baby receives an intestine transplant from a donor in cardiac arrest

Spain is the only country in the world that transplants all types of organs from donors without cardiorespiratory functions

ANTONIO PANIAGUA

Emma, who is barely 13 months old, will go down in the history of medicine. She is the first person in the world to receive an intestinal transplant from a donor who had died of cardiac arrest. The child, who is now enjoying almost perfect health has had her liver, pancreas, intestine and part of her stomach transplanted at the Hospital La Paz in Madrid.

The novelty of the operation lies in the fact that the donor was in asystole, that is her cardiorespiratory functions had stopped at the time of death. In most transplants, the deceased organ donor usually dies of brain death. In this case, to avoid damage, the organs were preserved by means of an oxygenation system.

Emma suffered from short bowel syndrome due to a congenital disease, which forced her to undergo several previous operations. The multi-organ transplant was the last resort and the only one capable of saving her life, according to Esther Ramos, head of the Intestinal Rehabilitation and Transplantation Unit at La Paz Hospital.

Emma's father, Daniel, said before the operation his baby girl was not gaining weight. “Before entering the operating room, our life was very hard. There came a point when we were not advancing. The hospital has been our salvation. Our life has taken a 180-degree turn. Now my girl is already crawling,” said Daniel.

Intestinal transplantation is difficult because it involves a high bacterial and lymphoid load, to which is added the danger of ischemia (lack of oxygen). The operation was carried out after three years of research by the Congenital Malformations and Transplantation Group of the Institute of Health Research (IdiPAZ), which undertook studies and developed protocols, financed by the Mutua Madrileña Foundation.

The donation consisted of restoring circulation to the heart and implanting the multi-organ bundle. To do this, the spleen and part of the colon and stomach were preserved, which is where the transplant was joined.

“The main difficulty of the operation, which lasted about twelve hours and for which there was no precedent was validating the donor and adapting the perfusion (tissue blood flow),” said Francisco Hernández head of the Pediatric Surgery Service of La Paz Hospital,

Emma, who was operated on two months ago, is doing extremely well doctors said. They expect she can be taken off her current intravenous feeding soon.

The director of the National Transplant Organisation (ONT), Beatriz Domínguez-Gil, said that the operation was a milestone. Donation in asystole is more difficult, given that the organs stop receiving blood flow after cardiac arrest. "Today Spain has the highest rate of asystole donation in the world," said Domínguez-Gil.