Life After Life
By Jesús Aguado
Guanajuato state is ranked in first place nationally in organ donations. Currently eight of every ten families of brain-dead patients decide to say “yes” to donating organs. The figure is a contrast with that of 2009, when only 20 percent agreed to help prolong life. The reason is simple: the past taboos about organ donation have been eliminated. Additionally, there are more specialized hospitals that can perform the surgeries.
In San Miguel de Allende, the act of love by the relatives of Maria Luisa Espinosa will help to keep her memory alive in more than 70 people.
On August 25, 1967 (on calle Juan Aldama 23 in colonia San Rafael), the tenth of ten siblings, Marilú, was born. The inhabitants of this city will keep the memory of “a happy, sometimes crazy, strong, and motivating woman.” People will remember her because, after her life, she will live in children and teenagers who benefit from tissue, bone, and organs she and her family decided to donate. Everybody will remember her popular and motivational phrases: “Goodbye, mamacita, you look beautiful! You do not need a man to succeed. God, our Lord, will help you.” Everybody will remember Marilú waving her hands and loudly saying goodbye while driving a blue Tsuru.
In the living room of the house where she lived, a cabinet displays several images of the Sanmiguelense heroine (as she is now known by locals). In the cabinet, the “Donor” medal that the Secretariat of Public Health gave to the family is also on display.
Marilú’s sister, María Carmen Espinosa Retana, shared some memories with Atención.
“Marilú was a girl who cried a lot when she was little,” commented her sister. “My mom had several women working in the house, and she had to be supervising. My older sister and I were like Marilú’s mom. She cried a lot, and we used to carry her”—she demonstrated how—“on our backs with a shawl, like the señoras who sell nopalitos. When we were making tortillas, we always rocked her on our back, at the same time.”
“The rebelliousness, happiness, strength, and solidity of the little girl showed up when she was growing up,” commented señora Cristina. “When she was growing up, she was never quiet; she was always doing something. At home there was a cistern. Once I was washing clothes and she was playing around. I did not notice, but eventually she fell into the cistern. We pulled her out, but she was very upset.”
María Luisa was very generous and most Sanmiguelenses know it. She learned this from her mother, Andrea Briseño, who always supported the street vendors with food. “Marilú always wanted to help. If there were beggars outside, she always gave them food—tortillas at least. We used to tell them—eat something, and then you can keep working.” Since she was in elementary school, Marilú was a hardworking woman. She helped her brother at the now gone Café Colón, and she also helped those who were hungry. Professionally, she worked for the offices of the National Land Register and also for the local administration in the Traffic Department.
Because of these characteristics, this Sanmiguelense drew people from all the social strata to her funeral. “She gathered more people than a politician,” said her sister. The people also went to the civil hospital when she was there and prayed for a miracle at the chapel. “She was so crazy (in a good way). She told everybody, “Adiós, mamacita. Papacito, keep working. Beautiful, you look so amazing!” shared Cristina, who said that her family also knew that they had an angel in their home.
Decision within tragedy
Tragedy overwhelmed the family when the oldest sister passed away and the very same day Marilú was taken to the civil hospital by ambulance. A few days later, on April 29 this year, doctors confirmed that they could do nothing for Marilú.
“She suffered a lot with her first husband. She never cried. She was very brave. When she was leaving her house, she used to say, ‘There is nothing going on.’ She was very strong and didn’t let things like that get her down. That taught me that you can be economically poor but spiritually rich; that is the purest lesson for me,” commented Cristina.
The new heroine was the mother of two girls, 13 and 14 years old. Her oldest son is Édgar. Édgar also shared that his mom regularly donated blood, sometimes to people she did not even know—people who knew about her and in their despair knocked at her door. “She always said yes to everybody because she had a philosophy that she would be well in a couple of hours. She was very good and motivated other people.” Édgar noted that when the doctors said they couldn’t do anything to save her life, the family decided to donate her organs because “that is what she would have done. We wanted to keep giving life though her. Actually, she helped us to make the decision because of her optimism. We want her to be happy wherever she is. What she did gives me strength and motivation to never give up,” he finished.
“When the doctors asked us to donate we immediately said yes because we wanted to help others. The only conditions were to keep the organs, tissues, and bones in Guanajuato and to use them for children and young people. We know that she is happy with what we did,” said her sister Cristina.
On April, 29 the Secretariat of Public Health informed the public about the donation in a press release. For Atención, Dr. Rodrigo López Falcony, general director of the State Center of Transplants, commented that her kidneys were transplanted in Guanajuato the very next day. He said as well that extractions from the donor bones, tissues, and organs would help more than 70 people. That is how Marilú is recognized as the eighth donor in the state who has given more than just organs.
Interview with the director of the CENETRA
The State Center of Transplants is in León, where Director Rodrígo López granted an interview to Atención. He assured that here the taboos from the past regarding organ donations have been overcome, and that is why Guanajuato occupies first place in national donations. López also commented that the process of transplants in the state is very transparent because “people question what they do not know, and in this state we let people know all the benefits of the program. I have worked here for eight years, and in the past people thought that the organs were transplanted to wealthy and very important people, but those taboos have been defeated with the information that we provide.” Dr. López also remarked that if somebody wants to know who received on organ, they can have access to the information by following the protocols. “It is very sensitive information, but there is access to it.” Testimony could be given by more than 3,000 people who have received transplants, assured the director.
Jesús Aguado: How do you define a transplant?
Rodrigo López: It is the substitution of a sick organ for a healthy one in order to reestablish its functioning.
JA: When was the first transplant performed in the state?
RL: It was from a living donor. It was a kidney, in 1989. It was performed by the Hospital of the IMSS. Ten years later, the first transplant from a dead donor was also performed by the IMSS. Since 2000, the activity has been more constant, and it keeps growing.
JA: What is the reason for the increase in transplants?
RL: The factors are many, but it is mainly because the hospitals can now perform the surgeries. In 2000, 25 kidney transplants were performed and that was because the relatives of those in need donated their organs. That was an act of love among families. Now the donations also come from dead people, and the campaigns are better to get relatives to donate the organs of the deceased.
JA: Besides kidneys, what else can be donated by a living person?
RL: Obviously a kidney and, although this is not well known by people, liver segments. Blood also, but for practical issues, kidneys. Due to the sociodemographic characteristics of Guanajuato, kidney problems are very common.
JA: Who pays for the transplants?
RL: The relatives of a donor will never pay for the extraction of an organ. Taking into account the helicopters and ambulances, as well as the solutions that we use (at 4,000 pesos per liter), everything is covered by the Secretariat. The same Secretariat conducts socioeconomic studies of those patients on waiting lists, and there are six different levels—from one to six. Sometimes those who cannot pay for the surgery still receive it. Those who are in the sixth level, which is the highest, do not pay more than 150,000 pesos.
JA: When a person dies, what can be donated?
RL: Organs (heart, liver, lungs, kidneys, pancreas, intestines). In Mexico there are no programs for transplanting lungs. There is no experience, not even in the Mexico City hospitals. The heart transplant is very common, as well as liver and kidneys. Several pancreases have been successfully transplanted. Talking about tissues: corneas can be donated, as well as long bones from legs and arms. Many people think that when a bone is donated the whole part of the body is taken, but that is not true. Only the bone is taken. The body is given back to the relatives with a prosthesis and in perfect condition.
JA: How many people can benefit from just one bone?
RL: When the bones are donated, these are processed, and we get sub-products that can benefit more than 70 people. When the bones are not donated, only six or seven people can receive an organ, and in addition that will depend on the conditions of the organs.
JA: Is the donation of bones and tissue common?
RL: It is a common topic. In San Miguel 8 people out of 23 have donated everything. But it depends also on the condition of the person, and it is not asked of everybody. For example, those who had drug or alcohol problems are not candidates for donating, and children cannot donate.
JA: Although it is common, is it easy to get the donation of bones?
RL: Of course, it is very complicated and intense work. It is a very emotional moment for the family and asking them to think of helping others without receiving a benefit makes things even more difficult. But we provide them with all the information requested, and the donation also helps them to endure their mourning because they can feel that part of their relative still lives. They can also have access to the information about who received the donation. We do not recommend that because there are cases of people who have been obsessed with the beneficiary and want to be close to him or her, and that is not healthy for anybody.
JA: What is the maximum age for donating corneas?
RL: We do have a microscope that helps us to analyze the quality of the corneas now. In the past we received corneas from 60-year-old people, but now we can receive from 70-year-old people.
JA: What about the black market for organs?
RL: That does not happen. To perform a transplant, very expensive compatibility studies are needed, and they are conducted at very specialized hospitals. Also, a transplant requires a team of more than 30 people. With so many people involved, it is just impossible.
JA: What are hospitals that perform transplants in Guanajuato, and what is the destination of the donated organs?
RL: Hospital General de Alta Especialidad del Bajío, Hospital Regional del ISSTE, Unidad Médica de Alta Especialidad del IMSS, and the Hospital General de Irapuato are the only public hospitals authorized for transplants. The authorized private hospitals are Hospital Aranda de la Parra and Hospital Ángeles. We have to be notified of any donation, even if it is from a private hospital. Each hospital has a donation committee that respects the law and decides the final destination of the organs. I can tell you that all the donations we have had from public hospitals have ended up in public hospitals.
JA: Are the organs exported?
RL: Exporting or importing organs in Mexico is forbidden by law. Only corneas can be imported and they are brought from San Diego or Miami. In this state, there is a clinic that imports its corneas from there.
JA: What is the protocol for getting the cadaver organs?
RL: We arrive at the scene when the medical group trying to save the life of somebody says that there is nothing more to do and the patient is brain dead. We explain the process to the family, and we try to make them understand that their relative will not come back. People are never forced to donate. Currently, there is not a single family with regrets for the donation because their tragedy is turned into life, and that helps with the mourning.
JA: Is there something else that you want to say?
RL: Since 2009 the negativity about donating has decreased. That year 6 of every 10 families said no to donation, and now it is only 2 of every 10—80 percent say yes. I also want to say thank you to all the donors who generate good news. I want to invite everybody to take part in the donation. There are 1,250 people waiting for a kidney transplant in Guanajuato.
Finally, for those on the waiting list, waking up every morning in despair and with the uncertainty of when a transplant will be available, I want to let them know that the CENETRA team wakes up daily with the sole mission of working hard to get the organ. We do not know when it will arrive. Unfortunately, it depends on accidents. I want them to stay tranquil because there is somebody looking out for them.