How to increase donation in an opting-out system the LSGO-model Diethard Monbaliu
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1 How to increase donation in an opting-out system the LSGO-model Diethard Monbaliu on behalf of UZ Leuven donor working group P Ferdinande (chair), S Dirix, S Van Cromphaut, A Neyrinck, G Meyfroidt, J Gunst, E De Troy, K Van Tricht, C Huygens, N Ectors, B. Desschans on behalf of dpt abdominal transplant surgery and transplantation coordination On behalf of the Transplantation council UZ Leuven
2 Opting out presumed consent? Change in legislation whereby organs can be used for transplantation after death unless Individuals have objected during their lifetime
3 Opting out in: international perspective Presumed consent alone is unlikely to explain the variation in organ donation rates between countries: - legislation, - availability of donors, - organisation and infrastructure of the transplantation service, - wealth and investment in health care, - public attitudes to and awareness of organ donation may all play a part, but their relative importance is unclear.
4 Organisation: 3 levels Micro level Individual patient & medical Meso level governement & political Macro level: society
5 Macro level Public support: Awareness of common interest Altruïsm & solidarity Ethically accepted Trust in medical profession
6 Meso level governement legislation organisation health care & insurance raising awareness education
7 Belgian law : presumed consent or opting out 13 juni 1986 every Belgian is a potential donor unless he/she objected against donation during life objection? formal (register town hall) informal (family, tattoo, facebook ) Explicit consent (register)
8 % potential organ donor Opting in < > opting out
9 number organ donors 2013 (pmi)
10 number liverttx 2013 (pmp)
11 Meso level: organisation health care Accessible for every citizen no social, financial burdens No extra costs for patient Awareness & education
12 Awareness
13 Education
14 Public awareness: Website Over Leven Door Geven (in collaboration with provincie Vlaams Brabant) Information on all aspects of donation AND transplantation Donation Transplantation Life after Tx Objective information by professionals Easy to understand visuals Testimonials
15 Micro level medical teams, transplantatiecoordinators donor hospitals transplant centers Individual patients Organ donors recipients
16 History organ donation in UZ Leuven 1963 First kidney Tx from brain dead donor Case 1-3. French speaking KUL (prof Morelle prof Alexandre) Case 4. Dutch speaking KUL (prof Michielsen prof Gruwez) Kidney procurements: first university hospitals collaborating hospitals
17 History organ donation in UZ Leuven 1963 First kidney Tx from brain dead donor Case 1-3. French speaking KUL (prof Morelle prof Alexandre) Case 4. Dutch speaking KUL (prof Michielsen prof Gruwez) 1978 LSGT Leuven collaborative group for Tx Kidney procurements: university hospitals collaborating hospitals 1986: Option out law in Belgium (W Demeester) 1987 First MOD (first Txcoordinator L Roels)
18 Collaboration Decentralization (follow up kidney tx reipicients by local hospitals) motivation to participate in organ procurement
19 History organ donation in UZ Leuven 1963 First kidney Tx from brain dead donor Case 1-3. French speaking KUL (prof Morelle prof Alexandre) Case 4. Dutch speaking KUL (prof Michielsen prof Gruwez) Kidney procurements: first university hospitals collaborating hospitals 1978 LSGT (Leuvense samenwerkende groep niertx) 1986: Option out law in Belgium (W Demeester) 1987 First MOD (first Txcoordinator L Roels) 2009: LSGO Leuvense samenwerkende groep orgaandonatie Leuven collaborative group for organ donation
20 Leuven CollaborativeGroup Organ donation LSGO Effective number organ donors local hospitals & University hospitals Leuven UZLeuven Samenwerkende ziekenhuizen
21 Aim LSGO? optimize organ donation in collaborating hospitals by Identifying key persons on every site Training (individual/group/hospital level) Education Feedback to optimally use the true donor potential
22 LSGO: focus on information & education Donorwerkgroep UZ Leuven: central coordinating role Annual report (in collaboration UZL TX COUNCIL) Website (in collaboration UZL TX COUNCIL) Annual donor symposium - since 1998 in collaboration dept abdominal transplantation and transplant coordination & UZL TX COUNCIL) Annual LSGO symposium (since 2011) Visits of local donor hospitals Education medical students and specialists in training Help line (24/7) Monitoring of donor numbers Medical file review deceased critical care patients Increase and maintenance of public awareness public
23 Annual report organ donation & Tx Donation within LSGO network > recent switch to performance indicators Results of Tx programs
24 Website
25 Central coordinating role Donorwerkgroep Multi-disciplinary group to promote & facilitate organ donor detection and dontation within the collaborating donor hospitals Composition: ICU, ANE, TRA, TXC, Tissue Bank, Psychologist chair prof dr em P Ferdinande Mission Raising awareness Protocol New (e.g. DCD III II V) Finetuning & updating existing Education Analysis of controversial cases / issues Lobbying with influential stakeholders (opinion makers politicians - national bioethics committee -..)
26 Annual symposium (since 1998): focussed on organ and tissue donation & Tx All medical and paramedical staff involved in organ donation & transplantation Open meeting
27 LSGO meeting Key persons/experts local donor hospitals local donor hospitals since 2012 Focussed topics (donor screening, management, legal and ethical issues) New evolutions (MP, NRP, donor cooling, donor management) Start of the art expert speakers (national & international) Interesting case reports Interactive presentation format Serves as interne tx raad (cf KB 2012), by invitation only
28 Education on site Local donor hospitals Awareness Education Programm & topics in consultation with local host (à la tête du client) Nursing schools Others (e.g. social assistents, nurses ) Other public forums on request (congress- primary care physicians-..)
29 Structural Training medical students Dedicated sessions General introduction on organ donation and transplantation Evening sessions (donor work group initiative ) Manama training program since 2015 Since 2014 integrated in offical medical specialists training Postgraduate training anesthesia and intensive care Communication & e-learning module in progress
30 Help line co-morbidity organ donor complexity organ donation (e.g. management of the potential donor, potential DCD selection, ) Low number of donors/head in local hospital (despite installation of a local donor coordinator who is not always on call/available) Experts in organ donation (number, type and difficulty) Through TXC (24/7) Well appreciated by local donor TXC
31 Evolution donor numbers UZ Leuven vs local donor hospitals Total number of effective organ donors
32 LSGO in a national perspective ( )
33 Conclusion Know your history before re-thinking the future (LSGT LSGO) Keymessage: Awareness (keep the attention) Collaboration Training and education
34 nano level
35 Hartelijkdank! Fons sapientiae, Lovanium
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