Evaluation and quality control of organ transplant coordination services, transplant procurement management based on the new vital cycle

Interventions to Improve the Quality in the Organ and Tissue Donation Process

BACKGROUND

Map Interventions is capable of supporting the multidisciplinary team that works in organ and tissue donation to disseminate quality in this process.

METHODS

A scoping review study that was conducted through the steps proposed by the Joanna Briggs Institute.

RESULTS

Fifty-six studies made up the sample. 2018 (no. 07, 12.5%) had the highest number of publications. The country that published the most was the United States (no. 16, 28.56%). The database with the most publications was the Cumulative Index to Nursing and Allied Health Literature - CINAHL (no. 15, 26.78%). The most used interventions, which had the most significant impact on the improvement of results and quality, were the use of indicators in all stages of the organ and tissue donation process; the use of real goals that can be achieved; frequent audits, validation of instruments to track opportunities for improvement; as well as methodologies to implement quality and education among professionals who work in this process. Such interventions reveal important changes in the organ donation process, especially in the notification of potential and effective donors, as well as providing an opportunity for safety in the stages of the organ and tissue donation process.

CONCLUSION

The interventions tracked suggest the implementation of a set of actions formed by the continuous use of auditing, indicators, continuing education with the team that works in the process of organ and tissue donation, combined with the management of the results obtained through the indicators, where it is generated from these data, actions that have a direct impact on the weaknesses identified.

Culture change initiatives in the procurement of organs in the United kingdom

In 2004, the United Kingdom began for the first time a systematic, countrywide initiative to increase organ donations. The approach, based on international research and with consultation from the United States, entailed encouraging the early identification and referral of potential donors, training critical care physicians in breaking bad news and in collaborating with donor coordinators, training coordinators in donation conversation skills, and getting them in to speak with families. The strategy represented a large culture change in the procurement of organs in the United Kingdom and has met resistance. However, the change has started to take hold and, despite a dramatic and unexpected 21% reduction in potential brain stem death donors over a 4-year period, is showing positive results. Herein we have described the historical model for procuring organs in the United Kingdom, the development of the new strategy, its components, and the results of its implementation, in terms of earlier referrals, the identification of non-heart-beating donors, the collaboration between physicians and coordinators in speaking with families and in converted donors.

The Registry of Brain Deaths in Quality Control Program: Evaluation of Potentiality of Each Hospital in Abruzzo and Molise Regions

Quality control procedures in donation and transplantation of organ and tissue, which were started in 2001, are aspects of the activity of Regional Centre for Transplantation. Over the years there has been a significant increase in the number of diagnosed brain deaths that is close to the figure reported in the international literature of 50/60 per million inhabitants (p.m.i). Misidentification of brain death is still the most important cause of loss of organs for transplantation; in fact in Italy, there are some regions that overcome this value, but there are other regions in which the number of brain death identified is still low. Abruzzo and Molise in 2003 achieved the highest registered brain deaths (61 p.m.i.); in 2004, 51; in 2005, 43; and the projection for 2006 is about around 50. For this study we collected data from five hospitals with a neurosurgical unit, which were representative of procurement activity in two regions, because they had identified the most brain deaths, 53/65 in 2005. The data were compared among hospitals and with the Spanish country data (1999-2003), which was avant-garde for the processing of organ donation and transplantation in Europe. Some useful indices to define the theoretical capacity of donation for each hospital (ability to identify brain death, the cause of donor loss) were evaluated for determining the efficacy of the procedure in organ procurement.

Substantial Increase in Cadaveric Organ Transplantation in Greece for the Period 2001–2005

The Hellenic Transplant Organization (HTO), a nonprofit organization sector of the Greek Ministry of Health, was officially established in 1999. Since March 2001, HTO has been responsible for donation and transplantation processes in Greece and organ sharing between Greece and other European countries. The organization's main tasks are: donor referral, charting, donor assessment, organ evaluation, organ allocation and transplantation. Today, the results show increased success rates to previously believed unthinkable levels. Precisely, the percentage of referred versus used cadaveric donors increased by 468% and 134%, respectively. Cadaveric kidney transplantation has also shown remarkable progress with a 126% increase during the same period. Similarly, liver transplantation showed a threefold rise (89%) during the same time. Unfortunately, heart and lung transplantations remain low, thus preventing statistical conclusions to be drawn. Although Greece in previous years had the lowest donor and transplantation rates per million population, its position compared with other European countries is expected to rise significantly this year. Undoubtedly, the numbers and percentages compared to previous years are due to the radical changes implemented by the HTO, by introducing transplant coordination principles and procurement management, which were concepts not previously established in Greece. However, there are still major obstacles, such as intensivists' refusal to disconnect, inaccessible geographical locations, few transplant centers, and society's suspicion of organ donation concept, that still need attention. Nevertheless, the first step has been taken and other European countries standards will hopefully be attained soon.

Improving the Organ Transplantation Program in Greece: Institution of Local Transplant Coordinators’ Network

The success of a transplantation program depends upon the quality and effectiveness of the donation process, whereby the key role is assigned to the local transplant coordinator (TxC). This important professional figure was only recently established in Greece. The local TxC duties were outlined alongside those of the Hellenic Transplant Organization (HTO) foundation in 1999, whereby three different transplant coordinator positions--central, local, and clinical--were specified. In 2002, the above-mentioned positions were legally consolidated. Local TxCs had to be doctors or nurses, in a 70%-30% ratio, already working in intensive care unit (ICU) and had to be appointed by the hospital and ICU directors in each hospital as requested by the HTO. By the end of 2004, this network consisted of 122 TxCs located in 74 ICUs, especially trained in donation procedures and ethics. Half of the doctors were ICU directors, especially appointed to influence ICU personnel. Furthermore in 2005, the board of directors of HTO decided that there should be closer cooperation between the 45 most donor generating ICUs and their TxCs. It was decided that the local TxCs would work part-time and receive a monthly grant. The 45 ICU network started in 2005, resulting in an 154% increased rate of potential donor referrals and a 33% and almost 38% increase in actual donors and transplantations, respectively, compared to 2004. This substantial increase was achieved by the institution of TxC network.

Use of Quality Index in the Evaluation of Organ Procurement and Transplant Programs in a University Hospital

AIM

To evaluate organ procurement efficiency at Hospital Clinic of Barcelona (HCP), a University Hospital, in 2000 and 2003 compared with other Catalan, other Spanish, and American (US) results.

METHODS

Efficacy rate of the donor procurement was calculated per million population per year (pmp/y). Efficacy rate in kidney, liver, and heart transplantation was calculated also in pmp/y. We evaluated 1-year graft survival.

RESULTS

During this period, the average rate number of donors was 49.1 pmp/y in HCP, 38 in Catalonia, 33.4 in Spain, and 21.7 in the United States. The average rate of kidney transplantation was 74 pmp/y in HCP, 55 in Catalonia, 47 in Spain, and 24.6 in the United States. The average rate of liver transplantation was 44.5, 26.6, 23.2, and 18 pmp/y, respectively. The average rate of heart transplantation was 13.3, 8.5, 7.8, and 6.4 pmp/y, respectively. One-year graft survival in HCP was 90.6% for kidney, 89.5% for liver, and 88.2% for heart transplants.

DISCUSSION

The results show that organ procurement and transplantation programs in HCP are efficient. The organizational model is based on a hospital transplant coordinator and efficient, well-trained transplant teams.