Adriana Castro Alverde

Adriana Castro de Alverde is not only developing a culture for organ donation in Mexico, but is demonstrating that public and private actors can be mobilized for organ donation.

Adriana is increasing the number of organ donations in Mexico and creating awareness for a culture of organ donation. Adriana’s innovative work in her role as a catalyst has made it possible for government agencies, companies, and social organizations to work together to increase organ donations in Mexico. She has created a working model that is mutually beneficial to government and society; government expands its health services, and society receives greater health services and infrastructure to promote organ donation.

Very few organ transplants are performed in Mexico from either living or deceased donors. While the transplant rate in Mexico is 3.3 for each 1,000 in the U.S. the rate is 36.2. Deceased donations have an advantage over living donations in that a single donation can be useful for many recipients. In 2005, 4,000 brain deaths occurred in Mexico, likely deceased donors, but only 310 were used.

This scarce number of donations means long waiting lists. In Mexico, more than 10,000 people are waiting for a transplant. The organ most needed for transplant is the kidney and due to the growing number of diabetes patients in the country, the need is increasing. All people waiting for a kidney transplant are under haemodialysis therapy, which is very expensive and not sufficient to help them, especially those patients who do not have private or employer provided healthcare benefits, and receive health benefits from the Secretaría de Salubridad y Asistencia Social (the equivalent of Medicare coverage in the U.S.). The yearly cost for a patient on haemodialysis is 189,000, pesos (US$15,303), while the cost of a kidney transplant is approximately 150,000 pesos (US$12,149), and has many advantages for the patient’s quality of life. Though the advantages are evident, organ donation is not encouraged.

Adriana has identified two significant reasons why the number of organ donations is so low: First, organ donation is not encouraged among both patients and physicians. The issue of organ donation is not often discussed. Therefore, when someone dies the decision of whether or not to donate body organs does not come to mind. The second reason is that hospitals are not prepared to deal with an organ donation program. Very few hospitals in the country are qualified for organ extraction and even less have the facilities and equipment to carry out implants. This means that many people, willing to donate their organs, are not able to do so because there are not enough certified and equipped hospitals.

To encourage people’s awareness of an organ donation culture, Adriana shares her personal story with the media. She participates in radio and television shows and her story has been published in magazines. When her five-year-old son, Alejandro, was declared brain-dead and died from a surgical complication, he became a deceased donor and his organs helped six other children.

Another more complicated goal of her work is to improve conditions for organ donation. Adriana encourages an innovative alliance with the government: Haemodialysis Units. Her organization, Fundación Ale, had made a commitment to equipping one of the hospital’s operating rooms with an independent Haemodialysis Unit that includes six haemodialysis machines, one water processing unit, one filter cleaning unit, a nutritionist, nephrologist, and internist. The hospital must in turn equip itself with two additional operating rooms to perform organ transplants and certify and maintain the operating rooms.

The independent Haemodialysis Unit performs routine treatments for patients on the waiting list for a kidney and during their visits to the Unit, patients and relatives talk with Fundación Ale volunteers about the risks and benefits of a transplant. If someone is willing to donate a kidney for their relative in haemodialysis treatment, the operation can be performed at the hospital with which the Unit is associated. It is key that the recipient of the organ enter the transplant unit in very good condition—he or she has been receiving the adequate treatment in the Haemodialysis Unit. Should a deceased donation become available in the area, the hospital is equipped and certified to perform organ extraction and implantation in its own facilities.

The Haemodialysis Unit is sponsored by the Seguro Popular (Public Health Insurance Program), a program that the federal government has put into effect to benefit people with no health coverage. Recently, haemodialysis became included with this insurance and the government will pay the costs of each patient treated at the Unit. The government’s alliance with Fundación Ale has been very helpful—each patient receives 300 thousand pesos (US$24,289) a year during their lifetime or until he/she is the recipient of a transplant. The kidney transplant costs 90,000 to 150,000 pesos (US$7,289 to US$12,149) and is spent only once.

Using the Haemodialysis Units, Adriana is paving the way to set up and develop the infrastructure for organ donation where it does not exist. The first unit is operating in Los Mochis, Sinaloa, at a public hospital and she is working to set up a second unit in Mexico City, at Hospital Escandón, a private hospital.

Although the Haemodialysis Units are government funded through the Public Insurance program, transplant costs are not. Thus, Adriana raises funds for disadvantaged families to have access to transplants for their relatives. She has signed an agreement with Fundación Telmex to cover 90 thousand (US$7,289) of the 150 thousand pesos (US$12,149) each operation costs. She has also signed agreements with laboratories in the pharmaceutical industry to have immunodepressants (necessary for post operatory treatment) made available to transplant patients at reduced costs.

Adriana plans to open two Haemodialysis Units a year in different hospitals, with the same working scheme in place in Los Mochis. Setting up the Haemodialysis Unit and equipping the hospital’s operation room is accomplished through fundraising. Operating costs of the Haemodialysis Unit are covered by the public insurance program. The equipment needed in each Haemodialysis Unit requires an investment of 1.5 million pesos (US$82,830) and an operation room, 2 million pesos (US$165,659).

To reach people throughout Mexico, Adriana is lobbying for federal representatives to pass a bill for organ donation. The intention of the law is to make it compulsory for every hospital to be certified in organ extraction and at least one in every city must be certified for organ implants. Thus, the organ transplant infrastructure would be reinforced all over the country.

Adriana plans to increase the number of organ donations in the country, and is working on many fronts. By promoting an organ donation culture, strengthening the haemodialysis and organ transplant infrastructure in hospitals, raising funds for disadvantaged families for their operations, and changing public policies.

Adriana grew up in Los Mochis, Sinaloa, in a large, close-knit and religious family. She studied marketing in Monterrey and was a very determined and decisive student.

After Adriana married, she worked in Mexico City as a fundraiser for Fundación Teletón. Her responsibility was to secure significant sponsorship (US$350,000) from companies for the annual television program that raised funds for the construction of rehab centres for disabled children.

As a mother she was devoted to her children. Then, at the age of three, Alejandro, her second child, underwent a tonsil operation and surgical complications left him brain-dead. When told of her child’s death she was asked if she was willing to donate his organs. Her immediate reaction was to reject the idea, however, after some thought, she accepted. During Alejandro’s funeral she was informed that six children had benefited from her child’s organs.

From that moment on Adriana has devoted herself to increasing organ donation. She has dedicated many hours to studying the topic of organ donation and the laws related to it in Mexico, the U.S., and Spain. In the beginning she took advantage of the programs and media that found her story attractive to focus on promoting an organ donation culture. Later, she widened her scope to include the lack of infrastructure for organ donation.