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Angel Piacenza  - Argentina - Monday 28 - Strategies to increase the number of cadaveric donors
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Angel Piacenza - Argentina - Monday 28 - Strategies to increase the number of cadaveric donors

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Angel Piacenza  - Argentina - Monday 28 - Strategies to increase the number of cadaveric donors Angel Piacenza - Argentina - Monday 28 - Strategies to increase the number of cadaveric donors Presentation Transcript

  • Institutional Quality Assurance Programs in Cadaveric Donors Ángel Piacenza ISODP 2011 28-11-2011
  • What are QAPs?
    • Quality Assurance Programmes (QAPs) in the DDP are defined:
      • Programmes based on a continuous and systematic evaluation of this process that are carried out fundamentally, but not exclusively, by means of self-evaluation
      • Performed by those professionals who have specific responsibilities in the DDP.
    • The overall objective of a QAPs in the DDP is to ensure continuous improvement in performance.
  • Specific Objectives of QAPs • Estimate and monitor the potential of deceased organ donation • Evaluate and monitor areas for improvement in DDP • Evaluate and monitor the effectiveness of the DDP • Analyze those hospital factors , demographic characteristics of potential donors existing practices … that have an impact on the previously mentioned areas
  • Why the need for QAPs in the DDP?
    • Kidney transplantation represents the best therapeutic option for patients with end-stage renal disease.
    • Liver, heart and lung transplantations represent an almost unique therapeutic alternative for patients with end-stage disease.
    • Pancreas and small bowel transplantation…
    • Results of organ transplantation are excellent…
      • continued improving over the years
        • advances in immunosuppression
        • acquired experience and knowledge
          • about surgical and medical procedures.
  • Why the need for QAPs in the DDP?
    • There are still many problems to be solved …
      • Recipients cardiovascular disease
      • Consequences of immunosuppression
      • SHORTAGE OF ORGANS TO COVER THE DEMAND
        • Waiting list has been progressively increasing
        • Number of donors and organs has not increased
        • Donation and transplantation activities differ among the countries ( effectiveness is highly variable )
        • Patients die while waiting for a transplant
        • Precludes physicians from including patients into the waiting list.
        • Economical consequences to the systems
        • Organ trafficking and transplant tourism
    • Deceased Donation is a Process with a set of steps:
    • DETECTION
    • IDENTIFICATION
    • ASSESSMENT
    • DONOR TREATMENT
    • DIAGNOSIS OF DEATH
    • DONATION CONSENT
    • ABLATION TEAM COORDINATION
    • CONSERVATION AND TRANSFER OF ORGANS
    • ORGAN IMPLANT
    • RELATIONSHIP WITH THE DONOR FAMILY
    • Central Role : Hospital Transplant Coordinator
    Why the need for QAPs in the DDP?
  • Why the need for QAPs in the DDP?
    • The DDP is a weak one because of its complexity.
    • Hig number of professionals from different backgrounds.
    • Potential donors may be lost during any of the different steps.
    • DDP must not be left to improvisation .
    • Professionals should be appointed with specific roles and duties.
    • DDP must be continuously evaluated in order to address performance and identify areas where improvement is possible .
    • A systematic approach to the DDP also offers the unique opportunity of identifying benchmarks.
  • Why the need for QAPs in the DDP?
    • Once identified, subsequent implementation of best practices , adapted to the local realities , might lead to a progressive improvement in performance and hence in organ donation and transplantation activities.
    • This systematic approach to the DDP is the global objective of Quality Assurance Programmes (QAPs) in the DDP.
  • 2- To provide a useful and common tool for assessing the potential of deceased donation, evaluating performance in the DDP and identifying areas for improvement. Third World Health Organization (WHO) Global Consultation on Organ Donation and Transplantation: Madrid, Spain, on March 23–25, 2010 International Organisms and QAPs
  • International Organisms and QAPs
    • Council of Europe.
    • Iberoamerican Council Network of Donation and Transplantation
    • … have recommended establishing QAPs in the DDP .
    • The creation of “Quality Improvement Programmes for organ
    • donation in every hospital where there is a potential for organ donation” has also been established as a priority action in the Action Plan prepared by the European Commission for the upcoming years 2009-2015 .
  • International Organisms and QAPs
    • Despite these recommendations and initiatives, the existence of QAPs is still limited to a few countries…
  • Potential of Donation COUNTRY, REGION, CITY DONOR HOSPITAL
  • Spanish QAPDD
    • • The creation of the Spanish QAPDD was promoted by the Spanish National Transplant Organization (ONT) in 1996 (1998)
    • Specifically focused on the process of donation after brain death
    • The program was developed to address three objectives:
      • 1) To estimate the potential of deceased donation.
      • 2) To evaluate performance in the process:
        • analyzing the reasons for losing potential organ donors
        • as a tool to identify areas for improvement
      • 3) To describe any hospital factors that have an impact on the aforementioned areas.
    • Internal Evaluation
    • Retrospective and systematic analysis of all the medical records of deaths occurred in CCUs of procurement hospitals to identify PDs.
    • Each case is then analyzed to verify whether the PD was referred to the transplant coordination team and, if not, the reasons behind this.
    • The reasons why identified PDs were not converted into actual donors are also assessed.
    • This information was appropriately collected and recorded.
    Spanish QAPDD
    • External evaluation
    • Is the most specific one , as it offers a unique opportunity to identify areas for improvement from the perspective of other professionals.
    • The external evaluation addresses three objectives:
      • 1) To verify the internal evaluation .
      • 2) To evaluate the effectiveness of the QAPDD in the procurement hospitals
      • 3) To identify areas for improvement
        • making recommendations to the local coordinators and the hospital administrators.
    Spanish QAPDD
  • Spanish QAPDD “ Men are good, but if controlled, they are better” “ Los hombres son buenos, pero si se los controla, son mejores”
  • Spanish QAPDD 131 hospitals from all Spanish regions. 96% of national actual donors.
  • Spanish QAPDD THE SPANISH QUALITY ASSURANCE PROGRAMME APPLIED TO THE PROCESS OF DONATION AFTER BRAIN DEATH: A KEY FACTOR TO IMPROVE. In Press
    • 6.8% consistent with brain death and medically suitable are not identified as PDs.
    • 10% of contraindications are considered inadequate by the auditors.
    • According to the external evaluation , the number of actual donors would be 22% higher.
    • Hence, this external evaluation approach is the gold standard in the assessment of the DDP.
    Spanish QAPDD THE SPANISH QUALITY ASSURANCE PROGRAMME APPLIED TO THE PROCESS OF DONATION AFTER BRAIN DEATH: A KEY FACTOR TO IMPROVE. In Press
  • Spanish QAPDD THE SPANISH QUALITY ASSURANCE PROGRAMME APPLIED TO THE PROCESS OF DONATION AFTER BRAIN DEATH: A KEY FACTOR TO IMPROVE. In Press
  • Europe DOPKI ( I mproving the K nowledge and P ractices in O rgan D onation)
  • Europe
  • 7 different work packages Europe
  • Europe
  • Europe
  • Europe
    • Centralist
    • Extra hospital Organization
    • Devaluation of the procurement activity
    • Gap between procurement and transplantation
    • No programs
    Previous Model to FPP FPP - Glasgow 7
    • Consider organs and tissues procurement of as a routine hospital activity
    • Greater role for Provincial Coordination
    • Creation of the Federal Transplant Committee
    • Financing system
    • Quality Control Program of the hospital procurement process
    FPP - Glasgow 7 Federal Procurement Program
    • Improve organ procurement process:
    • 100% detection of brain deaths
    • Increase the number of actual donors
    • Increase multiorgan ablation rate
    • Optimize procured organs quality
    FPP - Glasgow 7
  • FPP - Glasgow 7
    • QUALITY GUARANTEE PROGRAM IN THE DONATION TRANSPLANTATION PROCESS
    • Since September 2003
    • Part of the Procuration Federal Program.
    • All possible organ donors identified as having…
      • Glasgow Coma Scale score of 7 or below .
    • 90 hospitals covering the complete states of the country.
      • Neurosurgery Wards and ICU .
    RESULTS
  • FPP - Glasgow 7 RESULTS
  • FPP - Glasgow 7 FPP G7 14,5 DPMP 2010: highest donation rate in Latin American Countries
  • SPANISH MODEL ?? INCUCAI Prov. Coord H T C Health System Health System H T C CC AA ONT
  • FPP - Glasgow 7
    • Provide training, funding and legal regulatory framework :
    • 2003 Federal Procurement Program
      • 2003 Hospital Transplant Coordinator
      • 2003 Quality Control Program (Glasgow 7)
    • 2004 Family and Donation
    • 2004 EDHEP
    • 2006 law 26.066 (Alleged Doner)
    • 2007 Transplant Solidary Found
    • 2008 National Drug Program
    • 2008 - 2010 all programs
    Material & Methods General Programs (INCUCAI)
    • Involve responses to specific problems in the Province :
    • Presence in Intensive Care Units
    • Central Role of Hospital Transplant Coordinator
    • Improve intensive care units infrastructure
    • Reduce refusal to donation
    • Install the thematic in society - Media , internet, education.
    • Transplant program development
    Material & Methods Local Strategies
    • Involve responses to specific problems in the Province :
    • Presence in Intensive Care Units
    • Central Role of Hospital Transplant Coordinator
    • Improve intensive care units infrastructure
    • Reduce refusal to donation
    • Install the thematic in society - Media , internet, education.
    • Transplant program development
    Material & Methods Local Strategies
    • Once identified, subsequent implementation of best practices , adapted to the local realities , might lead to a progressive improvement in performance and hence in organ donation and transplantation activities.
  • Results Increasing Brain Death Detection
    • Improving Family Approach
    • 26.066 Law (Alleged Donor) as a useful tool
    Results Reducing Refusal to Donation
  • Results Anual Organ Donors
  • Results Period Average Donor THC FPP 26.066 Law All Programs P<0.01 P<0.01 P<0.01
    • Data derived from the Spanish QAPDD , provides essential information to design tailored strategies .
    • Countries should foster the development of Programs of this nature .
    • If built with a common methodology , there would be the additional benefit of a better understanding of differences in performance across countries and room for international benchmarking.
    CONCLUSIONS
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