dr. matesanz
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BRUSSELS - DECEMBER 3rd, 2008
RAFAEL MATESANZNATIONAL ORGANIZATION
FOR TRANSPLANTS (ONT) - SPAIN
ACHIEVING SUCCESS
IN E.U. TRANSPLANT SYSTEMS
Kidney Transplants
Liver transplants
Heart Transplants
65511(39% LIVING D).
20366(10% LIVING D).
5313
WORLD TRANSPLANT REGISTRY
ANNUAL GLOBAL ESTIMATES – TOTAL FIGURES
TOTAL ESTIMATES: 96820 SOLID
ORGAN TRANSPLANTS
LUNG TRANSPLANTS: 3051 PANCREAS TRANSPLANTS: 2551
http://www.transplant-observatory.org
•RENAL TRANSPLANT.................43 years
•LIVER TRANSPLANT...................36 years
•BONE MARROW TRANSPL........33 years
•HEART TRANSPLANT.................27 years
•PANCREATIC TRANSPLANT......24 years
•LUNG TRANSPLANT....................19 years
•SMALL BOWEL.............................16 years
U.C.L.A. Registry-2006
LONG TERMSURVIVAL
UNIVERSAL PROBLEM
662 429
1,3201,906
0
500
1000
1500
2000
2500
Kidney Liver Heart Lung
Dea
ths
in t
he
WL
(a
bso
lute
nu
mb
ers)
0.0
1.0
2.0
3.0
4.0
5.0
Dea
ths
in t
he
wai
tin
g li
st
(pm
p)
Absolute numbers Rate (pmp)
Total in the EU
4,317 persons (12 persons/day)
Total in the EU
4,317 persons (12 persons/day)
DEATHS ON WAITING LISTS – EUROPEAN UNION 2007
34.3DECEASED ORGAN DONORS P.M.P. -2007
16.9PMP
5,8 PMP
8293
8089
26,6 PMP 2918
9.4PMP
198
UE / 27
UE /27
34.3
13.2
25.3
2123.9
10.7
2119.2
18.713.2
19.9
14.5
17.2
24.5
10
1511.4
15.1
30 DONORS PMP
20 DONORS PMP
10 DONORS PMP
<10 DONORS PMP
21.1
21.6
ORGAN DONORS p.m.p. 2007
2.1
1.213.1
14.1
8.5
0
26.9
5.8
550 1550
550687
778 832 86996010371032
11551250
13451335141014481494154615091550
1334
14,3
17,820,2
21,722,6
26,829
33,932,5
33,733,934,635,133,834,1
2725
33,631,5
0
200
400
600
800
1000
1200
1400
1600
1800
1989 1991 1993 1995 1997 1999 2001 2003 2005 2007
0
5
10
15
20
25
30
35
40
NUMBER RATE pmp
ORGAN DONOR IN SPAIN SINCETHE START OF O.N.T.
44,3
ORGAN DONORS PMP-2007 SPAIN / REGIONS
30.4
40.0
48.6
32.0
45.6
25.8
34.0 33.0
37.217.4
29.2
74.2
34.2
41.7
26.241.1
>40
>35
>30
34.315-30
1182
98710171039
1240
1371
14921488
1633
1800
1707
1857
19962023
19381924
2032
21312125
22002157
2211
900
1100
1300
1500
1700
1900
2100
2300
RENAL TRANSPLANTSIN SPAIN
14 544 50
123170
313
412468495
614
698700
790
899960954972
103310371040107010511112
0
200
400
600
800
1000
1200
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
LIVER TRANSPLANTS - SPAIN
THE SPANISH MODEL
WAITING LIST DECREASESPAIN - 2005
-10%
-20%
-30%
-26,7
-10,3
-13,7%
-2%
LIVER KIDNEY HEART LUNG
-26,7%
-10,3%
IMPROVEMENT OF
ORGAN DONATIONIMPROVEMENT OF
ORGANIZATION
PHILOSOPHY OF THE SPANISH MODEL
NATIONAL
R
RR
R
REGIONAL
H
H
H
H
HOSPITAL
TRANSPLANT COORDINATION NETWORK
< 20 56 118 158
1988 1990 1992 2008
NUMBER OF TRANSPLANT COORDINATION TEAMS
46%
16%
29%
9%
I.C.U. NEPHROLOGY OTHER OP. ROOM
MEDICAL DOCTORS = ( 199 )FULL TIME DEDICATED = 6 %PART TIME = 94%
NURSES = ( 129 )FULL TIME = 32%PART TIME = 68 %
TRANSPLANT COORDINATION TEAMS SPAIN 2008 ( N =158 )
74%
9%
7% 5% 5%
I.C. UNITS NEPHROL. OTHER
EMERGENCY ANESTHESIA
3,8 3,7 3,67
20,4
3035,5
74,2
2000 2001 2002 2003 2004 2005 2006 2007
ORGAN DONATION IN LA RIOJA¡¡¡74, 2 DONORS PMP!!!
NEW COORDINATIONTEAM
T.C.
T.C. T.C.
T.C.TRANSPLANT
COORDINATORSINSIDE
THE HOSPITALS
GREAT EFFORT IN MEDICAL TRAINING
MORE THAN 4000 HEALTH PROFESSIONALSRECEIVED ALL KIND OF TRAINING RELATEDWITH ORGAN DONATION THROUGH THE LAST 18 YEARS SIN THE CREATION OF ONT
CENTRALOFFICEAS A SUPPORTAGENCYIN FAVOUR OFORGANDONATION
NOT JUST A SHARING OFFICE
QUALITY PROGRAMMEIN ORGAN DONATION
1998-2006
•A 9 YEARS “ON LINE” CHART REVIEW•ALL SPANISH REGIONS•129,230 DEATHS IN ICU•16,041 BRAIN DEATHS (12.4%/ ICU - DEATHS)•8,466 ACTUAL DONORS(52.8% OF BRAIN DEATHS)
AREAS FOR IMPROVEMENT:•FAMILY REFUSAL:.....................13.1%•BRAIN DEATH DETECTION: ......1.2%•DONOR MAINTENANCE :........... 3.2%•OTHER...........................................1.6%TOTAL.........................................25-30%
QUALITY PROGRAMMEIN ORGAN DONATION
POSSIBILITY OF EXTERNAL AUDIT:89 EVALUATIONS PERFORMED
HOSPITAL REIMBURSEMENT
)ESTIMATED MEAN VALUES(
EUROS )€(
Multi-organ procurement
6.000
Renal procurement 4.500
Multi-organ + tissue 7.500
1 hour of operating room: 1.500 €(
41 HOSPITALS WITHTRANSPLANT
PROGRAMMES--------------
63% OF THEDONORS
(21 DONORS pmp)
63%
120 HOSPITALSWITHOUT
TRANSPLANT PROGRAMMES-----------------------
37% OF THE DONORS(13 DONORS pmp)
37%
2006
GREAT ATENTION TO THE MEDIA
COORDINATION NETWORK
SPECIAL PROFILE
INSIDE THE HOSPITALS
BRAIN DEATH AUDIT
HOSPITAL REIMBURSEMENT
TRAINING OF PROFESSIONALS
ATENTION TO THE MEDIA
THE SPANISH MODEL & TRANSPLANTATIONORGAN DONATION
THE SPANISH MODELHAS BECOME A CENTRAL REFERENCE FOR ORGAN DONATION ALL OVER THE WORLD
COLLABORATINGCENTRE - WHO
LET’S MOVE INTO …
A MORE INTEGRATED EUROPE OF TRANSPLANTATIONS
DONACIÓN SIN FRONTERAS LE MODÈLE ESPAGNOLTHE LIFE - YEARS SAVED BY A DECEASED ORGAN DONATION
YEARS 15 30 45 60
TRANSPLANT OF SIX ORGANS: 55,8 YEARS
MEAN DONOR: 30,8 YEARS
LIVER: 16,1 AÑOS
HEART: 14,5
KIDNEY –PANCREAS: 12,9
KIDNEY: 7,2
LUNG: 2,1
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