More transplants in public hospitals in Mendoza: the impact of the crisis and the lack of donors

In the last decade (2015-2025), private hospitals performed twice as many transplants as the public sector, with 61.6% of the interventions, compared to 38.4% in state hospitals. However, this trend began to reverse in the last three years.

The impact of the economic crisis on the health system was also reflected in transplants. The recent deregulation of social security and prepaid health insurance fees, together with the drop in purchasing power, have led to a greater number of people turning to the public system in critical cases.

According to data from Sintra, Incucai's statistical system, there has been a sustained growth in ablation and implant operations in state hospitals starting in 2022. “People get transplants where their health insurance has an agreement. Over time, agreements with the State increased and that increased activity,” explains Cecilia Quiroga, Incaimen coordinator in Mendoza.

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He also points out that the Central Hospital has increased its number of operations, partly thanks to the creation of a bone marrow transplant center, a corneal transplant program, in addition to what it already performs (liver, kidney, etc.), which boosted activity and resulted in exponential growth in transplants in the state sector.

In fact, during 2022, state hospitals in Greater Mendoza and the southern capitals performed 232 transplants in total; that is, more than double the 132 registered in private institutions.

There are currently 318 people from Mendoza on the waiting list, waiting to be called to undergo a transplant operation, both for organs and tissues. Although the number is dynamic, Incucai affirms that it is necessary to keep the gap "as small as possible" between donors and patients seeking to be transplanted.

In this sense, the task of organ procurement in intensive care units in hospitals is essential, which requires training, greater will and better salaries, since in a short time, the organ procurer puts into play several skills: activating the complete clinical analysis (tomography and different studies) of the patient in critical condition; detecting when there is brain death; having communication with therapeutic doctors and warning the family about the fate of their loved one's organs. Of course, unless the family has previously expressed their opposition in writing to donating their organs.

“There is an increasing need for transplants and the number of donors remains stable, which creates a gap that we must reduce. We know that reaching the zero list is a utopia, but it is possible to provide a better response to those waiting for an organ,” Quiroga explains to Los Andes.

Another striking fact from Incucai is that almost all organ and tissue donors in Mendoza come from public hospitals (87.7%), compared to 12.3% who come from the private sector. For some surgeons consulted, however, this difference is “historical” since the main public hospitals, such as the Central Hospital, receive the majority of patients with serious trauma, which increases the possibility of brain death and subsequent donation. However, in recent years the gap has widened due to various factors.

For Quiroga, also a specialist in Intensive Care, the low number of donors in private clinics is due to failures in the procurement mechanisms. The activation of the ablation and implant protocols depends largely on the speed with which the medical teams detect possible donors in intensive care.

“Private hospitals’ intensive care units do not have a high procurement activity, even though several institutions have their own transplant centers. It is essential that they increase procurement in order to respond to the growing demand, since otherwise the quantity of organs and tissues available will continue to be insufficient,” Quiroga concludes.

In 2018, with the unanimous approval of Congress, Argentina passed the Justina Law (27,447), a milestone in organ donation. Inspired by the story of Justina Lo Cane, a 12-year-old girl who died waiting for a heart transplant, the law establishes that all people are donors by default, unless they state otherwise in writing.

The law changed the paradigm of organ donation in the country, eliminating the need for family consent, a factor that often delayed or prevented the procedure due to the emotional impact of grief. Now, the only way to not be a donor is to formally state it on the National Identity Document (DNI) or through the National Central Institute for the Coordination of Ablation and Implantation ( Incucai ). Registration on the driver's license is not valid.

Organ procurement specialist Cecilia Quiroga recalls complex situations in which families reacted with resistance. “We find ourselves with relatives who threaten, pull out weapons or create tense situations. Sometimes we have to wait up to 14 hours for another, more conciliatory relative to give their consent,” she says. Although the law establishes donation as the norm, in the pediatric field there is still reluctance, since it is the adults who decide about minors.

Incucai recommends that each person express their wishes while alive to speed up the ablation operations in the event of death. To do so, the decision can be registered in the Mi Argentina application, in the civil registry or when renewing the DNI. This simple action can mean the difference between life and death for those waiting for a transplant.