EUROPE 2006 by Wen-Chung Chiang. Jesuitenkirche, Vienna Stephansdom, Vienna, Austria.
Experience in Organ Donation in Austria and Vienna
description
Transcript of Experience in Organ Donation in Austria and Vienna
![Page 1: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/1.jpg)
Experience in
Organ Donation in
Austria and Vienna
Ferdinand MühlbacherDepartment of Surgery
Visit to Kopenhagen3.3.2010
![Page 2: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/2.jpg)
Basic Structure of Austrian Transplant System
InnsbruckGraz
ViennaLinz
• 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
Center based System with little national authority
![Page 3: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/3.jpg)
# of Tx Centers/ Mill PopVs
Cadaveric Renal Transplantation
![Page 4: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/4.jpg)
Transplantation Center
H
H
H
H
LabHLANeurologyEEGSurgLogisticTransport
Decentralized Donor Procurement
![Page 5: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/5.jpg)
Manpower (fte)
Donors 2009
Regional
Coordinator
Center Coordinator
Off hour coordination
North 50 0,5 1 MDOn call doctors
on demand
East 76 1,0 2 MD+2 Secr.
West 36 0,5 3 NursesOn call doctors
on demand
South 50 0,5 2 Students
National 212 3 economists
17,5 fte
![Page 6: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/6.jpg)
Budget (Federal Gonvernment)
€
Budget calculated for Organs 2 .460 .000
Budget effectuated for Organs 24D/M/Y
1.947.000
Returned to Fed. Gov. in 2007 513.000
![Page 7: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/7.jpg)
Budget Expences %
Transport costs 26%
Coodination fee 8%
Brain death fee 6%
Man power 20%
Education 11%
Donor Hosp. reimbursement 29%
![Page 8: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/8.jpg)
Potential of Organ Donors
Estimation between 20 und 80 Donors / Mio /Year• Schuster et al Öbig 1995:
– 85 potential 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
![Page 9: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/9.jpg)
Critical Steps in Organ Donation
• 1. Donor detection
• 2. Viability / Safety
• 3. Donor management
• 4. Consent / Authorisation
• 5. Organ retrieval / Logistics
The „Donor Chain of Events“
![Page 10: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/10.jpg)
Donor Age
0
25
50
75
100
125
0
25
50
75
100
125
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
≥6045-5930-4415-29<15
1998 - 2007
![Page 11: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/11.jpg)
Achilles´s Heel of Organ Donation
Donor Detection
Enthusiasm
Information
Legislation
Infrastructure
Kooperation
![Page 12: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/12.jpg)
“Singel Person effect”Trauma UnitLBK spender 1883-1990
0
2
4
6
8
10
12
1983- 1984- 1985- 1986- 1987- 1988- 1989- 1990-
Jahrgang
Spender
![Page 13: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/13.jpg)
“Single Person effect”6 month periods
![Page 14: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/14.jpg)
Regional Donor distribution
Inhabitants 2007 2008 2009
North 1.936.648 29,43 22,7 25,8
South 1.757.638 19,91 26,6 28,44
West 1.063.871 33,84 12,5 33,8
East 3.523.137 14,48 18,0 21,57
Austria 8,2 24,7 20,4 25,8
![Page 15: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/15.jpg)
Authorisation
Explicit consent(Japan)
Pure presumed consent(Mandatory autopsy)
No statement available:Include next of kin in the decision making process
There is still an advantage to "presumed consent version", both for doctors and for next of kin
presumed non consentopt in
presumed consentopt out
![Page 16: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/16.jpg)
"Since Henry VIII's time, the sole legal source for corpses for dissectionhad been the gallows - bodies of murderers handed over to the anatomists asa post-mortem punishment."(Introduction, xv)
UK Autopsy Tradition
Ruth Richardson: "Death, Dissection and the Destitute" (London, Routledge & Kegan Paul, 1987)
![Page 17: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/17.jpg)
Gerard van Svieten
1700-1772
![Page 18: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/18.jpg)
-
KAG § 25(1) and Wr. KAG §40(1)
Austrian Autopsy Law
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
![Page 19: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/19.jpg)
Transplantationsgesetz ÖsterreichKAG §62a BGBL Nr. 273/182
(2) Die Entnahme darf erst durchgeführt werden, wenn ein zur selbständigen Berufsausübung berechtigter Arzt den eingetretenen Tod festgestellt hat. Dieser Arzt darf weder die Entnahme noch die Transplantation durchführen. Er darf an diesen Eingriffen auch sonst nicht beteiligt oder durch sie betroffen sein.(3) Die Entnahme darf nur in Krankenhäusern vorgenommen werden, die die Voraussetzungen des § 16 Abs.1 lit. A und c bis g erfüllen.(4) organe und Organteile Verstorbener dürfen nicht Gegenstand von Rechtsgeschäften sein, die auf Gewinn gerichtet sind.
![Page 20: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/20.jpg)
Transplantationsgesetz Österreich
KAG §62b+c BGBL Nr. 273/182
§ 62b. Angaben über die Person von Spender bzw. Empfänger sind vom Auskunftsrecht gemäß § 11 Datenschutzgesetz, BGBl. Nr. 565/1978, ausgeommen.
§ 62c. Wer dem § 62a zuwiderhandelt, begeht, sofern nicht eine gerichtlich strafbara Tat vorliegt, eine Verwaltungsübertretung und ist mit Geldstrafe bis 30.000,- ATS zu bestrafen.
![Page 21: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/21.jpg)
Transplantationsgesetz Österreich
KAG §62a BGBL Nr. 273/182
§ 62a (1) es ist zulässig, Verstorbenen einzelne Organe oder Organteile zu entnehmen, um durch deren
Transplantation das Leben eines anderen Menschen zu retten oder dessen Gesundheit wiederherzustellen. Die
Entnahme ist unzulässig, wenn den Ärzten eine Erklärung vorliegt, mit der der Verstorbene oder, vor
dessen Tod, sein gesetzlicher Vertreter eine Organspende ausdrücklich abgelehnt hat. Die Entnahme darf nicht zu einer die Pietät verletzenden Verunstaltung
der Leiche führen.
![Page 22: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/22.jpg)
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
![Page 23: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/23.jpg)
What is not regulated in Austrian TX Law
• Living Donation
• Organ Allocation
![Page 24: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/24.jpg)
Advantages of Presumed Consent Regulation
• 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
![Page 25: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/25.jpg)
% Agreement
1. Forensic Criteria: 100Cold, Stiff,Spots, Fermentation
2. Clinical Criteria:Unconscious, No Breathing, No Heart Beat,
3. Brain Death Criteria: 96 / 92 *)No Brainstem Function +Flat EEG
Death Criteria
*) Wamser et al. Transplant.proc. 1992
![Page 26: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/26.jpg)
Controversy About Brain Death
Very dangerous!!
Brain Death vs Brain Stem Death
Pragmatic solution:
„Irreversible loss of all intracranial functions“
![Page 27: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/27.jpg)
Allocation
Basic requirements for Organ allocation
TransparencyEgalitarian Principle -- Utilitarian Principle
Simple
Trust
![Page 28: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/28.jpg)
Leiden
6666
3737
44
3939
2525
3838
ET transplant programsET transplant programs
Total population: 120 Mill.
![Page 29: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/29.jpg)
![Page 30: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/30.jpg)
Allocation:XCOMB (ET)Points Weight Maximum
HLA - A,B,DR Missmatch 100 4 400
Missmatch Probability 100 1 100
Waiting Time 100 2 200
Distance: Donor-Recipient Center
100 3 300
National Balances 100 2 200
![Page 31: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/31.jpg)
1989-2009
Donor- und Transplant-Frequencies in Austria
![Page 32: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/32.jpg)
Deseased Donor Frequencies in Europa*)
Transplant Newsletter Vol 9:1 2008 Council of Europe *)Donors per mill population
Country Inhab 2001 2002 2003 2004 2005 2006 2007 2008 2009
Spain 44,7 32,5 33,7 33,8 34,6 35,1 33,8 34,6 34,8
Austria 8,2 23,7 24,3 23,9 22,6 24,8 25,2 24,7 20,4 25,8
Belgium 10 21,6 21,7 24,8 21,8 20,0 27,1 29,8 25,5
Portugal 10 20,2 21,7 19,0 22,2 19,0 20,1 26,1 26,7
France 60 17,8 20,0 18,3 21,0 22,2 23,2 24,8
Czech.R. 10,3 16,7 18,6 20,5 20,3 18,8 21,1 19,2
Swiss 7 13,2 10,4 13,2 12,6 12,1 10,7 10,7 11,8
Italy 57,7 17,1 18,1 18,5 21,1 20,9 21,7 20,5 21,2
GB 62,9 13,1 13,0 12,1 13,8 10,7 12,9 13,2 13,4
Germany 83 13,1 12.2 13,8 13,0 14,1 15,3 16,5 14,6
Greece 4,5 5,9 8,1 6,5 6,0 8,1 7,1 5,8 8,9
Slovenia 2,0 11,5 17,5 14,0 18,0 10,2 15,0 11,4 19,5
![Page 33: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/33.jpg)
Renal Transplantation in AKH Vienna1965 - 2009
![Page 34: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/34.jpg)
Efficiency of RT in ESRD 49%
48% 48% 49% 50% 50%
49% 48% 48% 46% 45% 46% 45% 46% 45% 44% 45% 44% 40% 37% 35%
51%52%52%51%50% 50%51%52%52%54%55%54%55%54%55%56%55%56%60%63%65%
![Page 35: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/35.jpg)
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
![Page 36: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/36.jpg)
1.Paar 2.Paar
Empfänger 58 m B 56 m A
Spender 54 w A 36 w B
„Über Kreuz Transplantation“
![Page 37: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/37.jpg)
„Domino“ Transplantation
Empfänger 27 m B
Spender 53 w AB
ET-Spenderpool
Lokale Warteliste
![Page 38: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/38.jpg)
LRD vs LURD vs CAD
Terasaki P. et al: NEJM 333:6, 333-6, 1995
![Page 39: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/39.jpg)
•a) dead upon arrival •b) unsuccessful resuscitation
•c) awaiting cardiac arrest•d) circulatory arrest after brain death confirmation
NHBD Categories (Maastricht)
![Page 40: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/40.jpg)
Targets of Promotion
• >>> ICU Personnel (Communication Courses)
• >> Medical staff at large (Lectures, meetings, Courses, „Medical lay journals“
• > Public. (Donation days, „Media culture“-Information)
![Page 41: Experience in Organ Donation in Austria and Vienna](https://reader036.fdocuments.us/reader036/viewer/2022062322/568147e8550346895db51f9f/html5/thumbnails/41.jpg)
Folie 57