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STRATEGIES TO INCREASE    THE NUMBER OF  DECEASED DONORS:      CURRENT STATES            &       PERSPECTIVES             ...
“We can and will succed in creating a unified,    prosperous and democratic Europe”            ROMANO PRODI
FACTORS WHICH    EFFECTIVENESS   INFLUENCEORGAN DONATION    OF THE SYSTEM                  (HEALTH & TRANSPLANT)          ...
GREAT DIFFERENCES IN HEALTHCARE ALL OVER THE WORLDMAKE VERY DIFFICULT DECEASED DONATION IN MANY COUNTRIES
OPO SYSTEM INUNITED STATES
30 DONORS PMP  20 DONORS PMP                                                   12.6          17.0  10 DONORS PMP       ...
TRANSPLANT EVOLUTION IN SPAIN SINCE THE START OF THE ONT
INCREASE OF ORGAN DONORS IN PORTUGAL      190     AFTER THE INTRODUCTION OF “IN HOUSE” 329                     MEDICAL COO...
CROATIA: A SMALL COUNTRY, 4,4 MILLIONS             WITH AN IMPRESSIVE INCREASE OF                 ORGAN DONORS LAST YEAR  ...
EVOLUTION OF ORGAN DONATION RATE IN SPAIN /                                                 REGIONS                       ...
ORGAN DONATION IN TUSCANY - ITALY                                              22,4                                       ...
*2010 data                                                         LATINAMERICAN COUNTRIES                   (545 million ...
OPTIMIZATION                         OF                    BRAIN DEATH                     DONATIONDONATION               ...
DCD DONORS IN                                                                                     SPAIN : 8,6%140         ...
Countries with reported DCD activity to the Global                     Observatory. DCD pmp. Year 2008                    ...
LIVING RENAL TRANSPLANTATION IN SPAIN250                         OBJECTIVE: > 10-15%                                      ...
BENCHMARKING    IN THE PROCESSOF ORGAN DONATION       TRANSPLANT COMMITTEE    SPANISH REGIONAL COUNCIL      Madrid, Novemb...
Benchmarking project in the donation processProposal to optimize the process of donation after braindeath: To search, iden...
Donation Process after Brain Death     Detection   Detection                         Brain death    Obtaining             ...
A NATIONAL BENCHMARKING COMMITTEE  WAS CREATED, INVOLVING ONT STAFF.REGIONAL AND HOSPITAL COORDINATORS
FIRST INDICATOR            DETECTION OUTSIDE CUINDICATOR       CU deaths with selected ICD-9 codes                        ...
SECOND INDICATOR            MANAGEMENT INSIDE CU                       (waiting for consent)INDICATOR     Brain Deaths sui...
THIRD INDICATOR               OBTAINING CONSENTINDICATOR Brain Deaths suitable for recovery WITH consent                  ...
POSSIBLE DONOR     DETECTION OUTSIDE     CRITICAL CARE UNIT                                                       TOTAL HO...
Qualitative Benchmarking  QuestionnaireDesign to identify     Best practicesand describe best       description    practic...
RECOMMENDATION   ADDRESSED TO    EXPLANATION   IT IS NOT TO DESCRIBE HOW  TO MAKE THE PROCESS, BUT  WHAT IS THE     POINT ...
9 RECOMMENDATIONS
12 RECOMMENDATIONS
9 RECOMMENDATIONS
20 RECOMMENDATIONS
AVAILABLE IN SPANISH,  ENGLISH, ITALIAN &      GERMAN
EVOLUTION OF ORGAN DONATION ACTIVITY       MONTHLY RATE 2007 - 2011
EVERY COUNTRY SHOULD MAKE A DIAGONOSISOF SITUATION AND FIND THE MOST ADEQUATE WAY         TOWARDS SELF - SUFFICIENCY      ...
Rafael Matesanz  - Spain - Monday 28 - Strategies to increase the number of cadaveric donors
Rafael Matesanz  - Spain - Monday 28 - Strategies to increase the number of cadaveric donors
Rafael Matesanz  - Spain - Monday 28 - Strategies to increase the number of cadaveric donors
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Rafael Matesanz - Spain - Monday 28 - Strategies to increase the number of cadaveric donors

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Rafael Matesanz - Spain - Monday 28 - Strategies to increase the number of cadaveric donors

  1. 1. STRATEGIES TO INCREASE THE NUMBER OF DECEASED DONORS: CURRENT STATES & PERSPECTIVES RAFAEL MATESANZ DIRECTORBUENOS AIRES 28/11/2011 ORGANIZACIÓN NACIONAL DE TRASPLANTES SPAIN
  2. 2. “We can and will succed in creating a unified, prosperous and democratic Europe” ROMANO PRODI
  3. 3. FACTORS WHICH EFFECTIVENESS INFLUENCEORGAN DONATION OF THE SYSTEM (HEALTH & TRANSPLANT) HEALTH CARE STRUCTURE (ICU BEDS / DOCTORS / NURSES …) + EPIDEMIOLOGIC DATA PREDISPOSITION OF THE POPULATION TO DONATE ORGANS
  4. 4. GREAT DIFFERENCES IN HEALTHCARE ALL OVER THE WORLDMAKE VERY DIFFICULT DECEASED DONATION IN MANY COUNTRIES
  5. 5. OPO SYSTEM INUNITED STATES
  6. 6. 30 DONORS PMP 20 DONORS PMP 12.6 17.0 10 DONORS PMP 20.8 <10 DONORS PMP 14.8 25.0 12.6 10.9 16.4 13.7 15.8 13.3 20.5 6.0 19.6 16.8 23.8 12.6 23.3 PRESENCE OF “IN HOUSE 15.9 20.5 3.3 MEDICAL COORDINATORS” 30.7 30.2 32.0 21.6 2.7 3.6 3.9DECEASED ORGAN DONORS p.m.p. 2010
  7. 7. TRANSPLANT EVOLUTION IN SPAIN SINCE THE START OF THE ONT
  8. 8. INCREASE OF ORGAN DONORS IN PORTUGAL 190 AFTER THE INTRODUCTION OF “IN HOUSE” 329 MEDICAL COORDINATORS350 35 NUMBER RATE pmp 30,4 31300 30 26,7 23,9250 21,7 22,2 25 20,2 20,1 19,1 19,5 19200 19 20 329 322150 283 15 252 217 222100 190 199 202 190 190 201 10 50 5 0 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
  9. 9. CROATIA: A SMALL COUNTRY, 4,4 MILLIONS WITH AN IMPRESSIVE INCREASE OF ORGAN DONORS LAST YEAR 135/30,7 201078/17,7 Donors Donors pmp 140 130 120 110 100 90 80 70 60 50 40 28,66 30 17,83 17,38 13,3 13,7 13,09 20 7,2 9,2 9,06 10,2 10 2,7 0 2009 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
  10. 10. EVOLUTION OF ORGAN DONATION RATE IN SPAIN / REGIONS ANDALUCIA ARAGON ASTURIAS BALEARES CANARIAS CANTABRIA CASTILLA LA MANCHA CASTILLA y LEON CATALUÑA COM. VALENCIANA EXTREMADURA GALICIA LA RIOJA MADRID MURCIA NAVARRA PAIS VASCO 80.0 70.0 60.0Donantes pmp 50.0 40.0 30.0 20.0 10.0 0.0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
  11. 11. ORGAN DONATION IN TUSCANY - ITALY 22,4 DONORS PMP 160 140 120 100 80 DONANTES p.m.p. 60 40 20 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 42,3 DONORS p.m.p.
  12. 12. *2010 data LATINAMERICAN COUNTRIES (545 million inhabitants) Deceased Kidney Liver Heart Lung Pancreas Organ Donors Transplants Transplants Transplants Transplants Transplants (Included NHBD) 10112 2168 (42.4% LD) (7.7% LD) 350 120 210 3943 *2009 data(540.9 million inhabitants) 15 %Deceased Kidney Liver Heart Lung Pancreas Organ Transplants Transplants Transplants Transplants Transplants Donors(Included NHBD) 9759 1934 (42.6% LD) (2.7% LD) 401 65 903410
  13. 13. OPTIMIZATION OF BRAIN DEATH DONATIONDONATION INCREASE AFTER OF LIVINGCARDIAC DONATION DEATH STRATEGIC PLAN 2008 SPECIAL EXPANDED SURGICAL CRITERIA TECHNIQUES DONORS
  14. 14. DCD DONORS IN SPAIN : 8,6%140 3 2.7120 2.3 2.5 Número100 1.9 1.6 2 Tasa (PMP) 1.6 1.7 80 1.3 1.5 60 130 1.1 1 108 0.9 0.9 0.9 0.8 0.8 88 1 40 76 71 0.4 49 56 0.5 20 35 35 43 36 32 32 71 18 0 0 1995 1997 1999 2001 2003 2005 2008 2010
  15. 15. Countries with reported DCD activity to the Global Observatory. DCD pmp. Year 2008 7% of Deceased Donors are DCDCanada: 1.2 Rep.Korea: 0.1United States: 2.8 Japan: 0.8 >3 pmp Singapore: 0.9 1-3 pmp < 1pmp South Africa: 0.2 Australia: 1.1 New Zealand: 0.5
  16. 16. LIVING RENAL TRANSPLANTATION IN SPAIN250 OBJECTIVE: > 10-15% 240 OF LIVING RENAL TRANSPLANTATION 235200150 156 10,7% 137100 102 87 60 61 50 35 34 22 20 19 16 15 15 20 17 1931 20% INCREASE DURING 2011 0 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009
  17. 17. BENCHMARKING IN THE PROCESSOF ORGAN DONATION TRANSPLANT COMMITTEE SPANISH REGIONAL COUNCIL Madrid, November 15th 2010
  18. 18. Benchmarking project in the donation processProposal to optimize the process of donation after braindeath: To search, identify and spread the bestpractices in the process of donation after brain deathApplication of the benchmarking methodology to the processof donation after brain death• Hospitals with best results: indicators and influencing factors (dilation elements)• Interview: best practices description
  19. 19. Donation Process after Brain Death Detection Detection Brain death Obtaining Evaluation outside CU inside CU diagnosis consent Maintenance 1 2 3 Detection of Management of Obtaining consentpossible donor the possible donor to organ donation outside CU inside CU
  20. 20. A NATIONAL BENCHMARKING COMMITTEE WAS CREATED, INVOLVING ONT STAFF.REGIONAL AND HOSPITAL COORDINATORS
  21. 21. FIRST INDICATOR DETECTION OUTSIDE CUINDICATOR CU deaths with selected ICD-9 codes x 100 Hospital deaths with selected ICD-9 codesDILATION ELEMENTS1. Neurosurgery availability in the hospital2. Stroke Unit availability in the hospital3. CU workload (bed occupancy rate)4. CU resources (number of CU beds/ assigned population) x 100.0005. (Hospital deaths with selected ICD-9 codes / asigned population) x 1.000
  22. 22. SECOND INDICATOR MANAGEMENT INSIDE CU (waiting for consent)INDICATOR Brain Deaths suitable for organ recovery waiting for consent x 100 Total Brain DeathsDILATION ELEMENTS1. Neurosurgery availability in the hospital2. CU workload (bed occupancy rate)
  23. 23. THIRD INDICATOR OBTAINING CONSENTINDICATOR Brain Deaths suitable for recovery WITH consent X 100 Brain Deaths suitable for recovery waiting for obtaining consentDILATION ELEMENTS1. % Population with african or asiatic origin2. % Population aged > 64 years3. Number of brain deaths
  24. 24. POSSIBLE DONOR DETECTION OUTSIDE CRITICAL CARE UNIT TOTAL HOSPITAL DEATHS WITH SELECTED CODESospital deaths with selected codes per population ? NO Neurosurgery ? YES Higher % Bed Occupancy Rate ? NO Stroke Unit ? YES Higher % ? YES 26% CU beds per +beds DEATHS OCCUR IN THE Higher % population CRITICAL CARE UNIT
  25. 25. Qualitative Benchmarking QuestionnaireDesign to identify Best practicesand describe best description practices DIFUSSION Best practices guidelines in theHospitals selected organ donation process On-site Best practices meetings interview Adaptation
  26. 26. RECOMMENDATION ADDRESSED TO EXPLANATION IT IS NOT TO DESCRIBE HOW TO MAKE THE PROCESS, BUT WHAT IS THE POINT / SCONSIDERED THE KEY FOR SUCCESS
  27. 27. 9 RECOMMENDATIONS
  28. 28. 12 RECOMMENDATIONS
  29. 29. 9 RECOMMENDATIONS
  30. 30. 20 RECOMMENDATIONS
  31. 31. AVAILABLE IN SPANISH, ENGLISH, ITALIAN & GERMAN
  32. 32. EVOLUTION OF ORGAN DONATION ACTIVITY MONTHLY RATE 2007 - 2011
  33. 33. EVERY COUNTRY SHOULD MAKE A DIAGONOSISOF SITUATION AND FIND THE MOST ADEQUATE WAY TOWARDS SELF - SUFFICIENCY THERE IS NOT A SINGLE WAY TO SELF SUFFICIENCY WELL PROVEN SUCCESSFUL MODELS (BIG AREAS – SUSTAINED INCREASE) SHOULD BE TAKEN AS REFERENCE

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