ORGAN SHARING AMONGST CENTRES DEFINED PROTOCOLS Controversies meeting May 2011 Margaret Fourie

CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION Defined protocols:  Never been absolute  Vague system of “local first, nearest centre next”  Urgent listings  Local is lekker  Interprovincial sharing  Heart, liver and lungs the most common

CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION Referral Process  Referred to nearest provincial centre  Durban and Johannesburg equidistant to Cape Town  URGENT LISTINGS take priority  Who decides who is the most urgent?  Physicians to decide if a case is urgent. If there are 2 urgent listings, physicians are to communicate directly and decide who is to receive the organ. Closest center will win if equally urgent  Currently 4 patients on urgent heart listing

CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION URGENT LISTING - HEARTS  Currently 4 patients  3 are O group  1 is B group  B group donor in Cape Town on Berlin Heart  2 O group patients in Johannesburg  1 O group patient in Durban  WHO DECIDES AND WHAT THE PROTOCOL IS?

CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION COSTS  Air fares and private flights will increase costs  Costs increase when there are delays in the retrieval process  Donors frequently held overnight to accommodate inter-provincial harvests  Often this cannot be avoided

CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION TIME FRAMES  Excessive delays in organ acceptance  4-5 hours to accept or decline an organ is too long  AUSTRALIA AND NEW ZEALAND  30 minutes  EUROTRANSPLANT AND UNOS  60 minutes  What should our time frame be in South Africa?  Decision to accept an organ must be made within 1 hour of referral to a center

CARE | DIGNITY | PARTICIPATION | TRUTH | PASSION CONCLUSION  Defined protocols in inter-provincial referrals:  LOCAL then REGIONAL then NATIONAL referral  URGENT LISTINGS to take priority  Prioritization of urgent listed patients:  As before, Urgent takes priority, if 2 urgent, physicians to communicate directly  Principal of LOCAL, REGIONAL then NATIONAL to apply  Increased costs for inter-provincial procurements unavoidable, but delays could be reduced  Time frame should be considered to avoid unnecessary delays