1. Strategies to Improve Tissue Donors
Tissue Donors: Current Situation in Brazil
Rosana Reis Nothen, MD
Coordinator of Central de Transplantes do Rio Grande do Sul - BRAZIL

2. 2
Newsletter Red Consejo Latinoamericano, Nov 2011

3. Tissue Transplantation in Brazil
Corneal Tx
ME
Skin
3
RBT/ABTO, 3 T/2011

4. CONCENTRATE IN STATES OF SOUTH AND SOUTHEAST
4

5. Marks of Tissue Transplantation
in Brazil
• Corneal Transplantation – 1954 NO WAITING LIST CORNEA
• Eye Bank - 1964
• Muscle Skeletal Bank – 80’s
• National Transplantation Authority – 1997 (create by Federal Law 9434/970)
• Professionalization of Corneal Transplantation – 1998 26000 PATIENTS
CORNEA
• Skin Bank- 2000
• Professionalization of Eye Banks – 2000
• Cord Blood Bank- 2001
• Professionalization of MS tissue Bank – 2002
• Professionalization of Skin Bank – 2009 23000 PATIENTS WAITING LIST
CORNEA
• NEW INFORMATION MANAGEMENT TOOL AND $ IMPROVEMENT
• 2011 10000 PATIENTS CORNEA
• Multi-tissue Bank - None to date
• Amniotic Membrane – Only clinical research
5

6. Social and Economic Issues
GDP Tx Budget
2000 1,18E+12 U$ 100 million
2009 3,14E+12 U$ 800 million
2010 3,35E+12 U$ 880 million
↑ 184% 794%
4,3 X
SNT, 04/2011

7. Social and Economic Issues
• The decentralization, equal access and universal
coverage are constitutional principles.
• Full coverage by public health system – SUS
(Sistema Único de Saúde) – includes donation
and procurement, preoperative, surgical, and
post, including immunosuppressive therapy
when necessary, for almost all modalities.
• Donation and procurement are exclusively paid
by the public system.
• Allocation is a governmental duty.
7

9. Dental X Orthopedic Use of MS Grafts
18000
16000
14000
12000
10000 16781 DENTAL ALLOGRAFT
8000 14793
ORTHOPEDIC ALLOGRAFT
6000
4000
2000 1937
403 297 51
115 815
0
SP PR RJ BRAZIL
9

10. Authorization
Strategic Planning National Transplantation
Board Authority Technical/Scientific
Grupo de Assessoramento Sistema Nacional de Boards
Estratégico Transplantes (by Organ/Tissue)
GAE
SNT
National Transplantation
Office
Central Nacional de Transplantes
CNT
25 State Offices
Centrais de Notificação
Captação e Distribuição de
de Órgãos e Tecidos
CNCDO
Transplant Coordinators
OPOs Comissões Intra-Hospitalares
Organizações de de Doações de Órgãos e
Procura de Órgãos Tecidos para Transplantes / CIHDOTT
Transplant Teams (by Organ/Tissue)
Equipes, Estabelecimentos de Saúde
Transplantadores de Órgãos e
Tecidos
National Sanitary Authority
Agência Nacional de Vigilancia Sanitária Tissue Banks (by Tissue or Multi)
ANVISA
ONLY HOSPITALAR

11. Concerns…
• The public system doesn’t achieve the control
on the allocation except traceability.
• Except for ocular tissue, we lack established
criteria for allocation.
• The esthetic over the functional use of the
tissue.
• The need of a especific systemic tool to control
the process.
• Although the sanitary control of the bank is
regularly done, the process of donor selection is
scarcely monitored.
11

12. Concerns…
• The public system doesn’t achieve the control
on the allocation except traceability.
• Except for ocular tissue, we lack established
criteria for allocation.
• The esthetic over the functional use of the
tissue.
• The need of a especific systemic tool to control
the process.
• Although the sanitary control of the bank is
regularly done, the process of donor selection is
scarcely monitored.
12

13. Concerns…
• The public system doesn’t achieve the control
on the allocation except traceability.
• Except for ocular tissue, we lack established
criteria to allocation.
• The esthetic over the functional use of the
tissue.
• The development of a systemic tool to control
the process.
• Although the sanitary control of the bank is
regularly done, the process of donor selection is
scarcely monitored.
13

14. Concerns…
• The public system doesn’t achieve the control
on the allocation except traceability.
• Except for ocular tissue, we lack established
criteria to allocation.
• The esthetic over the functional use of the
tissue.
• The development of a systemic tool to control
the process.
• Although the sanitary control of the bank is
regularly done, the process of donor selection is
scarcely monitored.
14

15. Concerns…
• The public system don’t achieve the control on
the allocation except traceability.
• Except for ocular tissue, the lack of established
criteria to allocation.
• The esthetic over the functional use of the
tissue.
• The development of a systemic tool to control
the process.
• Although the sanitary control of the bank is
regularly done, the process of donor selection is
scarcely monitored.
15

16. 16

17. The Role of the OPO
TX TEAM
TC
TC
TX TEAM
TC TISSUE BANK
OPO
TC
TX TEAM
TC TX TEAM
TC TC TC
OPO
OPO
TC
STATE/REGIONAL OFFICE TC
TC
TX TEAM OPO
TX TEAM NATIONAL
TC EXTRACTION
TEAM TC
OFFICE
TC
TC 17

18. Development Policy
• Funding the implementation 10 new banks
or improvement of the already existing
– Priority to states that do not have a bank
– U$ 1.000.000,00 for inversion
– Mandatory be a center of hemotherapy or a
public teaching hospital
– Focus on Multi-tissue
• Supporting the processes for quality control
• Training human resources

19. Development Policy
• Funding the implementation 10 new banks
or improvement of the already existing
– Priority to states that do not have a bank
– U$ 1.000.000,00 for inversion
– Mandatory be a center of hemotherapy or a
public teaching hospital
– Focus on Multi-tissue
• Supporting the processes for quality control
• Training human resources

20. Development Policy
• Funding the implementation 10 new banks
or improvement of the already existing
– Priority to states that do not have a bank
– U$ 1.000.000,00 investment
– Mandatory be a center of hemotherapy or a
public teaching hospital
– Focus on Multi-tissue
• Supporting the processes for quality control
• Training human resources

21. Development Policy
• Funding the implementation 10 new banks
or improvement of the already existing
– Priority to states that do not have a bank
– U$ 1.000.000,00 for inversion
– Mandatory being a center of hemotherapy or a
public teaching hospital
– Focus on Multi-tissue
• Supporting the processes for quality control
• Training human resources

22. Development Policy
• Funding the implementation 10 new banks
or improvement of the already existing
– Priority to states that do not have a bank
– U$ 1.000.000,00 for inversion
– Mandatory be a center of hemotherapy or a
public teaching hospital
– Focus on Multi-tissue
• Supporting the processes for quality control
• Training human resources

23. Development Policy
• Funding the implementation 10 new banks
or improvement of the already existing
– Priority to states that do not have a bank
– U$ 1.000.000,00 for inversion
– Mandatory be a center of hemotherapy or a
public teaching hospital
– Focus on Multi-tissue
• Supporting the processes for quality control
• Training human resources

24. Development Policy
• Funding the implementation 10 new banks
or improvement of the already existing
– Priority to states that do not have a bank
– U$ 1.000.000,00 for inversion
– Mandatory be a center of hemotherapy or a
public teaching hospital
• Focus on Multi-tissue
• Supporting the processes for quality control
• Training human resources

25. Training Human Resources
• 3 (total 150 participants) editions of Course
Ibero-American for Control of Gestion of Quality
in Activities Related to Human Tissues
• Enfasis on Tissue Donor in courses for training
Transplant Coordinators
• QUALIDOTT – Project for partnership with
Universities and Scientific Societies regarding
the human resources in donation, procurement
and transplants
• Tax breaks in return for investiment in this
matter by private hospitals
25

28. Training Human Resources
• 3 (total 150 participants) editions of Course
Ibero-American for Control of Gestion of Quality
in Activities Related to Human Tissues
• Enfasis on Tissue Donor in courses for training
Transplant Coordinators
• QUALIDOTT – Project for partnership with
Universities and Scientific Societies regarding
the human resources in donation, procurement
and transplants
• Tax breaks in return for investiment in this
matter by private hospitals
28

29. Training Human Resources
• 3 (total 150 participants) editions of Course
Ibero-American for Control of Gestion of Quality
in Activities Related to Human Tissues
• Enfasis on Tissue Donor in courses for training
Transplant Coordinators
• QUALIDOTT – Project for partnership with
Universities and Scientific Societies regarding
the human resources in donation, procurement
and transplants
• Tax breaks in return for investiment in this
matter by private hospitals
29

30. PROJETO DE QUALIFICAÇÃO EM CAPACITAÇÃO NA PROCURA DE ÓRGÃO E TRANSPLANTES
Curso Duração Mês 1 Mês 2 Mês 3 Mês 4 Mês 5 Mês 6 Mês 7 Mês 8 Mês 9 Mês 10
Curso de Capacitação para Coordenadores Intra-
Hospitalares de Transplantes / Simulação Realística 40h Turma 1 Turma 2 Turma 3 Turma 4 Turma 5 Turma 6 Turma 7 Turma 8 Turma 9 Turma 10
(Módulo presencial)
Curso de Capacitação em Extração Multiorgânica 16h Turma 1 Turma 2 Turma 3 Turma 4 Turma 5
Curso de Capacitação/Módulos Avançados:
Comunicação de Más Notícias 20h Turma 1 Turma 2 Turma 3 Turma 4 Turma 5
Diagnóstico de Morte Encefálica 20h Turma 1 Turma 2 Turma 3 Turma 4 Turma 5
Avaliação do Doador 20h Turma 1 Turma 2 Turma 3 Turma 4 Turma 5
Manutenção do Doador 20h Turma 1 Turma 2 Turma 3 Turma 4 Turma 5
Curso de Gestão da Qualidade em Doação para
20h Turma 1 Turma 2 Turma 3 Turma 4 Turma 5 Turma 6 Turma 7 Turma 8 Turma 9 Turma 10
OPO e CIHDOTT
Curso de Capacitação em Bancos de Tecidos 25h Turma 1
Curso de Capacitação em Banco de Tecido Ocular
24h Turma 1 Turma 2 Turma 3 Turma 4 Turma 5 Turma 6 Turma 7 Turma 8 Turma 9
Humano (BTOH)
Curso de Formação de Formadores:
Módulo EAD 60h Turma 1
Universidade de Barcelona - Projeto TPM 24h Turma 1
Curso de Formação em Doppler Transcraniano
para Neurointensivistas e Neurologistas:
Módulo EAD xxx Turma 1 Turma 2 Turma 3 Turma 4 Turma 5
Módulo Presencial xxx Turma 1 Turma 2 Turma 3 Turma 4 Turma 5
Cursos EAD de sensibilização:
Coordenador Intra-Hospitalar de Transplantes 20h Turma 1 Turma 2 Turma 3 Turma 4 Turma 5 Turma 6 Turma 7 Turma 8 Turma 9 Turma 10
Banco de Tecidos Humanos 40h Turma 1 Turma 2 Turma 3 Turma 4 Turma 5 Turma 6 Turma 7 Turma 8 Turma 9 Turma 10
Diagnóstico de Morte Encefálica 20h Turma 1 Turma 2 Turma 3 Turma 4 Turma 5 Turma 6 Turma 7 Turma 8 Turma 9 Turma 10
Estágio para formação de transplantadores, voltado
para cirurgiões especializados em cirurgia torácica e 12 meses 20 vagas com Bolsa Integral
digestiva
Residência Multidisciplinar em Transplantes 12 meses 100 profissionais
Master Alianza em Doação e Transplante de Órgãos,
60 dias 5 Bolsas Integrais
Tecidos e Células

31. Training Human Resources
• 3 (total 150 participants) editions of Course Ibero-
American for Control of Gestion of Quality in
Activities Related to Human Tissues
• Enfasis on Tissue Donor in courses for training
Transplant Coordinators
• QUALIDOTT – Project for partnership with
Universities and Scientific Societies regarding the
human resources in donation, procurement and
transplants
• Policy of tax breaks in return for investiment in this
matter by private and acreditate hospitals (Einstein e
Sirio Libanês)
31

32. THANK YOU!
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