Organ donation and transplantation framework

1. The Portuguese Framework
“Why Portugal is having so many
organ donors?”
Ana França,MD
National Transplant Coordinator
18/10/2018

2. Portugal
IRODaT - International Registry
on Organ Donation.(aug 2017)
Portugal (1,34 ihab.)
53 Donor Hospitals
WORLDWIDE ACTUAL DECEASED
ORGAN DONORS 2017 (pmp)
NEWSLETTER
TRANSPLANT

3. NEWSLETTER
TRANSPLANT
0
10
20
30
40
50
60
70
80
90
2014 2015 2016 2017
70,7
79,7
83,6 86,8
Transplants pmp

4. Concepts !
11/10/2018 4

5. 2008 Main driving Change!
55
90
103
141138
158
189
150
182
206
215
205
165
190194
202
217
190
222
190
200
252
283
329323
301
252
0
50
100
150
200
250
300
350
1
9
8
6
1
9
8
8
1
9
9
0
1
9
9
2
1
9
9
4
1
9
9
6
1
9
9
8
2
0
0
0
2
0
0
2
2
0
0
4
2
0
0
6
2
0
0
8
2
0
1
0
2
0
1
2
Authority for Blood and Transplantation 1 Transplant
Coordinator
Instituto Português do Sangue e da Transplantação, IP
Regulation body related to the
Ministry of Health
1 Donor
Coordinator
Organ donation
Hospital Donor
Coordinator

6. Hospital Donation Coordinator
N=53, 77% intensivists ,mean age 45
Under direct
Supervision of the
Clinical Diretor of
the hospital
Supervision of
the National
Donation
Coordinator
Legislation
For Donation and transplantations responsbilities with
job descriptions and definition of Network

7. Deceased Organ Donors
194
202
217
190
222
190
200
252
283
329323
301
252
294
289
319
337
351
0
50
100
150
200
250
300
350
400
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8
2
0
0
9
2
0
1
0
2
0
1
1
2
0
1
2
2
0
1
3
2
0
1
4
2
0
1
5
2
0
1
6
2
0
1
7
National
Transplant
Coordinator
Responsible for the
network, strategic
planning, policies,
regulation
Instituto Português do Sangue e da Transplantação, IP
Portuguese Institute for
Blood and Transplantation

8. Altruistic population
Legislation
Procurement and
Transplantation Network
HOSPITAL BASED
• Opting out system – 1993
• Registry for Non Donors -1994
• Brain Death certification – 1994
• DCD, Maastritch II - 2013

9. Opting Out System
National Registry for NON DONORS since
1994
Objective
• the right to oppose the donation.
• Thus the will of the citizen is assured
and to this effect is obtained by
regular campaigns
• It is considered that only information
and enlightenment allows choice in
consciousness.
Legislation
if you donate your
organs someone
will say
But no
one is
obliged
to be a
donor
Thank You

10. Legislation/
Regulation
üEU Directives- transposed to Portuguese law
üRecommendations and resolutions apllied
üRegulatory procedures
üAudit – quality indicators ODEQUS (tbd)

11. Possible Donors
Detection
Potential Donor
Treatment
Procurement
Framework
Public and Private Hospital
Only Public Hospitals

12. Local
• Hospital
Donor
Coordinator
• Detection and
evaluation of
organ and
tissue donors
• Intra-hospital
organizational
measures
• Promotion of
donation
Regional
• Procurement
Team
• Logistic support
for retrieval and
transplantation
National Donation and Transplantation Framework
Transplantation
Centres
•Surgical Team
•Medical Team
National
•National
Transplantation
Coordinator
•Strategic
development
policy
•Organizational
measures
•Promotion of
donation

13. HLA LAb
Transplant
Units
4
x
1 x
3 x
2 x
8 x
National
Transplant
Coordnination
Procurement
OPO
Tissue
Bank
Tissues
Cells
National Framework for Donation and Transplantation
Portuguese
Air Force
Traffic
Police
National
Emergency
Institute
Cedace
BPCCU

14. Health and
Consumers
EU28
2016
122
%
Portugal
2016
148
%
Portugal
Ageing index
17/02/2018
Resident population
Actual
10,273,512
http://www.pordata.pt/en/Portugal
10,33
45,4
101,6
125,8
148,7
0,0
20,0
40,0
60,0
80,0
100,0
120,0
140,0
160,0
9,40
9,60
9,80
10,00
10,20
10,40
10,60
10,80
1981 2001 2011 2016
Population (Millions)
Elderly per 100 young
people

15. Communication / Network / News
Training
Registries
Regulation
ortuguese trategies
Stakeholders Engagement

16. Portuguese strategies
Training

17. 2 1 0 3 3 2 0 3 2 2 2 4 2 4 4 3 4
48
51
0
42
0
29
45
27
0
50
15,9
18,9
15
18,2
20,5
21,4
20,5
16,7
19,1 19,5
20,2
21,7
19
22,2
18
19
23,9
26,7
3130,4
28,4
23,9
27,8 27,7
30,9
32,6
34
5
10
15
20
25
30
35
40
0
10
20
30
40
50
60
70
80
1991
1996
2001
2006
2011
2016
Trainees Deceased Donors pmp
Organ Donation vs TPM Trainees
ASST IPST
OPT
2017
Training

18. National
Transplant
Coordinator
5
Regional
OPO
Stakeholders Engagement
Transplantation Centres
Heart -4
Liver -3
Pancreas -2
Lung -1
Kidney - 8
Hospital
Coordination
Donor Hospitals
Hospital
Coordination
Hospital
Coordination
Hospital
Coordination
Hospital
Coordination
Hospital
Coordination
HLA LAb
Tissue
Bank
Ministry of Health National Health
System

20. Portuguese strategies
Registries
web based

22. 22
Data Transparency Monitoring
NHS-
Transplants
https://www.sns.gov.pt/monitorizacao-do-sns/doacao-e-transplantacao-de-orgaos-2/

23. a. Expand The Influences Intensive Care
b. Set Ventilation strategies
c. Disseminate Concept Of Death Brain
Increase The
Number Of
Possible
Donors
a. Teams: Medical
and of Nursing
b. Need Vs
Availability
c. Respect The
Methodologies and
the Best Practices
Set And Implement
Concept Of Team of
donation
Actions Of Training
a. Motivate
b. Leadership
c. Innovation
Evaluate And
Audit

24. Deceased Organ Donation
2007 -2017
194
202
217
190
222
190
200
252
283
271
323
301
252
295 289
319
327
330
10
21
170
190
210
230
250
270
290
310
330
350
370
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8
2
0
0
9
2
0
1
0
2
0
1
1
2
0
1
2
2
0
1
3
2
0
1
4
2
0
1
5
2
0
1
6
2
0
1
7
DBD DCD
Portugal

25. What is really important?
• Key persons
• Legislation
• Framework
• Training
http://www.dticommunity.org/web/form/

26. Figure 10: The Model for Improvement
What are we trying to
achieve?
How will we know that
change is an
improvement?
What changes can we
make that will result in
improvement?
do
study
plan
act
do
study
plan
act
The aim should be clear, focussed and based
upon real and important problems. It should
measurable and, where relevant, in line with
national targets.
Any intervention should be designed in such a
way that its impact can be accurately
measured. Monitoring arrangements need to
be agreed before the change idea is
introduced.
Change ideas may come from many sources,
and are most likely to succeed when they
concentrate on the patient rather than the
various teams involved in the pathway.
The PDSA cycle is a controlled test of a
change idea that should provide a quick
assessment of whether the idea will be
effective or not.
3.1 What are we trying to achieve?

27. Thank you
Portugal
ana.franca@ipst.min-saude.pt