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Tasks and responsibilities of the German organ procurement organization DSO

Technical Assistance for Alignment in Organ Donation 1st International Symposium. Tasks and responsibilities of the German organ procurement organization DSO . th. Crowne Plaza İstanbul, 29 of May 2014 . Axel Rahmel MD. Contents. Legal Framework. 1. 2.

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Tasks and responsibilities of the German organ procurement organization DSO

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  1. Technical Assistance for Alignment in Organ Donation 1st International Symposium Tasks and responsibilities of the German organ procurement organization DSO th Crowne Plaza İstanbul, 29 of May 2014 Axel Rahmel MD

  2. Contents Legal Framework 1 2 The German Procurement Organisation (DSO) The Organ Donation Process 3 4 Tasks of hospitals 5 Finances in Organ Donation and Transplantation Finances in Organ Donation and Transplantation

  3. Legal Framework 1 2 The German Procurement Organisation (DSO The Organ Donation Process 3 4 Tasks of hospitals 5 Finances in Organ Donation and Transplantation

  4. The legal basis • German Transplantation Act (adopted in 1997) • Regulates organ donation, allocation and transplantation from deceased and living donors • Informed consent (opt-in) • Brain death: complete and irreversible loss of all brain function • No donation after cardiac death (DCD)! • First amendment on 4th September 2007 • Second amendment on 1st August 2012

  5. Eurotransplant Transplant-centers DSO Transplantation act – shared responsibilities Transplant-Centers Waiting list Organ donation procedure Transplantation Allocation Stiftung Eurotransplant Leiden / Niederlande OPO Deutsche Stiftung Organtransplantation since June 2000

  6. TT-Labs Hospitals Eurotransplant (NL) Transplant Centers Stakeholder in Organ Donation Process

  7. Legal Framework 1 2 The German Procurement Organisation (DSO The Organ Donation Process 3 4 Tasks of hospitals 5 Finances in Organ Donation and Transplantation

  8. The German Procurement Organisation (DSO) • is the national organ procurement organisation • The DSO has the responsibility to organise organ procurement in every German hospital (regulated by German Transplant Act)

  9. Germany Residents: 82,4 mill. Federal States: 16 DSO 7 regions 80 coordinators (nurses / physicians) Hospitals with ICU: 1.346 Transplant Centers: 47

  10. Cooperation with hospitals • Appropriate communication path • - Donor referral (suitability of donor/support) • Any time • (365 days / 24 hours) • Support in determination of brain death • Examinations / therapy regarding • - organ function • - diagnosis of infection • - tumor diagnosis • - immunological parameters • Process time ≤ 12 h • Data transfer to allocation authority • On the spot support • during organ donation • process • Organization of • - transport of organs/teams

  11. Contracts • 693 contracts with procurement surgeons • 181 contracts with consultants for brain death diagnosis • 45 contracts with transplantation-centres Pathology / Immunology • 12 contracts for HLA-typing

  12. Legal Framework 1 2 The German Procurement Organisation (DSO The Organ Donation Process 3 4 Tasks of hospitals 5 Finances in Organ Donation and Transplantation

  13. Organizationofthe organ donationprocessin Germany

  14. The Organ Donation Process Primary orsecondarybraininjury

  15. Causes of Death of Organ Donors • 84 % Atraumatic causes of death

  16. Killed in road traffic • 2010: 3657 Verkehrstote

  17. Reduced mortality after stroke

  18. Organ Donation in Germany (Age of Organ Donors)

  19. The Organ Donation Process Primary orsecondarybraininjury Diagnosis ofbraindeath

  20. Detection of brain death and confirmation

  21. Brain death protocol • According to the guidelines of the federal medical counsil • 2 qualified doctors not involved in transplantation have to confirm independently brain death

  22. The Organ Donation Process Primary orsecondarybraininjury Diagnosis ofbraindeath Reporting of potential donorto OPO (DSO)

  23. The Organ Donation Process Primary orsecondarybraininjury Diagnosis ofbraindeath Reporting of potential donorto OPO (DSO) Family discussion

  24. Written wish to donate

  25. Next of kin

  26. Accompany the Decision Process Therapy Death (Brain death) Decision Grieving Process To accompany the decision means: Competent partner with time, goal, kowledge and emotion • Ask helpful and prudent open question, build bridges • Reflect together • Provide information and guarantees • Avoid after decision-dissonance!

  27. Reasons for Refusal (%) Next of kin discordant Damage to bodily integrity Death not accepted Religious reason % % % Others % Deceased person´s attitude not known % % Unknown Negative attitude towards organ donation known % n = 2520

  28. Reasons for Consent (%) Desire to make sence of the sudden death of a loved one % Knowing someone who needs a transplant or benefied from a organ donation Altruistic motives (compassion) % % Other reason Unknown % Positive attitude towards organ donation known 44,8 % n = 4669

  29. The Organ Donation Process Primary orsecondarybraininjury Diagnosis ofbraindeath Reporting of potential donorto OPO (DSO) Family discussion Medical examinationofthedeceasedpatient

  30. Medical and behavioural history • Standardised questionnaires should be used to obtain the following information: • clinical history and pre-existing diseases • behavioral risk and previous medical treatment • history of chemical and/or radiation exposure, previous and current medication • travel history or overseas/out-of-country residency • recent history of any immunization with live vaccines • risk of transmitting prion disease • information about congenital or inherited disorders • other relevant family medical history

  31. Standardized medical history

  32. www.edqm.eu

  33. The Organ Donation Process Primary orsecondarybraininjury Diagnosis ofbraindeath Reporting of potential donorto OPO (DSO) Family discussion Medical examinationofthedeceasedpatient Data transferto Eurotransplant fororganallocation

  34. Attorney Relatives HTD Notification Legal prerequisite med. Evaluation LAB ICD OPS DIAG MED MNT Processing donor- & organinformation Allocation & XMRequest Transplant ET-Interface Procurement Report & Update • Medical history • Admission • Procurement Transports Orders

  35. Key Features • Different userprofiles • Documentation according to the process • Standardized diagnostics and procedures • Timerelated information • Calculator for laboratory values • Modification history • Validation and businessrules • Interfaces for medical and administative information • Data-Warehouse retrieval and reporting • New attributes easy to add - parameter model

  36. The Organ Donation Process Primary orsecondarybraininjury Diagnosis ofbraindeath Reporting of potential donorto OPO (DSO) Family discussion Medical examinationofthedeceasedpatient Organ harvesting Data transferto Eurotransplant fororganallocation

  37. Organization of the organ procurement • Organisational framework • Number of participating teams • Transport routes and times • Scheduling • Weather conditions • Experience of the teams • Coordination between the teams • Waiting time at the OT

  38. The Organ Donation Process Primary orsecondarybraininjury Diagnosis ofbraindeath Reporting of potential donorto OPO (DSO) Family discussion Organ transport Medical examinationofthedeceasedpatient Organ harvesting Data transferto Eurotransplant fororganallocation

  39. DSO: Air transport - extrarenal organs • Establishing an air transport network responsible for the organisation of all national and international transports of organ retrieval teams and organs. • Main goals and principles: • quality, safety and economic efficiency • medical necessities, CIT • consideration of transport distance • avoiding „empty“ flights • rare use of cost-intensive jets • trustworthy und competent partners

  40. The Organ Donation Process Primary orsecondarybraininjury Diagnosis ofbraindeath Reporting of potential donorto OPO (DSO) Transplantation Family discussion Organ transport Medical examinationofthedeceasedpatient Organ harvesting Data transferto Eurotransplant fororganallocation

  41. Legal Framework 1 2 The German Procurement Organisation (DSO The Organ Donation Process 3 4 Tasks of hospitals 5 Finances in Organ Donation and Transplantation

  42. SOP (Standard Operation Procedure) • Development and Implemantation of Standard Operating Procedures (SOP) together with DSO Coordinators and inclusion of contact persons from the hospital • 1 • 2 • 3 • 4 • 5

  43. Information materials for professionals Guidelines Manuals Annual reports CD-ROM www.dso.de

  44. Legal Framework 1 2 The German Procurement Organisation (DSO The Organ Donation Process 3 4 Tasks of hospitals 5 Finances in Organ Donation and Transplantation

  45. Finances in Organ Donation and Transplantation donor-hospital Healthinsurancecompanyofthe organ-recipient organremoval (DSO) § 11 TPG Lump sum per Tx refund organallocation (ET) § 12 TPG registration-lump sum DRGs organtransplantation (TPZ) § 10 TPG

  46. DSO: Budgeting systematics • Organisational flat rate • DSO does not recieve an entire budget sum but recieves a lump-compensation for every transplanted organ, negotiated yearly. • In the year 2013, the organisational flat rate is 8.460 € per transplanted organ. 4.000 transplantations are assumed. • DSO covers all costs theat occur during the donation process as well as structural costs with this flat. DSO has contracts with organ retrieval surgeons, neurologists, labs beside the own staff. • Exeptions: refund of costs to the donor hospitals and flight costs for non-renal organs. • Compensation mechanisms if the fixed number of cases is not reached or exeeded.

  47. Example: Allowances Surgeons • Allowance for abdominal retrieval teams • Special cases: • Kidneys en bloc: 820,00 € • Split liver, if both splits are transplanted: 1.640,00 €

  48. DSO: Air transport - extrarenal organs • Air transport of extrarenal organs • In 2013, the lump sum for an air transport of an extrarenal organ is • 7.652 € per transplanted organ for which a separate flight is carried out. • Unsuccessful operations are included in the lump sum and will noch be refunded separately. The lump sum is based on the assumption that 880 air transports will be carried out in 2013. • If the number of 880 flights is exeeded 50 % of the additional proceeds will be refunded to payers. If the number of flights is lower than 880 flights 50 % of the lacking revenues will be refunded by the payers.

  49. Thank you for your attention!

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