Tasks and responsibilities of the German organ procurement organization DSO Technical Assistance for...
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Tasks and responsibilities of the German organ procurement organization DSO Technical Assistance for Alignment in Organ Donation 1st International Symposium
Tasks and responsibilities of the German organ procurement
organization DSO Technical Assistance for Alignment in Organ
Donation 1st International Symposium Crowne Plaza stanbul, 29 of
May 2014 Axel Rahmel MD th
Slide 2
Legal Framework 2 2 The German Procurement Organisation (DSO) 3
3 The Organ Donation Process 4 4 Tasks of hospitals 5 5 Finances in
Organ Donation and Transplantation 1 1 Contents Finances in Organ
Donation and Transplantation
Slide 3
Legal Framework 2 2 The German Procurement Organisation (DSO 3
3 The Organ Donation Process 4 4 Tasks of hospitals 5 5 Finances in
Organ Donation and Transplantation 1 1
Slide 4
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
Slide 5
Transplantation act shared responsibilities Transplant-Centers
Waiting list Organ donation procedure Transplantation Allocation
Stiftung Eurotransplant Leiden / Niederlande OPO Deutsche Stiftung
Organtransplantation since June 2000 Eurotransplant DSO
Transplant-centers
Slide 6
Stakeholder in Organ Donation Process TT-Labs Transplant
Centers Hospitals Eurotransplant (NL)
Slide 7
Legal Framework 2 2 The German Procurement Organisation (DSO 3
3 The Organ Donation Process 4 4 Tasks of hospitals 5 5 Finances in
Organ Donation and Transplantation 1 1
Slide 8
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
Slide 9
Germany Residents: 82,4 mill. Federal States: 16 DSO 7 regions
80 coordinators (nurses / physicians) Hospitals with ICU: 1.346
Transplant Centers: 47
Slide 10
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
Slide 11
Contracts 693 contracts with procurement surgeons 181 contracts
with consultants for brain death diagnosis 45 contracts with
transplantation-centres Pathology / Immunology 12 contracts for
HLA-typing
Slide 12
Legal Framework 2 2 The German Procurement Organisation (DSO 3
3 The Organ Donation Process 4 4 Tasks of hospitals 5 5 Finances in
Organ Donation and Transplantation 1 1
Slide 13
Organization of the organ donation process in Germany
Slide 14
The Organ Donation Process Primary or secondary brain
injury
Slide 15
Causes of Death of Organ Donors 84 % Atraumatic causes of
death
Slide 16
Killed in road traffic 2010: 3657 Verkehrstote
Slide 17
Reduced mortality after stroke
Slide 18
Organ Donation in Germany (Age of Organ Donors)
Slide 19
Primary or secondary brain injury Diagnosis of brain death The
Organ Donation Process
Slide 20
Detection of brain death and confirmation
Slide 21
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
Slide 22
Primary or secondary brain injury Diagnosis of brain death
Reporting of potential donor to OPO (DSO) The Organ Donation
Process
Slide 23
Primary or secondary brain injury Diagnosis of brain death
Reporting of potential donor to OPO (DSO) Family discussion The
Organ Donation Process
Slide 24
Written wish to donate
Slide 25
Next of kin
Slide 26
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
Slide 27
Reasons for Refusal (%) Next of kin discordant Death not
accepted Religious reason Others Unknown Negative attitude towards
organ donation known Deceased persons attitude not known Damage to
bodily integrity % % % % % % % n = 2520
Slide 28
Reasons for Consent (%) Desire to make sence of the sudden
death of a loved one Knowing someone who needs a transplant or
benefied from a organ donation Other reason Unknown Positive
attitude towards organ donation known Altruistic motives
(compassion) % % % % n = 4669 44,8 %
Slide 29
Primary or secondary brain injury Diagnosis of brain death
Reporting of potential donor to OPO (DSO) Family discussion Medical
examination of the deceased patient The Organ Donation Process
Slide 30
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
Slide 31
Standardized medical history
Slide 32
www.edqm.eu
Slide 33
Primary or secondary brain injury Diagnosis of brain death
Reporting of potential donor to OPO (DSO) Family discussion Medical
examination of the deceased patient Data transfer to Eurotransplant
for organ allocation The Organ Donation Process
Slide 34
Report & Update Procurement Allocation &
XMRequestTransplant Medical history Admission Procurement Orders
Transports Notification DIAG LABICDOPS MNT MED med. Evaluation HTD
Attorne y Relative s Legal prerequisite Processing donor- &
organinformation ET-Interface
Slide 35
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
Slide 36
Medical examination of the deceased patient Primary or
secondary brain injury Diagnosis 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
Slide 37
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
Slide 38
Primary or secondary brain injury Diagnosis of brain death
Reporting of potential donor to OPO (DSO) Family discussion Medical
examination of the deceased patient Data transfer to Eurotransplant
for organ allocation Organ harvesting Organ transport The Organ
Donation Process
Slide 39
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
Slide 40
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
Slide 41
Legal Framework 2 2 The German Procurement Organisation (DSO 3
3 The Organ Donation Process 4 4 Tasks of hospitals 5 5 Finances in
Organ Donation and Transplantation 1 1
Slide 42
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
Slide 43
Information materials for professionals CD-ROM Guidelines
www.dso.de Manuals Annual reports
Slide 44
Legal Framework 2 2 The German Procurement Organisation (DSO 3
3 The Organ Donation Process 4 4 Tasks of hospitals 5 5 Finances in
Organ Donation and Transplantation 1 1
Slide 45
Health insurance company of the organ- recipient Lump sum per
Tx registration -lump sum organ removal (DSO) 11 TPG organ removal
(DSO) 11 TPG DRGs donor-hospital organ allocation (ET) 12 TPG organ
allocation (ET) 12 TPG refund organ transplantation (TPZ) 10 TPG
organ transplantation (TPZ) 10 TPG
Slide 46
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
Slide 47
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 2.460,00 4 organs 3.280,00 5 organs 4.100,00 If
no organ has eventually been transplanted 290,00 Allowance for
abdominal retrieval teams
Slide 48
DSO : Air transport - extrarenal organs Air 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.