Institutional Quality Assurance Programs in Cadaveric Donors Ángel Piacenza  ISODP 2011  28-11-2011
What are QAPs? <ul><li>Quality Assurance Programmes (QAPs) in the DDP  are defined:  </li></ul><ul><ul><li>Programmes base...
Specific Objectives of   QAPs •  Estimate  and monitor  the potential  of deceased organ donation •  Evaluate  and monitor...
Why the need for QAPs in the DDP? <ul><li>Kidney transplantation  represents the  best therapeutic option  for patients wi...
Why the need for QAPs in the DDP? <ul><li>There are still  many problems to be solved … </li></ul><ul><ul><li>Recipients c...
<ul><li>Deceased Donation is a Process with a set of steps: </li></ul><ul><li>DETECTION   </li></ul><ul><li>IDENTIFICATION...
Why the need for QAPs in the DDP? <ul><li>The  DDP is a weak one  because of its  complexity. </li></ul><ul><li>Hig number...
Why the need for QAPs in the DDP? <ul><li>Once identified,  subsequent implementation of best practices ,  adapted to the ...
2- To provide a  useful and common tool  for  assessing the potential  of deceased donation, evaluating performance  in th...
International Organisms  and  QAPs  <ul><li>Council of Europe. </li></ul><ul><li>Iberoamerican Council Network of Donation...
International Organisms  and  QAPs  <ul><li>Despite these recommendations and initiatives,  the existence of QAPs is still...
Potential of Donation COUNTRY, REGION, CITY DONOR HOSPITAL
Spanish  QAPDD <ul><li>• The creation of the  Spanish QAPDD  was promoted by the Spanish National Transplant Organization ...
<ul><li>Internal Evaluation </li></ul><ul><li>Retrospective and systematic analysis of all the medical records  of deaths ...
<ul><li>External evaluation </li></ul><ul><li>Is the most specific one , as it offers a unique opportunity to  identify ar...
Spanish  QAPDD “ Men are good, but if controlled, they are better” “ Los hombres son buenos, pero si se los controla, son ...
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 ...
<ul><li>6.8%  consistent with brain death and medically suitable  are not identified as PDs. </li></ul><ul><li>10%  of con...
Spanish  QAPDD THE SPANISH QUALITY ASSURANCE PROGRAMME APPLIED TO THE PROCESS OF DONATION AFTER BRAIN DEATH: A KEY FACTOR ...
Europe  DOPKI  ( I mproving the  K nowledge and  P ractices in  O rgan  D onation)
Europe
7 different work packages Europe
Europe
Europe
Europe
<ul><li>Centralist </li></ul><ul><li>Extra hospital Organization </li></ul><ul><li>Devaluation of the procurement activity...
<ul><li>Consider  organs and tissues procurement  of as a  routine hospital activity </li></ul><ul><li>Greater role for  P...
<ul><li>Improve organ procurement process: </li></ul><ul><li>100% detection  of brain deaths </li></ul><ul><li>Increase  t...
FPP - Glasgow 7 <ul><li>QUALITY GUARANTEE PROGRAM IN THE DONATION TRANSPLANTATION PROCESS </li></ul><ul><li>Since  Septemb...
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
<ul><li>Provide training, funding and legal regulatory framework : </li></ul><ul><li>2003   Federal Procurement Program </...
<ul><li>Involve responses to specific problems in the Province : </li></ul><ul><li>Presence in Intensive Care Units </li><...
<ul><li>Involve responses to specific problems in the Province : </li></ul><ul><li>Presence in Intensive Care Units </li><...
Results  Increasing Brain Death Detection
<ul><li>Improving Family Approach </li></ul><ul><li>26.066 Law (Alleged Donor) as a useful tool </li></ul>Results  Reducin...
Results  Anual Organ Donors
Results     Period Average Donor THC FPP 26.066 Law All Programs P<0.01 P<0.01 P<0.01
<ul><li>Data derived from the  Spanish QAPDD , provides  essential information  to  design tailored strategies . </li></ul...
IBERÁ: second largest Freshwater   Reserve in the world CORRIENTES
 
Tidelands  and Lagoons
 
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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

  1. 1. Institutional Quality Assurance Programs in Cadaveric Donors Ángel Piacenza ISODP 2011 28-11-2011
  2. 2. What are QAPs? <ul><li>Quality Assurance Programmes (QAPs) in the DDP are defined: </li></ul><ul><ul><li>Programmes based on a continuous and systematic evaluation of this process that are carried out fundamentally, but not exclusively, by means of self-evaluation </li></ul></ul><ul><ul><li>Performed by those professionals who have specific responsibilities in the DDP. </li></ul></ul><ul><li>The overall objective of a QAPs in the DDP is to ensure continuous improvement in performance. </li></ul>
  3. 3. 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
  4. 4. Why the need for QAPs in the DDP? <ul><li>Kidney transplantation represents the best therapeutic option for patients with end-stage renal disease. </li></ul><ul><li>Liver, heart and lung transplantations represent an almost unique therapeutic alternative for patients with end-stage disease. </li></ul><ul><li>Pancreas and small bowel transplantation… </li></ul><ul><li>Results of organ transplantation are excellent… </li></ul><ul><ul><li>continued improving over the years </li></ul></ul><ul><ul><ul><li>advances in immunosuppression </li></ul></ul></ul><ul><ul><ul><li>acquired experience and knowledge </li></ul></ul></ul><ul><ul><ul><ul><li>about surgical and medical procedures. </li></ul></ul></ul></ul>
  5. 5. Why the need for QAPs in the DDP? <ul><li>There are still many problems to be solved … </li></ul><ul><ul><li>Recipients cardiovascular disease </li></ul></ul><ul><ul><li>Consequences of immunosuppression </li></ul></ul><ul><ul><li>SHORTAGE OF ORGANS TO COVER THE DEMAND </li></ul></ul><ul><ul><ul><li>Waiting list has been progressively increasing </li></ul></ul></ul><ul><ul><ul><li>Number of donors and organs has not increased </li></ul></ul></ul><ul><ul><ul><li>Donation and transplantation activities differ among the countries ( effectiveness is highly variable ) </li></ul></ul></ul><ul><ul><ul><li>Patients die while waiting for a transplant </li></ul></ul></ul><ul><ul><ul><li>Precludes physicians from including patients into the waiting list. </li></ul></ul></ul><ul><ul><ul><li>Economical consequences to the systems </li></ul></ul></ul><ul><ul><ul><li>Organ trafficking and transplant tourism </li></ul></ul></ul>
  6. 6. <ul><li>Deceased Donation is a Process with a set of steps: </li></ul><ul><li>DETECTION </li></ul><ul><li>IDENTIFICATION </li></ul><ul><li>ASSESSMENT </li></ul><ul><li>DONOR TREATMENT </li></ul><ul><li>DIAGNOSIS OF DEATH </li></ul><ul><li>DONATION CONSENT </li></ul><ul><li>ABLATION TEAM COORDINATION </li></ul><ul><li>CONSERVATION AND TRANSFER OF ORGANS </li></ul><ul><li>ORGAN IMPLANT </li></ul><ul><li>RELATIONSHIP WITH THE DONOR FAMILY </li></ul><ul><li>Central Role : Hospital Transplant Coordinator </li></ul>Why the need for QAPs in the DDP?
  7. 7. Why the need for QAPs in the DDP? <ul><li>The DDP is a weak one because of its complexity. </li></ul><ul><li>Hig number of professionals from different backgrounds. </li></ul><ul><li>Potential donors may be lost during any of the different steps. </li></ul><ul><li>DDP must not be left to improvisation . </li></ul><ul><li>Professionals should be appointed with specific roles and duties. </li></ul><ul><li>DDP must be continuously evaluated in order to address performance and identify areas where improvement is possible . </li></ul><ul><li>A systematic approach to the DDP also offers the unique opportunity of identifying benchmarks. </li></ul>
  8. 8. Why the need for QAPs in the DDP? <ul><li>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. </li></ul><ul><li>This systematic approach to the DDP is the global objective of Quality Assurance Programmes (QAPs) in the DDP. </li></ul>
  9. 9. 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
  10. 10. International Organisms and QAPs <ul><li>Council of Europe. </li></ul><ul><li>Iberoamerican Council Network of Donation and Transplantation </li></ul><ul><li>… have recommended establishing QAPs in the DDP . </li></ul><ul><li>The creation of “Quality Improvement Programmes for organ </li></ul><ul><li>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 . </li></ul>
  11. 11. International Organisms and QAPs <ul><li>Despite these recommendations and initiatives, the existence of QAPs is still limited to a few countries… </li></ul>
  12. 12. Potential of Donation COUNTRY, REGION, CITY DONOR HOSPITAL
  13. 13. Spanish QAPDD <ul><li>• The creation of the Spanish QAPDD was promoted by the Spanish National Transplant Organization (ONT) in 1996 (1998) </li></ul><ul><li>Specifically focused on the process of donation after brain death </li></ul><ul><li>The program was developed to address three objectives: </li></ul><ul><ul><li>1) To estimate the potential of deceased donation. </li></ul></ul><ul><ul><li>2) To evaluate performance in the process: </li></ul></ul><ul><ul><ul><li>analyzing the reasons for losing potential organ donors </li></ul></ul></ul><ul><ul><ul><li>as a tool to identify areas for improvement </li></ul></ul></ul><ul><ul><li>3) To describe any hospital factors that have an impact on the aforementioned areas. </li></ul></ul>
  14. 14. <ul><li>Internal Evaluation </li></ul><ul><li>Retrospective and systematic analysis of all the medical records of deaths occurred in CCUs of procurement hospitals to identify PDs. </li></ul><ul><li>Each case is then analyzed to verify whether the PD was referred to the transplant coordination team and, if not, the reasons behind this. </li></ul><ul><li>The reasons why identified PDs were not converted into actual donors are also assessed. </li></ul><ul><li>This information was appropriately collected and recorded. </li></ul>Spanish QAPDD
  15. 15. <ul><li>External evaluation </li></ul><ul><li>Is the most specific one , as it offers a unique opportunity to identify areas for improvement from the perspective of other professionals. </li></ul><ul><li>The external evaluation addresses three objectives: </li></ul><ul><ul><li>1) To verify the internal evaluation . </li></ul></ul><ul><ul><li>2) To evaluate the effectiveness of the QAPDD in the procurement hospitals </li></ul></ul><ul><ul><li>3) To identify areas for improvement </li></ul></ul><ul><ul><ul><li>making recommendations to the local coordinators and the hospital administrators. </li></ul></ul></ul>Spanish QAPDD
  16. 16. Spanish QAPDD “ Men are good, but if controlled, they are better” “ Los hombres son buenos, pero si se los controla, son mejores”
  17. 17. Spanish QAPDD 131 hospitals from all Spanish regions. 96% of national actual donors.
  18. 18. Spanish QAPDD THE SPANISH QUALITY ASSURANCE PROGRAMME APPLIED TO THE PROCESS OF DONATION AFTER BRAIN DEATH: A KEY FACTOR TO IMPROVE. In Press
  19. 19. <ul><li>6.8% consistent with brain death and medically suitable are not identified as PDs. </li></ul><ul><li>10% of contraindications are considered inadequate by the auditors. </li></ul><ul><li>According to the external evaluation , the number of actual donors would be 22% higher. </li></ul><ul><li>Hence, this external evaluation approach is the gold standard in the assessment of the DDP. </li></ul>Spanish QAPDD THE SPANISH QUALITY ASSURANCE PROGRAMME APPLIED TO THE PROCESS OF DONATION AFTER BRAIN DEATH: A KEY FACTOR TO IMPROVE. In Press
  20. 20. Spanish QAPDD THE SPANISH QUALITY ASSURANCE PROGRAMME APPLIED TO THE PROCESS OF DONATION AFTER BRAIN DEATH: A KEY FACTOR TO IMPROVE. In Press
  21. 21. Europe DOPKI ( I mproving the K nowledge and P ractices in O rgan D onation)
  22. 22. Europe
  23. 23. 7 different work packages Europe
  24. 24. Europe
  25. 25. Europe
  26. 26. Europe
  27. 27. <ul><li>Centralist </li></ul><ul><li>Extra hospital Organization </li></ul><ul><li>Devaluation of the procurement activity </li></ul><ul><li>Gap between procurement and transplantation </li></ul><ul><li>No programs </li></ul>Previous Model to FPP FPP - Glasgow 7
  28. 28. <ul><li>Consider organs and tissues procurement of as a routine hospital activity </li></ul><ul><li>Greater role for Provincial Coordination </li></ul><ul><li>Creation of the Federal Transplant Committee </li></ul><ul><li>Financing system </li></ul><ul><li>Quality Control Program of the hospital procurement process </li></ul>FPP - Glasgow 7 Federal Procurement Program
  29. 29. <ul><li>Improve organ procurement process: </li></ul><ul><li>100% detection of brain deaths </li></ul><ul><li>Increase the number of actual donors </li></ul><ul><li>Increase multiorgan ablation rate </li></ul><ul><li>Optimize procured organs quality </li></ul>FPP - Glasgow 7
  30. 30. FPP - Glasgow 7 <ul><li>QUALITY GUARANTEE PROGRAM IN THE DONATION TRANSPLANTATION PROCESS </li></ul><ul><li>Since September 2003 </li></ul><ul><li>Part of the Procuration Federal Program. </li></ul><ul><li>All possible organ donors identified as having… </li></ul><ul><ul><li>Glasgow Coma Scale score of 7 or below . </li></ul></ul><ul><li>90 hospitals covering the complete states of the country. </li></ul><ul><ul><li>Neurosurgery Wards and ICU . </li></ul></ul>RESULTS
  31. 31. FPP - Glasgow 7 RESULTS
  32. 32. FPP - Glasgow 7 FPP G7 14,5 DPMP 2010: highest donation rate in Latin American Countries
  33. 33. SPANISH MODEL ?? INCUCAI Prov. Coord H T C Health System Health System H T C CC AA ONT
  34. 34. FPP - Glasgow 7
  35. 35. <ul><li>Provide training, funding and legal regulatory framework : </li></ul><ul><li>2003 Federal Procurement Program </li></ul><ul><ul><li>2003 Hospital Transplant Coordinator </li></ul></ul><ul><ul><li>2003 Quality Control Program (Glasgow 7) </li></ul></ul><ul><li>2004 Family and Donation </li></ul><ul><li>2004 EDHEP </li></ul><ul><li>2006 law 26.066 (Alleged Doner) </li></ul><ul><li>2007 Transplant Solidary Found </li></ul><ul><li>2008 National Drug Program </li></ul><ul><li>2008 - 2010 all programs </li></ul>Material & Methods General Programs (INCUCAI)
  36. 36. <ul><li>Involve responses to specific problems in the Province : </li></ul><ul><li>Presence in Intensive Care Units </li></ul><ul><li>Central Role of Hospital Transplant Coordinator </li></ul><ul><li>Improve intensive care units infrastructure </li></ul><ul><li>Reduce refusal to donation </li></ul><ul><li>Install the thematic in society - Media , internet, education. </li></ul><ul><li>Transplant program development </li></ul>Material & Methods Local Strategies
  37. 37. <ul><li>Involve responses to specific problems in the Province : </li></ul><ul><li>Presence in Intensive Care Units </li></ul><ul><li>Central Role of Hospital Transplant Coordinator </li></ul><ul><li>Improve intensive care units infrastructure </li></ul><ul><li>Reduce refusal to donation </li></ul><ul><li>Install the thematic in society - Media , internet, education. </li></ul><ul><li>Transplant program development </li></ul>Material & Methods Local Strategies <ul><li>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. </li></ul>
  38. 38. Results Increasing Brain Death Detection
  39. 39. <ul><li>Improving Family Approach </li></ul><ul><li>26.066 Law (Alleged Donor) as a useful tool </li></ul>Results Reducing Refusal to Donation
  40. 40. Results Anual Organ Donors
  41. 41. Results Period Average Donor THC FPP 26.066 Law All Programs P<0.01 P<0.01 P<0.01
  42. 42. <ul><li>Data derived from the Spanish QAPDD , provides essential information to design tailored strategies . </li></ul><ul><li>Countries should foster the development of Programs of this nature . </li></ul><ul><li>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. </li></ul>CONCLUSIONS
  43. 43. IBERÁ: second largest Freshwater Reserve in the world CORRIENTES
  44. 45. Tidelands and Lagoons

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