The Role of Coordinators Throughout the European Union Carl-Ludwig Fischer-Fröhlich, Stuttgart, Germany Thank you to the support of support of all coordinators with in Europe

…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“.

…the role of Coordinators throughout the EU ! Why do we have this presentation ?

Patient with end of life care: donor detection death confirmed consent donor evaluation Allocation (rules) organ exchange Organ recovery Donor Hospital (ED/ICU) Donor & organ Characterisation Organ procurement organisation Organ exchange organisation Waiting list Transplantation- unit Recipient Transplantation Rehabilitation follow up Transport 4°C 24h/365d Support in all of these tasks! …the role of Coordinators throughout the EU !

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,

67 years SAH ICU = 17 days ALAT = 91 IU/l BMI = 35 kg/m² paO 2 /FIO 2 = 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

 More organs transplanted after your contribution at the donor hospital ! Be aware of your efforts: donation ignored 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.

Patient with end of life care: donor detection death confirmed consent donor evaluation Allocation (rules) organ exchange Organ recovery Donor Hospital (ED/ICU) Donor & organ Characterisation Organ procurement organisation Organ exchange organisation Waiting list Transplantation- unit Recipient Transplantation Rehabilitation follow up Transport 4°C 24h/365d Support in all of these tasks! …the role of Coordinators throughout the EU !

Third WHO Global Consultation on Organ Donation and Transplantation organised by the WHO, TTS and ONT in Madrid, March 2010

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 diagnosis Brain Death diagnosis GCS < 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): Inside the ICU Outside the ICU

Internal Audit at an German hospital Audit period: April September 2011 (national In-house project) Cases Deceased patients with severe cerebral lesions256 (100%) * Absolute Contraindication88 (34,4%) * Not ventilated 0 h61 (23,8%) * DSO as OPO contacted prospectively23 (9,0%) Review of death records84 (32,8%) Brain death diagnostics started24 (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 diagnostics60 (23,4%) * Brain death could not have been certified47 (18,4%) * Brain death certification should have been initiated13 (5,1%)  Observation beyond study protocol: Sometimes evolution to brain death was not considered during withdrawl of live sustaining therapy. Therfore concluisons were impossible. *

Hospital Protocol Policies: TC activation PROTOCOL ON TREATMENT AND MANAGEMENT OF NEUROCRITICAL PATIENTS GCS <8 A&E NRL NRS ±ICU ±TC FOLLOW-UP PROTOCOL OF PATIENTS WITH GCS<8 TC ACTIVATION BRAIN DEATH DONATION PROTOCOL BD DIAGNOSIS ALGORITHM POTENTIAL DONOR MANAGEMENT ALGORITHM

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

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.)

Corporate Social Responsibility Hospital Vision Health care ProfessionalsMission HospitalVision Prevention Treatment Education Deceased Donation Death referrals for Organ & Tissues Donation

1993: Jochen is waiting for a heart… 2014 he is still alive… Success of the professional role as coordinator:

…the role of Coordinators throughout the world !