1 / 41

Experience in Organ Donation in Austria and Vienna

Experience in Organ Donation in Austria and Vienna. Ferdinand Mühlbacher Department of Surgery Visit to Kopenhagen 3.3.2010. Basic Structure of Austrian Transplant System. Center based System with little national authority. 3 Medical Universities with Transplant Programs for all Organs

vin
Download Presentation

Experience in Organ Donation in Austria and Vienna

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Experience in Organ Donation in Austria and Vienna Ferdinand Mühlbacher Department of Surgery Visit to Kopenhagen 3.3.2010

  2. Basic Structure of Austrian Transplant System Center based System with little national authority • 3 Medical Universities with Transplant Programs for all Organs • 2 Renal Transplant Program in non academic institutions (One City) • 4 Donor Regions • Donor regions and patient service regions match fairly well Vienna Linz Innsbruck Graz

  3. # of Tx Centers/ Mill Pop Vs Cadaveric Renal Transplantation

  4. Decentralized Donor Procurement

  5. Manpower (fte)

  6. Budget (Federal Gonvernment)

  7. Budget Expences %

  8. Potential of Organ Donors Estimation between 20 und 80 Donors / Mio /Year • Schuster et al Öbig 1995: • 85potential d/mio/year realised 21only • Barber K et al Transplant Proc 2005 37:568 • Out of 22668 ICU death: 1387 (6%) brain death (23/mio/year?) • Person N Lak 2005 • Out of 3114 ICU death; 174 (5,6%)brain death

  9. Critical Steps in Organ Donation The „Donor Chain of Events“ • 1. Donor detection • 2. Viability / Safety • 3. Donor management • 4. Consent / Authorisation • 5. Organ retrieval / Logistics

  10. Donor Age 1998 - 2007

  11. Achilles´s Heel of Organ Donation Enthusiasm Information Legislation Infrastructure Kooperation Donor Detection

  12. “Singel Person effect”Trauma Unit

  13. “Single Person effect”6 month periods

  14. Regional Donor distribution

  15. UK Autopsy Tradition "Since Henry VIII's time, the sole legal source for corpses for dissection had been the gallows - bodies of murderers handed over to the anatomists as a post-mortem punishment." (Introduction, xv) Ruth Richardson: "Death, Dissection and the Destitute" (London, Routledge & Kegan Paul, 1987)

  16. Gerard van Svieten 1700-1772

  17. Austrian Autopsy Law KAG § 25(1) and Wr. KAG §40(1) Corpses of patients, who died in public hospitals have to undergo autopsy in case of • Public health concerns • Forensic matters and • Public or scientific interest -

  18. Essentials of Austrian TX Law • Removal of organs from deseased persons allowed • For the purpose transplantation • No personal objection (presumed consent) • Death certified by licensed independent doctor • In public hospitals only • No commercial interest allowed • Piety has to be respected

  19. What is not regulated in Austrian TX Law • Living Donation • Organ Allocation

  20. Long tradition in Austria (Autopsy law) Personal - not family- decision Balances public vs personal interests No written decision by relatives necessary In favour of transplantation Advantages of Presumed Consent Regulation

  21. Death Criteria % Agreement 1. Forensic Criteria: 100 Cold, Stiff,Spots, Fermentation 2. Clinical Criteria: Unconscious, No Breathing, No Heart Beat, 3. Brain Death Criteria: 96 / 92 *) No Brainstem Function +Flat EEG *) Wamser et al. Transplant.proc. 1992

  22. Controversy About Brain Death Very dangerous!! Brain Death vs Brain Stem Death Pragmatic solution: „Irreversible loss of all intracranial functions“

  23. Allocation Basic requirements for Organ allocation Transparency Egalitarian Principle -- Utilitarian Principle Simple Trust

  24. ET transplant programs Leiden 66 39 37 25 4 38 Total population: 120 Mill.

  25. Allocation:XCOMB (ET)

  26. Donor- und Transplant-Frequencies in Austria 1989-2009

  27. Deseased Donor Frequencies in Europa*) Transplant Newsletter Vol 9:1 2008 Council of Europe *)Donors per mill population

  28. Renal Transplantation in AKH Vienna 1965 - 2009

  29. Efficiency of RT in ESRD 51% 52% 52% 51% 50% 50% 51% 52% 52% 54% 55% 54% 55% 54% 55% 56% 55% 56% 60% 63% 65% 49% 48% 48% 49% 50% 50% 49% 48% 48% 46% 45% 46% 45% 46% 45% 44% 45% 44% 40% 37% 35%

  30. Ethical Issues in Transplant Legislation - Cadaveric Source for Transplant Organs - Brain Death Criteria /Determination - Safety / Quality Control - Authorisation - Allocation - Live Donation - Non Profit Rule - Logistics

  31. „Über Kreuz Transplantation“

  32. „Domino“ Transplantation

  33. LRD vs LURD vs CAD

  34. NHBD Categories (Maastricht) • a) dead upon arrival • b) unsuccessful resuscitation • c) awaiting cardiac arrest • d) circulatory arrest after brain death confirmation

  35. Targets of Promotion • >>> ICU Personnel (Communication Courses) • >> Medical staff at large (Lectures, meetings, Courses, „Medical lay journals“ • > Public. (Donation days, „Media culture“-Information)

  36. Folie 57

More Related