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Trasplantes de riñón sin transfusión de sangre para testigos de Jehová


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Los testigos de Jehová rechazan las transfusiones de sangre, lo que, entre otras cosas, complica sus posibilidades de recibir un trasplante. Sin embargo, el Hospital del Mar de Barcelona acaba de poner en marcha un protocolo de trasplante renal apto para las personas de esta confesión religiosa.

El procedimiento, que garantiza que no se hará ninguna transfusión de sangre durante todo el proceso, ya se ha probado con éxito en dos pacientes en 2016 y 2017. Uno de ellos se realizó con un donante vivo, que también era testigo de Jehová, y el otro con el órgano de un paciente fallecido.

Según explican desde el centro sanitario, se puede realizar un trasplante renal sin contar con la opción de la transfusión si se sigue un protocolo específico que abarca los preparativos antes de la cirugía, así como la intervención y la atención postoperatoria.

Lo primero que se hace una vez que el paciente es aceptado como candidato a trasplante, explica Marta Crespo, jefa de sección de Nefrología del Hospital del Mar, es someter al enfermo a «un tratamiento con eritropoyetina» -un fármaco que estimula la producción de glóbulos rojos- "para garantizar que su organismo tiene unos buenos niveles de hemoglobina". No se permite, por ejemplo, que el paciente tenga un cierto grado de anemia, que sí es aceptable en otros pacientes (la falta de hierro es habitual en los pacientes con insuficiencia renal), porque en estos casos "el margen de seguridad debe ser más amplio" ya que la opción de la transfusión si se producen grandes pérdidas de sangre no se contempla.

Además, se informa al paciente sobre determinadas actuaciones posibles, como el uso de factores de la coagulación aislados, que podrían aplicarse en caso de sangrado agudo.

Ya durante la intervención, se utiliza un equipo denominado cell saver, que lo que hace es recuperar parte de la sangre del paciente si se producen hemorragias para, después de un proceso de limpiado, volver a transfundirle directamente sus propios glóbulos rojos. En caso necesario, el paciente recibe, por tanto, una especie de autotransfusión.

Al finalizar la cirugía, el enfermo se traslada a la Unidad de Reanimación Postquirúrgica, "donde es monitorizado y controlado para detectar precozmente un posible sangrado". Es importante realizar una detección rápida de cualquier problema en estos casos, subraya Lluís Cecchini, jefe del servicio de Urología y Cirugía del Trasplante del centro barcelonés, ya que, "como la transfusión está descartada, deben considerarse tratamientos más agresivos, como la realización de una nueva intervención quirúrgica".

Realizar cualquier trasplante renal es un procedimiento complejo en el que "hasta un 40% de los pacientes necesitan una transfusión", apunta Cecchini. Hacerlo en un paciente que rechaza este último procedimiento es, por tanto, aún más complejo y "obliga a tener un cuidado específico en determinados aspectos de la cirugía y durante el postoperatorio".

De cualquier manera, el riesgo de fallecimiento para los pacientes que rechazan recibir sangre de un donante es más alto ya que, aunque existen medidas para tratar de recuperar una pérdida importante de volumen sanguíneo, llegados a un punto crítico, no hay alternativas igual de efectivas que una transfusión.

Tanto Crespo como Cecchini recuerdan que, para poder llevar a cabo este protocolo, ha sido necesario que los profesionales sanitarios implicados hayan aceptado renunciar a las transfusiones como opción terapéutica en el caso de los testigos de Jehová.

"El equipo del centro ha adquirido el compromiso de respetar las creencias y valores de este colectivo y no realizar ninguna transfusión de sangre durante el proceso de trasplante", comentan.

El protocolo desarrollado "podría aplicarse en otro tipo de trasplantes o cirugías de otras características", explica Cecchini, aunque en algunos casos, como las cirugías oncológicas, podría no ser recomendable.

http://www.elmundo.es/ciencia-y-salud/salud/2018/03/13/5aa8292a22601d56608b45cb.html

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