tasks and responsibilities of the german organ procurement organization dso
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Tasks and responsibilities of the
German organ procurement organization DSO
Technical Assistance for Alignment in Organ Donation1st International Symposium
Crowne Plaza İstanbul, 29 of May 2014
Axel Rahmel MD
th
Legal Framework
2 The German Procurement Organisation (DSO)
3 The Organ Donation Process
4 Tasks of hospitals
5 Finances in Organ Donation and Transplantation
1
Contents
Finances in Organ Donation and Transplantation
Legal Framework
2 The German Procurement Organisation (DSO
3 The Organ Donation Process
4 Tasks of hospitals
5 Finances in Organ Donation and Transplantation
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-CentersWaiting list Organ donation procedure Transplantation
AllocationStiftung Eurotransplant
Leiden / Niederlande
OPODeutsche Stiftung Organtransplantationsince June 2000
Eurotransplant
DSO
Tran
spla
nt-c
ente
rs
Stakeholder in Organ Donation Process
TT-Labs
Transplant Centers
Hospitals
Eurotransplant (NL)
Legal Framework
2 The German Procurement Organisation (DSO
3 The Organ Donation Process
4 Tasks of hospitals
5 Finances in Organ Donation and Transplantation
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
GermanyResidents: 82,4 mill.Federal States: 16
DSO7 regions
80 coordinators (nurses / physicians)
Hospitals with ICU: 1.346Transplant 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 surgeons181 contracts with consultants for brain
death diagnosis 45 contracts with transplantation-centres
Pathology / Immunology 12 contracts for HLA-typing
Legal Framework
2 The German Procurement Organisation (DSO
3 The Organ Donation Process
4 Tasks of hospitals
5 Finances in Organ Donation and Transplantation
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
130
78
56
0
20
40
60
80
100
120
140
Verkehrstote/pmp 2008
USASpanienDeutschland
2010: 3657 Verkehrstote
Reduced mortality after stroke
Organ Donation in Germany (Age of Organ Donors)
Primary or secondary brain
injuryDiagnosis 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
injuryDiagnosis of brain death
Reporting of potential donor to OPO (DSO)
The Organ Donation Process
Primary or secondary brain
injuryDiagnosis 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 (%)
6,3
26,4 1,3
44,8
5,3
15,8
Desire to make sence of the sudden death of a loved oneKnowing someone who needs a transplant or benefied from a organ donationOther reason
Unknown
Positive attitude towards organ donation known
Altruistic motives(compassion) %
%
%
%
n = 4669
44,8 %
Primary or secondary brain
injuryDiagnosis 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
www.edqm.eu
Primary or secondary brain
injuryDiagnosis of brain death
Reporting of potential donor to OPO (DSO)Family
discussion
Medical examination of the deceased
patientData transfer to Eurotransplant
for organ allocation
The Organ Donation Process
Report & Update Procurement
Allocation & XMRequest Transplant
• Medical history• Admission• Procurement
OrdersTransports
Notification
DIAG LAB ICD OPS
MNTMED
med. Evaluation
HTD AttorneyRelatives
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
injuryDiagnosis 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
injuryDiagnosis of brain death
Reporting of potential donor to OPO (DSO)Family
discussion
Medical examination of the deceased
patientData 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 The German Procurement Organisation (DSO
3 The Organ Donation Process
4 Tasks of hospitals
5 Finances in Organ Donation and Transplantation
1
SOP (Standard Operation Procedure)
5
4
1
2
3
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
www.dso.de
Manuals
Annual reports
Legal Framework
2 The German Procurement Organisation (DSO
3 The Organ Donation Process
4 Tasks of hospitals
5 Finances in Organ Donation and Transplantation
1
Finances in Organ Donation and Transplantation
Health insurance company
of the organ-
recipient
Lump sum per Tx
registration-lump sum
organ removal (DSO)
§ 11 TPG
DRGs
donor-hospital
organ allocation (ET)
§ 12 TPG
refund
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 8.460 € per transplanted organ. 4.000 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 € 2.460,004 organs € 3.280,005 organs € 4.100,00
If no organ has eventually been transplanted € 290,00
Allowance for abdominal retrieval teams
DSO: Air transport - extrarenal organsAir transport of extrarenal organs
In 2013, the lump sum for an air transport of an extrarenal organ is
7.652 € 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 2013.
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!
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