Funding model of Slovenija transplant as National coordinating office, Organ exchange organisation and Competent authority Prim. Danica Avsec, M.D., Director of Slovenija Transplant Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Proverbs: A good paymaster never wants workmen. He who pays the pipper calls the tune. Money is a good servant, but a bad master. Money is not everythink.

The Republic of Slovenia $28, [12]A very high [12] Avstria Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova pmp 33pmp 14 pmp 23 PMP 27 pmp

Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova ITA 37 AUS 55 HU 67 CRO 75 SLO 140 MOL GDP mill of US(nominal) United Nations AUS 21 SLO 25 ITA 37 HU 47 CRO 113 MOL HDI0,89 high trend 0,89 0,88 0,83 0,80 0,65 medium trend 2012 EU27 SLO Moldova GDP/Health care exp9% 9% (all public) 5,4 %( public + private 12 Ne-6Ro Gross domestic product at purchasing power parity per capita (PPP), Human Development Index (HDI) composite statistic of life expectancy, education, and income

EU health care system- indicators Health expenditure /capita: 1869 Eur, EU ( 3890 Ne- 677Ro, AT 3383, IT 2282, HU 1231, CRO 1152, Practising doctors /1000: 2,4, Eu27 3,4 (6,1 GR-2,2 Po), MO 2,4, AUT 4,8, IT 3,7, HU 2,9, CRO 2,8 Hospital beds /1000: 4,6, EU27 5,3(8,3 Ge -2,7 Sw), AUT 7,6, HU 7,2, IT 3,5, CRO 5,6 Mortality rate/ : 601, EU27 664(488 Sp-970Bu), HU 898, CRO 794, AUT 563, IT 496, Mortality rate after transport traffic accident / : SLO 7,1, EU27 7,7 (3,4UK -15,1RO), CRO 10,3,HU 8,9, IT7,4, AUT6,9, Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Number of deceased donors (DBD) 2012 Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013 QAP

QAP started in 2012 Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

2012 Donor programme: pmp  23 DBD for organs  Additional 17 DCD donors for cornea  Other tissues Transplant programme: pmp  31,5 kidney  14 hearts  12 livers  2 kidney – pancreas  65 corneas Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

2012 Twinning programmes:  3 liver for small children, Italy  5 Lungs and 1 kidney for small children, Austria Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Slovenian donor programme and Slovenija transplant 10 Donor Hospitals Main Coordinating office ST- national Organ exchange organisation ST - supranational Competent authorities: ◦ For organs (MoH plus Slovenija transplant) ◦ For tissues and cells ( JAZMP plus Slovenija transplant) Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

National network Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova Donor Hospitals Transplant centres International communication via Eurotransplant Tissue typing centre Slovenija transplant

Legislative aspect 1/2 For procured/retrieved parts of the human body is not allowed any payment or other material benefits. This prohibition does not apply to the payment of medical and technical services in relation with the procured/retriveed and transplantation. Workshop on Funding Models For Deceased Donation and Transplantation / INT MARKT / April 2013, Chisinau, Moldova 12

Legislative aspect 2/2 “Donation of organs, tissues and cells in Slovenia is voluntary and unpaid”  Procurement of organs, tissues and cells carried out on non-profit way.  Advertising in relation to the donation of tissues and cells for profit and other benefits is not allowed.  Slovenia-transplant keep a central information system for tissues and cells. Workshop on Funding Models For Deceased Donation and Transplantation / INT MARKT / April 2013, Chisinau, Moldova 13

Funding of transplant medicine in SLO All transplant activities are paid by national insurance institution except Donation after death is not financed by public insurance institution The goverment decided to support the donor progamme by the national budget Is defined by the law from 2000 and also by the new draft in line with the EU Directive 2010/53 for organs Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Tasks of Slovenija transplant defined by law 2000 and current new draft DP: coordination of all institutions involved in the transplantation activities: donor centres, transplant centres, tissue typing centre DP: cooperation with related national and international transplant networks DP: promotion of donation act in public AG: keeping all the records – according to the rules AG: completion and maintenance of the central information system for the transplantation activities, TISS: to ensure the completion of the non related bone marrow register DP and AG: investigation of medical, juridical, ethical, economic and social questions in the field of transplantation activities And other activities based on statutory authorities. AG, DP: vigilanz Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Slovenija transplant programmes Donor programme Mixed issues Agencial tasks Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Agencial tasks: CA Quality Safety Legal-moral aspects Of human body parts Traceability Transparency Vigilanz system Anti trafficking programme In line with laws, directives and conventions Ethical principles Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Annual finansing is based on Ministry of health and ST On the basis of the current state budget and sum defined annually Contract Prepared by ST oficiers Controlled and accepted by Supervisory board Confirmed by the government Annual confirmation Tasks and competencies written in the SLO law Current needs in the field of transplantation EU, SLO Action plan Annual plan Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Goals for 2013/1 Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013 Following EU Action Plan Priorities  Developing donor program  Ensuring national coordination service  Developing all forms of donation of human body parts Law on the quality and safety of human organs intended for medical treatment  In cooperation with MoH  In compliance with The removal and transplantation of human body parts for the purposes of medical treatment act  Preparing corresponding regulations  Determining the role of Slovenija-transplant as authorised institution  Dividing tasks to regulatory and professional tasks Preparing regulations and effective system on control of adverse events and reactions for organs (organ-vigilance) Educating health professionals on organ donation and transplantation Organising international workshops on brain death diagnostics

Goals for 2013 Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Indexes 2012 Indexes 2012 Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013 Mesurable goals PlanReali.Index = 3/2 Number of brain death donors ,50 Number of explanted kidneys ,14 Number of explanted hearts ,43 Number of explanted livers ,71 Number of explanted lungs ,00 Number of exported organs ,00 Number of explanted corneas ,00 Number of transplanted organs in SLO ,00 Refusal ratio15%30% Number of patients on ET waiting list ,63 Number of patients on waiting list for kidney755776,00 Number of patients on waiting list for liver ,67 Number of patients on waiting list for heart ,00

Annual Budget ( 1,18 milj EUR) in the year 2012 Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Other costs: recipient side, transport Waiting list (WL) Eurotransplant fee Transport costs Procured in SLO and offered organs from ET for Slovene patients Procurement teams and coordinators working in transplant centres Education of surgical teams Promotion Non public coworkers in projects Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Other costs, sum Eur Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Competent autorithy-ST costs Competent autorithy-ST costs Human resourcesNon-eligible costs Meetings: EU, donor hospitals, Eurotransplant Maintenance and development of informatic system: software and hardware EU projects Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Slovenija transplant- sum Eur Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

TO CONCLUDE Money is important, but not the only problem which should be solved when developing transplant programme In the early beginning we need entusiasm, courage and motivation. Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013

Thank you for your attention Workshop on Funding Models for Deceased Donation and Transplantation TAIEX, Moldova 2013