This document discusses strategies to improve tissue donation rates in Europe. It notes that tissue transplantation has not followed the same patterns as organ transplantation. The role of Tissue Coordinators is currently limited and cadaveric tissue donation could be increased by better integrating tissue establishments and transplant coordinators into the donor detection process at hospitals. Establishing a specific role of Tissue Transplant Coordinator may help maximize the number of potential tissue donors.

1. Tissue donors. Strategies to improve tissue donors.
Europe
Jacinto Sánchez Ibáñez
Director of the Regional Transplant Office in Galicia. Spain

2. Donation rate
35
30
Donor detection
1996 1997 1998 1999 2000 2001 2002 2003
2004 2005 2006 2007 2008 2009
25
20
15
10
5
0
USA CAN AUS POL GRE ITA SWI HUN UK POR SK FRA ESP

3. 1. Has tissue transplantation followed the same pattern?
2. Are there any international figures ?
3. What should be the optimal rate?
4. What is the role of the TC?

4. BACKGROUND
RD 411 /1996:
•Law for human cells and tissues
•Has taken some elements from organ legislation
•Authorization for each of the phases
Extraction/procurement:
Processing: Tissue Banking
Implantation/clinical use

5. RD 411/1996
Human tissue Extraction/procurement/retrieval Centers :
“The obligation to maintain a permanent link with a TC team”
Centers that use human tissues:
“The obligation to maintain a permanent link with a TC team”
European Directive of Human Tissues (2004/23/EC)
Transposition with the same philosophy: major role of TC

6. •In many countries TCs do not consider Human Tissues as part
of their job
•In Spain the role of Tissue Transplant Coordinator does not
exist
•Most of the tissue donors are organ donors

7. Forensic department
Hospital
USA 90 % USA 2 %
Spain 99,5 % Donor Spain 0,1 %?
Funeral home
Morgue

8. Hospital units with possible tissue donors:
1. Emergency
2. Coronary department
3. Cardiology
4. ICU
5. Reanimation
6. Internal medicine unit

10. •All the organ donors should be tissue donors as well
•And the rest??
CHUAC Lugo
1718 deaths 1193 deaths
324 potentials 141 potentials
• < 75 years • < 75 years
• NO HIV, hepatitis B y C, no sepsis • NO HIV, hepatitis B y C, no sepsis
100 possibles 50 possibles
CIEs9 codes

13. Human tissue recipients. Spain
14000 amniotic membrane vessels Heart valves Skin Cornea Bone
12000
10000
8000
6000
4000
2000
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

14. Human tissue recipients
350 vessels
Heart valves
Skin
300
250
200
150
142
100
56
50
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

15. Hospital Son Llatzer (Mallorca)
300 hospital beds
16-18 ICU beds
200,000 inhabitants
Activity began in 2002.
Tissue detection donors.
 cornea.
 Cord Blood Units.
 Hematopoietic stem cells .
 Bones. 2010.
Organ donors transferred to Hospital Son
Espases
 Nurses.
 To help nurses from the transplant coordination
unit.
 Computer program.
 Online Access from outside the Hospital

16. Protocol to detect cornea and bone donors
In the event of any exitus, the nurse responsible for the patient:
 Performs the initial donor selection
 Age >75 years.
 Infection VIH-VHB-VHC.
 Leukemias and Lymphomas.
 Chronic hemodialysis
 Inputs the case in the computer program.

17. Computer program
The computer program
sends a SMS to the TC’s
mobile. He can access the
clinical history of the
patient from his house
using a secure connection

18. Tissue donors
Family refusal 25-30 %
Cornea Bones
50 Automatic phone call
45
45
40
35 35
35
30 Direct phone call
25 22 23 22
20 19
20 18
15
15
10
6
5 4
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 oct-11

19. •Sensitivization to donation: thanksgiving event, letters
•Local coordination centers, hospital operators: be part
of the team
•Education: course “Tissue donation and the role of
morgue’s operator
•Physician in charge of recovery: change the relationship
•On call/front desk operators

21. Tissue donor
• Limited involvement of the TC in human tissues.
• Limited relation beteween Tissue establishment and TC.
• Perception of need. Waiting list.
• Increase cadaveric tissue donors.
• Be part of the exitus circuit.
• Tissue transplant Coordinator ?