Izhodišče: Poleg prevladujočega odvzema organov in tkiv za namen zdravljenja po potrjenih nevroloških merilih oz. možganski smrti (angl. donation after brain death, DBD) pa število evropskih držav, ...ki vzpostavljajo programe odvzema po cirkulacijski smrti (angl. donation after circulatory death, DCD), vztrajno narašča. V zadnjih letih je DCD postala izpostavljena tema v donorski medicini, v praksi držav pa je moč prepoznati več različnih pravnih okvirov in medicinskih vidikov DCD-programov. V Sloveniji se DCD še ne izvaja. Slovenija-transplant je nacionalna pristojna ustanova, ki med drugim vodi razvoj donorskega programa. Zavod sledi usmeritvi, da so pred uvajanjem kakršnih koli sprememb potrebne jasne strokovne smernice, izobražena stroka ter soglasje strokovne in splošne javnosti. Ker se raziskava o stališčih strokovne javnosti do uvajanja programa DCD v slovenski donorski program po smrti še ni opravila, smo s kvalitativno raziskavo »Dileme v donorskih programih in razvoju transplantacijske medicine: stališča slovenske strokovne javnosti« zapolnili pomembno vrzel. Raziskovalni izsledki so bili osnova za nadaljnje korake, ki jih predstavljamo v članku.Metode: Na pobudo Slovenija-transplanta se je med januarjem in aprilom 2013 zasnovala in izpeljala kvalitativna raziskava med izbranimi ključnimi strokovnjaki za transplantacijsko medicino v Sloveniji. K sodelovanju je bilo povabljenih 22 strokovnjakov. Odzvalo se jih je 12 in z njimi smo izpeljali polstrukturirane in poglobljene intervjuje o polemičnih temah, tudi o odvzemu organov in tkiv po cirkulacijski smrti.Rezultati: Rezultati kažejo, da so imeli sodelujoči v raziskavi (razen enega sogovornika) več strokovnih in etičnih pomislekov do kratkoročnega uvajanja (nadzorovanega) DCD v posmrtni donorski program v Sloveniji. Menili so, da obstoječa struktura in organizacija donorskega sistema, ki temelji na programu DBD, nima ustrezne tehnične, kadrovske in organizacijske podpore za delovanje programa DCD. Poudarili so pomen strokovnega, pravnega, etičnega in družbenega soglasja glede odvzema organov po cirkulacijski smrti. Menili so, da je pred uvedbo sprememb treba oblikovati in pripraviti nacionalne smernice ter jasne strokovne in etično nedvoumne protokole za delo, upoštevajoč interdisciplinarne strokovne vidike.Zaključek: Izsledki raziskave so prispevali k poglobljenemu razumevanju stališč strokovne javnosti o širjenju posmrtnega donorskega programa z nadzorovanim DCD-protokolom. Pokazali so njihovo načelno podporo ter potrebo po reševanju izraženih dilem, izobraževanju stroke ter oblikovanju jasnih strokovnih smernic. Raziskovalni izsledki so se že upoštevali, zato v članku tudi predstavljamo korake Slovenija-transplanta, ki so bili v tej smeri že narejeni. V besedilu odpiramo razpravo o DCD. Srednjeročni načrt Slovenija-transplanta je uvedba DCD-protokola v nacionalni posmrtni program, ki bo temeljil na bolje preverjenih mednarodnih smernicah in dobrih izkušnjah iz tujine.
Presaditev organov je postala uveljavljena metoda zdravljenja odpovedi organa, v nekaterih primerih predstavlja celo edini učinkovit način zdravljenja.
S pospešenim razvojem transplantacijske ...medicine v svetu so se uveljavili trije glavni modeli dejavnosti – španski, ameriški in mešan model. V Sloveniji smo se pri razvoju organizacije dejavnosti oprli na španski model. Leta 2002 je z delovanjem pričel Zavod Republike Slovenije za presaditev organov in tkiv Slovenija-transplant, ki predstavlja osrednjo državno institucijo v donorski in transplantacijski dejavnosti. Obe veji dejavnosti sta povezani v nacionalno mrežo, ki vključuje 11 donorskih bolnišnic, transplantacijski center in Center za tipizacijo tkiv. Najpomembnejšo vlogo v dejavnosti imajo donorske bolnišnice z bolnišničnimi transplantacijskimi koordinatorji, ki skrbijo za aktivno izvajanje postopkov za darovanje. Za usklajevanje vseh ravni dejavnosti so zadolženi centralni transplantacijski koordinatorji. Slovenija-transplant z izvajanjem različnih dejavnosti zagotavlja učinkovit donorski program in kakovost ter varnost pridobljenih in presajenih organov. Zagotavlja tudi strokovni nadzor in izdaja strokovne smernice. Posebno pozornost namenja izobraževanju in usposabljanju zdravstvenega osebja na vseh ravneh zdravstvene dejavnosti kot tudi izobraževanju in ozaveščanju drugih javnosti.
Število umrlih darovalcev v Sloveniji od leta 1998 narašča. Po številu umrlih darovalcev na milijon prebivalcev in po deležu odklonitev smo primerljivi z uspešnejšimi evropskimi in drugimi državami. Takšni rezultati kažejo na zaupanje javnosti v donorsko dejavnost in v Slovenija-transplant kot institucijo.
Prihodnost donorskega programa predstavljajo etični kodeksi in smernice, ki bolnika v paliativni oskrbi ali oskrbi ob koncu življenja obravnavajo tudi kot možnega mrtvega darovalca. Tudi v Sloveniji je že bila dana pobuda za vključitev takšnega pristopa v etični kodeks.
The paper presents the findings of the first large-scale survey on post-mortem organ donation among the general Slovenian population. It focuses on the reported donation willingness, the barriers to ...joining the register of organ donors and the position towards consent to donate organs of deceased relatives.
A face-to-face survey was conducted on a probability sample of 1,076 Slovenian residents between October and December 2017. The performed analyses included estimations of means and proportions for target variables, an evaluation of between-group differences and a partial proportional odds model to study the relations between organ donation willingness and socio-demographic characteristics.
The mean reported willingness to donate one's own organs after death was 3.77 on a 5-point scale, with less than a third of respondents claiming to be certainly willing. Only 6% of those at least tentatively willing to donate organs were certain to join the register of organ donors in the future. The most frequently reported barriers to registration were unfamiliarity with the procedure and a lack of considering it beforehand. The reported willingness to donate organs of a deceased relative strongly depended on the knowledge of the relative's wishes, yet 80% of the respondents did not discuss their wishes with any family members.
The findings confirm the gap between the reported donation willingness and joining the register of donors. Future post-mortem organ donation strategies need to consider socio-demographic and attitudinal factors of donation willingness and help stimulate the communication about organ donation wishes between family members.
Organ transplantation has become an established method of treatment of organ failure. In some cases, it represents the only effective treatment. With the accelerated development of transplant ...medicine in the world, three main models of organ donation and transplantation have been established – the Spanish, the American and the mixed model. Slovenia's organisational aspect of organ donation and transplantation followed the Spanish model. The Institute of the Republic of Slovenia for the Transplantation of Organs and Tissues – Slovenia Transplant – became operational in 2002. Organ procurement and transplantation are intertwined in a national network, which consists of 11 donor hospitals, the transplant centre and the centre for tissue typing. The most important segments of the donor programme are donor hospitals with hospital transplant coordinators, while central transplant coordinators are responsible for coordinating the activities at all levels. Slovenia Transplant ensures effective execution of the donor programme and the quality and safety of procured organs and tissues. It issues professional guidelines and provides expert supervision. Special attention is devoted to the education and training of healthcare professionals at all levels of healthcare system and raising awareness of the general public. The number of deceased donors in Slovenia has been rising since 1998. In terms of the number of actual deceased donors per million population and the family refusal rate, our achievements are comparable to those in other European and other countries, thus indicating a high level of trust in the donor program and in the Slovenija Transplant as an institution. The future of the donor programme lies in progressive ethical codes and guidelines that treat palliative care or end-of-life care patients as possible deceased donors. In Slovenia, an initiative has already been taken to include such approach in the ethical code.
The primary aim of this study was to describe regulations and practices concerning the family approach to discuss donation, specifically after the neurological determination of death, one of the most ...challenging steps in the donation pathway. A secondary objective was to assess the impact of legislation on consent rates for organ donation. The Council of Europe surveyed 39 member states about national regulations, practices, and consent rates; 34 replied. Opt-out legislation is present in 19, opt-in in 9 and a mixed system in six countries. An opt-out register is kept by 24 countries and an opt-in register by 18 countries, some keeping both. The mean consent rate was 81.2% of all family approaches. Most countries regulate how death using neurological criteria is confirmed (85.3%), while regulation of other aspects of the deceased donation pathway varies: the timing of informing the family about brain death (47.1%) and organ donation (58.8%), the profile of professional who discusses both topics with the family (52.9% and 64.7%, respectively) and the withdrawal of treatment after brain death (47.1%). We also noted a mismatch between what regulations state and what is done in practice in most countries. We suggest possible reasons for this disparity.
The donation rate (DR) per million population is not ideal for an efficiency comparison of national deceased organ donation programs. The DR does not account for variabilities in the potential for ...deceased donation which mainly depends on fatalities from causes leading to brain death. In this study, the donation activity was put into relation to the mortality from selected causes. Based on that metric, this study assesses the efficiency of different donation programs.
This is a retrospective analysis of 2001 to 2015 deceased organ donation and mortality registry data. Included are 27 Council of Europe countries, as well as the United States. A donor conversion index (DCI) was calculated for assessing donation program efficiency over time and in international comparisons.
According to the DCI and of the countries included in the study, Spain, France, and the United States had the most efficient donation programs in 2015. Even though mortality from the selected causes decreased in most countries during the study period, differences in international comparisons persist. This indicates that the potential for deceased organ donation and its conversion into actual donation is far from being similar internationally.
Compared with the DR, the DCI takes into account the potential for deceased organ donation, and therefore is a more accurate metric of performance. National donation programs could optimize performance by identifying the areas where most potential is lost, and by implementing measures to tackle these issues.
The findings and recommendations of the 2019 consensus conference in organ donation, held in Kunming, China, are here reported. The main objective of the conference was to gather relevant information ...from experts involved in the field. The data and opinions provided allowed to propose a series of recommendations for “One Belt & One Road Countries” on how to achieve self‐sufficiency in organ donation. Leadership in organ donation should be results‐oriented and goal‐driven based on the principles of excellence, empowerment, and engagement, providing the means, resources, and strategies necessary to reach the goal in earnest. Management includes good governance and transparency of a national registry of patients in the waiting list, donors, transplants, transplant teams, quality, and safety programs with continuous educational training of health care professionals. Mandatory monitoring, auditing and evaluation of quality must be incorporated into donation practices as relevant points in innovation, as well as the adoption of already established and novel processes and technologies. Achievement of self‐sufficiency in organ donation is a crucial step to fight against transplant tourism and to prevent organ trafficking. Based on recommendations arising from the conference, each country could review and develop individualized action plans adjusted to its own circumstances and reality.
Full text
Available for:
DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
PDF
