Donor in Slovenian hospital: coordination of organ donation

1. Donor in Slovenian hospital: coordination of organ donation Overview and simulation Matevž Harlander

2. National network GH Murska Sobota UMC Maribor GH Slovenj Gradec GH Jesenice GH Ptuj GH Celje UMC Ljubljana GH Nova Gorica GH Novo mesto 1 Tx centre 10 donor hospitals GH Izola

3. Donor hospital coordinator • = MD located in donor hospital • Identification of potential donors • Family consent • Diagnostics • Reports to central coordinator

4. Central coordinator • = MD located in Slovenia Transplant • = hospital coordinator for UMC Ljubljana • Reports the donor to Eurotransplant • Coordination of organ allocation (in coop. with ET) • Coordination of transport • Coordination of explantation team • Receives organ offers from Eurotransplant • Coordination of implantation team

5. Availability 24/7

6. Organ donation process

7. Donor protocol

8. Donor detection • „Pasive“ detection model • Brain dead patients are reported to coordinator by ICU doctor • Medical data is reviewed • Decision whether the deceased is a potenial donor

9. Family consent • Legislation • Organ donation is possible when family members or persons close to the deceased do not disagree with it • Organ donation is presented to the family • Mostly positive decisions

10. Diagnostics • According to the ET protocol • Laboratory • ECG • Chest X-ray • Abdominal and cardiac echography • Microbiology • HLA typization • Other if neccessary (i.e. coronarography)

11. Organ allocation • Eurotransplant central office • Explantation team is notified • Offers to SLO-TP • Presented to doctors in charge • If accepted implantation teams are notified • Timing is coordinated with teams coming from other centers • Final explantation date and time is set and all the teams are notified again

12. Explantation • Liver and kidneys are explanted by local team • Heart, lungs and pancreas tipically by teams that will perform implantation (local or foreign) • Tissues (corneas, skin, bones) • Organs are dispatched • Private flights • Regular flights (kidneys) – Adria/Lufthansa

13. Example from practice

14. Potential donor 15:30 • Potential donor detected in ICU in UMC Ljubljana • 27-year old male with traumatic brain injury due to motorcycle accident • Brain death established

15. Family consent 16:30 • Slovenia-Transplant coordinator is notified • Family is informed about the death by the ICU doctor • Request for organ donation made by SLO-TP coordinator • Consent is obtained

16. Examinations 19:30 Standard ET protocol Explantation time set: 24:00

17. Organ allocation • First offer is to Belgium for HU patient • Reserve offer for Slovenia, also HU patient • Belgium declines, in this time we already reviewed the data and accepted the offer 20:30 TX team is notified

18. Organ allocation • First offer to Vienna (agreement) • Declined due to bilateral contusions • Also declined in other ET centers 19:30-22:00 No explantation • If accepted: • We are contacted by the accepting center • Transport details obtained (flight No.) • Notifications to air and border control • Notifications to ambulance car to pick up the team

19. Organ allocation • First offer is to Belgium for HU patient • Reserve offer for Slovenia • Belgium declines, in this time we already reviewed the data and accepted the offer 21:00 TX team is notified Frozen section planned, pathologist notified

20. Organ allocation Ambulance car Border and air control + 21:00 • Accepted in Insbruck, Austria Pancreas not transplantable Team returns empty handed

21. Organ allocation Ambulance car Border and air control Airline notifiation • Left to Zagreb, Croatia • Right to Nijmegen, The Netherlands 23:30

22. Thank you for your attention. • Questions?