Strategies to increase the number of cadaveric donors Introducing the concept of in house coordination Prof. Dr. Günter Kirste
Critical pathways for organ donation* POSSIBLE DECEASED ORGAN DONOR A patient with a devastating brain injury or lesion OR a patient with circulatory failure AND apparently medically suitable for organ donation Donation after Circulatory Death (DCD) Treating physician to identify/refer a potential donor Donation after BrainDeath (DBD) POTENTIAL DCD DONOR POTENTIAL DBD DONOR A. A person whose circulatory and respiratory Reasons why a potential donor A person whose clinical condition is suspected to functions have ceased and resuscitative does not become a utilized donor fulfill brain death criteria. measures are not to be attempted or continued. System or • Failure to identify/refer a potential or eligible donor B. A person in whom the cessation of circulatory • Brain death diagnosis could not be confirmed and respiratory functions is anticipated to occur within a time frame that will enable organ (e.g. does not fulfill criteria) or completed recovery. (e.g. lack of technical resources or clinician to make diagnosis or perform confirmatory tests) • Circulatory death not declared within the appropriate time frame. ELIGIBLE DBD DONOR ELIGIBLE DCD DONOR • Logistical problems (e.g. no recovery team) A medically suitable person who has been A medically suitable person who has been • Lack of appropriate recipient (e.g. child, blood declared dead based on the irreversible absence declared dead based on neurologic criteria as type, serology positive) of circulatory and respiratory functions as stipulated by the law of the relevant jurisdiction. stipulated by the law of the relevant Donor/Organ jurisdiction, within a time frame that enables • Medical unsuitability (e.g. serology positive, neoplasia) organ recovery. • Haemodynamic instability / unanticipated cardiac arrest ACTUAL DBD DONOR ACTUAL DCD DONOR • Anatomical, histological and/or functional A consented eligible donor: A consented eligible donor: abnormalities of organs A. In whom an operative incision was made A. In whom an operative incision was made • Organs damaged during recovery with the intent of organ recovery for the with the intent of organ recovery for the • Inadequate perfusion of organs or thrombosis purpose of transplantation. purpose of transplantation. Permission and/or and/or B. From whom at least one organ was B. From whom at least one organ was • Expressed intent of deceased not to be donor recovered for the purpose of transplantation. recovered for the purpose of transplantation. • Relative’s refusal of permission for organ donation • Refusal by coroner or other judicial officer to allow donation for forensic reasons UTILIZED DBD DONOR UTILIZED DCD DONOR An actual donor from whom at least one organ An actual donor from whom at least one organ was transplanted. was transplanted.*The “dead donor rule” must be respected. That is, patients may only become donors after death, and the recovery of organs must not cause a donor’s death .
In house coordinationDSO finances a pilot project for in-house-coordinationin university hospitals and hospitals with neurosurgical ICU’s Basic Principles of the Spanish Model •Adequate legal and technical background -------------------------------------------------------------- •Transplant coordination network •Special profile of the three levels of TC •Hospital coordinators inside the hospitals •Central Office: ONT - Support Agency •Continuous brain death audit •Hospital reimbursement •Great effort in medical training •Much attention to the mass media
In house coordinationPilot project in adaption of the „Spanish Model“Target Hopitals:University HopitalsHospitals with neurosurgical ICU In-house-coordination includes: Analysis of donor potential (quarterly evaluation) Identification of possible donors DSO Development and Implemantation of Standard Operating Procedures (SOP)Hospital Training of hospital staff In-house-coordination is done by:100 % ICU-physicians
In house coordination in detail:Profil: Target hospitals appoint physicians on ICU in charge of in-house- coordination Appointed physicians must proof special knowledge in organ donation (e.g. Curriculum for organ donation for key donation figures ” developed by DSO in cooperation with the German Medical Association)Reporting: Hospital reports quarterly about performance of in-house-coordination.Hospital-reimbursement: 800 € for the task of in-house-coordination for the hospital that ensures that this money benefits the physicians in charge
SOP (Standard Operation Procedure)Development and Implemantation of Standard Operating Procedures (SOP) togetherwith DSO Coordinators and inclusion of contact persons from the hospital 1 2 3 4 5
Analyse-Tool „Transplant – Check“ Screenshot for installation Bildschirm zur Aktualisierung der Filterdateien
„Transplant-Check“ – Filtered Data List of all cases with: 1. Reason for release = Death and 2. ICD 10-Codes that possibly lead to brain death Contradindications for donation are highlighted = relative CI = absolute CI