the role of coordinators throughout the european union carl-ludwig fischer-fröhlich, stuttgart,...
TRANSCRIPT
The Role of Coordinators Throughout the European Union
Carl-Ludwig Fischer-Fröhlich, Stuttgart, Germany
Thank you to the support of supportof all coordinators with in Europe
…the role of Coordinators throughout the EU !
EU-Recommendation (2005) 11 of the Committee of Ministers to member states on the role and training of professionals responsible for organ donation(transplant „donor co-ordinators“)
„…should be appointed in every hospital with intensive care unit“.
…the role of Coordinators throughout the EU !
Why do we have this presentation ?
Patient withend of life care:• donor detection• death confirmed• consent• donor evaluation
Allocation (rules)organ exchange
Organ recovery
Donor Hospital(ED/ICU)
Donor & organCharacterisation
Organ procurementorganisation
Organ exchangeorganisation
Waiting list
Transplantation-unit
Recipient
Transplantation
Rehabilitationfollow up
Transport 4°C
24h/365d Supportin all of these tasks!
…the role of Coordinators throughout the EU !
Consensus in 27 countries about:
• Organ donors with risk factors: - Infections - malignancy - rare diseases - poisoning
• vigilance (SAR / SAE)
• WHO-Pathway organ donation*
= EU-directive 2010/53/EU put to life
Inclusion criteria for organ donors
*see: Good Practice Guidelines in the process of organ donation, ONT, Madrid, 2011, www.ont.es
67 years SAH• ICU = 17 days• ALAT = 91 IU/l• BMI = 35 kg/m²• paO2/FIO2= 134
Example: Is this liver suitable for transplantation?
• Diabetes Typ II• Hypertension• Tetanus as child• anti-HBc +, HBsAg -
Careful examination at recovery + biopsy + care for HBV-transmission
5% macrovesiuclar steatosis,slight choelstasis, slight cholangitis
More organs transplanted after your contribution at the donor hospital !
Be aware of your efforts:
0
100
200
300
400
500
600
0 2 4 6 8 10
Costs
/ Eff
ort /
Inpu
t
donationignored
85 yrs.ICB
20 yrs.trauma
Example
Case
Effort within healthcare system
45 yrs.SAH
Is this safe?
We discuss this question tomorrow : “Expanding the donor pool: ECD and DCD practices”
…because without donors we can not discuss this.
Patient withend of life care:• donor detection• death confirmed• consent• donor evaluation
Allocation (rules)organ exchange
Organ recovery
Donor Hospital(ED/ICU)
Donor & organCharacterisation
Organ procurementorganisation
Organ exchangeorganisation
Waiting list
Transplantation-unit
Recipient
Transplantation
Rehabilitationfollow up
Transport 4°C
24h/365d Supportin all of these tasks!
…the role of Coordinators throughout the EU !
Third WHO Global Consultation on Organ Donation and Transplantation organised by the WHO, TTS and ONT in Madrid, March 2010
A person with a devastating brain injury or lesion and apparently medically suitable for organ donation
Possible donor
A person whose clinical condition is suspected to fulfil brain death criteria
Potential donor
A medically suitable person who has been declared dead based on neurologic criteria as stipulated by the law of the relevant jurisdiction
Eligible donor
A consented eligible donor in whom an operative incision was made with the intent of organ recovery………
Actual donor
Brain Death
diagnosisGCS < 8
FOLLOW UP
DONOR EVALUATION
DONOR MANAGEMENT
CONSENT TX TEAM COORDINATION
The critical pathway for deceased donation: reportable uniformity in the approach to deceased donation.
Transplant International 24 (2011):373-378
Inside the ICU
Outside the ICU
Internal Audit at an German hospital
Audit period: April 2010 - September 2011 (national In-house project) Cases
Deceased patients with severe cerebral lesions 256 (100%)
* Absolute Contraindication 88 (34,4%)
* Not ventilated 0 h 61 (23,8%)
* DSO as OPO contacted prospectively 23 (9,0%)
Review of death records 84 (32,8%)
Brain death diagnostics started 24 (9,4%)
* death confirmed (Refusal or contraindication) 12 (4,7%)
* death not confirmed (Refusal, contraindication, not brain dead !) 12 (4,7%)
Died without brain death diagnostics 60 (23,4%)
* Brain death could not have been certified 47 (18,4%)
* Brain death certification should have been initiated 13 (5,1%)
Observation beyond study protocol: Sometimes evolution to brain death was not considered during withdrawl of live sustaining therapy. Therfore concluisons were impossible.
*
Hospital Protocol Policies: TC activation
PROTOCOL ON TREATMENT AND MANAGEMENT OF NEUROCRITICAL PATIENTS GCS <8
A&E
NRL
NRS
±ICU
FOLLOW-UP PROTOCOL OF PATIENTS WITH GCS<8
TC ACTIVAT
ION
BRAIN DEATH DONATION PROTOCOL
BD DIAGNOSIS ALGORITHM
Organisation and involvement:
It is imperative to involve all services which take care of patients with severe cerebral lesions to develop, implement and spread this protocol
Treatment
Protocol of
severe cerebral lesions
PROMOTION, TRAINING AND EDUCATION
MULTIDICIPLINARY
PROCESS
(not only TC)
OPTION within END-OF-LIFE
CARE
Accepted reason for admission in
ICU
TC have to develop courses, promotion and education related to donation and transplant targeted ICU-staff (MD, nurses et al.) and other external services which treat such patient (neurology, neurosurgery etc.)
Corporate Social Responsibility
Hospital Vision
Health careProfessionals
Mission
HospitalVision
PreventionTreatment
EducationDeceased Donation
Death referrals for Organ & Tissues Donation
1993: Jochen is waiting for a heart…
2014 he isstill alive…
Success of the professional role as coordinator:
…the role of Coordinators throughout the world !