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The Role of Coordinators Throughout the European Union

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 !.

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The Role of Coordinators Throughout the European Union

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  1. The RoleofCoordinatorsThroughoutthe European Union Carl-Ludwig Fischer-Fröhlich, Stuttgart, Germany Thank you to the support of supportof all coordinators with in Europe

  2. …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“.

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

  4. …the role of Coordinators throughout the EU ! Transplantation-unit Organ exchangeorganisation Organ procurementorganisation Donor Hospital(ED/ICU) • Patient withend of life care: • donor detection • death confirmed • consent • donor evaluation Recipient Waiting list 24h/365d Supportin all of these tasks! Donor & organCharacterisation Allocation (rules)organ exchange Transport 4°C Organ recovery Transplantation Rehabilitationfollow up

  5. Inclusion criteria for organ donors • 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 *see: Good Practice Guidelines in the process of organ donation, ONT, Madrid, 2011, www.ont.es

  6. Example: Is this liver suitable for transplantation? • 67 years SAH • ICU = 17 days • ALAT = 91 IU/l • BMI = 35 kg/m² • paO2/FIO2= 134 • Diabetes Typ II • Hypertension • Tetanus as child • anti-HBc +, HBsAg - 5% macrovesiuclar steatosis,slight choelstasis, slight cholangitis  Careful examination at recovery + biopsy + care for HBV-transmission

  7. Be aware of your efforts: • More organs transplanted after your contribution at the donor hospital ! Effortwithinhealthcaresystem 85 yrs.ICB • Is this safe? • We discuss this question tomorrow : “Expanding the donor pool: ECD and DCD practices” • …because without donors we can not discuss this. Example 45 yrs.SAH 20 yrs.trauma donationignored Case 

  8. …the role of Coordinators throughout the EU ! Transplantation-unit Organ exchangeorganisation Organ procurementorganisation Donor Hospital(ED/ICU) • Patient withend of life care: • donor detection • death confirmed • consent • donor evaluation Recipient Waiting list 24h/365d Supportin all of these tasks! Donor & organCharacterisation Allocation (rules)organ exchange Transport 4°C Organ recovery Transplantation Rehabilitationfollow up

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

  10. The critical pathway for deceased donation: reportable uniformity in the approach to deceased donation. Transplant International 24 (2011):373-378 FOLLOW UP DONOR EVALUATION DONOR MANAGEMENT Actual donor Eligible donor Potential donor Possible donor CONSENT TX TEAM COORDINATION A person with a devastating brain injury or lesion and apparently medically suitable for organ donation A consented eligible donor in whom an operative incision was made with the intent of organ recovery……… A medically suitable person who has been declared dead based on neurologic criteria as stipulated by the law of the relevant jurisdiction A person whose clinical condition is suspected to fulfil brain death criteria Insidethe ICU Outsidethe ICU GCS < 8 BrainDeath diagnosis

  11. Internal Audit at an German hospital *  Observation beyondstudyprotocol: Sometimesevolutiontobraindeath was not consideredduringwithdrawlof live sustainingtherapy. Therforeconcluisonswereimpossible.

  12. Hospital Protocol Policies: TC activation

  13. 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

  14. PROMOTION, TRAINING AND EDUCATION 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.)

  15. Corporate Social Responsibility Prevention Treatment Education Deceased Donation Hospital Vision Health care Professionals Mission UHOPO Bcn Hospital Vision Death referrals for Organ & Tissues Donation

  16. Successofthe professional roleascoordinator: 1993: Jochen iswaitingfor a heart… 2014 he isstill alive…

  17. …theroleofCoordinatorsthroughouttheworld !

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