1. STRATEGIES TO INCREASE
THE NUMBER OF
DECEASED DONORS:
CURRENT STATES
&
PERSPECTIVES
RAFAEL MATESANZ
DIRECTOR
BUENOS AIRES 28/11/2011 ORGANIZACIÓN NACIONAL DE TRASPLANTES
SPAIN

2. “We can and will succed in creating a unified,
prosperous and democratic Europe” ROMANO PRODI

3. FACTORS WHICH EFFECTIVENESS
INFLUENCE
ORGAN DONATION OF THE SYSTEM
(HEALTH & TRANSPLANT)
HEALTH CARE STRUCTURE
(ICU BEDS / DOCTORS / NURSES …)
+ EPIDEMIOLOGIC DATA
PREDISPOSITION OF THE POPULATION
TO DONATE ORGANS

4. GREAT DIFFERENCES IN HEALTHCARE ALL OVER THE WORLD
MAKE VERY DIFFICULT DECEASED DONATION IN MANY COUNTRIES

5. OPO SYSTEM IN
UNITED STATES

6. 30 DONORS PMP
20 DONORS PMP
12.6 17.0
10 DONORS PMP
20.8
<10 DONORS PMP
14.8 25.0
12.6 10.9
16.4
13.7
15.8 13.3
20.5
6.0 19.6 16.8
23.8 12.6 23.3
PRESENCE OF “IN HOUSE 15.9
20.5 3.3
MEDICAL COORDINATORS” 30.7
30.2
32.0 21.6 2.7
3.6
3.9
DECEASED ORGAN DONORS p.m.p. 2010

7. TRANSPLANT EVOLUTION IN SPAIN SINCE THE START OF THE ONT

8. INCREASE OF ORGAN DONORS IN PORTUGAL
190 AFTER THE INTRODUCTION OF “IN HOUSE” 329
MEDICAL COORDINATORS
350 35
NUMBER RATE pmp 30,4
31
300 30
26,7
23,9
250 21,7 22,2 25
20,2 20,1
19,1 19,5 19
200 19 20
329
322
150 283 15
252
217 222
100 190 199 202 190 190 201 10
50 5
0 0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

9. CROATIA: A SMALL COUNTRY, 4,4 MILLIONS
WITH AN IMPRESSIVE INCREASE OF
ORGAN DONORS LAST YEAR
135/30,7
2010
78/17,7
Donors Donors pmp
140
130
120
110
100
90
80
70
60
50
40 28,66
30 17,83 17,38
13,3 13,7 13,09
20 7,2 9,2 9,06 10,2
10 2,7
0
2009 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

10. EVOLUTION OF ORGAN DONATION RATE IN SPAIN /
REGIONS
ANDALUCIA ARAGON ASTURIAS BALEARES CANARIAS
CANTABRIA CASTILLA LA MANCHA CASTILLA y LEON CATALUÑA COM. VALENCIANA
EXTREMADURA GALICIA LA RIOJA MADRID MURCIA
NAVARRA PAIS VASCO
80.0
70.0
60.0
Donantes pmp
50.0
40.0
30.0
20.0
10.0
0.0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

11. ORGAN DONATION IN TUSCANY - ITALY 22,4
DONORS
PMP
160
140
120
100
80 DONANTES
p.m.p.
60
40
20
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
42,3 DONORS
p.m.p.

12. *2010 data
LATINAMERICAN COUNTRIES
(545 million inhabitants)
Deceased Kidney Liver Heart Lung Pancreas
Organ Donors Transplants Transplants Transplants Transplants Transplants
(Included
NHBD)
10112 2168
(42.4% LD) (7.7% LD) 350 120 210
3943
*2009 data
(540.9 million inhabitants)
15 %
Deceased Kidney Liver Heart Lung Pancreas
Organ Transplants Transplants Transplants Transplants Transplants
Donors
(Included
NHBD)
9759 1934
(42.6% LD) (2.7% LD) 401 65 90
3410

13. OPTIMIZATION
OF
BRAIN DEATH
DONATION
DONATION INCREASE
AFTER OF LIVING
CARDIAC DONATION
DEATH
STRATEGIC PLAN
2008
SPECIAL EXPANDED
SURGICAL CRITERIA
TECHNIQUES DONORS

14. DCD DONORS IN
SPAIN : 8,6%
140 3
2.7
120
2.3 2.5
Número
100
1.9
1.6 2
Tasa (PMP) 1.6 1.7
80
1.3 1.5
60
130
1.1
1 108
0.9 0.9 0.9
0.8 0.8 88 1
40 76
71
0.4 49 56 0.5
20
35 35 43 36 32 32 71
18
0 0
1995 1997 1999 2001 2003 2005 2008 2010

15. Countries with reported DCD activity to the Global
Observatory. DCD pmp. Year 2008
7% of Deceased Donors are DCD
Canada: 1.2 Rep.Korea: 0.1
United States: 2.8 Japan: 0.8
>3 pmp Singapore: 0.9
1-3 pmp
< 1pmp
South Africa: 0.2 Australia: 1.1
New Zealand: 0.5

16. LIVING RENAL TRANSPLANTATION IN SPAIN
250 OBJECTIVE: > 10-15% 240
OF LIVING RENAL TRANSPLANTATION
235
200
150 156
10,7% 137
100 102
87
60 61
50 35 34
22 20 19
16 15 15 20 17 1931
20% INCREASE
DURING 2011
0
1991 1993 1995 1997 1999 2001 2003 2005 2007 2009

17. BENCHMARKING
IN THE PROCESS
OF ORGAN DONATION
TRANSPLANT COMMITTEE
SPANISH REGIONAL COUNCIL
Madrid, November 15th 2010

18. Benchmarking project in the donation process
Proposal to optimize the process of donation after brain
death: To search, identify and spread the best
practices in the process of donation after brain death
Application of the benchmarking methodology to the process
of donation after brain death
• Hospitals with best results: indicators and influencing factors (dilation
elements)
• Interview: best practices description

19. Donation Process after Brain Death
Detection Detection Brain death Obtaining
Evaluation
outside CU inside CU diagnosis consent
Maintenance
1 2 3
Detection of Management of
Obtaining consent
possible donor the possible donor
to organ donation
outside CU inside CU

20. A NATIONAL BENCHMARKING COMMITTEE
WAS CREATED, INVOLVING ONT STAFF.
REGIONAL AND HOSPITAL COORDINATORS

21. FIRST INDICATOR
DETECTION OUTSIDE CU
INDICATOR
CU deaths with selected ICD-9 codes
x 100
Hospital deaths with selected ICD-9 codes
DILATION ELEMENTS
1. Neurosurgery availability in the hospital
2. Stroke Unit availability in the hospital
3. CU workload (bed occupancy rate)
4. CU resources (number of CU beds/ assigned population) x
100.000
5. (Hospital deaths with selected ICD-9 codes / asigned
population) x 1.000

22. SECOND INDICATOR
MANAGEMENT INSIDE CU
(waiting for consent)
INDICATOR
Brain Deaths suitable for organ recovery
waiting for consent
x 100
Total Brain Deaths
DILATION ELEMENTS
1. Neurosurgery availability in the hospital
2. CU workload (bed occupancy rate)

23. THIRD INDICATOR
OBTAINING CONSENT
INDICATOR
Brain Deaths suitable for recovery WITH consent
X 100
Brain Deaths suitable for recovery waiting for
obtaining consent
DILATION ELEMENTS
1. % Population with african or asiatic origin
2. % Population aged > 64 years
3. Number of brain deaths

24. POSSIBLE DONOR
DETECTION OUTSIDE
CRITICAL CARE UNIT
TOTAL HOSPITAL
DEATHS WITH
SELECTED CODES
ospital deaths with selected
codes per population
?
NO
Neurosurgery
?
YES Higher %
Bed Occupancy Rate ?
NO
Stroke Unit
?
YES
Higher %
?
YES 26%
CU beds per
+beds DEATHS OCCUR IN THE
Higher %
population CRITICAL CARE UNIT

25. Qualitative Benchmarking
Questionnaire
Design to identify Best practices
and describe best description
practices
DIFUSSION
Best practices guidelines in the
Hospitals selected organ donation process
On-site Best practices meetings
interview
Adaptation

27. RECOMMENDATION
ADDRESSED TO
EXPLANATION
IT IS NOT TO
DESCRIBE HOW
TO MAKE THE
PROCESS, BUT
WHAT IS THE
POINT / S
CONSIDERED THE
KEY FOR
SUCCESS

28. 9 RECOMMENDATIONS

30. 12 RECOMMENDATIONS

31. 9 RECOMMENDATIONS

32. 20 RECOMMENDATIONS

33. AVAILABLE IN SPANISH,
ENGLISH, ITALIAN &
GERMAN

34. EVOLUTION OF ORGAN DONATION ACTIVITY
MONTHLY RATE 2007 - 2011

35. EVERY COUNTRY SHOULD MAKE A DIAGONOSIS
OF SITUATION AND FIND THE MOST ADEQUATE WAY
TOWARDS SELF - SUFFICIENCY
THERE IS NOT A SINGLE WAY
TO SELF SUFFICIENCY
WELL PROVEN SUCCESSFUL MODELS
(BIG AREAS – SUSTAINED INCREASE)
SHOULD BE TAKEN AS REFERENCE