The Role of Coordinators Throughout the European Union

Carl-Ludwig Fischer-Fröhlich, Stuttgart, Germany

Thank you to the support of supportof 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 withend of life care:• donor detection• death confirmed• consent• donor evaluation

Allocation (rules)organ exchange

Organ recovery

Donor Hospital(ED/ICU)

Donor & organCharacterisation

Organ procurementorganisation

Organ exchangeorganisation

Waiting list

Transplantation-unit

Recipient

Transplantation

Rehabilitationfollow up

Transport 4°C

24h/365d Supportin 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, www.ont.es

67 years SAH• ICU = 17 days• ALAT = 91 IU/l• BMI = 35 kg/m²• paO2/FIO2= 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:

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Costs

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ort /

Inpu

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donationignored

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 withend of life care:• donor detection• death confirmed• consent• donor evaluation

Allocation (rules)organ exchange

Organ recovery

Donor Hospital(ED/ICU)

Donor & organCharacterisation

Organ procurementorganisation

Organ exchangeorganisation

Waiting list

Transplantation-unit

Recipient

Transplantation

Rehabilitationfollow up

Transport 4°C

24h/365d Supportin 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

diagnosisGCS < 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):373-378

Inside the ICU

Outside the ICU

Internal Audit at an German hospital

Audit period: April 2010 - September 2011 (national In-house project) Cases

Deceased patients with severe cerebral lesions 256 (100%)

* Absolute Contraindication 88 (34,4%)

* Not ventilated 0 h 61 (23,8%)

* DSO as OPO contacted prospectively 23 (9,0%)

Review of death records 84 (32,8%)

Brain death diagnostics started 24 (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 diagnostics 60 (23,4%)

* Brain death could not have been certified 47 (18,4%)

* Brain death certification should have been initiated 13 (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

FOLLOW-UP PROTOCOL OF PATIENTS WITH GCS<8

TC ACTIVAT

ION

BRAIN DEATH DONATION PROTOCOL

BD DIAGNOSIS 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 careProfessionals

Mission

HospitalVision

PreventionTreatment

EducationDeceased Donation

Death referrals for Organ & Tissues Donation

1993: Jochen is waiting for a heart…

2014 he isstill alive…

Success of the professional role as coordinator:

…the role of Coordinators throughout the world !