How to Structure a Successful Organ Donation and Transplantation System in Eight (Not So Easy) Steps: An Italian Case Study (original) (raw)
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Transplant International, 2023
Over the past two decades, Portugal has become one of the world leaders in organ donation and transplantation despite significant financial constraints. This study highlights how Portugal achieved success in organ donation and transplantation and discusses how this information might be used by other countries that are seeking to reform their national programs. To accomplish this goal, we performed a narrative review of relevant academic and grey literature and revised our results after consultation with two national experts. Our findings were then synthesized according to a conceptual framework for organ donation and transplantation programs. Our results revealed several key strategies used by the Portuguese organ donation and transplantation program, including collaboration with Spain and other European nations, a focus on tertiary prevention, and sustained financial commitment. This report also explores how cooperative efforts were facilitated by geographical, governmental, and cultural proximity to Spain, a world leader in organ donation and transplantation. In conclusion, our review of the Portuguese experience provides insight into the development of organ donation and transplantation systems. However, other countries seeking to reform their national transplant systems will need to adapt these policies and practices to align with their unique cultures and contexts.
Ten Lessons From the Spanish Model of Organ Donation and Transplantation
Transplant International, 2023
The organ donation and transplantation program in Spain has long been considered the gold standard worldwide. An in-depth understanding of the Spanish program may promote the development and reform of transplant programs in other countries. Here, we present a narrative literature review of the Spanish organ donation and transplantation program supplemented by expert feedback and presented according to a conceptual framework of best practices in the field. Core features of the Spanish program include its three-tiered governing structure, close and collaborative relationships with the media, dedicated professional roles, a comprehensive reimbursement strategy, and intensive tailored training programs for all personnel. Several more sophisticated measures have also been implemented, including those focused on advanced donation after circulatory death (DCD) and expanded criteria for organ donation. The overall program is driven by a culture of research, innovation, and continuous commitment and complemented by successful strategies in prevention of end-stage liver and renal disease. Countries seeking ways to reform their current transplant systems might adopt core features and may ultimately aspire to include the aforementioned sophisticated measures. Countries intent on reforming their transplant system should also introduce programs that support living donation, an area of the Spanish program with potential for further improvement.
Organ transplantation in Italy: analysis of donors and recipients
European journal of epidemiology, 1999
The Istituto Superiore di Sanità (The Italian National Institute of Health) has been collecting information regarding organ donation and transplantation in Italy. Herein we describe organ procurement and transplant activity in Italy in the years 1992 1997 and show some of the characteristics regarding both donors and transplanted patients who received kidneys, hearts, livers and lungs. Although transplantation in Italy has been very difficult because of shortage of organ donors, national rates have been improving year after year. The present situation should ameliorate further to enable Italy to reach the same level of other advanced European countries.
The Tuscany Model of a Regional Transplantation Service Authority: Organizzazione Toscana Trapianti
Transplantation Proceedings, 2007
In 2003, the Tuscan Regional Government appointed a transplantation service authority to reorganize all regional donation and transplantation activities: the Organizzazione Toscana Trapianti (OTT). Herein we have presented a retrospective review of deceased donation and transplantation activities from 1993 until 2006 in Tuscany to illustrate the results of OTT activity and the methodology in reorganizing the regional network. After the advent of OTT, the mean rate of recovered deceased donors (DDs) rose from 16.9 Ϯ 7.7 per million population (pmp) to 32.7 Ϯ 4.3 pmp (⌬ ϭ ϩ93.4%); multiorgan DDs increased by 48.6%, from a mean of 12.8 Ϯ 5.2 pmp to 21.1 Ϯ 2.9 pmp, despite a 55.2% increase in recovered DDs Ն60 years. Recovered DD solid organs rose by 78.4% after the advent of OTT (from a mean of 53 Ϯ 20.1 pmp to 89.5 Ϯ 13.6 pmp), and the number of DD organ transplants rose by 87.3% (ie, from a mean of 49.9 Ϯ 23.9 to 91.9 Ϯ 5.2 pmp). The experience of OTT showed that an efficient regional network requires a global approach to donation and transplantation, according to the principles of clinical governance. A region-based model, whereby health care professionals share clinical governance with regional authorities and regional networks integrated at a national level, may prove favorable not only to increase donor procurement rates but also to improve the quality of the whole transplantation care process.
A Conceptual Framework for Evaluating National Organ Donation and Transplantation Programs
Transplant International, 2023
Conceptual frameworks are valuable resources that can be used to guide the planning, evaluation, and development of healthcare services. However, there are currently no comprehensive frameworks focused on organ donation and transplantation that identify the critical factors underlying a successful national program. To address this knowledge gap, we developed a conceptual framework that takes into account all major domains of influence, including political and societal aspects as well as clinical implementation. The framework was initially constructed based on a targeted review of the relevant medical literature. Feedback provided by a panel of international experts was incorporated into the framework via an iterative process. The final framework features 16 essential domains that are critical for initiating and maintaining a successful program and improving the health of patients with organ failure. Of particular note, these domains are subject to three overarching health system principles: responsiveness, efficiency, and equity. This framework represents a first attempt to develop a whole-system view of the various factors that contribute to the success of a national program. These findings provide a useful tool that can be adapted to any jurisdiction and used to plan, evaluate, and improve organ donation and transplantation programs.
Donation after circulatory death (DCD) is a valuable option for the procurement of organs for transplantation. In Italy, organ procurement after controlled DCD is legally and ethically conceivable within the current legislative framework. However, although formal impediments do not exist, the health care team is faced with many obstacles that may hinder the implementation of such programs. We report the case of Italy's first controlled DCD, specifically discussing the role of the patient's family in the shared decision-making process. In our case, the death of the patient subsequent to the withdrawal of life-sustaining therapies was consistent with the patient's wishes, showing respect for his dignity and honoring his autonomy, as expressed to his family previously. By making donation possible, the medical team was able to fulfill the family's last request on behalf of the patient. This case should stimulate deliberation regarding the potential to shorten the 20-minute no-touch period currently in place in Italy. Such an action would not have injured this patient and would certainly have increased the quality of the procured organs.
Organ donation and transplantation: a multi-stakeholder call to action
Nature Reviews Nephrology, 2021
Although overall donation and transplantation activity is higher in Europe than on other continents, differences between European countries in almost every aspect of transplantation activity (for example, in the number of transplantations, the number of people with a functioning graft, in rates of living versus deceased donation, and in the use of expanded criteria donors) suggest that there is ample room for improvement. Herein we review the policy and clinical measures that should be considered to increase access to transplantation and improve post-transplantation outcomes. This Roadmap, generated by a group of major European stakeholders collaborating within a Thematic Network, presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation. This framework can be adopted by countries and institutions that are interested in advancing transplantation, both within and outside the European Union. Within this framework, a priority ranking of initiatives is suggested that could serve as the basis for a new European Union Action Plan on Organ Donation and Transplantation.
Success factors and ethical challenges of the Spanish Model of organ donation
Lancet, 2010
With 34 donors per million population, Spain has impressed the international transplant community with the world's highest rate of organ donation (double the European average), short waiting lists for transplantation, and reduced reliance on living donation. 1 These data account for WHO's strategy to extend the so-called Spanish Model across the globe, and for the European Parliament's decision to incorporate some of the elements of the Spanish model into its 2010 action plan on organ donation and transplantation. In this Viewpoint, we explore the success factors of the Spanish system and look at whether these factors can be implemented in other countries. We also identify inherent ethical issues.
PubMed, 2022
Introduction: The paper investigates the critical care staff's support towards organ donation by analysing how their attitude, knowledge, confidence, engagement, and training can act as predictors of donation consent rates. Our study focused on hospitals in the Apulia Region, Italy. Material and methods: The study employs a quantitative methodology based on a survey of healthcare professionals. The rate of consent to organ and tissue donation at the hospital level, given as a ratio of the permissions received to the proposals performed, was extracted from GEDON software related to the year 2019 report. For each Apulian participating hospital, we calculated a median score for each of the five predictors (namely, attitude, knowledge, confidence, engagement, and training) and investigated the association with hospital consent rates. Results: The results highlight that the engagement of the intensive care units' healthcare personnel stands as the only influential predictor of the consent rate. Discussion: In Italy's Apulia Region, efforts are needed to increase consent rates for organ donation. Strategies should concentrate on continuous support, as well as specific training of hospital staff involved in the donation process.
Italian Journal of Medicine, 2020
For numerous patients suffering from pathologies that irreversibly damage organs and tissues, transplantation is the best therapeutic solution, and in several cases the only possible one. In this context the present study has set the objective to analyze the attitude of the respondents towards donation in relation to their education levels. A questionnaire was elaborated and administered. A range Linkert-score was associated with each question indicating as 0 the minimum preference and 5 the maximum preference. For each question participants had to indicate a single answer among proposals. Χ2 test among answers collected was assessed in order to statistically verify the significance between answers given by the two groups as regards organs donation. The recruited group was made up of 203 students of which 129 were girls (64%) and 74 were boys (36%). The youngest student was aged 17 and the oldest 21, mean age was 18.58±1.89 years. The population group considered in this study consis...