The Role of Coordinators Throughout the European Union
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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
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…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“.
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…the role of Coordinators throughout the EU !
Why do we have this presentation ?
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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 !
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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
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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
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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
/ Effo
rt / Inp
ut
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.
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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 !
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Third WHO Global Consultation on Organ Donation and Transplantation organised by the WHO, TTS and ONT in Madrid, March 2010
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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
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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.
*
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Hospital Protocol Policies: TC activation
PROTOCOL ON TREATMENT AND MANAGEMENT OF NEUROCRITICAL PATIENTS GCS <8
A&ENRLNRS±ICU
FOLLOW-UP PROTOCOL OF PATIENTS WITH GCS<8
TC ACTIVAT
ION
BRAIN DEATH DONATION PROTOCOL
BD DIAGNOSIS ALGORITHM
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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
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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.)
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Corporate Social Responsibility
Hospital Vision
Health careProfessionals
Mission
HospitalVision
PreventionTreatment
EducationDeceased Donation
Death referrals for Organ & Tissues Donation
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1993: Jochen is waiting for a heart…
2014 he isstill alive…
Success of the professional role as coordinator:
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…the role of Coordinators throughout the world !
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