Martin Torres - Argentina - Monday 28 - Management and organization models for donation and transplantation A challenge for healthcare systems

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  • Thank you chairman, Dr. Rafael Matesanz (Rafa), Dr. Gunter Kirste; Dr. Raul Mizraji Ladies a gentlemen Its an honor for me to represent the Latin american & the Caribbean region in this lecture. a region which has made significant progress in recent times
  • First , I wanna show you this huge and rich region, 21 different countries integrate it, mainly Spanish speaking, but keep in mind that Brazil is the largest and most populous country . Also, the difference is shown with the Donor rate, wich goes from 1.1 to 14.5 per million inhabitants. For the first time ever Argentina has the first position, Very close to Uruguay, with 14.4, was top one for many year, as shown in the latest iberoamerica Transplante 2011 newsletter.
  • In the first issue of International Newsletter with actvity data of 2003, you can see, that few countries have their transplantation numbers. And comparing with last slide some countries have almost duplicated their donation rate.
  • This slide show us the transplantation activity in latin american countries, around 10 thousands kidney transplants,.
  • And these are european union data with 18 thousand kidney transplants, almost the same inhabitants, double in donor number.
  • This slide shows that there are more kidney transplants in the region of the Americas (by WHO) with a higher percentage of living donor.
  • Here, you can see, the number of livers tránsplantated per WHO region
  • Here Kidney transplant rate in Latin american region, all its types. Also There are wide differences from 1.7 to 27.4, in this case uruguay has the highest number
  • As in the rest of the world this region has the same challenges concérning Organ Donation &Transplantation. as you can see organ shortage leads to Disparity between supply and demand, which in turn leads to Greater morbidity and mortality on waiting list …so patients have to look for other options, some of them are not ethical, like transplant tourism
  • As we have already mentioned in the previous slide, Donation and Transplantation in Latin american and the caribbean countries exhibit impórtant differences among them: Variability in donation rates after death, Differences in mortality rates, Differences in organizátional approach, Different level of devélopment in living donor transplantation. Different supply of transplant services, Differences in transplant accessilbilty.
  • In brief we could say that Kidney Transplant is performed in most countries. Specific types of organ transplant (such as heart, lung, liver and pancreas) are not aváilable in many countries. Low organ recovery per donor. Lack of expertise in donor detection and donor maintenance. unmet basic health needs. Liver And Intrathoracic transplants are not considered a priority.
  • We Don’t have to forget the usefulness of diferent inernational references, like the following:…..
  • Its important to highlight the 3 rd, WHO Global Consultation on Organ Donation and Transplantation: Striving to achieve self-sufficiency. these issues were widely discussed in 8 working groups with representatives of many countries around the world, Latin americans inclusive. These topics are:…. Asséssing needs for transplant System requeriments Meeting needs through donation Monitoring outcomes Fostering professional ownership in the ED y ICU The role of public health and society Ethics Measuring Progress
  • In This Scheme of the Madrid resolution, I would like to remark the importance of national accóuntibilities, like the chronic disease, oportunities for health care, capácities, striving to achieve self suffiency.
  • Now, I will tell you how do we work in Latin America. There is not only one model in transplant coordination. Certainly donation and transplantation are included in the appointment book of the ministers of health. There are specific transplant public health policies on curse, adequate legal and ethical framework, and tendency to presumed consent by the law .
  • In many latin american countries we have created and powered the national transplant organization, we´ve established the transplant coordination networks, the insertion of hospital coordination teams, and quality assurance programs. in some countries we are installing a new way of work: The donor hospital strategy. Every health worker (phisicians and nurses) should know how potencial donor may become a utilized donor.
  • We also are improving the accéss to waiting list, a better public transplant supply, better funding for transplant surgery and immunosuppréssive therapy. Also Registry and traceability from Donor to Recipient (SINTRA). And the Follow up of Living Donor.
  • Furthermores We are on doing in….
  • The foreing transplant percentage in colombia decreased from 16.5 to 1.3 percent by 2005 2010. this was mentioned in a report of Dr Chapman of transplant tourism.
  • This wasn’t an easy path, we are talking about around 20 years of work, in early times spain´s contribution was a key factor for the devélopment of Latin American transplantation. These Milestones were: Proyecto Siembra, two edition in (1994-1995) thanks to Spain. The born of Grupo Punta Cana in (2001) in the dominican republic The Iberoamerican council on donation and transplantation from (2005) Iberoamerican Society of Transplant Coordinators (2007) Originated as from the punta cana group
  • This slide shows proyecto siembra flyer; this project was a Master on Transplant Management . It was in 1994 y 1995, with 30 latin american schloars of 20 countries.
  • In this slide we can see teachers and fellows of the sixth edition of Master Alianza, more participants and fewer time than Projecto siembra
  • Here is the Declaration of Punta Cana, It was signed in june 18, 2001. somebody are here
  • This is the Grupo punta Cana webpage.
  • The iberoamerican council was created in October 2005 by minister of health conference in Granada, and ratified by presidents a month later. The First session in 2005 in Mar del Plata. 21 countries and related Scientific Societies, PAHO, EC. Every country has an official delegate appointed by their corresponding Ministers of Health. Proposes recommendations concerning all issues inherent in organ donation and transplantation in the region.
  • The latest issue of the Newsletter Trasplante iberoamerica, every recommendations are published in printed and digital version
  • First iberoamerican council meeting in Mar del Plata, Argentina, in 2005 and, the last reunion in Cartagena Colombia in march this year, with the congress of the STALYC. These two photos show over time. In the foreground, Dr. Carlos Soratti, the congress chair, where are you, Thanks to you I'm giving this lecture . I am so happy.
  • here, so you can see different kinds of international cooperation between countries in the region…
  • For example….. And the firs meeting of Argentine society of transplant coordinators.
  • Id like to point out the importance of data registries: they are: Latin America Transplantation Stalyc registry Punta cana Group data base, every contries input their self data. Global Observatory of WHO and ONT, all of them have information on donation and transplantion activities in an only database. Some of them publish these data in an excellent newsletter printed or virtual version like we see in other slide.
  • Pioneer data base on D & T, very good job of the transplantation society of Latin American and the Caribbean. Thanks to Valter.
  • As a consequence of all this we have witnessed an increase in the donor rate from 2001 to 2008.
  • Then, the kidney transplant number has increased too. More than 9000 in 2008.
  • In this slide I want to speak about The Mercosur CIDT Venezuela currently is In process to becoming a member state. They work toghether on common projects which are manifested in binding Agreements Acts.
  • Based on that analisys we well design policies to improve the population´s coverage
  • Proposes agreement acts. An example of this is shown here. Act number 10 slash 10. Here is in portughese. this congress was declared of regional interest and it recommended health ministers its difusion and to urge the attendance of health care profesionals. This agreement has been signed by the Ministers of Health of Brazil, Paraguay, Uruguay, Chile and Argentina
  • I do not want to forget of donasur…in construction.
  • Thanks Ines alvarez for this beatiful slide. Actions speak loader than words. Take home message. Cooperation to achieve self suffiency.

Transcript

  • 1. Management and Organization Models for Donation and Transplantation: A Challenge for Healthcare Systems Martín Torres Vicepresident INCUCAI Latin America and the Caribbean Region
  • 2. COOPERATION
    • Latina america map newsletter
    Latin America and the Caribbean Newsletter Trasplantes Iberoamerica 2011
  • 3. Newsletter Transplant 2004
  • 4.  
  • 5.  
  • 6. Global observatory on Donation & Transplantation (WHO-ONT)
  • 7. Global observatory on Donation & Transplantation (WHO-ONT)
  • 8. Newsletter Transplantes Iberoamerica 2011
  • 9. Organ Donation and Transplantation: Common Problems Organ Shortage Disparity between supply and demand Greater morbidity and mortality on waiting list Patients then resort to other options Unrelated Living Donor Transplant Tourism
  • 10.
    • Donation and Transplantation in Latin American and Caribbean countries exhibit important differences among them :
    • Variability in donation rates after death
    • Differences in mortality rates
    • Differences in organizational approach
    • Different level of development in living donor transplantation
    • Different supply of transplant services
    • Differences in transplant accessibility
    Characteristics of the Latin American and the Caribbean Region
  • 11.
    • Kidney Transplant is performed in most countries.
    • Specific types of organ transplant (such as heart, lung, liver, pancreas) are not available in many countries.
    • Low organ recovery per donor.
    • Lack of expertise in donor detection and donor maintenance.
    • Unmet basic health needs.
    • Liver and Intrathoracic transplants are not considered a priority.
    Characteristics of the Latin American and the Caribbean Region
  • 12. International References
    • WHO Guiding principles on Human Cell, Tissue and Organ Transplantation (WHA 63.22, May 2010)
    • EU Directive: Standars of quality and safety of Human Organs intended for transplantation. (2010/45, july 2010)
    • Declaration of Istanbul on Organ Trafficking and Transplant Tourism (2008)
    • Madrid Resolution on Organ Donation and Transplantation.(2010)
    • RCIDT Recommendations.
    • MERCOSUR Agreement Acts.
    • Spanish Good Practice Guidelines in the Process of Organ Donation. (2011)
  • 13.
    • Assessing needs for transplantation
    • System requeriments
    • Meeting needs through donation
    • Monitoring outcomes
    • Fostering professional ownership in the ED y ICU
    • The role of public health and society
    • Ethics
    • Measuring Progress
    3 rd WHO Global Consultation on Organ Donation and Transplantation: Striving to achieve self-sufficiency
  • 14.  
  • 15.
    • Not only one model.
    • Inclusion of D &T in the appointment book of the Ministers of Health.
    • Public Health Polices.
    • Adequate legal and ethical framework.
    • Tendency to presumed consent.
    Latin American Transplant Coordination Model
  • 16. Latin American Transplant Coordination Model
    • Creation or strengthening of national transplant organization.
    • Establish of Trasplant Coordination Networks.
    • Insertion of hospital coordinator.
    • Hospital Coordination Team.
    • Quality Assurance Programs. (Audit)
    • “ Donor Hospital strategy”.
  • 17.
    • Better access to waiting list.
    • Better public transplant supply.
    • Funding for transplant surgery and immunosuppressive therapy.
    • Registry and traceability from Donor to Recipient (SINTRA).
    • Follow up Living Donor.
    Latin American Transplant Coordination Model
  • 18.
    • Training (Transplant coordinators, EDHEP, Transplant teams, Management on Process on D&T).
    • Chronic Deceased Registries. (Dialysis Registry)
    • Integration with preventive medicine and primary health care.
    • Recommendations, Protocols and Guidelines. (Good Practice)
    Latin American Transplant Coordination Model
  • 19.  
  • 20. Cooperation Step by step
    • Milestones:
    • Proyecto Siembra (1994-1995) ONT
    • Grupo Punta Cana (2001)
    • RCIDT (2005)
    • Iberoamerican Society of Transplant Coordinators (2007)
    • Master Alianza
  • 21. Proyecto Siembra 94-95
  • 22. 2 EDICIONES: 1994 - 1995
    • 30 PARTICIPANTES
    • PATROCINIO:
      • FIS
      • FUNDACION MERIEUX
      • FRIAT
    Proyecto Siembra
  • 23.  
  • 24.  
  • 25. http://www.grupopuntacana.org/
  • 26. Latin America and the Caribbean
    • The Ibero American Donation and Transplantation Council (RCIDT).
    • First session in 2005 in Mar del Plata.
    • 21 countries and related Scientific Societies, PAHO, EC.
    • Every country has an official delegate appointed by their corresponding Ministers of Health.
    • Proposes recommendations concerning all issues inherent in organ donation and transplantation.
    RCIDT
  • 27.  
  • 28. Cartagena 2011 Mar del Plata 2005
  • 29.
    • Specific reciprocity agreement betwen countries: Organ interchange, and lung, small bowel and pediatric liver Transplant: Uruguay - Argentina
    • International training Courses:
      • Transplant Coordinators: basic and advanced (TPM, Spain)
      • Communication in Critical Situations. (Spain, Argentina, Dominican R.)
      • Postgraduate Course: Uruguay-Chile
    • Scientific and Technological Development: Uruguay - Venezuela
    • FoAr (Argentina Horizontal Cooperation Fund) Foreign Affairs Ministry: Paraguay, Bolivia and Ecuador.
    • With the support of the Professional Societies: AAPROTT, SUPRO, AMCOT, STALYC, SAT.
    International Cooperation
  • 30. 1º Congreso AAPROTT Carlos Paz Córdoba - 2003
  • 31. International Registries
    • Latin America Transplantation Registry (STALYC)
    • Punta Cana Group Data Base
    • Global Observatory on Donation and Transplantation (WHO & ONT)
    • IRODaT : International Registry on Donation and Transplantation (ETCO – TPM)
    • DONASUR (MERCOSUR)*
  • 32. www.stalyc.net
  • 33. Actual Deceased Organ Donors in Latinoamerica Anual Rate p.m.p
  • 34. Deceased Donors Kidney Transplant & Living Kidney Transplant
  • 35. CIDT
    • Intergovermental Commission of Donation and Transplantation from the Joint Ministers of Health
      • Member Countries: Paraguay, Uruguay, Brazil and Argentina. *Venezuela.
      • Associated Countries: Bolivia, Chile, Colombia, Peru y Ecuador.
      • Observer Country: Mexico
  • 36.
    • Objectives:
    • Cooperation in technical training of human resources.
    • Development of Cost Analisys: for Dialysis, Transplant surgery; immunosuppressive treatment and recipient follow-up.
    • Proposal of quality and safety common standards for the donation and trasplantation process.
    • Fight off Transplant Tourism.
    • Development of a Regional Donor Registry of Hematopoietic Stem Cells.
    Regions within the LA Region
  • 37. Brasilia, Brazil: 2010 RMS/Agreement Act Nº 10/10
  • 38. Donasur
    • Mercosur Donation and Transplantation Registry
    • Objectives:
    • To know and share information about Donation and Trasplantation activity of the Region.
    • To allow analysis of the activity and decision making.
    • To harmonize local registries.
    • To contribute with the battle against Transplant Tourism and the organ trade.
    • To Achieve donation - transplantation process traceability.
  • 39. I.N.D.T. Cooperation to achieve self-sufficiency Countries, sub-regions, regions, globe
  • 40. Buenos Aires, November 18 - 20 Welcome and enjoy the congress!