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S lovenian transplant medicine

S lovenian transplant medicine . Danica Avsec Ljubljana 2011. History of Slovenia. In the  Early Bronze Age , Proto- Illyrian  tribes settled an area stretching from present-day Albania  to the city of  Trieste . The Holy Roman Empire  controlled the land for nearly 1,000 years. 

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S lovenian transplant medicine

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  1. Slovenian transplant medicine Danica Avsec Ljubljana 2011

  2. History of Slovenia • In the Early Bronze Age, Proto-Illyrian tribes settled an area stretching from present-dayAlbania to the city of Trieste. • TheHoly Roman Empire controlled the land for nearly 1,000 years.  • Austro-Hungarian Monarchy • Modern-day Slovenia gained its independence from Yugoslavia in 1991, and is today a modern state and a member of the European Union.

  3. Southeastern Europe in the 8th century

  4. Map of Slovenia with Roman provinces and cities

  5. 4-geographic regions in Slo

  6. Modern Slovenia

  7. Transplant activities Donor program Recipient program TX Donor centers SLOTP Organs Tissues National waiting lists Clinical transplant coordinators • preparing the recipients • recipient follow-up

  8. History

  9. Where we are • We are performing txs: • Kidneys, livers, hearts • Pancreas- kidney • Heamatopoetic cells • Corneas, skin, bones • Knie cartilage, tendoms and others • Results are very comparable with other international centres • The procurement of organs and tissues from the deceased is increasing

  10. Transplantation activity numbers performed 2010 Kidney DD: 30,5 pmp Kidney LD: 0 Liver LD: 0 Liver DD: 13 pmp (A+C) Heart: 9,5 pmp Heart-Lung: 0 Lung: 1,5 (W) Pancreas: 0,5 pmp Small bowel 0 Total number of DD 41 DBD: 41 DCD: x DD:20,5 PMP DBD:0 PMP DD = Deceased Donor, LD = Living Donor, PMP = per million population DBD = Donation after Brain Death, DCD = Donation after Circulatory Death 11

  11. LeGISLATIVE BASIS

  12. Legislation basis for organ and tissue transplantation in Slovenia • 2000 Legislation on organ and tissue harvesting • 2000 Legislation for reproductive medicine • 2007 Legislation on quality and safety for cell and tissue transplantation • National regulations • EU directives, 2010, 2004, 2006 • New draft - implementation of the directive 2010

  13. Directive 2010/45/EC on Quality and Safety • Scope, objectives and definitions • Quality and safety of organs • National Quality Programmes • Organ procurement, procurement organisations, transplantation centres • Transport of organs • Organ and donor characterisation • Traceability • Reporting of serious adverse events and reactions • Donor and recipient protection and donor selection and evaluation • Unpaid and Voluntary Donation • Quality and safety aspects of living donation • Data protection • National oversight authority or authorities • Organ Exchange with third countries • General provisions

  14. Presumed OPT OUT register-new suggestion Information given to family 99% Consent for donation • Informed - explicit • OPT IN register • Donor card • Less than 1%

  15. ORGANIZational sheme

  16. ICU DEPARTMENT • BRAIN DEATH Diagnostics • DETECTION OF THE DONOR

  17. SLOTP organization and national network Donor centers Tissue typing TXcenters

  18. International cooperation 1 Eutransplant ( HU, hypersensitive patients, optimal matching, evaluation, optimal usage of organs ) Vienna – twinning programme for lung tx Bergamo, Graz for children programmes, liver, kidney Due to limited facilities at health care, number of cases, number of experts Slovenia is not able to cover all needs and develop all programmes by itself: 20

  19. International cooperation 2 with ONT, CNT and many important experts in the field of donation, transplantation On many EC projects, for EDD Guidelines is leading partner We are able to notice and analyze some aspects better that bigger countries nd therefore we could share such experience with other countries 21

  20. The purposes of national transplant network • Increase the availability of organs for transplantation • Fully exploit the potential of donation from deceased donors • Include all programs for the acquisition of organs(donation system from living donors, as a complementary program) • Equal opportunity for treatment with transplantation for all patients • Integration with clinicians

  21. The tasks at the level of governmentThe tasks at the level of government • Legislative documents • Organizational sheme,competent instition • Safety and quality as prevention of misuse, abuse • Traceability, transparency • Efficiency • Finances

  22. The tools for quality and safety in the field of donation Coordinators Protocols, guidelines Education od health care proffesionals and ICU doctors Motivation of ICU doctors Promotion of donation International cooperation Informatics program Controlling and monitoring the efficiency, QAPs 24

  23. TECHNICAL BASIS FOR DONOR PROGRAMME

  24. ICU - Intensive care doctors Knowledge, awareness, motivation • to treat the patient optimally • to communicate with relatives before death • to recognise a non responsive apnoeic coma • to make a decision to start BD diagnostics • to maintain the donor

  25. Determination of death ,detection of the donor Treatment Maintenance Removal,Tx Patient Donor consent

  26. Motivation in the ICU To know the purpose of the procedures and the results very well To release psychological burden To trust into the procedures To find the help and the support

  27. Positive overall attitude to organ donation and procedure among ICU doctors(Avsec, Logar-Zakrajšek, 2009)

  28. DECEASED DONORS pmp, refusal rate 23 15.9

  29. Education of all target groups

  30. Priorities for the near future 1. Education, auditing and motivating ICU for increasing donor rate 2. Improve WL for KTx (now 3,5 %) 3. EU directives on organ donation 4. Collaboration • We offer educational modules on brain death diagnosticsand research on public awareness • Coopeartion with SEEHN countries as benchmarking. • Related to ICU role in the donor progamme we offer the cooperation in joint actions on motivation and improving organizational, technical and ethical aspects on the basis of our own twenty-year-experience and current european knowledge reached as partners in different projects.

  31. www.europeandonationday.org

  32. Diagnostics of brain death, workshop • In February 2012, Ljubljana • Three parts: • Theoretical overview with round table discussions • Practical part of clinical tests in the ICU • Practical part in the simulation center on the basis of PACT porgramme • Cooperation between Slovenija transplant, UMC Ljubljana and regional office for SEEHN countries

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