Organ Donation. United States and European Union Perspective

Transcription

1 Organ Donation United States and European Union Perspective Carina Sokalski - Gonzalo Perez SANIT- December 14, 2004 Two Types of Organ Donation Deceased Organ Donation The majority of organ donors are people who suffer from a head injury that results in brain death Uniform Anatomical Gift Act (UAGA) provides individuals aged 18+ the right to donate organs & tissue for transplantation Requirement: signed donor card or indication on a driver's license. All U.S. states have enacted some form of the UAGA Living Organ Donation offers alternative for individuals awaiting transplant while expanding the organ supply Types of organs that can be given by living donors include: Single kidney Liver Lung Pancreas 1

2 Organ Procurement & Transplantation Network Patient is registered on UNOS Organ Center Waiting List through transplant hospital. Donation is made. Procuring organization accesses UNOS matching system to enter data about donor organs. Computer program generates list of potential recipients ranked according to objective criteria. List of potential recipients is printed. Procurement coordinator contacts transplant surgeon caring for the topranked patient. Criteria: blood type, tissue type, size of organ, medical urgency of patient, time on waiting list, and distance between donor and recipient Top ranked patient: organ characteristics best match the donor organ and time on waiting list, urgency status, and distance from donor organ comply with policy). Transplant surgeon determines if organ is suitable for patient. If organ is turned down, next listed individual's transplant center contacted until organ is placed. Once organ is accepted transportation arrangements are made for surgical teams to come to donor hospital and surgery is scheduled. Recovered organs are stored in cold organ preservation solution and transported from donor to recipient hospital. Organ is surgically transplanted Surgeon evaluates factors such as donor's medical history and current health of the potential recipient. Heart and lung transplants should occur within 6 hours of organ recovery. Livers can be preserved up to 24 hrs. UNOS = United Network for Organ Sharing Ranking of Organ Demand Waiting list candidates as of November 28, 2004 All 87,249 Kidney 60,175 Pancreas 1,650 Kidney/Pancreas 2,441 Liver 17,467 Intestine 200 Heart 3,326 Lung 3,925 Heart/Lung 173 All candidates will be less than the sum due to candidates wait ing for multiple organs Tr anspl ants per formed January - August 2004 Total 18,109 Deceased Donor 13,415 Living Donor 4,694 Based on OPTN data as of 11/19/2004 Donors r ecovered January - August 2004 Total 9,433 Deceased Donor 4,743 Living Donor 4,690 Based on OPTN data as of 11/19/2004 2

3 What Makes Organ Matching So Challenging Eligibility for organ donation Organs are matched by: blood & tissue type organ size medical urgency waiting time geographic location Patients are more likely to find matches among donors of their same race or ethnicity Median Waiting Times for Registrations Listed between by Blood Type Organ Year Listed Blood Type Registrations Added Median Waiting Time (Days) Heart/Lung ,533 Heart/Lung A 104 1,132 Heart/Lung B Heart/Lung AB 9 - Heart , Heart A 3, Heart B Heart AB Intestine Intestine A Intestine B 27 - Intestine AB Kidney ,846 1,592 Kidney A 13, Kidney B 5,567 1,697 Kidney AB 1,

4 Median Waiting Times for Registrations Listed between by Ethnicity Organ Year Listed Ethnicity Registrations Added Median Waiting Time (Days) Heart/Lung White 128 1,533 Heart/Lung African American 104 1,132 Heart/Lung Hispanic Heart White 6, Heart African American 1, Heart Hispanic Heart Asian Heart American Indian Intestine White Intestine African American Intestine Hispanic Intestine Asian 4 - Kidney White 21,166 1,043 Kidney African American 10,869 1,639 Kidney Hispanic 4,447 1,415 Kidney Asian 1,668 1,555 Kidney American Indian 377 1,572 EU Institutions & Roles - Overview European Union Council of Europe (COE) Committee of Ministers Intergovernmental organization EU Treaty (Art.152) Fundamental Principle: Free movement of people (patients), goods (organs) & services (physicians) Cooperation with COE & World Health Organization European Health Committee (CDSP) Steering Committee created in 1954 Committee of Experts in organ transplantation(sp- CTO) Permanent Body since 1987 General Policies High Autonomy Scope and Degree of Autonomy Operating Activities Low Autonomy 4

5 COE & CDSP Goals & Activities Council of Europe (COE) Institutional body Decision-making: Committee of Ministers of Foreign Affairs Goals to improve EU citizens quality of life to defend human rights European Health Committee (CDSP) Executive body Goals To Encourage European cooperation on promotion of health Democratization and humanization of health services Activities Ethics-oriented health policies Promotion of joint cooperation on improving standards of training & exchange of experience 1999 Comprehensive document on guidelines to improve organ procurement Contributions of the SP-CTO Guiding Principles Ensuring the dignity of the human being Maintenance and realization of human rights & fundamental freedom Non-commercialization of substances of human origin Protection of donors and recipients Activity Promotes international cooperation of organ transplantation Ethical, organizational & legislative aspects Recommendations to national governments not binding Recent Developments General list of recommendations & publications in the organ transplantation field Comprehensive document on coping with organ shortage Technical Recommendation on Xeno-transplantation & organ donor registration Yearly Newsletter (Sep 2004) 5

6 Transplant Support Organizations Origin: Need of organizations to support transplant activities in specific areas 1960s Professional agreements on kidney sharing 1980s Evolved to cover non-renal organs Organ Sharing Offices (OSOs) Organ Exchange Organizations (OEOs) Vary significantly by country i.e. scope, size of population served, management, structure, organization, objectives & activities covered 6