Tasks and responsibilities of the German organ procurement organization DSO Technical Assistance for Alignment in Organ Donation 1st International Symposium.

Slides:



Advertisements
Similar presentations
Midlands Collaborative, November 2012 Timely Identification and Referral of Potential Organ Donors Paul Murphy National Clinical Lead for Organ Donation.
Advertisements

THE PATIENT’S JOURNEY TO TRANSPLANT AND BEYOND
LEGAL ISSUES IN AUTHORIZATION FOR ORGAN DONATION IN MISSOURI & KANSAS Laurence R. Tucker November 18, 2011.
You have the power to Donate Life!. 20 people Every day nearly 20 people will die waiting for a life-saving organ transplant. The national waiting list.
FAMILY APPROACH 2nd part: REQUEST FOR ORGAN DONATION Danica Avsec, MD Key expert for Education and Communication Technical Assistance for Alignment in.
Donation Process: Preparing for the Gift Breakout Session A Presenters: Jennifer Do, RN, Unit Director, Surgical Transplant ICU, Ronald Reagan UCLA Medical.
Organ Donation End of Life care in the Operating Room Matthew Bock Surgical recovery coordinator University of Wisconsin Organ Procurement Organization.
Donation After Cardiac Death May 26, 2010 Margie Whittaker, RN MSN.
Nevada Donor Network The Donation Process. Who is Nevada Donor Network (NDN)? Federally designated, not-for-profit organ, tissue, and eye procurement.
Organ Donation & Transplantation in Ireland – Changing times Aileen Counihan Transplant Co-ordinator Beaumont Hospital Beaumont Hospital.
1st Internatonal symposium, Istanbul May Ethical and legal issues in Deceased organ donation – a birds eye view Michael Bos 1 st International.
DANICA AVSEC, MD KEY EXPERT FOR EDUCATION AND COMMUNICATION COMMUNICATION STRATEGY Technical Assistance for Alignment in Organ Donation project, 1st International.
Chapter 11-Death and Dying
Tasks and responsibilities of the German organ procurement organization DSO Technical Assistance for Alignment in Organ Donation 1st International Symposium.
Transplantology in the Małopolska voivodship. Analysis of results from a pilot project conducted by the Statistical Office in Krakow. Anna Jasiówka Centre.
The Recipient Experience Jaime Myers, RN, MSN, CCTC April 29, 2011.
Centers of Excellence Monterey Bay Public Employees Trust Centers of Excellence 2014 Centers of Excellence are selected after careful review by.
ORGAN DONATION By: Aubree Malone. “When you’re not an organ donor when you die, you’re taking a lot of people with you.”
DR NIRANJAN P DR K LAKSHMAN DR M S SRIDHAR AUDIT ON DISCHARGE SUMMARIES.
The Role of Coordinators Throughout the European Union Carl-Ludwig Fischer-Fröhlich, Stuttgart, Germany Thank you to the support of support of all coordinators.
Organ & Tissue Donation
Top 5 OPTN Policy Violations
Needlestick injuries and the introduction of a safety cannulae in a Dublin Teaching Hospital Elaine Dunne Clinical Nurse Manager 2 Occupational Health.
Todd Franzen, MPA Community Relations Team Leader.
ONELEGACY AND CORONER’S CASES Christopher Rogers, M.D. Los Angeles County Coroner.
Taskforce Implementation – Progress and Results Chris Rudge FRCS National Clinical Director for Transplantation Renal CDs Meeting 12 March 2010.
Challenges to Research and Innovation to Optimize Deceased Donor Organ Quality and Quantity Peter Abt, MD Sandy Feng, MD PhD American Society of Transplant.
The Importance of Organ, Eye and Tissue Donation.
Donate Life: An Overview of Organ, Tissue and Eye Donation UW Health Organ Procurement Organization.
October 2012S B Chetwynd – Human Organ Use1 The use of human organs and tissue for medical treatment Dr Sue Chetwynd Associate Fellow Warwick University.
Organ donation Peter Bishop Clinical lead for organ donation.
Organ Transplants Presentation
Stephen Cole SICSAG September 2009 “making donation usual, not unusual”
Regional variation of organ donors in Swedish ICUs may indicate missed opportunities for donation Thomas Nolin*, Sten Walther*, Caroline Mårdh*, Göran.
Implementing a Rapid HIV Testing Guideline for L&D NNEPQIN April 30, 2007.
“Patients’ Rights” – workshop at the regional meeting and workshop on the application of patients’ rights in cross-border health care Patients’ rights.
1. THE START OF THE PROCESS
ABOUT NEVADA DONOR NETWORK Federally designated, 501 (c)(3) not-for-profit Organ Procurement Organization (OPO) Coordinate, recover, and distribute donated.
Rowiński W., Kobryń A., Danielewicz R., Czerwiński J., Kosieradzki M., Jakubowska-Winecka A., Glyda M., Ostrowski M., Wejda B., Osińska P., Snarska J.University.
Collaborating for Life: The Organ and Tissue Donation Process Presented by: Liz Lowry, Hospital Services Coordinator.
UAGA Calif. Health & Safety CMS Collaborative Joint Commission 400.
Donation after Cardiac Death Supporting Patients and Families during End of Life Care in the Operating Room Douglas T Miller Symposium Breakout Session.
Basic Nursing: Foundations of Skills & Concepts Chapter 9
Title of presentation Implementing DCD Barriers and solutions VPNG 51 st State Conference 30 th July 2015 Nicky Stitt Donation Specialist Nursing Coordinator.
Inside Clinical Trials ® ALL RIGHTS RESERVED. What is a clinical trial? ALL RIGHTS RESERVED.
Introduction Organ Transplantation Program Update Advisory Committee on Organ Transplantation November 17, 2015 Melissa Greenwald, MD Acting Director Division.
Medical law and its place in the system of law and legislation in Ukraine. Legislative provision in healthcare in Ukraine.  The concept, object, method.
David A. Gerber, MD Professor and Chief Division of Abdominal Transplantation Department of Surgery University of North Carolina at Chapel Hill.
Family Approach - retroscective analysis of over family approaches - Franz Schaub; Carl-Ludwig Fischer-Fröhlich; Günter Kirste Deutsche Stiftung.
9. PCH. 1 Analyze wellness, disease prevention and recognition of symptoms 9.PCH 1.2 Summarize the procedures for organ donation, local and state recourses.
Hospital Records.
Organ / Tissue / Eye Donation Overview Essential Information for Health Care Professionals.
PATIENT & FAMILY RIGHTS AT DOHMS. Fully understand and practice all your rights. You will receive a written copy of these rights from the Reception, Registration.
Disclaimer This presentation is intended only for use by Tulane University faculty, staff, and students. No copy or use of this presentation should occur.
M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Working Group for Chapter 28 – Consumer and Health Protection.
Organ & Tissue Donation & Transplantation
MULTI DISPLINARY CARE.. . PATIENT PHYSICIANNURSESOTHERSDIETITIANPHYSIOTHERAPIST.
MELD Score, Listing for Liver Transplant, and Organ Allocation
Overview of key findings from the MUNROS project
University of Wisconsin Organ Procurement Organization
Enrolling in Clinical Trials
Hospitals Student lecture
Organ, Eye and Tissue Donation in New York
The Organ Donation Process
One Legacy Organ Donation
1. Evaluation 2. Allocation 3. Organ Recovery Coordinator Name:
The Organ Donation Process
Optum’s Role in Mycare Ohio
Midlands Organ Donation Services Team
25 May 2019 Emerging issues: The new Council of Europe Guide for the Quality and Safety of Organs for Transplantation 7th International Congress Infection.
Presentation transcript:

Tasks and responsibilities of the German organ procurement organization DSO Technical Assistance for Alignment in Organ Donation 1st International Symposium Crowne Plaza İstanbul, 29 of May 2014 Axel Rahmel MD th

Legal Framework 2 2 The German Procurement Organisation (DSO) 3 3 The Organ Donation Process 4 4 Tasks of hospitals 5 5 Finances in Organ Donation and Transplantation 1 1 Contents Finances in Organ Donation and Transplantation

Legal Framework 2 2 The German Procurement Organisation (DSO 3 3 The Organ Donation Process 4 4 Tasks of hospitals 5 5 Finances in Organ Donation and Transplantation 1 1

The legal basis German Transplantation Act ( adopted in 1997 ) Regulates organ donation, allocation and transplantation from deceased and living donors Informed consent (opt-in) Brain death: complete and irreversible loss of all brain function No donation after cardiac death (DCD)! First amendment on 4th September 2007 Second amendment on 1st August 2012

Transplantation act – shared responsibilities Transplant-Centers Waiting list Organ donation procedure Transplantation Allocation Stiftung Eurotransplant Leiden / Niederlande OPO Deutsche Stiftung Organtransplantation since June 2000 Eurotransplant DSO Transplant-centers

Stakeholder in Organ Donation Process TT-Labs Transplant Centers Hospitals Eurotransplant (NL)

Legal Framework 2 2 The German Procurement Organisation (DSO 3 3 The Organ Donation Process 4 4 Tasks of hospitals 5 5 Finances in Organ Donation and Transplantation 1 1

The German Procurement Organisation (DSO) The DSO has the responsibility to organise organ procurement in every German hospital (regulated by German Transplant Act) is the national organ procurement organisation

Germany Residents: 82,4 mill. Federal States: 16 DSO 7 regions 80 coordinators (nurses / physicians) Hospitals with ICU: Transplant Centers: 47

Cooperation with hospitals Appropriate communication path - Donor referral (suitability of donor/support) Support in determination of brain death Examinations / therapy regarding - organ function - diagnosis of infection - tumor diagnosis - immunological parameters Data transfer to allocation authority Organization of - transport of organs/teams On the spot support during organ donation process Any time (365 days / 24 hours) Process time ≤ 12 h

Contracts 693 contracts with procurement surgeons 181 contracts with consultants for brain death diagnosis 45 contracts with transplantation-centres Pathology / Immunology 12 contracts for HLA-typing

Legal Framework 2 2 The German Procurement Organisation (DSO 3 3 The Organ Donation Process 4 4 Tasks of hospitals 5 5 Finances in Organ Donation and Transplantation 1 1

Organization of the organ donation process in Germany

The Organ Donation Process Primary or secondary brain injury

Causes of Death of Organ Donors 84 % Atraumatic causes of death

Killed in road traffic 2010: 3657 Verkehrstote

Reduced mortality after stroke

Organ Donation in Germany (Age of Organ Donors)

Primary or secondary brain injury Diagnosis of brain death The Organ Donation Process

Detection of brain death and confirmation

Brain death protocol According to the guidelines of the federal medical counsil 2 qualified doctors not involved in transplantation have to confirm independently brain death

Primary or secondary brain injury Diagnosis of brain death Reporting of potential donor to OPO (DSO) The Organ Donation Process

Primary or secondary brain injury Diagnosis of brain death Reporting of potential donor to OPO (DSO) Family discussion The Organ Donation Process

Written wish to donate

Next of kin

To accompany the decision means: Competent partner with time, goal, kowledge and emotion Ask helpful and prudent open question, build bridges Reflect together Provide information and guarantees Avoid after decision-dissonance! Therapy Grieving Process Death (Brain death) Decision Accompany the Decision Process

Reasons for Refusal (%) Next of kin discordant Death not accepted Religious reason Others Unknown Negative attitude towards organ donation known Deceased person´s attitude not known Damage to bodily integrity % % % % % % % n = 2520

Reasons for Consent (%) Desire to make sence of the sudden death of a loved one Knowing someone who needs a transplant or benefied from a organ donation Other reason Unknown Positive attitude towards organ donation known Altruistic motives (compassion) % % % % n = ,8 %

Primary or secondary brain injury Diagnosis of brain death Reporting of potential donor to OPO (DSO) Family discussion Medical examination of the deceased patient The Organ Donation Process

Medical and behavioural history Standardised questionnaires should be used to obtain the following information:  clinical history and pre-existing diseases  behavioral risk and previous medical treatment  history of chemical and/or radiation exposure, previous and current medication  travel history or overseas/out-of-country residency  recent history of any immunization with live vaccines  risk of transmitting prion disease  information about congenital or inherited disorders  other relevant family medical history

Standardized medical history

Primary or secondary brain injury Diagnosis of brain death Reporting of potential donor to OPO (DSO) Family discussion Medical examination of the deceased patient Data transfer to Eurotransplant for organ allocation The Organ Donation Process

Report & Update Procurement Allocation & XMRequestTransplant Medical history Admission Procurement Orders Transports Notification DIAG LABICDOPS MNT MED med. Evaluation HTD Attorne y Relative s Legal prerequisite Processing donor- & organinformation ET-Interface

Key Features  Different userprofiles  Documentation according to the process  Standardized diagnostics and procedures  Timerelated information  Calculator for laboratory values  Modification history  Validation and businessrules  Interfaces for medical and administative information  Data-Warehouse retrieval and reporting  New attributes easy to add - parameter model

Medical examination of the deceased patient Primary or secondary brain injury Diagnosis of brain death Reporting of potential donor to OPO (DSO) Family discussion Data transfer to Eurotransplant for organ allocation Organ harvesting The Organ Donation Process

Organization of the organ procurement Organisational framework Number of participating teams Transport routes and times Scheduling Weather conditions Experience of the teams Coordination between the teams Waiting time at the OT

Primary or secondary brain injury Diagnosis of brain death Reporting of potential donor to OPO (DSO) Family discussion Medical examination of the deceased patient Data transfer to Eurotransplant for organ allocation Organ harvesting Organ transport The Organ Donation Process

Establishing an air transport network responsible for the organisation of all national and international transports of organ retrieval teams and organs. DSO : Air transport - extrarenal organs Main goals and principles:  quality, safety and economic efficiency  medical necessities, CIT  consideration of transport distance  avoiding „empty“ flights  rare use of cost-intensive jets trustworthy und competent partners

Organ harvesting Organ transport Transplantation Data transfer to Eurotransplant for organ allocation Medical examination of the deceased patient Family discussion Reporting of potential donor to OPO (DSO) Diagnosis of brain death Primary or secondary brain injury The Organ Donation Process

Legal Framework 2 2 The German Procurement Organisation (DSO 3 3 The Organ Donation Process 4 4 Tasks of hospitals 5 5 Finances in Organ Donation and Transplantation 1 1

SOP (Standard Operation Procedure) Development and Implemantation of Standard Operating Procedures (SOP) together with DSO Coordinators and inclusion of contact persons from the hospital

Information materials for professionals CD-ROM Guidelines Manuals Annual reports

Legal Framework 2 2 The German Procurement Organisation (DSO 3 3 The Organ Donation Process 4 4 Tasks of hospitals 5 5 Finances in Organ Donation and Transplantation 1 1

Health insurance company of the organ- recipient Lump sum per Tx registration -lump sum organ removal (DSO) § 11 TPG organ removal (DSO) § 11 TPG DRGs donor-hospital organ allocation (ET) § 12 TPG organ allocation (ET) § 12 TPG refund organ transplantation (TPZ) § 10 TPG organ transplantation (TPZ) § 10 TPG

Organisational flat rate DSO does not recieve an entire budget sum but recieves a lump- compensation for every transplanted organ, negotiated yearly. In the year 2013, the organisational flat rate is € per transplanted organ transplantations are assumed. DSO covers all costs theat occur during the donation process as well as structural costs with this flat. DSO has contracts with organ retrieval surgeons, neurologists, labs beside the own staff. Exeptions: refund of costs to the donor hospitals and flight costs for non- renal organs. Compensation mechanisms if the fixed number of cases is not reached or exeeded. DSO: Budgeting systematics

Example: Allowances Surgeons Special cases: Kidneys en bloc: 820,00 € Split liver, if both splits are transplanted: 1.640,00 € 1 organ (individual kidney, liver or pancreas)€ 820,00 2 organs€ 1.640,00 3 organs€ 2.460,00 4 organs€ 3.280,00 5 organs€ 4.100,00 If no organ has eventually been transplanted€ 290,00 Allowance for abdominal retrieval teams

DSO : Air transport - extrarenal organs Air transport of extrarenal organs In 2013, the lump sum for an air transport of an extrarenal organ is € per transplanted organ for which a separate flight is carried out. Unsuccessful operations are included in the lump sum and will noch be refunded separately. The lump sum is based on the assumption that 880 air transports will be carried out in If the number of 880 flights is exeeded 50 % of the additional proceeds will be refunded to payers. If the number of flights is lower than 880 flights 50 % of the lacking revenues will be refunded by the payers.

Thank you for your attention!