Spanish model of kidney transplantation and organ donation

Transcription

1 Spanish model of kidney transplantation and organ donation JM.Campistol, Nephrology and Renal Transplant Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.

2 SPAIN Population: 45 M

3 EVOLUTION OF ORGAN DONORS ( )

4 RENAL TRANSPLANT ACTIVITY SPAIN ( )

5 ETIOLOGY OF BRAIN DEATH DONORS

6 LIVING KIDNEY TRANSPLANTATION

7 TRANSPLANT PATIENTS VS. DIALYSIS

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9 SPANISH MIRACLE ON ORGAN TRANSPLANTATION SECRETS Organ donation law Universal and good health system Organ transplantation well introduced in the society Solidarity of Spanish Society Transplant procurement teams (TPM) Surgeons and professional dedicated Economical incentives Working team

10 ESRD SUBSTITUTIVE TREATMENT Survival KIDNEY TRANSPLANTATION QoL Economical ESRD HEMODIALYSIS PERITONEAL DIALYSIS

11 THE NEW VITAL CYCLE SOCIETY Follow-up Social Attitude TRANSPLANTATION DONATION Sharing Procurement EXTRACTION

12 EXTRA HOSPITAL Schematic flow of possible donors CASA HOME Demographic Factors Geographic factors Hospital beds. Access to Hospitals Social & Cultural factors 1. POTENTIAL FOR DONATION 2. PROCESS EFFECTIVENESS 3. IMPROVEMENT AREAS & ACTIONS INTRA - HOSPITAL URGENCIA Hospital Emergency DEL HOSPITAL Room PLANTA Admitted U.C.I. I.C.U. M.E. E.D. D.R. A.D. Another OTRO HOSPITAL Hospital practice variability Availability of beds Availability of ICU Beds ICU Policy for patient s admittance Variability in clinical practice QUALITY CONTROL PROGRAMME CALIDAD DE LA O.N.T. EXTRA - ICU INTRA - ICU

13 Investigate!!! How can you find out where the problems are? Retrospective analyses of the medical records from every dead person in intensive care unit* INTENSIVE CARE UNIT MORTALITY REFERRAL TO TRANSPLANT COORDINATION TEAM? BRAIN DEATHS ACTUAL DONORS Causes of loss of potential donors *Units with ventilation facilities and admitting patients for more than 12 hours

14 PROCURAMENT LOCATION ICU Hospital HOSPITAL Tx. Teams ICU HOSPITAL Tx. Teams OPO TPM ICU HOSPITAL Tx. Teams

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16 PROCUREMENT and SHARING NETWORK HOSPITAL Detection + Retrieval H. NTO REGION Detection H. SHARING PROCUREMENT Detection + Retrieval + Transplant H.

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18 Optimization of Detection Process Administrative Revision of list of admissions to ICU Active monitoring Daily visit to donor generating units ICU Active relation with external emergency system Permanent Health Care Professional approach Permanent on call service Focus on Target Unit personnel Increase awareness with Specific Training modules Provide simple and clear guidelines Hospital development to collaborating centers Show transplant results

19 ORGAN AND TISSUE PROCUREMENT LIVE Donors after BRAIN-DEATH Donors after CARDIAC-ARREST EXITUS KIDNEY NHBD + LIVER TISSUES + ORGANS AND TISSUES TISSUES CELULLAR THERAPY

20 The process of Donation after Brain Death Matesanz R. Am J Transplant 2012; 12: 2498

21 Deceased donors in Spain (DBD + DCD)

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23 Living Kidney Transplant Spain

24 DCD Types Classification of Maastricht Category Condition Event Frequency 1 Uncontrolled Death on arrival Rare 2 Uncontrolled CPR maneuvers unsuccessful 3 Controlled Removal of ventilatory support followed by cardiac arrest 4 Uncontrolled Brain death followed by cardiac arrest Very frequent Less Frequent Rare CPR, cardiopulmonary resuscitation

25 DONORS AFTER CARDIAC DEATH TYPE II CPR RECOVERY CARDIAC ARREST DX DEATH PRESERVATION COLD PERFUSION 5 MINUTES KB KPPM RNR Procedure 4h ORGAN VIABILITY EVALUATION 30 min. 2 ½ hours KT

26 Donors after Cardiac Death. Normothermic Recirculation Normothermic Recirculation 1-4h (6h) with a pump maintenance > L/m 2 Continuous gasometric and ionic control (30 min) Biochemical renal & hepatic control Hemoglobin control Re-heparinization (1,5 mg/kg/90min)

27 DONORS AFTER CARDIAC DEATH TYPE III + NRP

28 DONORS AFTER CARDIAC DEATH TYPE III + NRP

29 DONORS AFTER CARDIAC DEATH TYPE III + FAST ORGAN RETRIEVAL + In situ Perfusion

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31 EMERGENCY AREA MULTIDISCIPLINARY PROGRAM OUT OF HOSPITAL EMERGENCY SERVICES (SEM) OCATT / ONT TRANSPLANT HOSPITALS EMERGENCY ROOM TRANSPLANT COORDINATION UNIT ER & SURGERY NURSES LIVER SURGERY UROLOGY / RTU Pathology Microbiology Infectious Dept. Immunology ER Lab

32 HOSPITAL End of life process Home / ER RELATIVES Severe Brain Damage Severe Cardiac Damage DCD type II - III RELATIVES RELATIVES RELATIVES Clinical Diagnosis of Brain Death Cardiac death WLTS Cardiac or circulatory death DEATH CERTIFICATION DEATH CERTIFICATION DEATH CERTIFICATION

33 Conclusions key points - Education: 1.- TPM specialists 2.- Generating units 3.- Population - Htal. Development: 1.- Htal. responsibility 2.- Global resuscitation 3.- TPM staff - TPM network: 1.- Sharing office 2.- Procurement and transplant hospitals network 3.- Allocation priority for procurement / transplant centres

34 Thank you!!!! Catalan Castle